Cultural and contextual dimensions of portfolio-based learning: A mixed-methods study

Culture and context are increasingly recognized in debates on the globalization and standardization of medical curricula. This study explored how cultural and contextual factors shaped students' and mentors' experiences of portfolio-based learning in a Middle Eastern setting.

An explanatory sequential mixed-methods design was used. Ethical approval was obtained. Participants were clinical-year medical students during their clerkships at Prince Sattam Bin Abdulaziz University, Saudi Arabia. A questionnaire assessing perceived cultural and contextual influences on portfolio-based learning was developed and validated. Student group discussions and mentor interviews explored perspectives. Survey data were analyzed using descriptive statistics, Spearman's correlation coefficients, and multiple regression analyses. Qualitative data were analyzed thematically within cultural and contextual domains.

A total of 111 students completed the survey (response rate 78.7%), and qualitative data comprised group discussions with 79 students and interviews with six mentors. Students rated portfolio usefulness at 4.17 (SD ± 3.13) on a 10-point visual scale, indicating low perceived educational value. Perceived portfolio usefulness was positively associated with training level (ρ = 0.626, p < 0.001), appeared to be negatively associated with uncertainty avoidance (ρ = -0.79, p < 0.001; B = -1.01, p = 0.002), and positively related to long-term orientation (B = 1.69, p < 0.001). Qualitative findings clarified cultural and contextual influences on portfolio engagement. Students demonstrated high uncertainty avoidance, collectivist learning preferences, and short-term goal structures, with variable orientation regarding power distance. Significant associations were observed between cultural dimensions, students' perceptions of portfolio usefulness, and training level. Contextually, students perceived limited alignment between portfolios and the formal curriculum and described the hidden curriculum and learning environment as influential in shaping engagement.

Sociocultural and contextual factors appeared to shape experiences of portfolio-based learning. Recognizing these influences may support more acceptable and meaningful portfolio implementation in diverse medical education settings.