Use of an apprenticeship model to facilitate prescribing learning on clinical placements

Background Effective mentorship is an important component of medical education with benefits to all stakeholders. In recent years, conceptualization of mentorship has gone beyond the traditional dyadic experienced mentor-novice mentee relationship to include group and peer mentoring. Existing theories of mentorship do not recognize mentoring’s personalized, evolving, goal-driven, and context-specific nature. Evidencing the limitations of traditional cause-and-effect concepts, the purpose of this review was to systematically search the literature to determine if mentoring can be viewed as a complex adaptive system (CAS). Methods A systematic scoping review using Krishna’s Systematic Evidence-Based Approach was employed to study medical student and resident accounts of mentoring and CAS in general internal medicine and related subspecialties in articles published between 1 January 2000 and 31 December 2023 in PubMed, Embase, PsycINFO, ERIC, Google Scholar, and Scopus databases. The included articles underwent thematic and content analysis, with the themes identified and combined to create domains, which framed the discussion. Results Of 5,704 abstracts reviewed, 134 full-text articles were evaluated, and 216 articles were included. The domains described how mentoring relationships and mentoring approaches embody characteristics of CAS and that mentorship often behaves as a community of practice (CoP). Mentoring’s CAS-like features are displayed through CoPs, with distinct boundaries, a spiral mentoring trajectory, and longitudinal mentoring support and assessment processes. Conclusion Recognizing mentorship as a CAS demands the rethinking of the design, support, assessment, and oversight of mentorship and the role of mentors. Further study is required to better assess the mentoring process and to provide optimal training and support to mentors.

Mentoring as a complex adaptive system – a systematic scoping review of prevailing mentoring theories in medical education

Teo,

Ibrahim,

Lin

et al. 2024

A systematic scoping review of mentoring support on professional identity formation

Krishna,

Kwok,

Ravindran

et al. 2024

Background Mentoring’s success in nurturing professional identity formation (PIF) has been attributed to its ability to build personalised and enduring mentoring relationships. However, beyond functioning as communities of practice (CoPs) supporting socialisation processes, how mentoring integrates programme values and instils a shared identity amongst mentees remains unclear. The need for personalised guidance and timely attention to a mentee’s unique needs in evolving mentoring relationships point to the critical role of support mechanisms (‘mentoring support’). We conducted a systematic scoping review (SSR) studying “What is known about mentoring support’s role in nurturing PIF?”. Methods Adopting PRISMA-ScR guidelines, this SSR was guided by the Systematic Evidence-Based Approach (SEBA). Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2023 in PubMed, Embase, ERIC and Scopus databases. The Split Approach saw concurrent, independent thematic and content analyses of the included articles. The Jigsaw Perspective combined complementary themes and categories, creating broader themes/categories. The subsequent Funnelling Process formed key domains that platformed the synthesis of the discussion. Results Two thousand three hundred forty-one abstracts were reviewed, 323 full-text articles were appraised and 151 articles were included and analysed. The key domains identified were (1) definitions and roles; (2) personalisation; (3) shepherding; and (4) PIF. Conclusion The success of mentoring in PIF lies in its ability to blend role modelling, supervision, mentoring, coaching and teaching, with self-care, guided reflection, apprenticeship and assessment to meet the individual needs of the mentee and their changing circumstances. Blending the contents of the mentoring umbrella emphasises the critical role of the mentor and host organisation in supporting mentor training, communications, support and assessment mechanisms. Mentee engagement and its active role in support measures complement the CoP-like mentoring programme’s use of blending mentoring support to advance the socialisation process. These insights reflect a complex interactive process scaffolding the development of mentoring relationships and PIF. The effect of the mentoring umbrella on clinical practice requires further study.

Teaching therapy decision-making to medical students: a prospective mixed-methods evaluation of a curricular innovation

Garcia-Huidobro,

Fernandez,

Espinosa

et al. 2024

Background Therapy decision-making (TDM) is an essential medical skill. However, teaching therapeutic reasoning poses significant challenges. We present a comprehensive TDM course for medical students and report on student satisfaction with the educational strategies, their perceived importance of various TDM domains, and their self-efficacy in incorporating these elements into clinical decisions. Methods Three student cohorts participated in a 16-week TDM course, which included self-instruction modules, application assignments, faculty symposia, and application seminars as educational strategies. The course focused on TDM and emphasized how factors such as the patient’s diagnosis, needs and preferences, treatment options, physicians’ viewpoints, the patient-physician relationship, and contexts of medical practice impact TDM. After the course, students completed a before-and-after survey assessing their satisfaction with the educational strategies, their perceived importance of ten TDM domains, and their ability to incorporate these domains into patient management. Scores ranged from 1 to 10. Students from the first two cohorts completed a 1- and 2-year follow-ups. Results A total of 387 students completed the course. All educational strategies were well-received, with self-instruction modules and faculty symposia yielding the highest satisfaction rates (94.8% and 88.6% respectively). Before-and-after evaluations indicated that students` perceived importance of the TDM domains increased from an average of 8.0 ± 2.4 at baseline to 9.9 ± 1.0 after the course. Additionally, their perceived ability to integrate TDM domains into practice rose from an average of 5.2 ± 3.2 to 9.4 ± 1.5 by the end of the course. Follow-up results showed a decrease in these outcomes over time. Conclusion This course serves as a successful model for systematically teaching TDM to medical students.