Attributes of an Effective Mentor in a Learning Community: Comparison of Mentor and Mentee Perspectives

Abstract

Acknowledgement of the importance of students interacting with faculty in a social context has prompted the development of Learning Communities (LCs) in many medical schools. Understanding successful LC and fruitful mentor–mentee relationships is essential to recognize the perspective of multiple stakeholders, i.e., both mentors and mentees. This study used inductive qualitative analysis methods to compare the key attributes and competencies of mentors that are most important to mentors with those most important to mentees in LCs. Six mentor focus groups (N = 50) and four mentee focus groups (N = 22) were conducted. Thematic analysis revealed twelve distinct themes. Three were categorized as mentor/mentee similarities: (1a) individualized approach, (1b) history and physical skills, and (1c) group interaction. Three were categorized as mentor/mentee differences: (2a) teaching versus relationship competence, (2b) mentor as a relatable figure, and (2c) faculty development. Four themes were unique to mentees: (3a) cultural competence and role modeling, (3b) feedback to students, (3c) one-on-one sessions, and (3d) clinical pearls, and two themes were unique to mentors: (4a) communication and (4b) peer development. Formative evaluation is needed to recognize new styles of learning preferences and new forms of feedback. Awareness of the similarities and differences in the perspectives of mentors and mentees can inform modifications to LCs that can potentially improve the experience of both mentors and mentees.

1. Introduction

Medical education is characterized by the interaction between faculty and medical students and is driven by various sociological concepts, including Social Learning Theory. Social learning theory includes the observation of an act within a social context, creating an image for the learner to recall when needed. Components of social learning theory have been consistently implemented in medical education settings [1], creating a shift toward small group active learning, with techniques including case-based learning, role modeling/mentoring, team-based activities, and peer problem solving [2,3]. Effective role modeling allows learners to assimilate new knowledge, clinical skills, and roles through observation, rehearsal, and reproduction of the desired behavior. The combination of role-modeling behavior and social context provides the learner with a deeper understanding of why tasks are performed a certain way. This heightened acknowledgment of the importance of students interacting with faculty in a social context has prompted the development of Learning Communities (LCs) in many medical schools across the United States [4,5,6,7,8,9,10]. LCs are broadly defined as an intentionally-created group of faculty and students who actively engage in learning from each other [9]. LCs enhance (and link) both formal and informal student learning [6] and can be individualized to the needs of each small group of students [7,11,12,13,14]. The traditional LC classroom experience is a potential benefit based on being involved in reciprocal interactions with their mentors [5].

The University of Texas Southwestern Medical School formed an LC known as “The Academic Colleges” (Colleges) in 2007 to help further the school’s academic goals and mission. In 2015, the Colleges were extended from a two-year to a full four-year mentorship program. This LC is composed of six Colleges, each divided into six or seven faculty-led groups of six medical students. Each College is assigned a faculty “master” whose role is to guide faculty leadership and development. During the 18-month pre-clerkship phase at the University of Texas Southwestern Medical School, each small group of students has been meeting weekly with their respective faculty member (their “mentor”) to perform supervised histories and physical examinations on both standardized and actual patients. Students receive feedback on their clinical skills from both faculty and their peers through interactive group discussions. Intermixed with these sessions are occasional meetings focused on case-based ethics, medical professionalism, visits to other healthcare settings, and social events. During the clerkship phase of medical school, the focus of the LC shifts to less frequent, monthly meetings revolving around discussion of students’ clinical experiences.

Although the literature provides varying definitions of mentoring, a mentor is defined herein as someone who develops relationships with mentees, supports professional and personal development, and helps in maintaining work/life balance [4,15]. Faculty involved in LCs are given a structured framework to mentor a small group of students. As mentors, they are able to develop relationships with mentees, support professional and personal development, and help maintain work/life balance [4,15]. Mentees benefit from participation in LCs through networking opportunities, career guidance, and leadership development [11]. Mentors benefit through the improvement in clinical skills, productivity, communication abilities, and job satisfaction [4,11,16,17]. The benefits of mentorship in medical education are well described in the literature; however, current studies utilize primarily quantitative methods and are generally reflective of only the mentor’s perspective [6,15,18]. A study of mentoring in a nursing program comparing mentors’ and student mentees’ perspectives found differences in the evaluation of mentors’ competency, suggesting that focusing on mentors provides incomplete information [19]. To achieve a holistic understanding of a successful LC and fruitful mentor–mentee relationship, it is essential to recognize the perspective of multiple stakeholders, i.e., both mentors and mentees.

