Article: A growth mindset, when combined with Entrustable Professional Activities (EPAs), creates a powerful and supportive learning environment that fosters continuous growth in medical education.

By Roel Smabers and Robert Smeenk

Introduction

The concept of a growth mindset, introduced largely thanks to the work of Carol Dweck, is gaining increasing significance. This is especially true in medical education, where it is crucial that current and future professionals can perform effectively. When combined with Entrustable Professional Activities (EPAs), a growth mindset provides a structured framework for professional development and helps in achieving “entrustment.” In addition, both concepts can be integrated into a programmatic assessment approach, in which systematic feedback on growth and development—collected from multiple data sources—offers a more objective picture of progress. Together, these three elements—growth mindset, EPAs, and programmatic assessment—form a powerful triad for creating an effective learning environment. This article explores how connecting these three concepts can amplify their impact.

The essence of mindset theory

Carol Dweck’s mindset theory distinguishes between two fundamental ways of thinking: a fixed mindset and a growth mindset.

• Fixed mindset: People believe their abilities are static and cannot meaningfully change.
• Growth mindset: People see their abilities as malleable, believing they can grow through effort and learning.

Characteristics of a fixed mindset:

• Avoiding challenges: Challenging situations are often avoided, as they are seen as threats rather than opportunities, leading to missed chances for growth.
• Giving up easily: Obstacles are interpreted as signs of inherent inability rather than natural parts of the learning process.
• Seeing effort as pointless: Effort is viewed as evidence of a lack of talent rather than a pathway to mastery.
• Ignoring useful feedback: Feedback may feel like a personal attack, limiting the ability to adapt and improve.
• Feeling threatened by others’ success: Others’ achievements can cause jealousy and demotivation, reducing self-confidence.

Characteristics of a growth mindset:

• Embracing challenges: Challenges are sought out as opportunities to grow and develop new skills.
• Persevering through setbacks: Failures are seen as temporary obstacles and learning opportunities, fostering resilience.
• Viewing effort as the path to mastery: Improvement and success come through consistent practice and dedication.
• Learning from criticism: Feedback is valued as a tool for continuous improvement.
• Finding inspiration in others’ success: Others’ achievements motivate personal goal-setting and perseverance.

How mindsets develop

A fixed mindset often develops from a combination of personal experiences, upbringing, and personality, leading to the belief that intelligence and abilities are unchangeable. This can be reinforced by environments that emphasize talent over effort. In contrast, a growth mindset develops through positive learning experiences, encouragement to take on challenges, and the normalization of mistakes as part of learning. Educational environments that focus on effort, perseverance, and the learning process rather than outcomes help foster a growth mindset.

In medical education, much attention is paid to the learning climate. Hospitals regularly survey interns and residents to assess it. Creating a safe and stimulating learning environment is challenging, especially where mistakes can have serious consequences. The pressure to perform can overshadow the opportunity to learn. Structured approaches like EPAs and programmatic assessment can help counterbalance this by encouraging a growth-oriented learning climate.

Growth mindset in medical education and EPAs

A growth mindset fosters a love of learning and resilience—both essential for academic and clinical success. It helps medical students and practitioners handle feedback, improve clinical skills, and maintain motivation. It encourages seeing failures as opportunities, which is critical in the complex world of healthcare.

EPAs provide a structured pathway for professional development, gradually increasing responsibility as competence grows—aligning perfectly with growth mindset principles. This synergy not only enhances clinical skill development but also creates a more supportive and inclusive learning environment.

Synergy between growth mindset and programmatic assessment

One barrier to a positive learning climate is the perception that assessments are unfair. Single-point assessments can reinforce this problem. In contrast, multi-source and multi-moment assessments—combined with ongoing, lower-stakes feedback—boost learner motivation.

Programmatic assessment acts as a catalyst alongside growth mindset and EPAs. By collecting multiple data points and presenting them in dashboards, both learners and assessors gain a clearer, more transparent view of progress. Continuous feedback throughout the learning journey—not just at the end of a course—encourages risk-taking, reflection, and personal growth.

E-portfolios as a catalyst for growth mindset

An e-portfolio platform—such as Scorion—integrates these three concepts effectively. Programmatic assessment is nearly impossible to implement well on paper; without a digital tool, feedback quickly loses its timeliness. Likewise, EPAs require a portfolio tailored to the content and structure of the medical curriculum, making generic “course-oriented” portfolio systems insufficient.

By promoting ongoing reflection and documentation of learning experiences, an e-portfolio helps learners visualize their growth. It supports continuous tracking of progress over time, reinforcing the idea that skills and knowledge develop through effort. It also facilitates timely feedback, encouraging learners to see challenges as opportunities rather than threats. Documenting both successes and learning moments fosters a mindset in which mistakes are valued as essential steps in the learning process.

An integrated approach

An integrated approach in medical education combines growth mindset, EPAs, programmatic assessment, and a flexible e-portfolio to create a holistic learning environment. Here, assessment becomes an integral part of learning—often referred to as assessment as learning. Workplace-based assessments (WBAs) offer continuous, real-world feedback, connecting clinical performance directly to learning goals. This combination encourages students to embrace challenges, provides clear professional targets, and supports lifelong learning.

