INTRODUCTION

University life requires social, academic, self-care and organizational resources to deal with a new routine. The way students face and receive support to deal with these challenges has an important impact on their adaptation and their professional future^1)-(3.

An important way to support students and foster their global development at the university and in the future profession is mentoring^4)-(6. Although the term can be used with several meanings, in academic contexts mentoring involves a collaborative relationship between two people, one of them older, the teacher, and the other younger, the student^4),(6)-(14.

Johnson⁶ defines mentoring as “a reciprocal personal relationship where a more experienced, usually older, university teacher acts as a guide, role model, teacher, and protector for a generally younger and less experienced student or teacher”. The mentor provides the mentee with knowledge, guidance, advice, challenges and supports them in their quest to become a full member of a particular profession” (p.23). There are different mentoring formats, such as the mentor/mentee dyad, mentoring groups and peer mentoring. Group mentoring can include students attending the same course semester or students from multiple semesters. The latter format is mentored by both the teacher and peers, as students at more advanced stages of the course can support their younger peers^5),(15.

Studies carried out on mentoring in different areas and with different populations (e.g., children/adolescents, university students, professionals) indicate positive results from this experience, both for mentors and mentees^{8)-(10),(12),(15)-(18}. Regarding the university mentoring, the benefits for the mentee include academic performance, productivity, professional skills development, networking, help in getting their first job, confidence and professional identity development, higher income level and faster promotions, professional visibility, satisfaction with one’s career and the university, lower levels of stress and less conflict regarding one’s roles (e.g., career X family)⁶.

The mentoring process is also seen as an important element of teacher training^19),(20. It encourages updating and understanding of institutional changes over time, favors an asymmetrical non-hierarchical relationship and the mentor’s self-perception in relation to their professional, personal attitudes and their life project^21),(22. The motivation to play the role of mentor includes several factors, such as interest in students and their development, feeling reinforced by the mentee’s success, satisfaction with their relationship with students and responsibility for training good professionals^6),(16. Students who participated in mentoring programs, when they become teachers, report a desire to participate in programs as mentors due to their experience and as a form of retribution²¹.

Regardless of the reason for becoming a mentor, these teachers must be adequately selected and trained for the task. They should also know the institutional policy and available resources at the university and in the community, in order to help students⁶.

Since the prospective follow-up of mentoring programs and the evaluation of their impact still need to be further explored, this study assesses strengths and weaknesses of a mentoring program in a medical course in a private institution from the perspective of mentors and mentees. It also identifies, among the students who did not participate in mentoring, reasons for non-participation, knowledge about the mentoring concept and desire to participate in the future.

METHOD

RESULTS

The institution had 21 mentors at the time this study was carried out, 18 months after the mentoring was implemented. All of them were invited, but only nine participated. Of the 600 medical students at the institution at the time of the study, 300 (50%) regularly attended mentoring activities and 144 participated in it. Among students who did not attend mentoring, 130 participated in the study.

Mentor and mentee’s answers were grouped into two broad categories: strengths (positive aspects) and weaknesses (difficulties). There was 100% agreement between the two judges who evaluated the responses regarding their inclusion in the two categories.

DISCUSSION

Results of evaluations of the mentoring process with medical students are not well established yet and many difficulties have been pointed out in the literature. These include, for instance, the use of instruments that adequately assess the evolution characteristics of mentoring, the mentor-mentee relationship and the organization where this process takes place²⁷. The confounding variables present throughout the academic trajectory, which also have an impact on the outcome considered as career success, as well as the different definitions for this outcome, are still obstacles to carry out this measure and perform broader studies^28),(29.

The mentoring assessment is mainly qualitative, focused on satisfaction. Few studies explore the experience, the characteristics of the relationship, program configurations and the members’ view, even a negative one. Therefore, the use of open questions was a strategy used in the present study to cover the participants’ experiences and perceptions, both positive and negative ones^18),(30.

This study included just under half of the mentors, half of the mentees and approximately half of the students not participating in mentoring. Participation was, therefore, higher than in other studies, such as the one by Moreira et al.⁴¹, which had the participation of 18.9% of the mentees in the medical course at a university in the Northeast. It is possible that a greater adherence by the mentees in this study was due to the fact that the mentoring is part of other student support programs and is carried out in an educational institution that only offers the medical course. Moreover, attributing a certification of complementary activity to mentoring is a positive consequence of the participation, which may have been generalized to student participation in the present study.

Among the domains evaluated in the studies on mentoring are communication, the mentoring process, the development of the mentee, the mentor and the program itself²⁷. Promoting a safe environment for discussing problems and consolidating relationships is considered crucial for the satisfactory development of mentoring, which can have a personal, educational and professional impact^31)-(32),(33. In this study, the possibility of creating bonds, of having a safe and welcoming space to express one’s feelings were pointed out by both mentors and mentees as positive aspects of the experience.

The mentors are encouraged to participate as a way of updating themselves, attaining recognition in the academic career and being closer to students, strengthening the bond with the students and the institution²⁸. In this study, the mentors pointed out as positive aspects the exchange with their peers (other mentors, the psychiatrist who supervised the group), the possibility of better understanding the difficulties of students and the characteristics of a generation that is different from theirs, to getting closer to the students, having more empathy and being able to help.

