Mentorship involves a sustained relationship, usually between a senior colleague and junior colleague, the goal of which is the nurturing and development of the junior colleague’s career and professional identity. Mentorship goes beyond the simple passing on of knowledge and skills. It also includes encouragement, support, sponsorship, constructive feedback, role modeling, and any other processes that will facilitate the junior colleague achieving their professional and personal goals (1, 2, 3).
Mentoring relationships are common in academic medicine and are felt to be important contributors to the academic development of trainees and junior faculty. One survey of faculty at U.S. medical schools found that 54% of junior faculty reported a recent mentoring relationship (4). Male and female faculty reported having a mentor with equal frequency, as did minority and majority faculty. Mentorship has been associated with increased research activity, increased retention in academic medicine, and increased career satisfaction (5, 6). Also, a study of female faculty found that women with mentors published more papers and were more satisfied with their careers (7, 8). However, the academic study of mentoring is relatively new and insufficient to support widespread systematic application. Further research and evaluation of the process of mentorship is needed to ensure that practical recommendations are evidence-based (9).
The dyadic model has dominated the mentoring landscape. Junior and senior faculty members are drawn together by mutual appeal to pursue a productive relationship (10). These arrangements are most often informal and occur more by chance than by design, as a myriad of factors determine their conception and success. When the “chemistry” is right, the outcome can be highly productive and rewarding for both participants. Some medical educations have advocated formal mentoring programs which pair senior physicians to junior trainees (11). However, this mentoring format is akin to an “arranged marriage” and may not always result in a fruitful and successful relationship.
In addition to benefits, problems have been attributed to the dyadic mentoring model (10). Levels of commitment and expectation may be discordant between mentor and protégé. Unrealistic demands may be imposed onto either party. Power differentials, generational values, and personality clashes may lead to unhealthy outcomes. In extreme circumstances, exploitation and sexual harassment may occur (11). In subtler ways, the mentoring experience may inhibit the freedom of self-expression and self-direction (1).
Mentoring through peers can offer an alternative to the dyadic mentoring model, particularly for the 46% of junior faculty above who did not report a recent mentoring relationship (4, 10). The collective knowledge base and experience of peers can be comparable to a senior colleague. Peers are well suited to providing emotional support, encouragement, feedback, and a sense of acceptance, all of which can be valuable in the mentoring process (12). Peer support for scholarly activity may be a fairly common informal practice, but little has been published to support the potential benefits (13).
Despite the potential of a peer group mentoring model, very little has been written about it in academic medicine. One of the few studies published focused on a highly structured program that bore more resemblance to a course involving peer interaction rather than on peer group mentoring per se (10). Thus, more descriptions and evaluations of peer mentoring programs are needed to help determine whether these programs represent useful alternatives.
This article describes a pilot program for peer mentoring of junior faculty in a department of psychiatry within a university teaching hospital. The program’s development and structure is outlined and the results of an initial exploratory evaluation are reported and discussed.
Sunnybrook Health Sciences Centre is a fully accredited teaching hospital affiliated with the University of Toronto, Ontario. The Department of Psychiatry includes 27 full-time psychiatrists, of which 11 members were identified as having five or fewer years of academic posting within the university department.
A senior faculty member in the department (JM) identified the potential need for mentorship in this group. In July 2004, an e-mail was sent to these 11 junior faculty members inviting them to attend an informal information meeting to explore the potential of starting a peer mentoring group. An additional invitation was extended to a faculty member with 6 years of practice in an effort to be inclusive. Ten invitees accepted the invitation for a first meeting.
At the first meeting, the agenda was left open for the group to determine. The participants identified and discussed the group’s purpose, meeting format, and leadership. The participants established specific learning objectives for the group. These included identifying and discussing key issues affecting junior faculty, implementing improvements to current clinical and academic practices, and developing a greater sense of support and collegiality. The participants also generated a list of specific topics to be discussed. One member volunteered to collect the information and assume responsibility for establishing the dates and locations for future meetings. The group decided to meet every 2 months over the course of the academic year and evaluate the program in the summer of 2005. The department chief provided a budget of $1,200 to cover costs for dinner meetings. The senior faculty member who had initiated the group was invited to document the meeting proceedings.
The program proceeded over the course of the academic year with 2-hour meetings held on a weekday evening every second month. After the second meeting, the participants decided to invite guest speakers who could be used as resources for a given topic. For example, for the topic of income taxes and financial planning, an accountant was invited to the meeting. Some meetings were hosted in the home of a group member while the remaining meetings were held in the hospital boardroom. The meetings were relatively unstructured, with some initial comments by the guest speaker and then an open discussion period directed by the participants. The senior faculty member made every effort to restrict his role to that of observer for the purposes of documenting attendance and summarizing the content of each meeting.
