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INTRODUCTION
Medical residency represents a period with a high level of professional demand, being a unique and very challenging moment. Experiencing an environment with a high level of demand, the resident doctors must develop skills within their specialty, while dealing with several stress factors, such as a deficient public assistance system, extensive workload and sleep deprivation, which results in losses to their mental health, making them less able to provide adequate and safe care to patients1),(2),(4.
Therefore, tutoring programs, in the form of mentoring, have been proposed as a strategy to offer personal support and encourage the professional development of future specialists1),(2. In this teaching modality, there is an empathic relationship between the resident doctors, the mentees, and their mentor, an experienced doctor who assists in the different challenges throughout the training, representing a figure that inspires and guides4),(5.
Mentoring programs promote personal growth and professional development to the mentee, aiming at addressing issues related to the medical career, psychosocial well-being and role-model. In a study assessing 24 medical schools, mentees showed significantly more professional satisfaction than those without mentors3. Moreover, mentoring has been strongly associated with better performance in specialty board certification exams in the United States2.
Therefore, the implementation of a medical training plan that combines the development of technical skills and specific knowledge with affective, social and ethical development, with close contact between mentor and mentee, will have a positive impact on the mental health of the resident doctor, contributing to the improvement of this professional’s self-confidence, making them more confident to perform, including the role of a mentor, in the teaching-learning process for medical students and interns. That is how an institutional support network is structured1)-(4.
This report brings the unprecedented experience of a mentoring program developed for the Internal Medicine residency in a secondary hospital, located in the state of Ceará, Brazil, in which we describe the stages of its structuring and implementation, as we evaluate, through the application of a standardized questionnaire, the practical impacts of the topics and strategies discussed in the daily life of the medical resident.
EXPERIENCE REPORT
Structuring, Implementation and Organization of the Mentoring Program
In 2018, a group of preceptors participated in a mentoring workshop at a medical congress, when the idea of implementing a mentoring program in the medical residency arose. In April 2019, after a meeting between the Medical Residency Commission (COREME, Comissão de Residência Médica) and the Internal Medicine Residency Coordination, a mentoring program for thirty Internal Medicine residents, lasting 11 months, was implemented. A group of mentors was chosen according to the service preceptors’ interest. After this choice, the group was trained on the mentoring technique, and this training was carried out with the collaboration of a team of medical mentors, previously experienced in a university hospital from another state. The training was carried out through videoconference meetings, in which a team of preceptors reported their mentoring experiences during the medical residency and transmitted some theoretical concepts and practical notions for the method organization.
The group of mentors then defined that ‘Mentoring’ should be structured in groups consisting of one mentor and five mentees. Thus the mentor should invariably be a doctor with experience in Internal Medicine preceptorship, in addition to being available to hold monthly meetings. It was essential that the mentors have characteristics such as empathy, spirit of leadership and desire to share their experiences with the group of mentees, contributing to their personal and professional evolution. As for the mentees, they must be Internal Medicine residents, which is related of the first and second years of specialization.
The topics to be discussed were previously defined by the residency mentors and coordinators, namely: professionalism, burnout and quality of life, empathy, role model, conflict management and time management.
Each topic should be introduced by the mentor; however, two mentees would be in charge of having a greater theoretical basis for the topic being discussed, with scientific references. The mentor initially presented some questions at the start of the meeting, which later took place freely, as the mentees desired or manifested.
The meetings took place monthly, and the activity was categorized as a priority and mandatory within the medical residency workload. The place and time was jointly defined by the group based on the interests of its members, with several meetings taking place in areas outside the hospital environment, so there was an atmosphere of greater relaxation, such as restaurants or cafes. The activity lasted two hours. During the discussion, questioning and reflections were generated and debated together, creating an environment in which residents could speak freely, safely, without demands caused by their professional routine.
Mentees’ Feedback
At the end of the activity, in February 2020, an opinion poll was carried out on the topics discussed with all the mentees using a standardized questionnaire with answers arranged on a six-point Likert scale (0 to 5), with categorized answers ranging from “I totally agree” to “I totally disagree”, using the Google Forms platform, anonymously. Questions were developed to assess how important the discussed topics were and the answers were graded on a 6- point scale, from 0 to 5, with 0 being considered “not important” and 4 and 5 as “very important”.
To understand the relevance of the mentoring program for each resident, the questionnaire contained the following questions: “Were the discussed topics relevant to your professional practice?”, “Did the mentoring program change your professional medical/resident conduct?” and “Which of the chosen topics had the greatest potential for change in your performance as a health professional?”. Each resident was also asked to suggest a topic to constitute the discussions, as well as which improvements could be implemented to improve the activity structure and dynamics. We received 90% of responses to the questionnaire, a total of 27 residents (n = 30).
A quantitative analysis shows that 44.4% of residents totally agreed that the developed discussions changed their way of thinking and acting as professionals, while 51.9% partially agreed. When we analyzed this result qualitatively, asking them to justify their positions, we obtained several positive evaluations:
“They help to open your mind to issues that we do not usually take the time to discuss and that are essential to our routine as doctors and as persons.”
“Discussing mentoring topics opened our minds about different opinions and allowed us to grow personally and professionally, in addition to helping to embrace and feel embraced in our difficulties.”
“The discussions covered topics that are part of medical practice, but that they do not teach us in medical school. Managing time, conflicts, and burnout are present in our daily lives and are also part of the medicine we practice. Talking about others and listening to their conflicts teaches us to better address these problems on a daily basis”
“Mentoring allowed residents to be placed, in the presence of their staff, in a horizontal position, thus allowing them at that moment, to position themselves in a more free and natural way, enabling important, but usually not developed topics, to be treated in depth and naturally. This resulted in a large part of what was discussed to be apprehended.”
