Abstract
Background:
This study evaluated the impact of the mentorship model used in the psychiatry clerkship at Nassau University Medical Center (NUMC), with a focus on its effectiveness in improving medical knowledge and professional development in psychiatry.
Methods:
This survey-based study at NUMC involved 16 attending psychiatrists and 13 past medical student mentees. Data were collected via electronic surveys from March to May 2022, examining effectiveness of mentorship and mentees’ experiences. Descriptive analyses were performed using R (v. 4.1.2).
Results:
The attendings were mostly in the 46 to 55 years age group (37.5%), and a gender distribution showing a slight majority of females (56.25%). Regarding the mentorship, 75% of attendings reported that mentoring was not time-consuming, and all of them found it beneficial. All mentees (100%) confirmed that the clerkship improved their understanding of psychiatric disorders and interviewing skills. A significant 69.2% of mentees believed the mentorship model should be an essential component of the Psychiatry Clerkship, and 92.3% did not find the management of psychiatric disorders overly challenging.
Conclusion:
NUMC’s Psychiatry Clerkship employs a strong mentorship model that markedly enhances medical education and prepares mentees effectively for psychiatric practice. Emphasizing empathy and interdisciplinary understanding, this model shows positive outcomes. Future research should include larger and more diverse cohorts to further substantiate and refine these mentorship practices in medical education.
Background
Within the United States (U.S.), there are mandatory clerkship cores in the third-year curriculum; these typically involve 6- to 12-week rotations in various disciplines including Psychiatry. 1 The rotations are structured in a manner to improve proficiency of participants in 6 core competencies as enlisted by the Accreditation Council for Graduate Medical Education (ACGME); these include (i) patient care, (ii) medical knowledge, (iii) professionalism, (iv) interpersonal and communication skills, (v) practice-based learning and improvement, and (vi) systems-based practice. 2 Mastering these competencies is imperative as they lay the groundwork for all medical practice areas. 3 While Clerkship rotations are widely studied in terms of competency development, 1 underexplored area is how structured mentorship models integrated into these rotations can influence the educational and professional outcomes of medical students (ie, mentees).
The COVID-19 pandemic posed significant challenges to medical education, particularly by disrupting in-person Clerkships and clinical rotations. This required many institutions to adapt quickly, including rethinking their educational and mentorship models. At Nassau University Medical Center (NUMC), a structured mentorship model was implemented to ensure that educational quality and student support were maintained during the pandemic. NUMC, a 631-bed level 1 trauma center and teaching hospital in East Meadow, Long Island, NY, is affiliated with several institutes; these include the American University of the Caribbean, Sint Maarten, New York Institute of Technology, NY, and Stony Brook University Health Sciences Center, NY. NUMC’s Psychiatry clerkship offers an abundance of clinical exposure with 167 inpatient adult and pediatric psychiatric beds, a dedicated psychiatric emergency department, in addition to an active Consultation-Liaison service. This level of clinical engagement is designed keeping in mind the various psychiatric challenges mentees face during their formative years. This study focuses on evaluating the impact of the structured mentorship model used in the Psychiatry Clerkship at NUMC, specifically examining its role in enhancing medical knowledge, clinical skills, and professional development in Psychiatry. Adjustments were made during the COVID-19 pandemic to ensure that mentorship and education continued uninterrupted despite the challenges posed by the crisis.
Mentorship Model
The mentorship model at NUMC involves a structured and tiered system, with Attendings, the Clerkship Director, the Clerkship Coordinator, and the Medical Student Chief Resident serving as the mentors. Medical students are the mentees. The focus of this model is on fostering professional growth through interpersonal relationships, receptivity to feedback, and active participation by the mentee group.
The model is structured around multiple mentorship interactions, including one-on-one sessions, group mentorship, and an open-door policy that allows mentees to seek guidance throughout their rotation.
Curriculum Objectives
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Mentorship Structure and Activities
1. Orientation: Orientation is a 2-part process designed to introduce mentees to their responsibilities and the clinical environment they will work in:
2. Weekly Mentorship Group Sessions: A key component of the mentorship model is weekly 1-hour group sessions, led by the Clerkship Director. These sessions focus on clinical skills development, with interactive discussions on:
• Conducting mental status exams
• Interviewing and key interviewing techniques
These sessions ensure that all mentees have an opportunity to learn, ask questions, and receive feedback in a collaborative setting.
