A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery

Abstract

Background:

Mentoring is crucial to the growth and development of mentors, mentees, and host organisations. Yet, the process of mentoring in surgery is poorly understood and increasingly mired in ethical concerns that compromise the quality of mentorship and prevent mentors, mentees, and host organisations from maximising its full potential. A systematic scoping review was undertaken to map the ethical issues in surgical mentoring to enhance understanding, assessment, and guidance on ethical conduct.

Methods:

Arksey and O’Malley’s methodological framework was used to guide a systematic scoping review involving articles published between January 1, 2000 and December 31, 2018 in PubMed, Embase, Scopus, ERIC, ScienceDirect, Mednar, and OpenGrey databases. Braun and Clarke’s thematic analysis approach was adopted to compare ethical issues in surgical mentoring across different settings, mentee and mentor populations, and host organisations.

Results:

A total of 3849 abstracts were identified, 464 full-text articles were retrieved, and 50 articles were included. The 3 themes concerned ethical lapses at the levels of mentor or mentee, mentoring relationships, and host organisation.

Conclusions:

Mentoring abuse in surgery involves lapses in conduct, understanding of roles and responsibilities, poor alignment of expectations, and a lack of clear standards of practice. It is only with better structuring of mentoring processes and effective support of host organisation tasked with providing timely, longitudinal, and holistic assessment and oversight will surgical mentoring overcome prevailing ethical concerns surrounding it.

Keywords

Surgery mentor professionalism ethics

Introduction

Mentoring in surgery enhances the job satisfaction of mentees and mentors,^1,2 boosts mentees’ personal and professional growth,^2-11 and advances the reputation of the host organisation through improved research productivity¹ and faculty retention.¹⁰ Described as ‘an activity in which a more senior or experienced person who has earned respect and power within his or her field takes a more junior or less experienced person (known as a mentee or protégé) under his or her wing to teach, encourage and ensure the protégé’s success’,¹¹ mentoring’s success pivots on the formation of enduring and personalised mentoring relationships between mentors and mentees.^12-15 However, nurturing mentoring relationships between senior clinicians and junior doctors and/or medical students renders mentees heavily reliant on the mentoring relationship for their success.^10,16-24 These concerns are multiplied when surgical mentoring occurs within a hierarchical work environment that propagates power differentials.^10,16-24 Concerns are further raised given suggestions that surgical mentoring has done little to address growing concerns about potential abuse of mentoring relationships, the misappropriation of mentee’s work,^10,16-24 and its poor record on whistleblowing.^16,25,26

Concerns over professional and ethical lapses in mentoring practice are also compounded by data suggesting that mentors and mentees are poorly equipped to meet their mentoring roles^27-29 and host organisations are not well equipped to assess mentoring relationships^{1-11,16,18-21,30-47} or programmes in surgery.^12-16,48-67 Policing compliance of mentoring processes are also limited by the presence of varied mentoring practices fed in part by diverse understanding of mentoring processes due to conflation of distinct mentoring approaches^14,15,54-68 and due to mistaken intermixing of mentoring approaches with supervision, role modelling, coaching, advising, networking, and/or sponsorship.^69,70 Limiting the efficacy of prevailing mentoring assessment tools⁷¹ has been their failure to account for different curricula, mentee and mentor populations, and health care and education systems^{13-15,49,52,71,72} as well as mentoring’s evolving, adaptive, goal-specific, context-sensitive, and mentee-, mentor-, relationship-, and host-organisation-dependent nature (mentoring’s nature).⁷³

The need for this review

At the heart of these limitations has been a lack of an effective understanding of prevailing ethical concerns in surgical mentoring. Although redesigning assessment tools lies outside the remit of this article, a good start to overcoming these obstacles is better understanding the nature of ethical issues impacting surgical mentoring.^16,19-21,74

