Higher Education and Research

Portfolio for enrolment of foreign doctors
in the Dutch medical science programme

A.M.A. Mak, A.M. Scholten, R.Teuwsen, & F. Sikkema (editors)

Nuffic, Centre of International Recognition and Certification

PO Box 29777, 2502 LT The Hague, Netherlands
Web: www.nuffic.nl/competentiewaardering
E-mail: competentiewaardering@nuffic.nl

Foundation for Refugee Students UAF

PO Box 14300, 3508 SK Utrecht, the Netherlands
Web: www.uaf.nl – E-mail: secretariaat@uaf.nl

This article was written in close cooperation with
the Foundation for Refugee Students UAF, and with
financial support of the European Refugee Fund.

Abstract
To work as medical doctor in the Netherlands, professional recognition must be received from the Ministry of Health. Applicants who don’t receive recognition need to qualify themselves by earning a Dutch medical diploma. Credential evaluation is one of the main instruments that is currently used in the recognition process. To further enhance insight in the experience of candidates, instruments for the assessment of competences should become available. The portfolio instrument has potential to present competences that have been gained during both formal and non-formal learning. During several pilot projects, a portfolio format for foreign doctors has been developed. Portfolio development empowers the candidates to better present their experience. Assessors consider it as a valuable information source. However, the various stakeholders should come to a consensus about the purpose of portfolio for foreign doctors and the type of information it should contain. Concluded was also that portfolio should always be used in combination with other forms of assessment.

1 Introduction
As in many countries over the world, the profession of medical doctor is legally protected in the Netherlands. Every year, considerable numbers of foreign medical doctors arrive, requesting for professional recognition at the Ministry of Health (563 in 2003). To support the decision process, the ministry has composed a list of recognised foreign diploma’s, and European Directives are applicable for citizens of the European Economic Area (EEA) who have obtained their diploma within the EEA. If these two instruments do not apply, an advice on the value of the foreign diploma can be received from the expertise centres for International Credential Evaluation (which is Nuffic for Higher Education, Colo for Vocational Education). However, the majority of foreign doctors from outside the EEA do not receive professional recognition. In order to qualify themselves in the Netherlands, they need to enrol in a Dutch medical science programme to earn a Dutch qualification. Among this group are many refugees.

The Foundation for Refugee Students UAF supports refugees and asylum seekers to study in the Netherlands, by means of study advice, student counselling, scholarships and support in finding a job after graduation. UAF organised a special programme for refugee doctors to prepare them for working in the Dutch healthcare. As most refugees have studied outside the EEA, they are among the category of foreign doctors that have to enrol in a Dutch medical science programme to obtain professional recognition. However before enrolment is possible, a thorough preparation is required: they will have to learn the Dutch language, acquire ICT skills and a first acquaintance with the Dutch healthcare system is necessary. The entire trajectory of preparation, studying and doing internships generally takes at least five years. Unfortunately, the period of preparation can prolong the trajectory considerably due to waiting lists and other inefficiencies. The period between arrival in the Netherlands and starting a Dutch study programme has increased during the past five years from over 40 months to over 60 months. This situation induced UAF to start a specific project for refugee doctors in 2003, for which co-financing was granted by the Dutch office of the European Refugee Fund. The project aimed to offer financial support and other forms of guidance to refugee doctors, in order to enhance their chances for employment in the Dutch healthcare. As part of this project, UAF organised mentorship and intensive tailor-made Dutch language courses. Because many refugee doctors practised their profession in their country of origin, Nuffic was asked to help refugee doctors to develop a portfolio in which they describe their medical expertise. It was expected that the portfolio instrument might contribute to realising a better tailored enrolment in the Dutch medical science programme.

In the Netherlands are eight universities that offer the medical science programme. For the enrolment of foreign doctors, every university has its own admission requirements and has developed its own educational programme. To increase the uniformity in the admission of foreign doctors, several parties pleaded for central examination (Herfs, 2001; MDW-werkgroep, 2001). The medical faculties established a Committee for “Streamlining Policy Foreign Doctors” (Stroomlijning Beleid Buitenlandse Artsen) and advised in 2002 to develop a central assessment procedure (OCG-DMW, 2002), in which international credential evaluation and the recognition of competences should be integrated (CBGV, 2002). Presently, the Ministry of Health is working on the development of such a central assessment procedure for foreign medical doctors and all other regulated professions in the healthcare sector. It is expected that this procedure will become operational in 2005.