Some residents mentioned negative points:
“Over time, and the difficulties of everyday life, the discussed ideas are not very feasible”.
Moreover, it is also mentioned that
“The groups are heterogeneous due to the mentor’s difference. Maybe try to standardize to a minimum of activities so that the experience between the residents is not so different”.
In addition, when asked about a specific change in conduct as a resident doctor related to some aspect, 81.4% agreed that there was an impact (37% totally and 44.4% partially). When asked about the relevance of the topics proposed for discussion, 96.3% agreed that they are relevant to medical practice.
Regarding the most relevant topics for the meetings, Burnout was the topic of greatest impact for the mentees in terms of modifying the field of practice, receiving scores four and five by 77.8% of the resident doctors, of which 51.9% gave the maximum score and 25.9% gave a score of four.
Immediately afterwards, the Empathy topic was the second most relevant one, with a percentage of 70.3% (40.7% gave a score of four and 29.6% gave the maximum score). Conflict Management was relevant and a practice modifier for 66.6% of the residents, followed by Professionalism, with 59.3% of positive evaluation, Time Management, with 51.9% and Role-Model, showing 48.1% (Table 1).
Table 1 Which of the discussed topics had the greatest potential for change in your performance as a health professional?
| Relevant Topics | % (4-5) |
|---|---|
| Burnout and Quality of Life | 77.8% |
| Empathy | 70.3% |
| Conflict management | 66.6% |
| Professionalism | 59.3% |
| Time management | 51.9% |
| Role-Model | 48.1% |
Among the topics suggested for inclusion in the mentoring program in 2021, Financial Education stands out, mentioned by 35% of residents (n = 14). The following were also mentioned: “How to define your subspecialty”, “Interpersonal relationship and leadership”, “Interpersonal relationship with the multidisciplinary team”, “Patient’s Experience Evaluation” and “The role of the resident doctor in facing the pandemic”.
Improvement points were requested from the mentees, and it was pointed out that: “Changing the mentoring group more than once, to have contact with more preceptors and other colleagues” would be positive, as well as welcoming “Residents from other specialties, to evaluate the viewpoint of each specialty on these issues”, as a way of aggregating and diversifying the view of the proposed topics. Moreover, it was suggested, since it was scored as a negative point, the difficulty of reaching a consensus regarding the time to hold the meetings, so that the activity could be “scheduled in advance”. Another suggestion was to “include it into the 60-hour workload of the residency”, since some mentors and mentees held meetings at times that exceeded the recommended workload.
DISCUSSION
By evaluating the mentees’ feedback related to the structuring of topics and the activity itself, as well as the practical relevance of what was discussed, we demonstrated there is a positive impact on the resident doctor’s training. When addressing topics that are not usually discussed during undergraduate school training and that are invariably part of a trained professional’s life, it was perceived that there is a change of conduct in the field of practice, resulting in beneficial reflections5.
Mentoring programs were associated to the improvement in self-confidence, with a long-term impact on professional careers, with reports of observational studies carried out in England of improved results in the annual performance assessment and competency progression tests, with 86.4% of these mentees significantly reaching maximum scores5.
In addition to the performance, we realized that the most relevant topic for the program residents was Burnout and quality of life. There is a prevalence of approximately 40% of professional burnout syndrome among doctors and residents, with negative consequences for these professionals’ mental health. Medical residency, due to its structure and operation characteristics, increases the risk of mental problems related to this syndrome6),(8. Therefore, with the association of mentoring programs to the possibility of psychosocial support, with the creation of an environment of free access between the resident and the preceptor4, we realize the importance of the activity in the context of a young doctor within their specialty, as mentioned by one of the residents:
“Talking about and listening to the conflicts of others teaches us to better address these problems on a daily basis”.
Mentoring, even during medical residency, promotes the development of professionalism4),(7. In a satisfaction pool carried out in a North American mentoring program for Internal Medicine residents, 70% of the participants reported that mentoring was important for their professional development4, similar to what was observed in our questionnaire2.
According to the report by RAMANAN et al, when asked about difficulties that could be encountered by residents who were not part of mentoring programs, 37% of the residents reported being afraid of approaching a preceptor to question topics discussed in mentoring, while 28% reported that they did not have someone they could trust4),(5),(10. However, as mentees, 52% answered that they had a significant personal relationship with their mentor4. Therefore, one of the positive aspects of the activity is precisely to promote the proximity between apprentice and teacher, since medicine, historically, is taught by the most experienced professional. In our assessment and based on the answers to our questionnaire, we understand that there was a positive association between mentors and mentees5),(9.
We had some limitations in performing the activity, such as difficulty in defining the time to hold the meetings in a consensual way, with the occurrence at several times, at night, of an extrapolation of what was recommended as the ideal workload for the residency. Moreover, the heterogeneity of some groups, as mentioned in our questionnaire, may be the result of the difficulty in standardizing the introduction of the discussed topics by the mentors, which is a point to be improved for the next classes during the training.
CONCLUSION
In Ceará, the mentoring program for Internal Medicine residents was unprecedented. According to the answers to the questionnaire, we found a positive effect of the program on the mentees, in which topics equally important for medical education were discussed in more depth, allowing greater personal and professional growth. In view of this experience, the authors suggest that mentoring be maintained and included as an essential activity in the curriculum of Medical Residency programs.
