Thesis (MPhil)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: A portfolio assessment system was designed to meet the needs of a Rural Clinical School education platform, hosting final year MB ChB students for the duration of their final year. A study entitled “What can be learned from the implementation of a portfolio assessment system, to be used in the assessment of clinical reasoning of final MB ChB students placed in a Rural Clinical School in South Africa? “ was conducted. The experience of educators and students during this process was explored. The findings are in keeping with the literature. Van Tartwijk & Driessen 2009, Eley et Al 2002, Lake & Ryan 2004, Burch & Seggie 2008 claim that portfolios drive deep student learning and develop clinical reasoning. Burch & Seggie (2008) offer an assessment tool which has proved feasible within the South African setting on which this portfolio assessment system was modelled. The assessment tool design faced a number of challenges within the RCS setting which were addressed during a review process. The portfolio assessment system is viewed as a work in progress requiring further development. Despite the constraints and challenges, both staff and students unanimously supported the development of patient case studies within the design as a valuable learning tool. / AFRIKAANSE OPSOMMING: ‘n Portefeulje assesserings sisteem is ontwerp om die behoeftes van ‘n UKWANDA Landelike Kliniese Skool opvoedings program wat die gasheer van die MB ChB student tydens hul finale jaar is, na te kom. ‘n Studie genaamd “ Wat kan geleer word uit die implementering van ‘n portefeulje assesserings sisteem, wat gebruik gaan word om die kliniese redenering te bepaal van finale jaar MB ChB student wat geplaas is in ‘n Landelike Klinieke Skool in Suid Afrika? ” is uitgeoefen. Die ervaring van die dosent, so wel as die studente, is ondersoek. Die bevinding is in lyn met die literatuur. Van Tartwijk & Driessen 2009, Eley et Al 2002, Lake & Ryan 2004, Burch & Seggie 2008 beweer dat portfeuljes dryf student tot diep studie en ontwikkel kliniese redenasie. Burch & Seggie (2008) bied ‘n assesserings (hulp)middel aan wat toepaslik en uitvoerbaar is in die SA konteks , waarop die portfeulje assessering sisteem gebaseer is. Die ontwerp van die assesserings (hulp)middel het vele uitdagings binne die RCS opset in die oog gestaar. Dit is aangespreek tydens ‘n proses van hersiening. (Lather, 2006).Die portefeulje assesserings sisteem word gesien as ‘n werk onder hande en vereis verdere ontwikkeling. Ten spyte van die beperkinge en uitdagings het beide die staf en die student onomwonde die ontwikkeling van pasiente gevalle studies, binne die ontwerp, as ‘n waardevolle leermiddel gesien.

As an expression of current challenges faced by contemporary societies, past decades have witnessed heavy demands for higher education to change and transform. One key question here has been the increased digitalization of higher education. Within this wider setting, this thesis deals with an attempt to handle the increasing shortage of physicians in Sweden by way of digitalizing medical education. The aim of this explorative and longitudinal thesis is to describe and analyze structural and educational transformation work in medical education during the digitalization of the program and the transition from face-to-face to distance education. This thesis focuses on teachers, students and management, who are all heavily involved in this transition of the medical program. Two questions guide the research: (1) what are teachers’ and students’ expectations pending the transition, and what are the influences of already established tools and activities on the program and (2) in what ways do conflicts and changes occur over time, and how do teachers, students, and management deal with these as part of the transition? Cultural-historical activity theory (CHAT) serves as the theoretical framework of the thesis. In particular, the concepts of dominant and non-dominant activities, conflicts, transitional actions, and levels of learning inform the analysis. The data are generated by surveys (N = 108), logging of actors’ activity patterns (N = 100 teachers and 100 students), field studies (65 hours), and interviews (N = 62). The data cover teachers’, students’ and management’s roles in the transition. The analysis shows that the way of theoretically understanding the transition – from a dominant face-to-face activity to a new and unproven non-dominant distance activity – have proved to contribute to deeper understanding of the process of digitalizing medical education. The analysis further displays how the transition from face-to-face to distance education creates considerable conflicts that over time force teachers, students and management into structural and educational transformation work. This type of work successively renders new educational design solutions and new flexible ways of organizing distance medical education. This thesis discusses how the structural and educational transformation work forces actors to collectively engage in the transition by experimenting with new suitable methods and designs, as digital technologies and technology-enhanced learning (TEL) could make sense to teachers and students when they are at a distance.