In order to recognise the competences of foreign doctors, not many instruments are available yet. Already since 1999, Nuffic has recognised the need for a methodology to link international credential evaluation and the recognition of competences (nationally referred to as Erkennen van Verworven Competenties (EVC), internationally referred to as Prior Learning Assessment and Recognition (PLAR)). In situations when foreign qualifications are not recognised, or additional information about somebody’s competences is required, assessment instruments that evaluate non-formal learning experiences should be used as well (Nuffic, 2001).

Portfolio is an instrument that has potential to identify and present competences that have been gained during both formal and non-formal experiences. According to Klarus (1998), developing a portfolio enables a person to describe and clarify his competences, which on its turn enables an assessor to evaluate the professional competence of the person for the purpose of recognition. Therefore since 2002, Nuffic is working on the development of a portfolio instrument that can help foreign trained immigrants to present their competences. Specific experience was gained with portfolio development by foreign doctors for the purpose of enrolment in the medical faculty.

2 Development of the portfolio instrument
2.1 Pilots at the University of Utrecht
To gain experience with portfolio development by foreign doctors, Nuffic conducted two pilot projects in 2002 and 2003 at the medical faculty of the University of Utrecht1. This faculty had shown interest for the portfolio instrument, because they were looking for ways to gain more insight in the medical experiences of the foreign students. The portfolio was expected to improve the communication about the former learning experiences between the candidate and the assessor, which might improve the process of enrolment in the medical programme (see Figure 1).


Figure 1: Portfolio as communication tool about professional competences

To develop guidelines on the professional competences for which evidence should be shown in the portfolio, information was sought about the competences that Dutch medical doctors should have. It appeared that no competence standards for medical doctors are formulated yet. The ‘Raamplan Basisarts 2001’ (Metz, Verbeek-Weel, & Huisjes, 2001a/b), describes the learning goals that should be attained after completion of the Dutch medical science programme, but were hard to translate into competence standards. In addition, interviews were held with medical experts to investigate what kind of information they would like to read in the portfolio. The following topics were mentioned:
The formal educational programme(s) that the candidate has followed;
The position(s) and belonging tasks and responsibilities as medical doctor;
The types of syndromes and diseases with which much experience has been gained;
The experience in the conduction of scientific research;
Potential experience in the health care sector in the Netherlands;
They way the medical expertise has been further developed after completion of the formal educational programme.

During the two pilots, a portfolio format evolved that covers the above stated topics. Two groups of foreign doctors that were enrolling in the medical science programme of the University of Utrecht developed their own portfolio. Both the faculty and the candidates were generally positive about the instrument. The candidates found it valuable to develop a document in the Dutch language that summarizes their learning and working experiences. The medical faculty believed that the portfolio can be used during the admission procedure as a good source of information about the candidate. Further clarification of the information that is given in the portfolio can be received during an interview.

2.2 Expert evaluation of the portfolio format
In 2003, interest was shown for the portfolio instrument by the Foundation for Refugee Students UAF. As mentioned before, they organised – with financial support of the Dutch office of the European Refugee Fund (ERF) – a specific project for refugee doctors to enhance their chances for employment in the Dutch healthcare. As part of this project, also several activities were conducted that are dedicated to the further development of the portfolio instrument for the specific group of medical doctors.

As part of the ERF-project, first of all an evaluation of the portfolio format as evolved until July 2003 was conducted among experts from the various medical faculties2. The goal of this study was to receive feedback on the structure and content of the format on the one hand, and to enhance commitment for using portfolio among the faculties on the other. The respondents all received the portfolio format itself, optionally accompanied with two portfolios of anonymous foreign doctors as concrete example. Evaluation information was received through questionnaires, interviews and open written reactions. Fourteen experts from seven medical faculties in the Netherlands responded. Among them were presidents, professors, student advisors, educational programme coordinators and assessors, some with medical schooling, others with a background in educational science or sociology. Most respondents had heard about portfolio before, but only a few had worked with the instrument.