Previous studies have identified themes present in both mentors’ and mentees’ perspectives of LCs. A limitation of both these studies was the exclusive use of either mentors or mentees in identifying key attributes of effective LCs and the mentor–mentee relationship. In order to fully understand the ideal LC, the two perspectives cannot be viewed in isolation; the interaction between mentors and mentees has been garnering more interest [15]. The purpose of this study was to compare the key attributes and competencies that are most important to mentors with those most important to mentees. The focus groups engaged in meaningful discussions about the attributes and competencies needed in an effective mentoring relationship. This method uses an inductive approach rather than a hypothesis-deductive approach by arranging the data collected into concepts and themes to yield empirically based conclusions. In this case, data collected in separate efforts from mentees and mentors were analyzed to compare and contrast findings to yield new results. This approach to inquiry is similar to that used in Grounded Theory [20], where information gained in one setting is used to inform both the inquiry and subsequent data collection and analyses. This article presents similarities and differences between themes from both mentor and mentee perspectives, using selected and illustrative quotes, leading to recommendations on how to shift the direction of the LC program with these insights.

2. Materials and Methods

The data used in this analysis were collected in two previous studies of the LC, the first from focus groups of mentors and the second from focus groups of mentees, both conducted by this research team. Six focus groups with 50 participants were conducted for mentors, and four focus groups with 22 participants were conducted for mentees. These were volunteer samples responding to invitations circulated in the medical school to participate in this study. The focus groups lasted 45–90 min each. The mentor and mentee focus groups were conducted during semi-annual retreats for the LC’s faculty and mentees, respectively, in the summer of 2016 and the following year. The focus groups were audio-recorded and professionally transcribed.

The methods and findings from the mentor and mentee focus groups have been described in detail in separate articles [16,21]. To summarize, focus group data collection and analysis methods refined by members of this research team in several previous studies were used (with citations available to readers upon request). The current article uniquely compares and contrasts mentors’ and mentees’ responses.

Facilitators were trained to use a nondirective approach to promote discussion. The groups were initiated with broad instructions to elicit spontaneous discussion of members’ thoughts, perceptions, feelings, responses, and concerns related to the following questions for the mentors’ groups:

• What are the essential, observable elements of an excellent LC faculty member?
• When do you think these elements should be shared with or taught to new LC faculty members and experienced LC faculty members?
• Should these elements be assessed in new and/or experienced LC faculty? If so, when and how often?

In the mentees’ focus groups, the facilitators provided the mentors’ perspectives on the qualities necessary for a good mentor through quotes and topics obtained in the mentor’s focus group sessions. Mentees were then asked the following three questions to stimulate discussion.

• Did the mentors identify all the important elements?
• Are any elements missing?
• Are any of the elements unimportant?

Qualitative analysis using inductive methods was performed to organize and interpret the findings separately for mentor and mentee groups. Detailed analysis of descriptive definitions and content was conducted on both mentor and mentee data sets by two members of this team, with excellent interrater reliability obtained for coding content into topics for both. Comparisons of the content themes of the mentors and mentees were conducted to align content themes with similar descriptive definitions. The two reviewers carefully examined the content of the mentors’ and mentees’ discussions to find areas of similarities and differences in the two perspectives. The five themes from the mentors’ discussions were analyzed, and the mentee responses to those themes were subsequently analyzed to identify unique areas addressed by mentees or mentors.

3. Results

Thematic analysis of content between mentors and mentees revealed twelve distinct themes around which the conversations were centered.

Table 1. Definitions of Themes.

Themes	Definition
Individualized Approach	Students have unique sets of needs based on their personal backgrounds and academic performance, and taking an individualized approach refers to tailoring mentorship based on each student
History and Physical Skills	Providing teaching in basic clinical skills
LC Group Interaction	Having a healthy, safe environment for students to communicate and be comfortable asking questions and making mistakes in order to have a good learning experience
Teaching versus Relationship Competence	The relative importance of having a mentor who is competent in teaching and knowledge versus a mentor who is able to develop a supporting and positive rapport and relationship with a mentee
Mentor as Relatable Figure	Having a mentor who not only is able to recognize their limitations but also tell the group their limitations and shortcomings, allowing students to see them as a relatable figure
Faculty Improvement	Strategies for mentor improvement and development in order to become more effective
Cultural Competence	The importance of having discussions on how physicians should ethically navigate relationships with patients and peers from various backgrounds
Feedback to Students	Providing timely and specific feedback and critique to students
One-on-One Sessions	The importance of having dedicated sessions where the mentor meets with each mentee individually
Clinical Pearls	Having the mentor take a role beyond teaching the traditional history and physical tips on the “soft science” or art of medicine, including tips on patient interaction, the structure of life on the wards, navigating the EMR, etc.
Communication Issues	Concerns about being able to bridge the gap between mentor and student given the generational gap and difference in backgrounds
Peer Development	The desire to work with fellow mentors to observe and obtain feedback on mentoring in order to improve effectiveness as a mentor

Note: LC = Learning Community.

below provides definitions of the themes.

