Assessment for learning: a realist evaluation of the portfolio in the transfusion medicine area of focused competence program

In Canada, additional training in Transfusion Medicine (TM) can be pursued through Area of Focused Competence (AFC) Diploma programs. The Transfusion Medicine AFC program was one of the first in Canada to adopt a competence by design philosophy through a portfolio. This objective of this study was to evaluate the TM AFC assessment portfolio and its impact on interest-holders. A realist framework was used to explore the outcomes of the competency portfolio, and the contexts and mechanisms involved. Purposive sampling was used to recruit participants trainees, teachers, and curriculum developers from across the country. Qualitative data was collected from 22 participants through semi-structured interviews. Data was coded and used to refine initial program theories. Key outcomes were identified such as increased trainee confidence and knowledge, recognition of specialist knowledge, and a sense of community within the transfusion medicine field. Data analysis revealed mechanisms that enabled these outcomes within the contexts of academic care centres and Canadian blood suppliers. This realist evaluation highlighted the positive outcomes of the TM AFC competency-based portfolio and provided a modified program theory that reveals how the portfolio impacts learners.