How to Portfolio a Competency (Activity vs Assessment)
The short version — watch it on TikTok.
Someone asked me a brilliant question: “How would you portfolio a competency?” It’s the question every clinician expanding their scope should be asking — and almost everyone gets the answer wrong. Because a portfolio is not what most people think it is.
The short version
- A portfolio is not a log. It’s a structured collection of assessed evidence.
- Activity fills your diary. Assessment fills your portfolio.
- Map it to a framework — e.g. the RPS/RCP core advanced curriculum.
- Climb Miller’s triangle: knows → knows how → shows how → does.
- Every piece countersigned. Self-declared evidence is worthless; verified is defensible.
First — what a portfolio actually is
Here’s where most people trip up. They think a portfolio is a record of what they’ve done. “Have a look — I’ve seen 20 patients and written their prescriptions. That’s my portfolio.” It isn’t. That’s a log. It’s a diary.
A portfolio is a structured collection of evidence that demonstrates you can work safely, independently and consistently against a recognised standard. The distinction that makes it click: seeing a patient is an activity. Seeing a patient while being assessed against a standard, in a structured way, by someone qualified to judge — that’s evidence. Your portfolio is the collection of those assessments. Not the activities themselves.
That’s why a pharmacist who’s seen 500 patients can still have a weak portfolio — and someone with 20 well-assessed cases can have a strong one.
Map it to a framework first
Before you collect a single piece of evidence, pick the framework you’re mapping to — and map evidence to its outcomes, rather than just logging what you did. For advanced pharmacy practice that’s the RPS / Royal College of Pharmacy core advanced curriculum, which provides a credentialing assessment to assure pharmacists have the capabilities to practise at an advanced level. The medical world works the same way: the GMC’s credentialing model has two routes — completing training, or providing evidence of relevant skills and experience that is evaluated against the standards. In other words, even the regulators say you can prove competence by evidence, not only by sitting a course. Framework first, evidence second.
Miller’s triangle: the map
The cleanest way to think about which evidence you need is Miller’s triangle. Four levels, bottom to top:
Knows — you have the knowledge. Knows how — you can apply it. Shows how — you can demonstrate it under controlled conditions. And at the top, does — what you actually do, routinely, in real practice. A certificate only proves the bottom. You cannot OSCE your way to the top — “does” can only be evidenced in real practice.
The tools — and matching them to the level
So how do you turn an activity into evidence at each level? Recognised, structured assessment tools — each one countersigned by someone competent in that scope:
| Tool | What it is | Miller level |
|---|---|---|
| CbD | Case-based discussion — a supervisor probes your reasoning on a complex case. | Knows how |
| OSCE | Demonstrating the skill under controlled, simulated conditions. | Shows how |
| Mini-CEX | An assessor observes a whole real consultation and rates you against a standard. | Does |
| DOPS | Direct observation of a practical procedure (injection, examination technique). | Shows how / does |
| MSF | Multi-source feedback — colleagues and patients on how you actually practise. | Does |
A worked example: an ADHD titration clinic
Say you’re a prescriber expanding into ADHD titration. One clinical activity — running the clinic — can generate different pieces of evidence at different levels, depending on the tool you apply:
- Knows — your CPD and pharmacology learning (with an MCQ or marked assessment behind it, not just attendance).
- Knows how — a case-based discussion on a complex titration: why you held the dose, how you handled a raised heart rate, the reasoning behind the decision — signed by a specialist.
- Shows how — an OSCE or simulated consultation before you’re doing it for real.
- Does — Mini-CEX of real clinics, a prescribing audit against NICE and the shared-care protocol, and multi-source feedback from the team around you.
That’s a portfolio. That’s a competency you can actually defend — not a diary of clinics you happened to run.
The countersignature — someone competent in that scope confirming what they observed — is what turns “I saw a patient” into “I can prove I’m competent.”
Where this ties back to getting struck off
This is the flip side of my piece on how you prove you’re competent. Competence is evidenced, not conferred — and the portfolio is how you evidence it. If you’re expanding your scope of practice, “trust me, I did a course” will not protect you in front of the GPhC. A framework-mapped, assessed, countersigned portfolio will.
How I can help
Building a portfolio that genuinely evidences competence — choosing the framework, picking the right assessment tools, and getting them countersigned — is exactly the work I do through MEDLRN. If you’re expanding your scope or building your competence, let’s make sure you can prove it.
Frequently asked questions
What is a portfolio of competency?
A structured collection of evidence that demonstrates you can work safely, independently and consistently against a recognised standard. It is not a diary, a log, or a folder of certificates — it is a collection of assessments of your activities, each mapped to a framework (e.g. the RPS/RCP core advanced curriculum) and countersigned by someone competent in that area. Activity fills your diary; assessment fills your portfolio.
What is the difference between activity and assessment?
The activity is the thing you do — seeing a patient, running a clinic, prescribing. The assessment is a structured evaluation of that activity against a standard, by someone qualified to judge. Your portfolio is the collection of those assessments, not the activities. That is why 500 patients can make a weak portfolio and 20 well-assessed cases a strong one.
How does Miller's triangle apply?
Miller's triangle has four levels: knows, knows how, shows how, does. A certificate only proves the bottom. Different tools evidence different levels — a certificate/MCQ at 'knows', CbD at 'knows how', OSCE at 'shows how', and Mini-CEX, audit and MSF at 'does'. You cannot OSCE your way to the top; 'does' is only evidenced in real practice.
Which assessment tools should I use?
Match the tool to the competence: CbD for reasoning, Mini-CEX for observed consultations, DOPS for procedures, OSCE for controlled demonstration, MSF for how you actually practise. Every one must be countersigned by someone competent in that scope — self-declared evidence is worthless; verified evidence is defensible.
Is Mini-CEX or DOPS right for assessing prescribing?
For prescribing in a consultation, use the Mini-CEX, not DOPS. DOPS is for practical procedures (injections, ear irrigation, examination technique). Prescribing — for example an ADHD titration — is a decision-making episode, so an assessor observes the whole consultation and rates it against a standard. Mini-CEX is the consultation equivalent of DOPS.
Comments
What’s the hardest part of building your portfolio — the framework, the assessments, or getting them countersigned? Tell me below; I read every comment.