Figure 1 presents a schematic of the relationship of themes comparing mentors’ and mentees’ responses. Three categories of “similarities” were discussed similarly by both mentors and mentees. Although there were some minor differences between mentors and mentees in the three “similarities” categories, their content and importance were very similar. Three categories of “differences” were discussed by both mentors and mentees but with different perspectives. And lastly, four themes were unique to mentees, and two themes were unique to mentors.

Similarities between mentor and mentee perspectives.

1a. Individualized approach. Both mentors and mentees stressed the importance of providing individualized support to students. Students come from a variety of personal backgrounds and academic performances, and both groups recognize that mentors adapt how they support mentees to help with growth throughout medical school. Both groups mentioned that what works for one student may not work for another, and the mentor must maintain a flexible approach. Mentors should be aware of the personal health, wellness, and academics of both mentors and mentees and be available to provide certain students additional support.

Mentee: I think she [student’s mentor] does a good job of being there for struggling students and giving them the individualized attention that they need but she also doesn’t just say, “okay, good job” to the students who are doing well on an area. She will really push the goal post even farther so that they develop past that.

Mentor: Recognize students who are lagging and figure out ways to bring them up to speed…Get out of the way of the good students and gravitate towards students who are having a little trouble, who need a little more help;

1b. History and physical skills. Both mentors and mentees discussed the importance of mentors helping mentees with patient encounter skills, proficiency in the history and physical, as well as the association of the physical exam with real patient interactions. Both groups seemed to emphasize this fact equally.

Mentee: [We need] more association of the physical exam with actual pathological findings or, like, real patients.

Mentor: Demonstrate the methodology, in performing, whether that is the history, physical exam, the assessment from H&P, to the plan. It’s the method we are trying to teach them;

1c. LC group interaction. The importance of facilitating a healthy, productive group was emphasized by both mentors and mentees. Both groups mentioned the importance of good communication and bringing all group members into discussion. It was important for all parties to have positive group interactions to create a safe and productive learning environment.

Mentee: …Fostering relationships between students…bring students of different backgrounds together…having the ability to build common ground among people, especially now that medical schools have such a diverse group of students.

Mentor: To be able to bring students from disparate backgrounds, goals and life, and to work together in a consistent and efficient way.

Differences between mentor’s and mentee’s perspectives. Three themes fit in the category of differences. They were discussed by both mentee and mentor groups, but there were important differences in perspectives on these topics (see Table 1);

2a. Teaching versus relationship competence. Both mentors and mentees discussed the importance of a good relationship between faculty and students. However, students stressed that the most important component of a mentor–mentee connection is the relationship the mentor has with each student. Students, particularly clerkship students, emphasized the value of having a trusting and comfortable rapport with their mentors. They emphasized that mentors should make a concerted effort to form strong, personal bonds with their respective mentees by taking time to learn about their personal and professional lives. Mentees expressly ranked relationship as more important than the educational and clinical skill of mentors and stated that this relationship was more vital to mentees’ well-being than clinical teaching.

Mentee: “I think that relationship is probably the most important for me in colleges and that should be something that should be stressed in a mentor even more than clinical or teaching competence”.

Mentors: What we are doing is skill building here…The physical examination skills that we teach, you should be able to do that at a high level…you should be able to demonstrate whatever cardiac exam we want people to…learn at least in the first year.

Mentor: The competence of the mentor to really discuss complex patients or to perform physical exam maneuvers.

Mentor: They ought to be competent. That is, if he has got to teach about CBLs [Case-Based Learning sessions], he ought to know the basic elements of being interested and teaching about complicated medical patients.

