Contemporary medical education is increasingly competency-based and requires a curricular framework to support individual students' professional identity formation concurrently with defined and benchmarked competencies (1, 2). The transition to a competency-based curriculum requires both longitudinal and integrated assessments (Schmude et al., unpublished),¹ which are challenging to deliver on an individual level (2–4). Much has been written regarding the evaluation of professionalism, especially among medical students and residents (5). Expert consensus about professionalism assessment is that “Professionalism should be assessed longitudinally. It requires combinations of different approaches, assessing professionalism at individual, interpersonal, and societal/institutional levels” (6). The challenge to medical educators in the longitudinal assessment of professionalism involves integrating a large and dispersed amount of data into an organized and easily accessible format (7, 8, 29, 30). Our work focuses on promoting adult learners' professional identity formation through a longitudinal Personal and Professional Development curriculum in undergraduate medical education.

ePortfolios have been identified as a high-impact practice for education and are widely used by colleges and universities in the United States (9). Developing an ePortfolio allows adult learners to cultivate their skills as master learners and participate actively in their education, a key tenet of adult learning theory (11). The Association of American Colleges and Universities has worked to promote the value of portfolios in assessing student learning through their Valid Assessment of Learning in Undergraduate Education (VALUE) project (https://www.aacu.org/initiatives/value). Scholars who study student assessments have evaluated ePortfolios to promote and assess student learning (7, 9). These researchers similarly conclude that professionalism is not a solitary pursuit; student self-reflection and self-assessment without external guidance are suboptimal (12). Faculty increasingly realize the value of implementing ePortfolios for students to demonstrate competence, while students appreciate the value of reflecting on what they learn throughout their medical education (9). Researchers have reported that ePortfolios promote students' reflection and learning: one group reported that “ePortfolios are currently celebrated as a way to facilitate and document more authentic forms of assessment” (13, 14). Subsequent studies have reported positive student perceptions of using portfolios, particularly the utility of reflective learning (15–17).

Although ePortfolio use in medical education continues to grow, documented use within a medical school curriculum is still developing (10, 18). Early descriptions of ePortfolio use included how portfolios could be utilized in medical education (7, 8, 30), yet few medical schools have used ePortfolios to assess professionalism.

At Geisinger Commonwealth School of Medicine (GCSOM), we defined the ePortfolio as a student-assembled electronic portfolio that displays academic accomplishments, essays, videos, samples of work, and volunteer and extracurricular activities in required and optional, student-driven artifacts. This tool can monitor and promote each student's curricular progress through course assignments tied to these ePortfolio artifacts related to competency development (11, 19). Comprehensive ePortfolio assessment data for Doctor of Medicine (MD) program evaluation can highlight opportunities for continuous quality improvement. Therefore, developing and implementing an ePortfolio may be applied to any competency-based educational setting, such as health professions and medical education (16).

We felt that using an ePortfolio to assess professionalism could have several benefits, including (1) enabling multidimensional assessment by facilitating longitudinal integration of students' assignments, termed artifacts, (2) highlighting opportunities for continuous quality improvement within our curriculum and (3) serving as an example for educators using an ePortfolio in any competency-based educational setting. Therefore, we aim to share our experience with developing and implementing an ePortfolio for longitudinal assessment of professionalism within undergraduate medical education.

The GCSOM Total Health Curriculum includes personal and professional development as one of the six programmatic objectives woven throughout the MD curriculum (Appendix A). The personal and professional development curriculum, one of six longitudinal curricular themes, is used to demonstrate achievement in meeting the learning objectives of the MD curriculum (see text footnote 1). The development and implementation of the ePortfolio assessment at GCSOM was based on Design Thinking, which incorporates organizational and systems theory with social psychology and practical research through inspiration, ideation, and implementation (20). By reflecting on their learning, students practiced collective generation of ideas, rapid prototyping, and continuous testing to align technologically based tools with users' needs (20). In this manner, we engaged student leaders and faculty champions to review the implementation and provide timely feedback for improving the ePortfolio (21). Partnering with a faculty member, students engaged in ePortfolio development while strengthening their professional identity formation (20, 22, 23).

To begin the implementation of the ePortfolio, we evaluated the curriculum to identify assessments that would be appropriate to use as evidence of individual student growth and achievement in the curriculum's personal and professional development programmatic learning objectives (10, 24). The step-by-step inventory process included:

Three GCSOM medical students developed several ePortfolio prototypes. One was selected based on its ability to track students' progress toward achieving programmatic learning objectives (25).

All first-year students attend a session that explains the programmatic requirements, introduces the personal and professional development curriculum, and provides an overview of the ePortfolio. Students are also given an ePortfolio manual so they have the necessary educational guidance to construct their ePortfolio correctly. In addition, an active learning workshop is conducted so students can build confidence in using the ePortfolio within the Portfolium platform and upload evidence in real time while receiving feedback from faculty members.

The longitudinal personal and professional development ePortfolio was created in Portfolium (https://portfolium.com) and embedded as a curricular requirement for all students. Students completed ePortfolio entries for corresponding assignments that reinforced what they learned in basic science and doctoring courses and themes related to professionalism, social justice, health equity, and community engagement (19, 25). Personal and Professional Development theme faculty members evaluated student submissions, termed evidence, within the ePortfolios and provided feedback regarding student growth in the personal and professional development curriculum. These faculty members also mentored students' reflective skills and construction of the ePortfolio. In addition, courses throughout the MD curriculum support the student's growth for reflective practice. Students submitted data were used to determine if curricular requirements were achieved.

Reflective writing and practices are embedded throughout the MD curriculum, providing formative feedback to students for future incorporation into their learning. Students were given a document that contained the specific ePortfolio evidence needed by class year, assignment name, name to be used in Portfolium for the type of evidence, and the specific labels to assign to the evidence. ePortfolio labels can be assigned at the individual student level (personal use), theme level (evidence for the personal and professional development theme), and programmatic level (evidence for programmatic objectives). Labels allowed for ePortfolio assessment data to be used by faculty in institutional research for MD program evaluation and to identify opportunities for continuous quality improvement. Students were periodically reminded via announcements in the Canvas Learning Management System (www.instructure.com/canvas) about ePortfolio deadlines and requirements. At the end of the academic year, students were required to upload their completed ePortfolio from Portfolium into a designated assignment in Canvas for individual student evaluation by faculty.

One example of an educational activity within the personal and professional development theme is viewing the Association of American Medical College virtual seminar Legacy of Medicine in the Holocaust. After watching the seminar, students must complete a reflective writing assignment, which they are required to submit as an ePortfolio assignment. The reflective writing submission links directly to MD program outcomes and is contained as evidence within the ePortfolio. The associated ePortfolio “skills” document the MD program outcomes directly related to the students' achieved competency (26).