On-site peer mentorship’s effect on personal and professional development, stress reduction, and ease of transition into the medical education system

Definition of mentoring

Mentorship is defined as a supportive professional relationship that necessitates active participation from both the mentee and mentor to foster an individual’s skills or knowledge and supports the mentee’s development in professional development, emotional and psychological support, and role modeling. In medicine, medical students receive a variety of sources of mentorship. Our study identified several possible sources of mentorship, including:

1. Family mentor: a family member who is either a physician or medical student

2. On-site peer mentor: an individual on the same level of education as the mentee who is one or more years senior and provides guidance that is set up by a third party

3. Distance peer mentor: a form of remote (virtual) mentorship with a more senior medical student at a different medical school or campus

4. Informal peer mentor: characterized by an organic interpersonal relationship between the mentor and mentee (i.e., interacting through common interests)

5. Faculty mentor: a faculty advisor set up by the school partnered with multiple medical students

6. Learning specialist/center: hired personnel specialized in learning strategies that help students to be successful in coursework

Inclusion criteria

Based on these defining characteristics, we established the following inclusion criteria to be included in our analysis: (1) a newly established medical school with a current inaugural class and second class enrolled; (2) the medical school does not have an established relationship between the inaugural class of students and a senior medical student on the same campus; and (3) the medical school does have an established relationship between the second class of medical students and a more senior medical student on the same campus.

Ethical approval and data privacy

The Boise State University Office of Research Compliance Institutional Review Board (IRB) waived Ethical Approval for the study through an Exempt Protocol Application for the investigation to be performed at the Idaho College of Osteopathic Medicine. The IRB protocol number is 998-SB20-140. Appropriate guidelines were followed, including obtaining electronic informed consent from study participants. The anonymous data were collected and stored securely.

Electronic survey

We designed an IRB-approved anonymous survey (Appendix A) to distribute to the inaugural and second classes at a newly established osteopathic medical school that opened in 2018 in the United States. The survey was available for participation from February 2021 through March 2021. We contacted the research department by email and asked them to forward the invitation to the inaugural and second classes. The survey consisted of questions pertaining to unidentifiable demographics, sources of mentorship, quality mentor/mentee characteristics, and a 5-point Likert scale assessing aspects of PPD, ET, and SR. The questions were derived from Akinla et al. [13] and developed de novo. The survey asked students to rate their subjective growth on a scale of 1–5 throughout their first year of medical school within the three domains: PPD, SR, and ET.

Data analysis

Self-growth ratings were analyzed by first creating two groups for each type of mentorship: those who utilized the specific type of mentorship and those who did not. The mean differences between groups were then compared utilizing a 95 % confidence interval (CI) and a two-sample t-test, separately for each type of mentorship. A two sample t-test was chosen for statistical analysis due to the normal distribution of the subjective growth across the number of types of mentorship utilized (Supplemental Figure 1). The statistical software utilized to analyze the results was SAS v9.4 (SAS, Cary, NC).

Theme 1: faculty mentorship’s impact on personal and professional development and ease of transition into medical school

Many factors differentiate the effects of the diverse types of mentorships on the subjective growth of medical students during their first year of medical school. In this review, we consider the factors that may have resulted in faculty mentor having a more significant impact on PPD and ET into medical school, but also why their influence on SR is not as pronounced.

The outcomes of faculty mentorship may be affected by the pre-established structure of the relationship, professional interaction, and determined goals of the relationship. The relationship between faculty and students is generally more professional and focused. Regarding the pre-established structure of the relationship, the definitions associated with the faculty mentors are an essential consideration. McLaughlin [6] author of Mentoring: What is it? How do we do it and how do we get more of it?, stated: “In contrast, a mentor is seen as a role model, someone the student wants to emulate professionally, and therefore, by necessity, a faculty member.” Due to this interpretation, a professional interaction is upheld by putting aside politics and opinions, focusing on the value that one can provide.

The goals established for faculty mentors primarily focus on PPD, including advantages in job placement, research skills, research productivity, and self-efficacy [15]. These goals likely align with the strengths of the faculty and their experiences and expertise. The faculty mentors and mentees enter the relationship with the intention to advance their careers, which aligns with professional development in their chosen field.

Furthermore, faculty mentorship can also ease the transition into medical school. Medical school can be a significant transition for students, both academically and personally. Faculty mentors can help students adjust to this new environment by guiding how to manage their time, study effectively, and build relationships with their peers and professors [15, 16]. Doing so helps students feel more confident and comfortable in their new surroundings, which can significantly improve their academic experience. Throughout their career, faculty mentors have worked with various students. They have experienced how and what skills are needed for an easier transition and can, therefore, better prepare future students for the rigors of the medical education system.

Although faculty mentorship positively impacts PPD and ET into medical school, it does not strongly influence SR. Throughout the literature, there are several explanations for this outcome. As mentioned in the article by Akinla et al. [13], a faculty mentor may be illustrated with an intimidating demeanor. This environment may elicit higher expectations, creating a more stressful environment for students navigating a new professional relationship and diminishing a faculty member’s ability to alleviate stress.