Mentors, particularly experienced faculty, also discussed the importance of having a good relationship with mentees. They mentioned that it was important to understand the context in which students are learning, take time to emotionally connect with students, and care for both their personal and professional growth. However, mentors seemed to place significantly more emphasis on “teaching competence”. Mentors described this competence as being able to engage a group, lead a discussion, and teach clinical skills on an individualized basis while also being able to recognize limitations. To quantify importance, the “mentoring competence” theme, when mentors discussed the importance of a personal relationship with students, was represented in 86 passages. Teaching competence, on the other hand, was much more frequently discussed, appearing in 149 passages, thus representing that mentors did find teaching competence to be more important than the relationship aspect. This was in direct contrast to mentees, who discussed that relationship was more important than teaching competence;

2b. Mentor as a relatable figure. Another theme that differed in the emphasis placed on it was mentors’ limitations. Both groups discussed that sometimes, mentors had gaps in knowledge or skillset and were unable to provide a full scope of teaching or mentorship to students. Mentors emphasized that limitations should be recognized and addressed by mentors through either mentor learning or by arranging to have an expert instruct students.

Although mentees agreed that mentors should recognize shortcomings and that a successful mentor could address this issue through the use of community resources or other students, they also further expanded on this topic. Mentees discussed the importance of the mentor also being upfront in acknowledging these aspects to the group. It helped make the mentors feel more relatable and added to the relationship between mentor and mentee.

Mentee: “How awesome that he can admit that [he, as a pediatrician, did not remember something about adult medicine] and recognize his limitations, but that made him more real and relatable”.

Mentor: You also have to be good at taking a good history yourself; you can’t teach somebody if you can’t do that as well;

2c. Faculty Development. Mentors emphasized faculty development in their discussions—it had the second-highest number of coded passages in the discussion, comprising almost one-fourth of all the passages from the focus groups. Mentees, on the other hand, did not emphasize faculty development quite as much. Regarding this theme, mentors discussed a variety of topics, including receiving feedback and experiential learning from experts in both medicine and education. They elaborated on their desire to evaluate their performance against a standard with regularly structured evaluations.

The key difference in this theme between mentors and mentees is the role of feedback. Mentors desired evaluation and improvement methods beyond simply student feedback and even expressed concerns that reliance on student feedback would turn into a “popularity contest”. Mentees, on the other hand, mainly discussed faculty improvement in the context of their desire to have a mentor be receptive to student feedback. They only briefly mentioned faculty development in any other context, as they touched on faculty recruiting specialists to fill gaps in skillsets but did not elaborate on this topic nearly as much as mentors.

Mentor: “In the sense that the mentors say I will do that which is popular … I think it’s a good idea to be assessed and I think it’s a good idea to improve one’s educational capacity by being assessed, but I don’t want to necessarily have to cater to the group in order to get a good grade”.

Mentee: “As much as the student wants to know what they can do better, the mentor should want to know what they can do better for the student”.

Unique themes to Mentees. Four themes were found to be uniquely discussed by mentees and not mentioned by mentors;

3a. Cultural Competence and Role Modeling. Mentees expounded on the need for cultural competence and guidance in ethical decision-making, with a measured frequency of 22 times during their discussions. Mentees discussed the need for mentors to help students navigate relationships with individuals from unique backgrounds, helping to reinforce ethical and compassionate decision-making as a physician. Multiple mentees expressed concern that ethical decision-making was missing from the mentor’s skillsets. This was discussed more frequently by clerkship students than pre-clerkship students. Mentors only very briefly discussed cultural competence and ethical decision-making. Only one faculty member made a single comment relevant to this theme. Mentors, instead, discussed role modeling more in the context of being adept and proficient at patient encounter skills such as performing a physical exam.

Mentee: I think Colleges are really important trying to make us all really professional and ethical because I know that is an issue with a lot of physicians around the country;

3b. Feedback to Students. Mentees wanted feedback from mentors and desired specific examples of how to meet expectations. Mentees discussed the importance of bidirectional feedback, where they would not only give feedback to mentors but also be provided feedback about their own performance.

Mentee: Giving that feedback but also providing examples of how you can get to that grade level or standardization or whatever that they are looking for;

3c. One-on-one sessions. Mentees stated that one-on-one time was valuable for bidirectional feedback and helped with individualized sessions for mentees. They discussed that, ideally, this time should be scheduled in advance and structured into the program. The theme of “one-on-one time” had an estimated frequency of 27 in mentee discussions. Mentors, on the other hand, only mentioned the one-on-one sessions in passing a single time in the larger context of discussing mentoring competence.

Mentee: For the one-on-one sessions, it would be nice if they were structured in a way that they are built into the schedule because I know that my mentor is super busy…Having some way to have structure so the mentors know when and how to have those one-on-ones;

3d. Clinical pearls. When it came to the history and physical examination, both mentors and mentees agreed on the importance of mentors helping mentees learn these clinical skills. However, mentees mentioned they desired their mentors to give practical insights based on the mentor’s own experience as a physician. These insights could range from means of teaching soft skills, modeling how to organize clinical information, counseling on avoiding real-life pitfalls, and sharing practical and logistical information such as note-writing.