3. Biweekly Mentorship Sessions: In addition to weekly group meetings, biweekly 1-hour group mentorship sessions are conducted. These sessions involve mentees and second-, third-, and fourth-year Psychiatry Residents, under the supervision of the Medical Student Chief Resident. The focus of these sessions is on discussing various psychiatric syndromes and disorders, ensuring that mentees are exposed to a wide range of psychiatric conditions and real-world case studies.
4. One-on-One Mentorship Sessions: Personalized, one-on-one mentorship sessions with Attendings and the Clerkship Director are an integral part of the program. These sessions provide mentees with individualized feedback, career guidance, and support to help them achieve their specific learning goals during the rotation. This direct mentorship fosters a deeper connection between the mentees and their supervisors, allowing for more personalized growth and development.
Mentorship Evaluation and Feedback
This thorough review process ensures that mentees receive tailored feedback that helps them continue to grow professionally after the rotation ends.
Measurable Educational Outcomes
Psychiatric Shelf Exam Success: One of the key performance indicators of the mentorship model is the 97% passing rate of the Psychiatric Shelf Exam for the past five years. This consistently high passing rate demonstrates the effectiveness of the mentorship structure in preparing students for their assessments.
End of Rotation OSCE (Objective Structured Clinical Examination): Another measurable outcome is the performance of mentees in the End of Rotation OSCE. This exam involves one-on-one patient interviews conducted in inpatient units under the supervision of an attending physician. The OSCE tests the students’ clinical and interpersonal skills, and mentees are expected to meet or exceed the performance expectations set by the program.
Open-Door Policy
The mentorship model includes an “open-door policy” where mentors, especially the Clerkship Director and Coordinator, make themselves available to mentees throughout the rotation. This policy ensures that mentees can approach their mentors for guidance, support, or questions at any time, fostering an environment of open communication and continuous learning.
Distinctive Features of the Mentorship Model
At NUMC, the mentorship model is a structured and integral component of the Psychiatry Clerkship, designed to provide personalized and ongoing support. While all attending psychiatrists are involved in clinical teaching, primary mentorship responsibilities are assigned to specific individuals, including the Clerkship Director, Clerkship Coordinator, and the Medical Student Chief Resident. These mentors engage with mentees through a combination of one-on-one sessions, group mentorship, and an open-door policy, ensuring consistent, tailored guidance throughout their clerkship experience. This approach helps facilitate both academic and professional development, differentiating it from standard clinical supervision, which may not be as structured or tailored to individual student needs.
The program’s mentorship approach aims to support the professional growth and career advancement of mentees while also emphasizing the importance of interpersonal relationships, openness to feedback, and active participation by the mentee group. With evolving mentorship models, this report aims to provide meaningful insights specifically tailored to mentorship for medical students. This carefully structured mentorship is integral to ensure that mentees are prepared to enter their disciplines of interest (ie, Psychiatry) after they complete training; this shift has been evidenced by prior studies suggesting that making delineations in medical mentorship settings can lead to significant increase in readiness and confidence in mentees from all walks of life.4,5 As there is limited research on structured mentorship models within Psychiatry Clerkships, this study aimed to descriptively evaluate the impact of such a model on the educational outcomes and professional development of mentees. This is a descriptive study aimed at understanding how the mentorship model contributes to mentees’ educational experiences and their potential interest in Psychiatry as a specialty.
Methods
Setting
This descriptive survey-based study was conducted at NUMC, a community hospital in East Meadow, New York, during a period that included the disruptions caused by the COVID-19 pandemic. The adaptations to the mentorship model during this time were taken into account. The sample consisted of 16 psychiatry mentors and 13 mentees who completed their Psychiatry Clerkship at NUMC. The anonymous surveys were electronically conducted from March 2022 through May 2022. This study was approved by the Institutional Review Board (IRB) as an exempt study.
Variables and Anonymity
Demographic variables included patient age (years), sex (male, female, non-binary), and race/ethnicity (White, African American, Hispanic, Asian, Middle Eastern, or Other) for both mentors and mentees questionnaires.
To protect participant confidentiality, especially given the small sample size, all responses were anonymized and handled securely. Participant identifiers were removed, and data were aggregated to prevent identification of individuals. Additionally, any demographic or other identifying details were presented in a generalized manner to ensure privacy. These measures ensured confidentiality while maintaining the integrity of the study.
Survey Questions
The survey questions were designed specifically for this study, with input from educational experts familiar with the Clerkship’s mentorship structure. While the survey was not formally validated, it was reviewed by faculty members to ensure relevance, clarity, and alignment with the study’s objectives.