Most mentoring programs do not offer financial compensation, the time spent is not included in the teacher’s formal workload and it has no impact on the institutional plan for career progression. Hence, the mentors’ motivation is a personal one, and their gains include experience, contact with students and the possibility of growing in this process, as pointed out by the mentors who participated in this study.

The attachment to the group and the development of relationships appeared as motivators for participation, both for mentors and mentees. For the students, although the certification attribution and obtaining “complementary credits” were mentioned as the initial motivation, these reasons were later replaced by the bonding experience.

The possibility of exposing one’s feelings in a safe and welcoming environment has already been reported as a strong point and a reason for satisfaction by the participants³³. It is not unusual among health professionals, especially among physicians, for the exposure of feelings to be considered inappropriate³⁴. Therefore, teachers - especially those trained in the traditional methodologies - have difficulty addressing the anxieties of students included in contexts of teaching active methodologies. When they become mentors, the program participants that make it possible to get closer to and understand the academic context report a high degree of satisfaction and consider this involvement an important part of teacher training¹⁶. This point was highlighted by the mentors of this study, who felt able to welcome students in their difficulties.

With the velocity of technological development, the opening of new medical courses and the hiring of younger teachers, there is the coexistence of several generations in the same scenario, among teachers and in the student body itself, which can be a source of conflicts classically enunciated as “in my time” or “when I was a student”. In some cultures, the concept of “respecting one’s elders” and maintaining the distance is still present³⁴. But for most millennials, the willingness to build closer and more personal relationships, even in a professional environment, can be stimulating and make an important contribution to the development of mentors.

Data from this study indicate that mentoring provided an exchange relationship, even between people of different generations. The mentees reported perceiving mentoring as a space to talk, where they respect and feel respected. The mentors, in turn, pointed out the exchange relationship with the students and the possibility of learning from them. This integration space provides a reduction in competitiveness, learning from differences and expansion of perspectives about the discussed topics¹⁸. Moreover, the exchange of experiences between students attending different semesters of the course, with the mentor’s mediation, provides a broader and more comprehensive course for all participants³⁵.

Addressing the following areas is considered important in the mentoring context: career orientation, connection between students and teacher, development of professionalism, choice of specialty, research support and academic career encouragement, planning of extra-curricular activities, stress reduction²⁸. Aspects such as the bonding and support perceived in mentoring, learning about the course, the development of professionalism (mentor as a model) and stress reduction were pointed out in this study. The latter is a crucial point for future doctors, who need to learn, during their training and in their professional life, to adequately manage high levels of stress.

Studies comparing students who had a mentoring experience with those individuals without this experience indicate a better performance by the mentees²⁸. There is also a report of improved academic performance in assessments such as CEX (Mini-Clinical Evaluation Exercise) and OSCE (Objective Structured Clinical Examination) when followed by mentors. The verification of this type of result can increase the credibility of mentoring programs, although this type of assessment privileges domains of training that are more directed to the summative or content than to the formative model.

Frei et al. emphasize that negative effects and difficulties of mentoring are rarely reported¹⁰. Therefore, the results of this study, containing criticisms and pointing out difficulties, are considered important.

Including mentoring meetings in the agenda was a problem frequently pointed out by the study participants. Difficulty managing time and conciliating the course load or professional life with other activities were reported by mentors and mentees. An excess of activities and problems in adequately managing time are important stressors among medical students³⁶.

Therefore, teaching time management skills is an important topic to be discussed in mentoring meetings.

Although obstacles are only briefly mentioned in the literature, one-fifth of mentoring relationships are lost within a year³¹. Dismissal/resignation of mentors, irregular scheduling of meetings, communication difficulties and uninteresting topics were pointed out by the mentees in this study. The inclusion of the activity in the curriculum is seen as an advantage by some participants, but for others, the mandatory nature impairs the development of mentoring. Identifying the variables responsible for low adherence is therefore relevant, since it discourages both mentors and students.

During the implementation of the mentoring program in this study, it was difficult to communicate with students by e-mail and the use of social networks was more effective in obtaining responses. For this reason, the questionnaire was sent by email only to the teachers. For the students, handing over the printed version and collecting it right after they answered it was the best way to obtain it. This observation points to the need to evaluate communication strategies, as the generational differences and used tools can interfere with the program success and the obtaining of answers when conducting research about it^19),(20.

Another aspect described in the literature and related to the availability of mentors is the importance and recognition attributed to the mentoring programs by the Institutions. This involves the provided financial and administrative support, the inclusion of the activity in the teacher’s workload, the remuneration for the activity, the inclusion of mentoring as an evaluation item for promotions or career progression, access to continuing education and updated literature²⁸.

The institutional discourse is even related to the issue of the hidden curriculum, as it contrasts what the institution claims to be important and what it demonstrates to be important. In this sense, the existence of “protected time” and not concurrent with preparatory activities for external evaluations, for instance, must be considered and organized by medical courses, in addition to being disseminated among teachers, so that the discourses are consistent and do not exclude such activities²⁸.