In discussions about teaching clinical skills, mentors focused their discussion on competence in performing basic histories and physical exam maneuvers. Unlike the mentees, they did not mention the theme of unscripted “pearl passing” as a means of teaching soft skills.

Mentee: I think something that is missing here is managing logistics like writing notes, modeling good behavior, actually on the wards…all the stuff outside of patient care because I feel like I’m struggling on all of them.

Unique Themes to Mentors. Although most themes brought up by mentors were touched on by mentees, there were two themes in the mentors’ discussion that were not identified in the mentee discussion;

4a. Communication. One theme that was discussed by mentors but virtually untouched by mentees was the theme of communication gaps between mentors and mentees. They discussed diversity and generational gaps that could cause communication issues and influence their teaching techniques. Mentees did not discuss this at all and did not cite the communication gap as a concern with mentors.

Mentor: The intergenerational thing of dealing with millennials and how they handle conflict…and what their goals are…how it’s different from…other generations…negotiating that was a big part of what we spent time on.

Mentor: How do you communicate to them…there is like a gap sometimes…the way I would say or do it could be completely different from how they’re going to approach it…so those elements or skills should be taught too;

4b. Peer Development. Another theme unique to mentors was the theme of peer development. Mentors discussed the desire to improve by working with peers and sharing experiences, observations, and strengths for mutual improvement. This was represented in 72 passages, representing a significant amount of the discussion regarding faculty development. In contrast, mentees only discussed faculty development in the context of student feedback and did not mention peer development.

Mentor: Pair yourself up, but it might be good to observe a couple of different experienced [LC faculty] so you can get a flavor for what they do…Not everybody’s the same way, not everybody teaches the same way.

4. Discussion

Knowledge of attributes that comprise the makings of a quality mentor is important to ensuring that mentors are prepared to best serve the mentees. Data gathered from mentor and mentee focus groups revealed that mentors and mentees predominantly agreed on the competencies of a good mentor. Although conceptually, mentees and mentors believe that LCs are beneficial, some differences in execution were found between the two groups. An early review of the medical mentoring literature suggests differences in roles between mentors and mentees similar to those found here [18] but presents these as separate without examining how they may be shared or viewed in different manners. A predominant difference between mentors and mentees found in the current study is the order of importance of the key attributes. The comparison of teaching competence and relationship competence shows that mentors and mentees rate both as important; however, mentees rated relationship as most important, and mentors rated teaching as most important. This can potentially be explained by mentors having the duty to ensure that they can instruct and provide feedback on new concepts that they will teach to their mentees.

Mentors and mentees emphasized the importance of mentor competence in teaching and relationships. What mentees want is closer to Social Learning Theory, which is learning communally, stressing the importance of culture, relationship, and an awareness of the student as a person. Similar to previous research [11], mentees emphasized the desire to establish a relationship with their mentor as a first step, a priority. The mentees’ perspective has teaching following the relationship. Mentees become more receptive to learning once the relationship is established. The findings from the current study follow those of similar studies in the literature, which suggests the importance of Social Learning Theory in developing mentoring relationships [19].

Awareness of the similarities and differences in the perspectives of mentors and mentees allows for the implementation of modifications to LCs that can potentially improve the experience of both mentors and mentees, a recommendation found in studies published in the nursing literature that have examined mentor and student mentee perceptions [1]. While noting that differences exist, it is important to mention that one perspective is not more correct than another. Differences can be expected between novice and expert perspectives (and roles). What this information provides is the ability to keep the similarities and address the differences with the goal of improving both mentor and mentee experiences. Similar to existing research focusing on mentors [11,15], the current study emphasizes the importance of flexibility in both programs and across mentoring dyads. This flexibility contributes to active learning between the mentor and mentee, as noted in previous research [2,3].

New generations of mentees have new concerns. Cultural concerns are a focal point of competent care. This is an important concept for current trainees that has not been central to established mentors following conventional methods. Incorporating cultural competence into the mentor–mentee relationships will advance their relationships and optimize learning. Mentor relationships are increasingly being recognized as a facet necessary for a successful teaching–learning environment [22]. Formative evaluation of LCs is needed to recognize trends of new styles of learning preferences and new forms of feedback. Such feedback will likely be useful to keep mentors informed and responsive to current trends and feedback from mentees.