All respondents considered portfolio as a valuable instrument to clarify the competences of foreign doctors. Most of them also believed that it can be useful for the enrolment process of foreign doctors in the Dutch medical programme. A few respondents mentioned that the portfolio might also contribute to the determination of additional test instruments that should be used for the assessment of each particular candidate. However, the following conditions were added to these remarks:
Based on the portfolio, assessors should receive further elaboration during an interview with the candidate;
It should be thought carefully about the right moment for developing a portfolio;
The enrolment process is supposed to result in a tailor-made educational programme, but in reality this seems hard to organise;
Portfolio should be used within a more extensive assessment procedure; portfolio is useful to clarify competences, but for recognition more objective test instruments should be used. Therefore was recommended to embed portfolio within the national assessment procedure that is presently being developed by the Ministry of Health.

Concerning the structure and content of the portfolio format, the respondents were generally positive. Most of its topics were considered relevant. Feedback was given on the issues that need further elaboration and those that were superfluous. Based on these recommendations, the portfolio instrument was revised.

2.3 Portfolio development course for refugee doctors
As part of the preparation programme that UAF organized for refugee doctors for enrolment in the medical faculty, Nuffic offered a portfolio development course. Participation was voluntary, but interest among the refugee doctors appeared to be large. Three groups of clients from UAF followed the course. In the same period, Nuffic was asked to offer the portfolio course to a group of foreign doctors in another context as well3. The majority of this group were also refugees, and clients of UAF. In total 44 foreign doctors followed the portfolio development course in 2003-2004 (see Table 1).

Group

Period

Number of participants

Countries of origin

UAF – 1

Sept. – Nov. 2003

12 (all refugees)

Afghanistan (9), Kongo (1),
D.R. Congo (1) and Iran (1)

UAF – 2

Jan. – March 2004

12 (all refugees)

Afghanistan (9) and Iraq (3)

UAF – 3

April – June 2004

10 (all refugees)

Afghanistan (6), Iraq (1), Iran (1),
Georgia (1) and Palestine (1)

Rotterdam

Jan. – April 2004

10 (6 refugees)

Afghanistan (5), Russia (3),
Romania (1) and Turkey (1)

Table 1: Refugee doctors that followed the portfolio course in 2003-2004

The portfolio format
The portfolio format is developed in a digital way, so that information can be modified or added easily. The course participants received the digital format on a floppy disk, accompanied with a course manual, which contains detailed instructions on the information that should be given in the portfolio. To give an idea of the desired result, the manual also contains examples of portfolio descriptions. The portfolio format contains the following seven chapters:

1. Curriculum Vitae

Brief overview of factual information like personal details, education, medical activities during study, working experience, (voluntary) experiences in the Netherlands, computer and language skills, and information on fluency in Dutch. In the following chapters is elaborated upon these topics.

2. Formal education and courses

More extensive descriptions are given about the structure and content of the formal education that the candidate has taken, and the additional medical courses that have been followed.

3. Working experience as medical doctor

Further elaboration of the working experience. For each job, information is given about the type of organisation, the tasks and responsibilities, the field of medical expertise and the way in which was cooperated and communicated with colleagues. Potential activities in a private clinic can be described in a separate paragraph. To gain more insight in the medical expertise field of the candidate, a top-ten list is given of the most important medical diseases with which experience was gained.

4. Experience with scientific research

This chapter is dedicated to describing experience in scientific research. A brief description of the research activities is given, focussing on the context and occasion, goals and research questions, design, results and conclusions, reflection and recommendations, and potential publications.

5. Experience in the Dutch healthcare

Description of potential experiences in the healthcare sector in the Netherlands. For each (voluntary) job or internship, information is given about the type of organisation, the tasks, and the feedback that was received from supervisors or colleagues. The candidates also reflect on the differences between the healthcare system in the Netherlands and in the country of origin.

6. Expertise development and maintenance

This chapter contains information about the way the medical expertise was developed and maintained in the country of origin, and the way the candidate tries to do this in the Netherlands.

7. Future perspective

Description of the medical position the candidate would like to have in the Netherlands, and the steps that still need to be taken to achieve this goal. The candidate is encouraged to reflect on his situation and the possibilities and challenges that might affect the chance for achievement.