Methodology

Given mentoring’s nature which limits scrutiny of mentoring practice to studies of mentoring programmes in similar health care, educational, and clinical settings and congruous mentor and mentee populations, this study focuses its interests on articles focused on ethical issues in surgical mentoring.^{12,14,15,49,52,72} A systematic scoping review of ethical issues in mentoring in surgery is adopted to explore the scope and depth^{12,14,15,49,52,72} of limited existing data on mentoring malpractice in surgery.^{16,19-21,28,75-84} Guided by Arksey and O’Malley’s⁷⁹ and Levac et al’s⁷⁸ methodological framework for conducting scoping reviews,^77,80,81 the flexible nature^75-77 of systematic scoping review⁷⁶ allows a summary of current data on ethical issues in mentoring across multiple contexts and population backgrounds in peer-reviewed and grey literature^{28,79,82,83,85} in novice mentoring in surgery.^{28,78,79,81-83} Defined as ‘dynamic, context dependent, goal sensitive, mutually beneficial relationship between an experienced clinician and junior clinicians and/or undergraduates that is focused upon advancing the development of the mentee’, novice mentoring is the dominant form of mentoring medical education.^52,53 Attention on novice mentoring in surgery is also apt given that it is especially susceptible to power differentials in mentoring relationships.^52,53

Similarities between novice mentoring practices in undergraduate and postgraduate surgery programmes allow them to be analysed together.^{14,15,49,52,72}

Stage 1: Identifying the Research Question

With the objectives of this review established under the guidance of librarians at the National University of Singapore’s (NUS) medical library and the National Cancer Centre Singapore’s (NCCS) medical library and 5 local educational experts and clinicians, the 6 members of the research team determined and developed the primary research question to be ‘What are the ethical issues and professional lapses affecting mentoring in surgery?’. The secondary questions included ‘What factors precipitate concerns about abuse of mentoring?’ and ‘What solutions have been offered to mitigate them?’. This research question was established with the use of the PICO framework as illustrated in Table 1.

Table 1.

PICO, inclusion criteria, and exclusion criteria applied to literature search.

PICOs	Inclusion criteria	Exclusion criteria
Population	Medical students Junior and senior clinicians Residents	Allied health specialities such as dietetics, nursing, psychology, chiropractic, midwifery, and social work
Intervention	Mentoring by senior clinicians for junior clinicians Mentoring by junior clinicians or residents for medical students	Non-medical specialities such as Clinical and Translational Science, Veterinary, and Dentistry
Comparison	None	Non-surgical specialities including anaesthesiology and obstetrics and gynaecology
Outcome	Attitude of Health Personnel Interprofessional Relations Ethical behaviour Professionalism Problems/barriers of mentoring	Peer mentoring, near-peer mentoring, mentoring for leadership, mentoring patients, or mentoring by patients
Study design	All study designs are included - Descriptive papers - Qualitative, quantitative, and mixed study methods - Perspectives, opinion, commentary pieces and editorials	Role modelling, coaching, supervision, and advising

Stage 2: Identifying Relevant Studies

With guidance from librarians at the NUS’s medical library and the NCCS’s medical library and 5 local educational experts and clinicians, the 6 members of the research team finalised the inclusion and exclusion criteria of this review.

The research team worked in pairs and examined all the abstracts retrieved from a MEDLINE search while applying the abstract screening tool, using variations of the word ‘mentor’ AND ‘ethics’ OR ‘morals’ OR professionalism OR barriers OR negative attitudes OR ‘concerns’ that appeared in the title or abstract of surgical papers. Applying the abstract screening tool that the research team designed, the 3 reviewers (F.Q.H.L., W.J.C., C.W.S.C.) guided by the 2 senior reviewers (L.K.R.K. and S.M.) and the near-peer mentor (AT) independently screened the titles and abstracts identified in the PubMed search and compared the first 50 identified abstracts. F.Q.H.L., W.J.C., and C.W.S.C. received individual feedback on their findings and then proceeded to employ the abstract screening to the rest of the search results from PubMed.

On completing their review of PubMed articles, the 5 members of the review team compared their individual findings at online meetings and met to discuss discrepancies in their findings with the senior researcher (L.K.R.K.) and the near-peer mentor (AT). F.Q.H.L., W.J.C., and C.W.S.C. participated in group feedback sessions on the findings and were provided a chance to discuss their concerns and queries. Reviewing the results, the 6 reviewers employed Sambunjak et al’s²⁷ ‘negotiated consensual validation’ approach to achieve consensus on the inclusion/exclusion criteria for the search, the search teams, and the abstract screening tool. Five members of the research team (F.Q.H.L., W.J.C., C.W.S.C., AT, L.K.R.K.) reviewed the search results and agreed on the inclusion/exclusion criteria which formed the basis of the abstract screening tool used in this study. All study designs (qualitative, quantitative, and mixed approaches) were included in this review. Articles that did not focus on ethical issues and professional lapses within mentoring in surgery were excluded.

