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Introduction
Research demonstrates that learning is enhanced when learners identify their own needs, select their own strategies and evaluate their own learning outcomes. Over the past decade, the concepts of reflective practice and life-long learning have influenced the organization of both medical education and continuing medical education. In addition the disciplines of distribution of medical informatics and education knowledge management have been catalyzed into the consciousness of medical educators by the speed of information access and distribution from Internet-based technologies.

These concepts incorporated into a learning model based on reflection and self-management of knowledge have not been broadly incorporated into obstetrics and gynecology residency training in Canada. Upon completion of residency, students are evaluated by exam and satisfactory completion of FITER, the Final In-Training Evaluation Report. FITER is based on the roles outlined in the RCPSC's Canadian Medical Education Directions for Specialists 2000 Project report. These new roles, including Medical Expert/Clinical Decision-maker; Communicator; Collaborator; Manager; Health Advocate; Scholar; and Professional, necessitate that residents hone their information literacy and knowledge management skills. Both the Project Panel on the General Professional Education of the Physician and Assessing Change in Medical Education, The Road to Implementation reports highlight that a strong grounding in information management can enhance professional practice.

One of the educational tools that lend itself to the integration of the principles of reflective pratice, information literacy, and educational knowledge management is that of a learning portfolio.

Documentation of activities in a portfolio has been used in both undergraduate and continuing education to promote reflection and self-management of learning. To stimulate self-reflection and cultivate information literacy the Computerized Obstetrics and Gynaecology Automated Learning Analysis (KOALA) was developed. KOALA is an educational knowledge management system that offers an easy-to-use, point-and-click interface through which the user can record details about the motivation for a particular learning event, specific questions relevant to the situation, the information found and applied to the event, and the treatment and learning outcome. It also benefits program directors, who are able to review the learning experiences of all residents, enabling the provision of timely feedback for personalized educational planning, and subsequent evaluation.

A stand-alone version of the dynamic relational database was first introduced at a Canadian obstetrics and gynecology residency-training program in June of 1995. The subsequent development of an Internet version allowed for a multicentre pilot project to measure the impact of the KOALA program on self-directed learning habits and perceptions. 7,049 patient encounters and 1,460 critical incidents of learning were recorded by 41 residents at one KOALA-exposed school and three KOALA-naive schools over five months during 1997. Residents at the KOALA-exposed school were more likely to have a cognitive critical incident (45% vs 6%, p<0.0001), had a significantly higher perception of their self-directed learning abilities (p<0.05), were looking forward to learning for life (p<0.000), tended to learn new things on their own each year (p<0.015), had a strong desire to learn new things (p<0.018), and believed that maintaining a learning portfolio during their residency would contribute to their learning (p<0.011). In 354 cases (30%) residents reported that a change in subsequent practice would occur.
To date, number of school participating are 14, and the total number of cases entered is 61,887 with 10,046 critical incidents with 340 residents. Initial analysis confirms that high volume users demonstrate the characteristics of self-directed learner. In addition, the program has allowed the potential to create a community of learners with effective knowledge building capability.

Reflection on the unique successes that we have experienced are both political and behavioural in nature. Many schools cooperated by contributing to, and sharing their residents' learning portfolios so that the specialty as a whole could benefit. We view this as a unifying process providing a common platform for future collective educational initiatives. The implementation of a learning portfolio has facilitated the shift from an apprenticeship model to a inquiry-based model that is grounded in the structured requirements for certification and maintenance of certification as required by the Royal College of Physicians and Surgeons of Canada.

Future research challenges include the evaluation of learning portfolios in a structured manner which can be replicated in a number of schools; establishing mechanisms to identify deficiencies in training through regular review of learning portfolios; and pairing residents with an electronic mentor to support inquiry-based training on an on-going basis. This capability will be further enhanced by the integration of new multi media technology, hand-held computing and the enrollment of other countries.

Ultimately society will benefit from this enhanced model of residency training that focuses on the development of practitioners that are prepared to engage in life-long learning.