The portfolio development course
The portfolio development course consisted of 5 group meetings of 4 hours. During each lesson is worked actively on a particular part of the portfolio. To prepare the candidates for each next step in the portfolio development process, reflection assignments are used. To enable the candidates to work on their portfolio descriptions among supervision of the course leaders, the lessons are organized in a computer room. The course leaders revise the portfolios twice for more extensive, personal feedback. The global outline of the course is as follows:

Group meeting 1

Introduction and making of CV
After making acquaintance, the purpose and programme of the course is explained. During a group assignment, the additional value of a portfolio above a Curriculum Vitae is shown. Among supervision, the candidates get started with developing the chapters 1 (CV) and 2 (education and courses) of the portfolio.

Group meeting 2

Working experience and scientific research
The homework (chapters 1 and 2) is discussed. A group assignment is done to give the candidates an idea how to clearly describe their tasks and responsibilities during work experience. Among supervision, the candidates get started with developing the chapters 3 (working experience as medical doctor) and 4 (experience in scientific research) of the portfolio.

Group meeting 3

Experience in the Dutch health care
The homework (chapters 3 and 4) is discussed. During a group assignment the candidates thinks about potential differences between the healthcare system in the Netherlands and their home country. Among supervision, the candidates get started with developing chapter 5 (experience in the Dutch health care) of the portfolio.

Group meeting 4

Expertise development and future plan
The homework (chapter 5) and personal feedback from the course leader on the portfolio descriptions are discussed. During a group assignment, the candidates are encouraged to think about their desired future job and what they need to do to achieve this. Among supervision, the candidates get started with developing the chapters 6 (expertise development) and 7 (future plan) of the portfolio.

Group meeting 5

Feedback and evaluation
The last important issues that need to be stressed are discussed. The candidates have the opportunity to ask questions and give feedback on the course.


3 Monitoring the use of portfolio for enrolment
3.1 Design of the monitoring study
To investigate how the portfolios that the foreign doctors developed are used for enrolment at the medical faculty, a monitoring study was conducted. Candidates that were in the process of enrolment were followed and the actual use of the portfolio was evaluated. The following questions were addressed:

    1. To what extent does the current portfolio model affect the educational programme that the refugee doctor has to follow at the Dutch medical faculty?
    2. What changes should be made in the current portfolio model in order to increase this influence?
    3. How do the participants of the pilot experience the use of the portfolio model?

From the forty-four candidates that developed a portfolio in 2003-2004, only twelve candidates could be monitored. Seventeen candidates had to postpone their enrolment because they didn’t pass the Dutch language exam yet. Five candidates had chosen not to enrol in the medical faculty, but to follow another educational path. Six candidates had already concluded the enrolment procedure and started their education at the medical faculty. Four candidates had postponed their enrolment for personal reasons. From the twelve remaining candidates, one didn’t want to participate and one dropped out, which means that ten foreign doctors participated. From these, six candidates intended to enrol at the medical faculty of the Erasmus University of Rotterdam, three at the University of Utrecht and one at the Radboud University of Nijmegen.

The design of the study was as follows: Each portfolio candidate had an interview with the enrolment committee from the medical faculty4. In preparation of the interview, the enrolment committee received the portfolio of the particular candidate, so that they already had extensive background information about the persons competences. By means of questionnaires, information was collected about the perceived value of using the portfolio during the interview. Both the enrolment committee and the candidate themselves were asked to fill out two questionnaires, one before and one after the interview. To further clarify the results of the questionnaires, interviews have been conducted as well.

An important note for the interpretation of the evaluation results is the fact that the function of the interview is different at the three participating faculties. At the Erasmus University of Rotterdam, only a selected group is invited for the interview because there are more applicants than study positions. The selection of interviewees is made based on a document evaluation. International credential evaluation is an important instrument in this process. Once the selected candidates meet the formal admission requirements, they are invited for an intake interview, which is once again used for further selection. At the University of Utrecht and the Radboud University of Nijmegen, the candidates were already ensured of a study position. The interview at these faculties was intended to make acquaintance with the new student and get a better understanding of their educational and professional background.

The enrolment committees of the three faculties were all compounded of people with various expertise fields. Generally, people with medical expertise, expertise in the required attitude towards Dutch patients and Dutch language teachers were represented. It should be taken into account that the committees evaluated portfolios of different candidates. Due to the different experiences of each person, each portfolio contains different information, is developed according to a personal style and may be of varying quality. Obviously, this may have caused variation in the evaluation outcomes.