The finalised search strategy included the following keywords: (medicine OR medical OR clinical) AND (mentor* OR mentee*) AND (ethics OR morals OR professionalism OR barriers OR negative attitudes). Following the standardisation and training process, the 5 reviewers performed searches of the other databases, then screened the list of full text independently, created their individual lists of articles to be included, and shared them online with all the reviewers. The same keywords were used for all the databases.

Centring around mentoring in surgery, 5 databases, namely, PubMed, Embase, ERIC, ScienceDirect, and Scopus, were searched between April 18 and October 24, 2018. After the pilot search, the search strategy was further evaluated and refined after consultations with the librarians. The same search strategy was replicated on OpenGrey and Mednar databases between September 12 and September 20, 2018. An identical search strategy was again performed on March 10, 2019 for all 7 databases to retrieve all relevant 2018 articles. Articles published in English or with English translations describing ethics in mentoring, challenges, barriers, and unprofessional practices from January 1, 2000 to December 31, 2018 were analysed.

Articles published before year 2000 were excluded as they often failed to delineate the specific mentoring approach being studied and were prone to conflating novice mentoring with distinct forms of mentoring such as group, mosaic, mixed, patient, family, youth, leadership, near peer, and e-mentoring as well as role modelling, coaching, supervision, networking, advising, and/or sponsorship.^{14,15,49,52,72} All allied health specialities (eg, dietetics, nursing, psychology, chiropractic, midwifery, social work), non-medical professions (eg, science, veterinary, dentistry), and other non-surgery medical specialities were excluded.

Stage 3: Selecting Studies to Be Included in the Review

To provide a wide perspective of ethical issues in surgical mentoring, the features and nature of ethical issues facing novice mentoring programmes across various educational, clinical, health care, health care financing, and cultural settings in surgery were examined. To circumvent limitations arising from mentoring’s nature, Braun and Clarke’s⁸⁶ approach to thematic analysis was used to determine the consistent characteristics of a surgical mentoring approach across different contexts, objectives, and mentee and mentor profiles within novice mentoring programmes.^27,86,87 Braun and Clarke’s⁸⁶ approach to thematic analysis was also employed given the absence of an a priori framework of mentoring^27,86,87 and as it circumvents the vast array of research methodologies used by the included articles, which prevent the adoption of statistical pooling and analysis.

Analysis of the Transcripts

The senior mentor (L.K.R.K.) and the near-peer mentor (AT) who are well versed with Braun and Clarke’s⁸⁶ approach to thematic analysis guided the 3 junior members of the research team (F.Q.H.L., W.J.C., C.W.S.C.) as they performed independent searches of the 7 databases. The abstract screening tool was applied to extract potential articles before importing to EndNote, where removal of duplicates, organisation of references, and compilation of a list of individual abstracts to be analysed were done. Each list was shared among members of the review team. Disputes were settled during online or face-to-face review meetings. Sambunjak et al’s²⁷ approach of ‘negotiated consensual validation’ was applied to achieve consensus on the finalised abstracts to be reviewed.

Each reviewer independently analysed the final list of abstracts and compiled a list of full-text articles to be reviewed. The lists were compared and discrepancies resolved at online or face-to-face review meetings. ‘Negotiated consensual validation’ was used to achieve consensus on the finalised full-text articles to be reviewed.²⁷

All full-text articles to be reviewed were added to a shared Google folder and independently reviewed by the research team who developed individual lists of articles to be included in the study. These lists were compared and discussed online and ‘negotiated consensual validation’²⁷ was used to achieve consensus on the final list of articles to be included (Figure 1).

Figure 1.

PRISMA flowchart.

The data charting form used by Tan et al¹⁴ that characterised all publications by author, year of publication, objective of the study, practice setting, methodology, population profile, and outcome evaluation was adopted. The data charting form was trialled on the first 10 articles and evaluated by the 5 members of the review team (F.Q.H.L., W.J.C., C.W.S.C., AT, L.K.R.K.) to ensure comprehensibility. The research team independently coded all the included articles and shared their findings online.