Mentors responded to the following questions:
1. Is it time consuming to have students on your team? (Yes/No)
2. If yes, what is time consuming?
A: Teaching
B: Seeing patients with them
C: Burdensome to have exam with student
3. Are students on the team helpful for you? (ie, completing collaterals; Yes/No)
4. Do you think you have enough time to teach your student? (Yes/No)
5. Do you think you need more time to teach your student? (Yes/No)
6. Do you know how to be a mentor to students? (Yes/No)
7. Would a support group for mentoring students be useful for you? (Yes/No)
8. Would you be a better mentor if you have only 1 student to mentor at a time? (Yes/No)
9. Does it make a difference to mentor an International Medical Graduate (IMG) or a US graduate? (Yes/No)
10. Does the gender of the mentee have an impact on the mentoring? (Yes/No)
Mentees were asked to respond with Yes or No to questions about their experiences during their Psychiatry Clerkship at NUMC, including:
Did your rotation in Consultation Liaison Psychiatry at NUMC help you learn psychiatric disorders better? (Yes/No)
Did your experience in Consultation Liaison Psychiatry at NUMC help you in sharpening your interviewing skills? (Yes/No)
Did your clerkship rotation in Consultation Liaison Psychiatry at NUMC help you understand the importance of a multidisciplinary approach in Medicine? (Yes/No)
Did your experience in Consultation Liaison Psychiatry at NUMC help you choose Psychiatry as your specialty? (Yes/No)
If you answered No to question 4, did your experience in Consultation Liaison Psychiatry at NUMC help you choose another primary specialty? (Yes/No)
Do you think a rotation in Consultation Liaison Psychiatry at NUMC should be a necessary part of the Psychiatry clerkship? (Yes/No)
Do you consider the demands of dealing with various psychiatric disorders on a Consultation Liaison Psychiatry at NUMC to be too difficult for a third-year medical student? (Yes/No)
Do you think that the psychiatry clerkship rotation made you aware of the social determinants of the mental health of psychiatric patients (lack of insurance, job security, poverty etc.)? (Yes/No)
Do you think your psychiatry clerkship rotation helped you to improve your empathy and remove your stigma toward psychiatric patients? (Yes/No)
Do you think having a clerkship directorship with availability for students helped you be better adapted for your clerkship? (Yes/No)
Did the initial interaction with the Clerkship Director help you prepare for a better Psychiatry rotation? (Yes/No)
Did you feel individualized lectures/ meetings with the Clerkship Director provide you with the necessary mentoring you needed as a student? (Yes/No)
Data Analysis and Visualization
Data were analyzed using R statistical software (Version 4.1.2). Descriptive statistics, including frequencies and percentages, were computed for demographic and survey data to provide a clear understanding of the distribution across different categories. The visualization of this data was carried out using the ggplot2 package, a widely recognized tool within the tidyverse suite in R.
For each survey question, data were visualized using bar graphs to effectively illustrate the distribution of responses. The dplyr and tidyr packages from the tidyverse were utilized for data manipulation as needed to prepare the data frames for plotting. This method ensured efficient data handling while maintaining accurate and clear data representation.
Results
Demographic Characteristics
Concerning the age of attendings in the survey, they were predominantly from the middle-age bracket; the highest representation was from the 46 to 55 years age group (n = 6, 37.5%). This was followed by those from the 56 to 65 years age group (n = 4, 25%). Three attendings were in the 36 to 45 years age group (18.75%), two were from the over 65 group (12.5%), with one that did not report age. There was a near balance for the gender distribution with nine females (56.25%) and seven males (43.75%). Concerning ethnicity, Asians had the highest representation (n = 9, 56.25%), which was followed by three Caucasians (18.75%), and each from the African American, Hispanic, and Other category (6.25% each).
The mentees in the survey were aged 25 to 35 years (n = 11, 84.6%), representing the predominant age group, followed by those aged 36 to 45 years (n = 2, 15.4%). Gender distribution among the mentees showed a greater number of males (n = 7, 53.8%) compared to females (n = 5, 38.5%) and one non-binary mentee (n = 1, 7.7%). In terms of ethnicity, Caucasian mentees were slightly more prevalent (n = 5, 38.5%), followed closely by Asians (n = 4, 30.8%) and African Americans (n = 3, 23.1%), with one mentee identifying as “Other” (n = 1, 7.7%).