3.2 Results of the monitoring study
The response that was received from both the candidates and the enrolment committee members is depicted in Table 2 below.

University

Rotterdam

Utrecht

Nijmegen

# candidates

6

3

1

# pre-interview questionnaires

6

3

1

# post-interview questionnaires

5

2

1

# interviews

6

-

1

# committee members

3

4

3

# pre-interview questionnaires

7
(from 2 members about 6 candidates)

7
(from 3 members about 3 candidates)

2
(from 2 members about 1 candidate)

# post-interview questionnaires

9
(from 2 members about 6 candidates)

5
(from 3 members about 2 candidates)

2
(from 2 members about 1 candidate)

# interviews

1
(group interview)

-

-

Table 2: Evaluation information that was received

Evaluation among the enrolment committee members
The feedback that was received from the committees can be structured in three main topics:
Relevance of information in the received portfolios
Most of the information in the portfolios was generally considered as relevant and clearly structured.
The committees agreed that the portfolios don’t provide enough information concerning the medical expertise. They would like to read more about the diagnostic and therapeutic skills and the diversity of medical problems the candidate encountered.
Rotterdam mentioned that the Dutch language fluency should not be described in a portfolio, but rather evaluated during an interview. However, the portfolio should contain more factual information about the scores at Dutch language exams. The Nijmegen committee would like to read more about the English language fluency. Besides, they also stated that brief information about the personal situation of the candidate could be a valuable addition.
Additional value of using portfolio during the interview
Utrecht and Nijmegen found that the portfolios gave a reasonable impression of the candidates experience. They agreed that reading the portfolio is a valuable preparation, so that more detailed information might be retrieved from the interview. The medical experts of these committees also actively used the portfolio during the interview, by asking for further elaboration.
The committee of Rotterdam didn’t use most portfolios during the interview, because they found the documents too long and received them rather late, so that they didn’t have enough time to read them in advance. They didn’t see an additional value of reading the portfolios, because the information that is relevant to them (for the purpose of selecting candidates for the available study positions) can also be retrieved during the interview.
The role of portfolio in the enrolment procedure
Although Rotterdam didn’t find portfolio valuable in the stage of intake, it might be useful in the stage of document evaluation. After the interviews, two candidates were rejected because their working experience didn’t meet the requirements, so that they would have to follow nearly the entire medical programme. If the committee had known this before, these candidates could have prepared for a different path instead of the medical programme.
All committees agreed that portfolio cannot affect the educational programme a candidate has to follow. The portfolio instrument alone doesn’t provide reliable information, and should always be used in combination with an interview, and other assessment instruments. An important function of an interview is to verify the information in the portfolio, and to receive further elaboration. A member from Utrecht mentioned that the portfolio might be valuable to determine the educational programme in the specialisation phase.
Utrecht and Nijmegen believe that portfolio and an interview together can provide better insight in the background and attitude of the candidate. The committees were more doubtful whether these instruments can provide information about the professional competence. To measure this, additional forms of assessment might be necessary. However, the medical experts of Rotterdam and Utrecht believe that portfolio and an interview can help to determine the additional tests that a candidate will have to make.