Stage 4: Data Characterisation and Analysis

Of the 50 included articles, 43 discussed mentoring practice and relationships, and 7 scrutinised mentoring obstacles and how to mitigate problems in surgical mentoring.

In total, 24 articles employed quantitative methods,^{1,3,4,7,10,34,36,37,39,40,42,88-100} 3 were qualitative,^101-103 5 used mixed methods,^{9,38,45,104,105} 8 were literature reviews,^{2,8,11,18,31,35,106,107} 5 were perspective papers,^{6,30,32,33,43} 3 were descriptive in nature,^41,44,108 and 2 were systematic reviews.^5,109 Nineteen studies in-volved mentees only,^{3,4,32,36,40,42,45,88,90,92,94-96,98,99,101,102,104,108} 4 studies involved mentors only,^1,33,100,103 25 articles involved both mentees and mentors,^{2,5-9,11,18,30,31,34,35,37,38,41,43,44,89,91,93,97,105-107,109} 1 included the views of mentees and programme directors,³⁹ and 1 involved chairs of departments of surgery.¹⁰

The review team independently ‘coded’ the ‘surface’ meaning of the same 10 included articles. Thematic saturation was achieved after 8 papers. The coding process comprised line-by-line coding and subsequently focused coding ‘evolving to produce categories that responded to these codes’.¹¹⁰ The independent analyses and ‘negotiated consensual validation’²⁷ were used to delineate a common coding framework and code book. The ‘detail-rich’ codes were grouped together to determine semantic themes.^14,15,86,111 The data, themes, coding framework, and code book were regularly reviewed^86,112 and ‘negotiated consensual validation’²⁷ was used to decide on the finalised themes.

Stage 5: Collating, Summarising, and Reporting the Results

The 3 themes identified were the ethical issues at the mentor or mentee level, relational level, and the host organisation level. Given that most of these concerns have not been discussed in detail in prevailing publications and to enhance use of the data, the findings will be presented in tables.

Results

Ethical issues at the individual mentor or mentee level

Ethical issues at the individual mentor or mentee level are presented in Table 2.

Table 2.

Ethical issues at the individual mentor or mentee level.

Ethical issues
Mentor	Negative attitudes towards mentee	^{8,9,18,36,38,41,43,45,100,103,107}
	Lack of motivation	^8,36,41,45
	Refusal to communicate	⁴³
	Hostility and disrespect	⁴⁵
	Failure to give mentees due credit	^10,11
	Prejudice against women and/or ethnic minorities	^2,11,98,100
Mentee	Lack of initiative	^{2,11,18,32,34,38}
	Belief that seeking mentors is a sign of weakness	^8,18,35,41
	Failure to take responsibility	³⁸
	Failure to nurture mentoring relationships	³²
Predisposing factors
Mentor	Inadequate mentor training	^{4,5,7-10,30,98,100,106}
	Inability to cater to all mentee’s needs	^{2,10,11,30-34}
	Lack of experience	^9,11,34
	Personality traits and training that ran contrary to received knowledge on the ideal mentor	^3,4,8,9,107
Mentee	Limited professional contact	^1,35,36
Both mentor and mentee	Poor attitudes and misconceptions towards mentoring and mentoring culture	^{2,11,18,32,34,38}

Possible solutions

Training programmes and routine evaluation of the mentoring relationship run by the host organisation were the most common proposals to address ethical issues at the mentor or mentee level. The proposed solutions are summarised in Table 3.

Table 3.

Proposed solutions to ethical issues at mentor or mentee level.