When evaluating a mentoring program at an institution with the mandatory inclusion in the curriculum in a given semester of the course, the students consulted after the end of the activity and near the end of the course wanted the activity to have been continuous throughout the course, not mandatory and with fortnight or monthly meetings³⁷. A significant percentage of the interviewed students also admitted that they would not attend the activity if it were not mandatory³⁵.

Bauman describes the changes in bonding and relationships nowadays and highlights the fragility in relationship stability and the time dedicated to coexisting in this context of instantaneity. The photograph of the meeting is enough, but not necessarily being present in it³⁸.

Another difficulty found in mentoring, according to the students who participated in this research, was the performance of the group dynamics by the mentor and the topics chosen for discussion. Although the coordination and supervision of the program provide suggestions for topics or formats, it is the mentor’s responsibility to define the functioning of the group, because there is an understanding that the process occurs more in the relationship between the participants than in the content or format itself.

Some students, however, felt they were “wasting their time” in the face of the undefined and unstructured. It is known that reflective activities encounter resistance among medical students, who do not perceive the value of this type of activity for learning curricular contents and aiding in assessments. The lack of time and the excess of work, as well as the discomfort in discussing in a group, also justify this type of evaluation, with data being found in our findings and in the literature¹⁸.

Assistance in career planning, networking, examples of professionalism, support for one’s personal development, incentive for research and academic careers are among the most desired topics in mentoring meetings^10),(28),(29. It is possible that some of these topics, as the incentive for academic and research careers, have had little prominence in this study due to the fact that few teachers at the institution are primarily scholars and researchers.

The need for training and support for mentors is also highlighted, especially at the beginning of the activity, as the skills necessary for good group management may not be known beforehand. Mentor training programs are therefore described and recommended^39),(40.

In our experience, the formation of a communication group among mentors, using the WhatsApp application, allowed the sharing of materials and ideas, both in terms of topics and formats, as well as meeting dynamics. Some groups need permanently discussion triggers, while others refuse external topics. The profile of the mentor and the members of the group directly influences this issue, and the group of the same mentor can acquire different characteristics over time. At this point, supervision and support to the mentor, in addition to the sharing of experiences between mentors, favors a better acceptance of this dynamic process of changes and needs of the group.

As the last difficulty found, we cite the integration between the members of the group. The mentor’s availability to initiate and deepen relationships seems to be related to better results in this integration. But a guiding posture, a paternalistic attitude and mentor conflicts of interest can prevent an authentic relationship from being built³¹. As well as excessive formality or politeness, generational and cultural differences can distance mentors and students³⁴.

The random assignment of mentors or for the formation of groups can also be related to personality differences and communication difficulties that prevent the consolidation of the mentoring relationship^28),(41. The mentoring relationship is a natural and spontaneous process; the choice to formalize the relationship and create an institutional program must be conducted in such a way that the “artificiality” of the process does not impede its development³⁵.

The literature also describes that there is a desire to be close to the mentor from a temporal point of view, that is, to have contact with a recently graduated professional or with students from more advanced semesters³⁷. In this sense, group mentoring that favors the participation of internship students, the designation of “junior” mentors among students and even visits by graduates to the group were experiences in our program and considered positive for the integration of the group. A former student was hired as a preceptor and applied for mentorship. His curricular evaluation in the residency exams was an experience that received special attention from the examiners; and the group was very well attended and evaluated by the students.

Studies also show that, although mentoring is associated with better emotional support and development, improved emotional adjustment, student well-being, improved social relationships, better performance, and reduced behavior problems, the effect size of such findings is small⁷.

There is agreement among authors that the success of mentoring is related to the establishment of intimate relationships, which is also confirmed at other times throughout life. Individuals need stable and meaningful relationships^7),(42.

As a strong point of this study, we can mention the identification of difficulties, pointed out by the participants, that hinder adherence to mentoring. As a weakness, the participation of less than half of the mentors in the study may not represent the perception of most teachers about the program.

CONCLUSION

Through this study, it was possible to identify positive points and others that still need to be improved in the institution’s mentoring experience. Among the positive ones are the possibility of creating connections, integration, a safe space for displaying affections and feelings and learning for all participants, mentors and mentees. As negative points, the difficulty in managing time, in proposing topics of interest to the group, the excess of complaints by some students and integration among some members.

Among the students who did not participate in mentoring activities, approximately one-third reported knowing the concept of mentoring. Lack of time was the alleged reason for non-participation and most of them stated a desire to participate in the future.

The possibility of prospective monitoring of a mentoring program favors the identification of relevant aspects for the program to be effective (it makes sense and promotes improvement in the development of those involved, in addition to reducing suffering throughout the process) and allows addressing difficulties for the improvement of the program.

As perspectives for future works, we can list that time management and bonding capacity are aspects to be studied and observed in the institutional and work context of mentoring. The longitudinal monitoring of students and graduates may also contribute to verifying the effectiveness of mentoring as a tool in medical training.