Evaluation among the foreign medical doctors
Also the feedback that was received from the candidates can be structured in three topics:
Value of portfolio for preparation work in general
The candidates all felt empowered by the portfolio course and were encouraged to actively orientate on their possibilities for working in the Netherlands. Besides, they agreed that the portfolio course helped them to better explain their experience in the Dutch language.
Most candidates updated their portfolio after completion of the course and were satisfied about its content. However, only two candidates also used the portfolio to explain their experience, both for the purpose of job application.
Additional value of using portfolio for the interview
Most candidates used the portfolio in preparation of the interview, by rereading it and preparing answers to the questions that the enrolment committee might have. Most of them intended to bring the portfolio to the interview as well, but they weren’t sure whether to actively refer to it during the interview or not.
Before the interview, most candidates believed that the portfolio contained enough clear information about their education and work experience. They were more doubtful whether enough information was given about their working environment and medical expertise. After the interviews appeared that additional information was mostly required about the experience in the Netherlands. The candidates in Utrecht could give enough information during the interview to give the committee a good impression of their experience. Four of the candidates in Rotterdam however stated that there wasn’t enough time for this.
Most of the candidates believe that the portfolio has contributed to a better interview, because it helped them to have a better overview of their experiences and also to explain their experience in the Dutch language. None of the candidates has referred actively to the portfolio during the interview.
The role of portfolio in the enrolment procedure
Before the interview, a slight majority of the candidates believed that portfolio is a valuable instrument to give insight in their experience. Most of them found that additional forms of assessment are necessary, like 1) an interview, 2) practical exams to show (pre)clinical skills, communication and attitude, 3) a self-assessment, 4) a theoretical exam of basic medical knowledge and the specialisation field, or 5) a test about medical cases.
After the interview, most of the candidates indicated that the portfolio is a subjective assessment instrument, but that it is a valuable component for the assessment procedure of foreign medical doctors. Half of them agreed that also an interview should be held, from which 3 stated that this should be based on the portfolio.

3.3 Expert meeting
To conclude the monitoring study, an expert meeting was held where the main conclusions were discussed with national parties who are involved in the enrolment of foreign doctors in the medical programme. As mentioned before, the Ministry of Health is currently developing a national assessment procedure, which will become obligatory for each foreign doctor that applies for professional recognition. Those who don’t receive recognition will have to enrol in the Dutch medical faculty. Based on the assessment results, an enrolment advice will be given. The discussion during the expert meeting focussed on the following questions:

    1. What role might the portfolio instrument fulfil in the national assessment procedure?
    2. What information should a portfolio contain and how should it be structured?

Role of the portfolio within the national assessment procedure
The experts concluded that portfolio might be a valuable instrument within the national assessment procedure. Especially for the candidates, portfolio development may be useful. The purpose of portfolio within the assessment procedure should however be very clear to both candidates and assessors. Portfolio can be used for two purposes: assessment and development. The monitoring project showed that the medical faculty of Rotterdam prefers to use portfolio as assessment instrument during the phase of document evaluation, while the faculties of Utrecht en Nijmegen use it as development instrument. During the expert meeting, some medical experts stated that portfolio should be used as assessment instrument to identify whether the candidate is specialised in a certain medical area. Several other stakeholders pleaded to use portfolio as development instrument, to encourage candidates to reflect on their experience and their possibilities in the Netherlands. To combine these two purposes, a portfolio archive should be developed in which the candidate can include all information that may be relevant for various purposes (See Figure 2).

Structure and content of the portfolio
The current portfolio format is structured according to themes. Another possible way to structure the information could be according to competency standards, or according to the tests that will be used in the new assessment procedure. However, presently no competence standards are available. It was concluded that the structure according to themes is satisfying for its goal. Depending on the purpose that portfolio has to fulfil, different themes might have to be described. Issues that were mentioned to need more attention in the portfolio format are the medical specialisation, the type of medical problems the candidate encountered, working experience of the last five years, the Dutch language fluency and the ability to adjust to the Dutch (medical) culture. This should be looked at during the further development of the portfolio instrument for the national assessment procedure.

Figure 2: Portfolio archive from which information can be selected for different purposes (Cinop, 2003)

4 Conclusions and recommendations
The portfolio is a valuable instrument to be used for enrolment, but should always be used in combination with an interview, and other assessment instruments. Portfolio might provide better insight in the background and attitude of the candidate and might help to determine additional test instruments. The foreign doctors themselves found the development of the portfolio a valuable activity. It gave them a better overview of their experience and enabled them to better explain their experiences in the Dutch language. This helped them well in their preparation for enrolment in the medical programme. Besides, the portfolio forms a good information source for Dutch organisations and the candidates felt empowered to actively orientate on their possibilities in the Netherlands. This may help them to make the best choices for their future career. This shows that portfolio is important as development instrument for the candidates. However, it is recommendable that they can start the process of portfolio development as early as possible.