Conclusion

A growth mindset contributes significantly to the development of medical professionals by encouraging perseverance and the embrace of challenges. When combined with innovative educational methods like EPAs and programmatic assessment, it creates a highly effective learning environment that promotes continuous growth.

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Sustainability is more than just a trend; it is a responsibility that we all must embrace. At Scorion, we are committed not only to offering innovative digital solutions for educational institutions but also to contributing to sustainability. In this article, we want to highlight how our digital portfolio system combines ecology, efficiency, and responsibility.

Paper Savings, Resource Optimization, and CO2 Reduction
A key feature of Scorion is the significant reduction in paper usage. Where once tons of paper were needed for documentation, exam papers, and evaluations, Scorion enables a fully digital process. A university that implemented our system, for example, demonstrated that the savings in paper costs far exceeded the initial investment in the system. This is not only an advantage for the environment but also for the budget planning of educational institutions.

An often-overlooked aspect of sustainability is the reduction of CO2 emissions resulting from logistics and transport. By eliminating the need to print and ship documents, exam books, or other physical materials, Scorion helps minimize transport distances. This is particularly relevant for universities with multiple campuses or international exchanges and directly contributes to reducing the carbon footprint.

Efficiency Improvement through Digitalization
However, the benefits go beyond just reducing paper usage. Scorion creates a more efficient system in which the development progress of students can be monitored at any time. Teachers and administrators can immediately see which competencies have been acquired and where there is still room for improvement.

Additionally, many time-consuming tasks, such as digitizing paper documents or manually managing Excel lists, are eliminated. Digitalization brings order, transparency, and traceability—everything with a fraction of the effort required by traditional methods.

Sustainable Implementation
Like any new technology, the implementation of Scorion requires an initial investment. Staff need to familiarize themselves with the system, and system administration takes time and resources. However, after a short adaptation period, it becomes clear that the long-term benefits far outweigh these initial efforts. Processes that used to be manual and error-prone are now automated and efficient. This not only saves time but also reduces potential sources of error.

Responsible Data Management
Another important aspect of sustainability is the responsible handling of data. Scorion allows educational institutions to securely store and manage sensitive data. This is not only essential for compliance with data protection regulations but also emphasizes our commitment to providing sustainable and forward-looking solutions.

A Contribution to Sustainable Education
With Scorion, we aim not only to improve the educational landscape but also to make our contribution to a more sustainable world. The combination of resource conservation, efficiency, and technological innovation shows how digital solutions can positively impact both the environment and the daily operations of educational institutions.

We are convinced that sustainability and progress can go hand in hand—and Scorion is an example of how this can be achieved.

In 2021, Scorion started its journey in Germany with an exciting partnership in Berlin. Our first partners were the midwifery and nursing programs, which was a big step forward in bringing such an innovative system to Germany. At that time, using a portfolio-based system was completely new and a big test for the future of digital tools in education.

Today, these programs have been using Scorion for several years, improving and developing their portfolios along the way. With many changes happening in healthcare education, these programs are now also implementing and testing Entrustable Professional Activities (EPAs). This is an exciting development that many other universities in Germany are watching closely.

Another major milestone was creating Germany’s first Scorion portfolio for human medicine. This project focuses on competency-based documentation of clinical skills during the practical year (PJ), while supporting the professional development of medical students. (For more details, visit: Charité PJ E-Portfolio).

Soon after, the dentistry field also joined the Scorion family, showing how flexible the system is. Following these projects in Berlin, Scorion has expanded to other top institutions in Germany. This includes our work at the HAW Hamburg, where two portfolios are now in use, and a recent kick-off in Frankfurt. At Frankfurt University of Applied Sciences, Scorion is being used to help midwifery and nursing programs with modern digital tools for documenting practical training. (Learn more about this exciting project here: Innovative Digital Documentation).

We are very happy to see Scorion’s journey in Germany gaining momentum. The growing interest from universities shows the need for innovative digital solutions in education. With every new project, we aim to help institutions create portfolios for learning at the workplace that support both students and educators.

Looking ahead, we are inspired by the collaboration and progress happening across Germany. We are excited to keep growing and working with institutions that share our vision of transforming education with our tool Scorion.

Towards a more inclusive curriculum

Research worldwide also shows that diversity within medicine improves its quality. And when we see that there is still a considerable imbalance between the physician population and society, there is still a lot to be gained.One of the studies recently conducted at the GP training programs has formulated a so-called DEI (Diversity, Equity, and Inclusivity) strategy. This consists of 7 very concrete strategies, of which these are the most important:

• DEI expertise promotion for all those involved in GP training using training programs;
• Appointment of DEI ambassadors in all teams of GP training, who contribute to knowledge transfer, reflection on possible prejudices;
• Participation in DEI networks; Giving an active voice to trainees from ethnic minority groups in developments within GP training.