To date, evaluating the effectiveness of mentorship has focused primarily on associated outcomes such as research productivity, retention of faculty, self-ratings of research skills, and satisfaction (4, 5, 6, 7). Little attention has been paid to other potential benefits of mentoring relationships, including development as a teacher/educator, clinician, or an administrator, and the healthy balancing of career and home life. Little attention has also been paid to evaluating the process of the mentoring relationship.
For a variety of reasons, a focus group was chosen as the primary method for evaluating this peer group mentoring program. Given the pilot nature of this program, we were interested in obtaining a more detailed understanding of the subjective experience of the participants. We were interested in exploring participants’ views on the process of the program as well as on the content. Thus, a qualitative approach to evaluation was more relevant than a quantitative approach (14). Although one group has developed quantitative tools to measure the effectiveness of dyadic mentoring relationships, these tools may not be as relevant to evaluate a peer group mentoring process (15). Other measures of effectiveness, such as research productivity and faculty retention, were determined to be too long-term to be relevant to initial outcomes of our program.
A focus group was conducted following the completion of six peer group mentoring meetings that met in the period of July 2004 to June 2005. The senior faculty member (JM) selected the focus group leader (ML) because of his extensive knowledge and expertise leading focus groups and because he practiced at a separate teaching hospital and had no existing supervisory or mentoring relationship with any of the participants or with the senior faculty member. The group participants were informed of the focus group leader in advance to ensure there were no known conflicts of interest or objections. Prior to the focus group, the senior faculty member met with the focus group leader for an overview of the origins of the peer mentoring group and the group’s learning objectives. The focus group leader was asked to conduct a meeting in an exploratory fashion, examining both the process of participation in the mentorship group and the substantive issues of the subjects addressed. The senior faculty member was not present for the focus group itself, so that the junior faculty members could speak more freely.
The focus group leader took notes during the focus group. The notes were analyzed for themes by the focus group leader, who then summarized these themes and his general observations in a written report. The other two authors (JM, JT) each reviewed this report independently and reorganized the themes as reported below. Both authors had attended the meetings in the capacity of senior faculty member (JM) and junior faculty participant (JT). The focus group leaders’ report was circulated to all junior faculty members, but their feedback was not directly solicited.
The senior faculty member also distributed a brief questionnaire to all members of the peer mentoring program to gather demographic information.
A demographic profile of the ten group members is summarized in Table 1
. The mean age of participants was 35.2 years. Sixty percent of participants were male. Ninety percent of the group began the program while they were in their first 3 years of practice. Sixty percent held the academic rank of Lecturer; the other 40% held the rank of Assistant Professor. (In our academic setting, lecturer is the usual entry level appointment. Following a 3-year review these positions become permanent. Faculty members are eligible for promotion to assistant, associate, and full professor, although these rankings do not come with university salaries. Faculty are considered fulltime or part-time and are defined by clinical, administrative, educational, and research responsibilities.)
Although $1,200 had been budgeted for the program, the actual cost of running the program for the first year was $700, or about $117 per meeting. A mean of eight participants attended each meeting (Table 2
). Thus, the cost per participant per meeting was $14.58.
Eight participants (out of 10) attended the focus group. The main themes that emerged from the focus group can be organized into several categories: the development of the program, knowledge gains from the program, interpersonal gains from the program, psychological/emotional gains from the program, process of the program, and future directions of the program.
Development of the Program
Participants valued that the program was not developed in a “top down” manner, but instead allowed for the incorporation of their own wishes and needs. Allowing the participants to be involved from the outset in the planning and creation of the program was considered to be very important.
Knowledge Gains from the Program
Participants indicated that “the topics chosen were very relevant and instructive.” Participants highlighted specific topics they valued, such as supervision of residents and creation of a teaching dossier. Some topics were valued to the extent that participants felt that multiple sessions should be devoted to aspects of those topics. Participants also commented on the importance of learning about how clinical and academic systems work. They also stressed the importance of learning about “issues that have not yet made their way onto the radar screen of the junior faculty.”
Interpersonal Gains from the Program
Participants talked about the importance of “support” from the other members of the group. Through their increasing familiarity and sense of collegiality, participants were “much more likely to turn to one another outside of the group than to other members of the department.” Thus, participants could “continue dialogue and discussion outside of the group itself.”