Root causes of ethical issues faced	Recommendation
Lack of proper training	1. Training programmes for both mentors and mentees focused on communication strategies, roles, responsibilities, goals, and a definition of mentorship^{3,4,7-10,18,98}
Inability to cater to all needs of mentee	1. Paradigm for online mentoring to have a network of mentors to meet mentee’s varied needs⁴ 2. Multiple mentors for mentee^{2,10,11,31,32,98} 3. Routine evaluation by mentoring committee of mentor-mentee relationship to check for potential conflicts and a failing relationship. If relationship is failing, an exit strategy, eg, a ‘no fault divorce’, should be implemented¹⁰ 4. Use of social media for mentorship has the potential to establish a community of mentors for multiple needs and career stages of mentees⁹¹
Negative attitudes towards mentee	1. Mentees to seek the advice of a more senior colleague, possibly at a different institution, and the advice of multiple colleagues to effectively manage ending an ineffective mentoring relationship¹¹ 2. Training programmes for both mentors and mentees which are focused on communication strategies, roles, responsibilities, goals, and a definition of mentorship¹⁸ 3. Routine evaluation by mentoring committee of mentor-mentee relationship to check for potential conflicts and a failing relationship. If relationship is failing, an exit strategy, eg, a ‘no fault divorce’, should be implemented¹⁰ 4. Mentors with poor feedback from mentees should not be allocated to trainees¹⁰³
Prejudice against women and/or ethnic minorities	1. Multiple mentors, especially for minority groups and women trainees⁴ 2. Institutions to step up efforts to enhance faculty development opportunities by targeting professionals often marginalised from the traditional tenure-track environment¹¹ 3. Sex and cross-cultural exposure to foster mutual understanding and growth² 4. Routine evaluation by mentoring committee of mentor-mentee relationship to check for potential conflicts and a failing relationship. If relationship is failing, an exit strategy, eg, a ‘no fault divorce’, should be implemented¹⁰ 5. Organisational structural support to address sex biases in medical culture and encourage sex diversity¹⁰¹ 6. Mentors with poor feedback from mentees should not be allocated to trainees¹⁰³
Failure to give proper credit or take credit of mentee’s work	1. Routine evaluation by mentoring committee of mentor-mentee relationship to check for potential conflicts and a failing relationship. If relationship is failing, an exit strategy, eg, a ‘no fault divorce’, should be implemented¹⁰ 2. Discussions about authorship and credit should take place at the onset of every project to avoid offence subsequently¹⁸ 3. Mentors with poor feedback from mentees should not be allocated to trainees¹⁰³
Failure of mentee to take initiative	1. Allowing mentees to choose their mentors helps mentees to become more proactive in the mentoring relationship^10,34 2. Mentee may have a periodic priority list which includes his or her personal preferences, goals, and current commitments and share the list with his or her mentor³⁵ 3. Mentee to be open and honest during discussions and to advice, to ask for guidance where and when he or she needs it will help increase proactivity of the mentee^2,11,18
Perception that seeking mentors is a sign of weakness	1. Institutions can dissuade this misconception and provide resources to bring mentors and mentees together through a mentoring programme¹⁸
Mentees have little professional contact	1. Provide formal training to mentees to teach them how to choose a mentor¹⁰ 2. In the process of seeking mentors, potential mentees to research departmental websites, talk to other students, and evaluate a potential mentor’s interactions with peers and medical students during teaching conferences or on rounds¹¹ 3. Senior mentoring to broaden mentee’s network³¹ 4. Formal mentoring programmes which facilitate exposure between students and potential mentors^1,18,36 5. Speed mentoring programme¹⁰⁵ 6. Provide students shadowing opportunities and chances to assist in operating rooms to broaden professional network¹⁰⁷ 7. Social media can serve as a valuable tool to enhance networking of mentees in seeking mentorship⁹¹

Ethical issues at the level of the mentoring relationship

Ethical issues at the level of the mentoring relationship are presented in Table 4.

Table 4.

Ethical issues at the level of mentoring relationship.

Ethical issues
Competition (perceived and real) between mentors and mentees	^9,11,18,41
Conflicts of interest	^9,18,31
For example, mentor involved in appraisal and career progression of mentee	³¹
Breaches in professional boundaries (eg, inappropriate personal relationships)	^2,11,31,100
Predisposing factors
Competitive environment of surgical practice	⁴¹
Lack of time	^{1-5,7-9,11,18,34,36,38,39,45,88-90,97,98,103,104,108,109}
Culture and sex differences	^{2,5,11,18,101}
Generational gaps	^{5,11,18,42,98}
Power differences inherent within surgical specialities	^10,34,42
Personality conflicts	^{9,11,36,39,41,43,44,91,98,107}
Overstepping boundaries	^2,11,31,100

Possible solutions

The proposed solutions explore methods to address the lack of time of both mentors and mentees, and reconcile the inherent differences between both parties. The proposed solutions are summarised in Table 5.

Table 5.