Despite the fact that there is a lot of attention and a number of initiatives have already been started within medicine, there are still plenty of challenges remaining. To address these challenges, it is essential that medical education actively works towards a more inclusive curriculum. In general, the following aspects are often mentioned as supporting the process towards more ‘DEI’:

• Awareness of implicit biases
• Knowledge about health issues specific to particular groups
• Skills to communicate effectively with a diverse patient population

The role of digital tools in inclusivity

Digital tools, including e-portfolios, can make a modest but potentially valuable contribution to promoting inclusivity in medical education. For example, we see in studies on biasing and the transfer of graduated doctors to the practical work environment as residents (learner handovers), the influence of negative feedback has a major impact on how the learner continues the learning path. A student who carries negative feedback consistently receives lower grades. And often this happens unconsciously or at least out of sight.

A number of very practical tools to promote diversity are:

• Personalized learning: E-portfolios allow students to follow their own learning path and reflect on their experiences. This can help recognize and value the unique perspectives and backgrounds of students.
• Equal opportunities for feedback: Digital platforms can provide a more structured and objective way of giving feedback, reducing the chance of unconscious biases.
• Accessibility: Online tools can increase the accessibility of education for students with physical limitations or other challenges.
• Cultural competence: E-portfolios can contain specific modules aimed at developing cultural competence, better preparing students to work with diverse patient populations.

Conclusion

Although digital tools such as e-portfolios may contribute more positively to more inclusive medical education than we think, they are only part of the solution. Real change requires a holistic approach, where all aspects of the training are critically examined and adjusted. Instruments or concepts such as ‘workplace-based assessment’, programmatic assessment, multi-source feedback, OSCE, where the origin of a decision can always be clear for the learner and the assessor, can be very useful in this regard. That’s why we believe these are also important elements of a good digital portfolio. Especially now that algorithms and AI support are increasingly being applied in such tools.

Creating an inclusive learning environment in medical education is not only a matter of justice for students but also an investment in better healthcare for everyone. By embracing diversity and promoting inclusivity, we train doctors who are better able to provide care to an increasingly diverse society.

Sources

1. https://www.huisartsopleiding.nl/kwaliteit-innovatie/opleidingsinnovatie/bevorderen-van-diversiteit-inclusie-en-gelijke-kansen-tijdens-de-opleiding/
2. https://www.revalidatie.nl/ntr/diversiteit-en-inclusie-in-de-opleiding-tot-revalidatiearts/
3. https://dejongedokter.nl/djd-schrijft/hoe-ver-zijn-we-al-diversiteit-en-inclusie-in-het-medisch-onderwijs/
4. Naar een inclusieve opleiding in de zorg: Diversiteit en inclusie onder artsen (Obihara & Maarse 2024)
5. Lee HW, Kim E. Workforce diversity and firm performance: Relational coordination as a mediator and structural empowerment and multisource feedback as moderators. Hum Resour Manage. 2019;1–19

E-portfolios as support

To track students’ performance and progress, digital e-portfolios such as Scorion are increasingly being used. These digital tools continuously document feedback and assessments on the EPAs performed, giving students and educators a structured overview of the competencies learned. Such e-portfolios not only promote student reflection but also better preparation for exams and clinical requirements (1). 

Bridge between theory and practice

EPAs serve as a bridge helping students transfer theoretical knowledge acquired in the lecture hall to clinical practice. The gradual transfer of responsibility ensures that aspiring dentists not only acquire professional skills but also learn to act safely in a real clinical environment (1).

By combining EPAs with digital e-portfolios, students receive a clear structure for their education and can work specifically on their independence and clinical skills.

Conclusion

The use of EPAs in dentistry helps to meaningfully connect theory and practice and best prepare students for everyday professional life. In conjunction with modern e-portfolios like Scorion, not only is the learning curve managed, but transparency and objectivity in assessing clinical skills are also increased. EPAs thus create a sound basis for high-quality dental education.

Sources

1. https://link.springer.com/article/10.1007/s00103-023-03803-3

Challenges and solutions

One of the biggest challenges in implementing holistic assessment is ensuring the objectivity and comparability of the assessments. Standardized assessment tools and regular training of instructors can help minimize subjective influences. Moreover, it is important that the assessment tools are regularly reviewed and updated according to new scientific findings and societal needs.

Conclusion

The introduction of holistic assessment in medical education is a necessary step to improve the quality of medical care. It ensures that future physicians not only possess the required specialized knowledge but are also capable of applying this knowledge in practice and addressing the needs of patients. However, such an education requires continuous adaptation and development of curricula, as well as close cooperation among all stakeholders in the healthcare system.

Sources used for this article

1. PDF: Bildungskonzepte für_das Gesundheitswesen
2. TOP XI Ankündigung des 129. Deutschen Ärztetages 2025 in Leipzig (bundesaerztekammer.de)
3. PDF: Berufsbildung und Beschäftigung im personenbezogenen Diensleistungssektor
4. PDF: Zwischen Licht und Schatten – eine explorative Studie zum Ausbildungserleben von Auszubildenden in der Pflege unter besonderer
   Betrachtung von Migrationshintergründen