Faculty can work to help change this outcome through evidence-based strategies that instructors may use to address and alleviate student stress and anxiety. According to Hsu and Goldsmith [17], faculty can learn/prepare to act and promote connections with students. Faculty can make the necessary adjustments to become familiar with the underlying mental health challenges and to know how and when to refer students to campus resources. They can also improve their relationships with their mentees by utilizing student names, empathizing with students, providing opportunities for interpersonal connection, and utilizing humor [17]. This can make students more comfortable and willing to engage with the instructor on a more personal level, promoting the relationship and mitigating student anxiety.

Theme 2: on-site peer mentorship’s impact on stress reduction

Peer mentoring is a well-established concept in medical education, with a growing body of research indicating its benefits for both mentors and mentees. For mentees, peer mentoring can improve academic performance, increase self-confidence, and provide a sense of community and support [4]. Mentors, on the other hand, can benefit from the opportunity to develop leadership and teaching skills and a sense of personal fulfillment from helping others.

A peer mentorship program helps strengthen and support medical students’ transition phases. The aim of mentoring is to facilitate an easy adaptation of the first years into the medical school curriculum. A key finding was that the mentees met with their peer mentors more often than their faculty mentors. The reasons for this include: they were less intimidated by them, felt they could relate better to them, and the peer mentors understood them better because they had recently gone through situations that the mentees were now facing [13]. Mentors may also be a central source of ideas for themselves and friends about relieving stress and maintaining balance as a medical student. Peer mentoring relationships provide a safe environment for giving and receiving feedback without concern for being evaluated or judged. Students view these relationships as allowing them to be more authentic and to reveal their true feelings [15]. Chatterton et al. [18] suggests that based on student feedback, medical students are more inclined to discuss personal issues with their peers because they align with similar present experiences.

A large part of the reason why any mentorship has the outcomes it does is because of the goals of the relationship and the inherent roles that mentors take as a result of these goals. These goals may or may not be defined for mentors, and mentors may have different ideas of their roles. Still, mentors often exhibit general characteristics that may impact how they help their mentees, such as the capacity for SR.

Theme 3: informal peer mentorship’s negative impact on personal and professional development, ease of transition, and stress reduction

Informal peer mentorship can take many forms and considerations. It is a broad category that may misrepresent specific subtypes of mentorship within this category. Informal mentoring assumes the natural coming together of mentor and mentee through similar interests, and it lacks structure and third-party affiliation.

There are many aspects of informal mentoring relationships that can be attributed to the study’s results, including unspecified goals, unknown outcomes, limited access, self-selection, and no expert training or support. There can also be sharing of biases, increasing student competition, variable advice, and its inherent lack of structure and balance. It is also possible that these results include sampling bias of the survey respondents.

While a formal relationship, such as faculty mentorship, is more structured, professional, and objective, an informal relationship between students may involve more freedom of conversation and therefore more bias shared between students. These biases, although they likely seem like good insider information from an informal mentor, could inhibit a mentee’s capability to form their own opinions or stay open-minded about medical school factors such as study methods, professors’ teaching methods, time management, etc. Preformed ideas about the many factors of medical school prior to interaction with them may lead to further difficulty in individualizing methods and students’ PPD, ET, and SR could be negatively impacted.

Informal mentorship has no structure or training and may not help students grow in the three domains studied throughout our survey. Inzer and Crawford [16] suggest that “good mentoring may lead to positive outcomes, bad mentoring may be destructive, or in some cases may be worse than no mentoring at all.” Informal mentorship has a role in the medical education system, but it must be tailored and guided by goals. Informal mentoring is beneficial due to engagement in positive psychosocial activities, including counseling, social interactions, role modeling, and providing friendship [16]. The mentor may be more invested in the mentee due to seeing oneself in the mentee. It is important to properly navigate these relationships because they can be focused on “friendship first, learning and career second and third” [16].

Recommendations for new medical schools to help the inaugural class facilitate growth without peer mentors

The most positive contribution to growth that on-site peer mentorship provides is within the SR domain. This domain includes growth within subcategories such as destressing, morale building, development of resilience, coping with new situations, and confronting difficulties. Ideas to help aid SR for students without on-site peer mentors include:

1. promote a growth mindset to help students rise above negative thoughts and perceived limitations

2. teach mindfulness to be aware of their thoughts, feelings, and body sensation and how they impact students’ actions

3. practice deep breathing to reduce tension and relax the body

4. help students obtain the services they need: mental health support, partnering with school wellness, or school health advisory committees

5. host wellness events: therapy dogs, exercise classes, and fun outing events

6. support a collaborative environment between classmates

Although improving these things may help replace some of what is lost from not having an on-site peer mentorship program, there are likely external factors impacting inaugural-class medical students during their first year that are not considered in these surveys and that may need to be addressed in different ways.

Limitations

This study is not without its limitations. Some sources of error within the research may lead to misinterpretation of data or misrepresentation of a population. These sources include the low number of responses to the survey. Due to nonresponse bias, it is challenging to show the statistical significance of the data. In future studies, we would like to increase the study population by incorporating more students from newly established medical schools to increase the study population size.