The above stated implicates that portfolio serves both purposes of assessment and development. This means that the current portfolio format should be revised so that it can used for both purposes. However, the foreign doctors that participated in the monitoring study were quite disappointed about the fact that the portfolio didn’t really affect the educational programme, because the portfolio instrument wasn’t recognised by the faculties. Therefore, it is very important that the purpose of the instrument should be clear to both candidates and assessors. It is expected that portfolio will be used in the national assessment procedure for foreign doctors which is currently developed by the Ministry of Health. At central level should be decided what purpose portfolio should fulfil in this procedure. This decision will affect the necessary format and content of the portfolio instrument. To keep both functions of the portfolio separated, it is recommended to work with a portfolio archive, from which information for different purposes can be retrieved. More pilot projects should be conducted to test the use of such a portfolio archive, to investigate how portfolio use can further be integrated in the assessment procedure, and to identify how the specific experience of each candidate can better be taken into account.

References
CBGV - Bureau of Foreign Degree Holders of the Ministry of Health, Welfare and Sports (2002). Vakbekwaamheid zonder grenzen? (Professional competence without borders?). Den Haag: CBGV.
CINOP (2003). Working with the portfolio instrument. ‘s-Hertogenbosch: CINOP.
UAF - Foundation for Refugee Students (2003). Gevluchte arts van wachtkamer naar spreekkamer (Refugee physician, from waiting room to consultation room). Utrecht: UAF.
Herfs, P. G. P., Yari, P., Haalboom, J. R. E., and Kruijshoop, M. A. (2001). Onderzoek naar de loopbanen van “CIBA-artsen” (Investigating the careers of “CIBA doctors”). Utrecht: Universiteit Utrecht.
Klarus, R. (1998). Competenties erkennen (Recognising Competencies). ’s-Hertogenbosch: CINOP (PhD thesis).
Metz, J. C. M., Verbeek-Weel, A. M. M., en Huisjes, H. J. (2001a). Raamplan 2001 artsopleiding, bijgestelde eindtermen van de artsopleiding (Outline 2001 medical programme, revised education goals of the medical programme). Nijmegen: Mediagroep.
Metz, J. C. M., Verbeek-Weel, A. M. M., and Huisjes, H. J. (2001b). Raamplan 2001 artsopleiding, Bijlage: lijst van vaardigheden, lijst van ziektebeelden (Outline 2001 medical programme. Appendix: list of skills, list of syndromes). Nijmegen: Mediagroep.
Scholten, A.M. & Teuwsen, R. (2001). International Credential Evaluation (ICE) and Prior Learning Assessment and Recognition (PLAR). Nuffic recommendations to the Kenniscentrum EVC (APL Knowledge Centre). The Hague: Nuffic.
Scholten, A. M., Teuwsen, R. and Mak, A. M. A. (2003). Portfolio in een opleidingsgerichte EVC procedure voor buitenlandsgediplomeerde geneeskunde studenten (Portfolio in an education oriented PLAR procedure for foreign medical students). Houten: Kenniscentrum EVC.
Scholten, A.M, Teuwsen, R., & Mak, A.M.A. (2003). Portfolio-ontwikkeling door buitenlandse artsen (Portfolio development by foreign doctors). Nuffic: Den Haag.
Scholten, A.M, Teuwsen, R., & Mak, A.M.A. (2003). Stilstaan bij portfolio-gebruik voor buitenlandse artsen (Reflection at portfolio use for foreign doctors). Nuffic: Den Haag.
OCG-DMW – Onderwijs Commissie Geneeskunde van het Discipline overlegorgaan Medische Wetenschappen (december 2002). Naar een nieuwe stroomlijn voor buitenlandse artsen, 2e concept (To new streamlining for foreign doctors, 2nd concept).


1 For a more extensive description, see the following project reports (in Dutch):

2 For a more extensive description, see the project report (in Dutch): Scholten, A.M, Teuwsen, R., & Mak, A.M.A. (2003). Stilstaan bij portfolio-gebruik voor buitenlandse artsen. Nuffic: Den Haag.

3 The municipality of Rotterdam organised a project for foreign doctors in their region. In cooperation with an employment service agency for refugees (Emplooi), and a regional education centre (Albeda College), a 1-year educational programme that prepares foreign doctors for enrolment in the medical faculty was offered. On request of the project team, Nuffic has offered a portfolio course to a group of 10 participants of this programme.


4 The interview was already a standard component of the enrolment procedure at all three participating faculties. The difference with their normal procedure is that during the monitoring study, they used the portfolio of each candidate as preparation for the interview.