Psychological/Emotional Gains from the Program
Participants indicated that the program helped to reduce a sense of professional isolation, by allowing them to dialogue with peers and find out that they shared many concerns and issues. This process helped to normalize and legitimize these concerns and issues for the participants. As a result, participants felt they could be “more forthright” and they felt more “empowered” to “influence the culture of the department.” Participants reported that they felt they had “gained a voice in the department.” Participants also felt more supported and valued by the department because of its interest and support for such a program.
Participants indicated that the program created an opportunity for a “reflective space for the members of the group.” During the regular clinical day, they were “often too busy to have time for informal and unstructured contact.” They felt that the program allowed them to “think more broadly about their experience” and allowed them to “develop new understanding of and strategies regarding their professional roles.”
Participants also valued the involvement of the senior faculty member. They indicated that the program would not likely have been developed or sustained without his support. They described him as “striking the right balance between encouragement and authorization of the group.” They also expressed a wish for his continued involvement into the future.
Future Directions of the Program
Participants indicated that they wanted the program to continue and raised a number of topics for future meetings: issues and challenges in research, cultural competency, small group teaching, and maintaining one’s own continuing professional development. They raised questions about how new faculty would be incorporated into the existing program. They also wondered what should happen to the program as they themselves aged and matured. Participants also pondered the possibility of meeting with junior faculty from other sites “to compare experiences.”
Based on our 1-year experience, a peer group model of mentoring junior faculty is feasible to implement and appears to provide a number of benefits to the participants. The peer group model of mentoring was acceptable to most junior faculty. All but one potential participant agreed to initially attend the program and the average attendance was high (80%). The cost to the department was also relatively low, amounting to roughly $15 per participant, per meeting. Participants identified a number of benefits from the program, including knowledge gains, interpersonal gains, and psychological/emotional gains.
A peer group model of mentoring assumes that the knowledge, support, feedback, role modeling, and other aspects of mentorship can be largely provided by the peers themselves to each other. In this way it is similar to peer-supervision groups that are maintained by community practitioners (16). New knowledge and skills are developed by the participants through their collaboration and sharing of collective knowledge, consistent with the principles of social constructivism (17). However, participants in this program continued to value and seek out information and guidance from senior colleagues and other local experts. For four out of the six initial sessions, the group invited guest speakers as external sources of knowledge and experience. The group also valued the presence of the senior faculty member and wanted him to continue his presence for future meetings. Thus, the participants seemed reluctant to rely solely on their own collective abilities and resources to provide each other mentorship. Whether this reluctance reflects an accurate self-assessment of collective gaps in knowledge, a transient stage in the group’s development or a more long-term need for external guidance remains to be seen.
Perhaps as the participants become more confident in their own capacities, their reliance on external and more senior experts will diminish. Participants did indicate that they developed a greater sense of collegiality and were more likely to turn to each other for help as a result of participating in the program. Participants also spoke about an increased sense of support from the department and empowerment within the department, suggesting that they are becoming more confident in their roles and abilities.
Another important theme that emerged from the focus group was related to reflection. Participants indicated that the group provided an opportunity for reflection, allowing them to think more broadly about issues and develop new understandings. The process of reflection has been identified as a crucial component of professional learning and development (18). Encouraging reflection increases the likelihood that participants will develop new ideas and be willing to apply them to new situations in the future. The nonhierarchical environment and perceived support of the group likely facilitated the process of reflection, by providing a “safe” place in which participants could think more freely and exchange ideas that would stimulate further reflection.
To date, few other models of peer group mentoring have been described in the medical literature. Pololi et al. (10) reported on a peer group mentoring program for junior faculty at the Brody School of Medicine at East Carolina University. Their program was a much more structured and intensive program, involving 80 hours of sessions over an 8-month period. Although the program did involve a lot of peer interaction, the curriculum appears to have been determined by senior faculty and visiting content experts provided facilitation for most sessions. Thus this program’s model was also not purely peer-driven and peer-led.
This pilot study has a number of limitations. The number of participants was small. There was no randomization and no control group. The participants were all colleagues with the senior faculty member and all were familiar with the focus group facilitator, potentially leading participants to speak primarily about positive outcomes and to avoid harsh criticisms. The focus group evaluation did not involve a more rigorous analysis of transcribed text segments by multiple readers. Lastly, the time frame for the evaluation was too short to capture many potential outcomes of the program.
In summary, a peer group model for mentoring junior faculty appears to be a feasible and inexpensive alternative to a traditional dyadic model of mentoring. Further development of programs and more thorough and rigorous evaluation methods are needed to determine how effective these programs can be.