Mentors’ Survey Responses
Regarding the experience of having medical school student mentees on their team, the majority of attendings mentors (n = 12, 75%) did not find it time-consuming, whereas 4 (25%) reported that it was. Those who found it time-consuming cited teaching (n = 3) and the burdensomeness of examinations with mentees (n = 1) as the primary reasons. Patient-facing activities were not reported as time-consuming. All attendings mentors (n = 16, 100%) agreed that having mentees on their team was helpful. A substantial majority also felt they had sufficient time to teach their mentees (n = 14, 87.5%), although 6 (37.5%) expressed a need for more teaching time. The mentorship confidence was unanimously high, with all attendings mentors (n = 16, 100%) confident in their mentoring skills. When asked about the potential benefits of a support group for mentors, more than half (n = 9, 56.25%) supported the idea, while 4 (25%) did not see it as necessary. Additionally, most attendings mentors (n = 10, 62.5%) believed they would be better mentors if tasked with only one mentee at a time, rather than multiple. In terms of mentoring effectiveness relative to the mentee’s background, the vast majority (n = 14, 87.5%) indicated no difference in mentoring effectiveness between IMG or U.S. graduates. Similarly, the gender of the mentee was overwhelmingly seen as non-impactful on the mentoring process (n = 15, 93.75%), with only 1 attending (6.25%) suggesting otherwise (Figure 1).
Graphical representation of mentors’ survey responses (N = 16).
Mentees’ Survey Responses
All mentees (n = 13, 100%) agreed that their rotation in consultation liaison psychiatry at NUMC enhanced their understanding of psychiatric disorders and sharpened their interviewing skills. Similarly, all participants acknowledged the rotation’s role in appreciating the importance of a multidisciplinary approach in Medicine.
The rotation influenced career paths, with nearly half of the mentees (n = 6, 46.2%) stating it helped them choose Psychiatry as their specialty, while the rest (n = 7, 53.8%) decided against Psychiatry. Among those who opted not to pursue Psychiatry, a few (n = 3, 23.1%) found the rotation helpful in choosing another specialty, whereas a few others (n = 4, 30.8%) did not. Notably, 6 mentees (46.2%) did not respond to this follow-up question.
A significant majority of the mentees (n = 9, 69.2%) believed that a rotation in Consultation -Liaison Psychiatry should be an essential component of the Psychiatry Clerkship, although a few (n = 3, 23.1%) disagreed, and one did not respond (n = 1, 7.7%). Regarding the demands of dealing with various psychiatric disorders, most mentees (n = 12, 92.3%) felt that these were not too difficult for a third-year medical student, with only one mentee (n = 1, 7.7%) expressing the opposite view.
The rotation was effective in raising awareness about the social determinants of mental health, with most mentees (n = 10, 76.9%) acknowledging this impact compared to a few who did not notice a difference (n = 3, 23.1%). Unanimously, mentees (n = 13, 100%) reported that the experience helped enhance their empathy and reduce stigma toward psychiatric patients.
The availability of a Clerkship Director was seen positively, with most mentees (n = 12, 92.3%) stating that it helped them adapt better to their clerkship; only one mentee (n = 1, 7.7%) disagreed. Initial interactions with the Clerkship Director were also beneficial, as reported by most mentees (n = 11, 84.6%), in preparing them for a better psychiatry rotation. Additionally, individualized lectures and meetings with the Clerkship Director provided necessary mentoring, confirmed by most mentees (n = 11, 84.6%), while a few felt otherwise (n = 2, 15.4%; Figure 2).
Graphical representation of mentees’ survey responses (N = 13).
Discussion
Our study findings confirm that the NUMC Psychiatry Clerkship program aligns with established best practices for effective trainee mentorship, which are characterized by clear mentor roles, open communication, and active mentee participation as outlined in prior research. 6 The majority of mentors (75%) reported that interacting with mentees was not overly time-consuming, which supports the program’s efficiency in integrating educational activities without excessively burdening mentors. This is particularly noteworthy as effective time management in mentorship can significantly influence the quality of educational outcomes. 6
The interactions by the Clerkship team consisted of an initial orientation coupled with detailed lectures on core psychiatric skills required; the program’s commitment to inculcating an understanding of psychiatric principles among mentees was essential. This approach was thereby reflected in the fully positive feedback, which was given anonymously, and 100% of the mentees saw improvement in their psychiatry knowledge along with interviewing capabilities. These findings are very important as they reflect on the program’s success, with possible proxy-application to other disciplines as well, in instilling clinical skills for direct patient care. The firsthand experiences among mentees could be a source of lasting interest in Psychiatry. The engagement in real-world challenges and achieving success in the provision of mental healthcare could allow students to truly understand if they are passionate or not about pursuing a career in Psychiatry. This helps create a new generation of rooted psychiatrists that are equipped with the growing demand for mental healthcare professionals within the US. The mentorship program’s focus was based on multidisciplinary education, and it was effective with all mentees’ appreciating their experiences within the realm of medical practice. This emphasis placed herein is important in contemporary medical education as it helps integrate values of cross-specialty competencies in order of improving patient-reported outcomes. 7 Moreover the unanimous responses from mentees that the Clerkship helped in improving empathy and reducing stigma toward psychiatric patients care reflects the more vast-reaching impacts in shaping compassion in medical caregivers—equipped to handle sensitive clinical interactions.
This mentorship model also demonstrated support for professional development, as reflected by the significant portion of mentors (62.5%) who believed that mentoring one student at a time could enhance their learning experience. This mentorship model differs from the typical structure found in Psychiatry Clerkships in that it emphasizes structured, consistent mentorship alongside clinical supervision. Unlike traditional clerkships where mentoring may be sporadic and dependent on the attending’s availability, the model implemented at NUMC provides a formalized system where mentees engage in regular mentorship interactions. These interactions ensure that students receive continuous feedback, professional guidance, and academic support throughout their rotation. This approach allows for tailored mentorship that adapts to the individual student’s learning needs, which is novel in comparison to more traditional Psychiatry Clerkship models. 8
However, whereas the program supported most mentees in their professional growth, it also discovered some areas needing attention, such as the mixed responses about career influence, with a nearly equal split among mentees on whether the rotation influenced their choice of Psychiatry as a specialty. This highlights the complex decision-making processes involved in selecting a medical specialty. It suggests that while clerkships play a significant role, they are just one of several factors that mentees weigh when determining their career paths.9,10
As reported in the current literature, many students often identify Psychiatry as a potential career specialty, with key decisions typically made during medical school. 11 As with other disciplines, the unique practices in Psychiatry largely influence mentees’ specialist choice with initial perceptions having make-or-break effect on prospective trainees.12,13 The Psychiatry Clerkship gives the mentee a first and formal introduction to the field, and is imperative in shaping perceptions and prospects in these areas. 14 Conversely, studies suggest that clerkship has minimal influence on career interest specifically in Psychiatry, but the literature also supports that these experiences can be instrumental in improving clinical skills and empathy toward patients with mental health disorders.15,16 Another study finds that the clerkship duration correlated with higher recruitment in Psychiatry. 17
The COVID-19 pandemic led to large disruptions in medical education that led to canceled in-person classes and clinical experiences; these led to the adoption of virtual learning modalities. 18 While some individuals appreciated the efficacy and flexibility of the necessary adaptations going for them to continue post-COVID, other individuals faced great challenges due to reduced hands-on experiences 19 ; this also affected mentees’ abilities to secure recommendation letters typically acquired through elective rotations. 1 In current times, there are concerns about the validity and reliability of clinical skills and bedside manner obtained through virtual methods, 20 however many do report feeling well prepared for examinations and further training. 21 One underexplored aspect is how the modifications made to the clerkship during the COVID-19 pandemic, including changes to clinical exposure and educational delivery, influenced students’ specialty preferences and future career choices.
There are certain limitations that must be acknowledged. At first, the sample size is small and there is an absence of a control group; this limited our ability to conduct inferential statistics, leading to low generalizability from the findings. This constraint also prevented us from highlighting any correlational insights that could have highlighted the unique benefits of the NUMC Psychiatry Clerkship. Furthermore, without conducting inferential statistics, the impact of the mentorship model may not be fully applicable to other educational settings. An additional limitation of this study is the lack of a formally validated survey instrument. As the study was exploratory in nature, the survey questions were developed specifically for this context. Future research should aim to validate and standardize these questions to improve the generalizability of the findings.
Conclusion
The NUMC Psychiatry Clerkship per our findings, represents a feasible and effective mentorship model that can largely enhance mentees’ education and professional development. The program couples structured teaching along with a focus on empathy and interdisciplinary collaboration, while preparing them for more advanced roles in psychiatric practice. In order to refine and add on these mentorship strategies more, future research must ensure to include larger, more diverse cohorts and also run inferential statistics in different educational settings. These measures can improve the effectiveness, generalizability, and cross-disciplinary application of the mentorship practice within the realm of medical education and practice.
Footnotes
Acknowledgements
We would like to acknowledge Samantha Goldstein, Research Assistant to NUMC’s Psychiatry Department, for her initial review and suggestions to our manuscript during the preliminary phase of our project.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval
Nassau Health Care Corporation Institutional Review Board under the ID IRB# 22-406 stated that the current study has been approved as an exempt study.