Proposed solutions to ethical issues at the level of mentoring relationship.

Root causes of ethical issues faced	Recommendations
Difference in culture and sex of mentor and mentee	1. Miscommunications due to differences can be avoided by establishing and clearly defining goals and objectives of the relationship⁷ 2. Mentors must maintain cultural and sex sensitivity towards mentees^11,18 3. Mentors and faculty members must gain insight into the additional challenges mentees from different backgrounds face^98,101 4. Good communication and being perceptive to the possibility of misinterpretation or misunderstanding² 5. Matching cross-cultural mentor partnerships through modern communication technology² 6. Match mentees with mentors based on certain attributes, eg, racial, ethnic, religious, and sex differences¹⁸
Generational gap	1. Mentors and mentee to understand and reconcile their differences⁵
Power differential	1. Proper oversight to avoid abusive situations¹⁰ 2. Mentors should support mentees through a collaborative partnership where neither party has power over each other³¹
Personality conflict	1. ‘Speed-matching’ that entails quick meetings between mentors and mentees for each party to make a quick evaluation of their willingness to work together^34,105 2. Self-selection of mentors by mentees³ 3. Active listening of mentor and constructive, early, and definitive feedback to mentees^43,98 4. Personality assessment can provide a guide for addressing problems with mentee and become an additional tool in the training process⁴⁴ 5. Encourage residents to meet with at least 3 potential faculty members and submit ranked mentor preferences to the programme director⁹⁷ 6. Extensive data collection and analysis of resident profiles to help mentors be aware of which factors are associated with match success⁹³
Lack of time	1. Greater emphasis and support at the institutional level are needed to address the issues of time⁷ 2. Give financial incentives to encourage mentors to make time⁸ 3. ‘Protected time’ within the work schedule for mentoring responsibilities will provide mentors and mentees with time and reduce obligations elsewhere^{5,96,97,100,103,104,108} 4. Modern communication technology can be used to enable the mentee to communicate with a compatible mentor regardless of distance^2,91 5. Recruit potential faculty mentors with full-time surgical faculty and academic appointments who are more likely to be able to dedicate the effort necessary to facilitate a productive mentorship experience⁹⁷
Inappropriate boundaries or competition between mentor and mentee	1. Mentee may consider seeking the advice of a more senior colleague¹¹ 2. Routine evaluation by mentoring committee of mentor-mentee relationship to check for potential conflicts and a failing relationship. If relationship is failing, an exit strategy, eg, a ‘no fault divorce’, should be implemented¹⁰
Conflicts of interest between mentor and mentee	1. Effective and structured oversight of mentoring relationships to avoid abusive situations¹⁰ 2. Routine evaluation by mentoring committee of mentor-mentee relationship to check for potential conflicts and a failing relationship. If relationship is failing, an exit strategy, eg, a ‘no fault divorce’, should be implemented.¹⁰ Mentees can then seek a mentor without similar conflicts of interest¹⁸ 3. Distance mentoring so that mentor’s advice is less likely to be affected by conflicts of interest that arise within a shared place of work³¹

Ethical issues at the level of the host organisation

Ethical issues at the level of the host organisation are presented in Table 6.

Table 6.

Ethical issues at the level of host organisation.

Role of host organisation
Recruitment, training, and matching of mentors to mentees, supporting the parties involved, and setting the direction through the course of the mentoring relationship	^{12,13,62,113-123}
Predisposing factors
Lack of institutional support	^{1,3,8,10,11,18,34-37,39,41,90-92,95,97,98,104,107-109}
Poor access to trained mentors	^{1,4,5,18,35-39,90,91,95,97,102,104,107,108}
Poor access to same-sex mentors	^{1,2,5,7,9,11,18,31,35,36,40,91,100,105,107}
Lack of protected time	^{18,34,35,104,109}
Insufficient recognition of mentor contributions	^{3,8,10,18,39,98}
Insufficient financial rewards for mentor	^{8,18,37,41,109}
Failure to facilitate adequate mentee-initiated relationships	^{2,4,7,10,11,31,34,91,92,95,98,107}
Poor support of formal matching	^{1-3,7,10,11,31,34,39,98,107}
Inadequate mentoring networks that support mentees	^{8,11,90,97,108}
Absence of official mentoring programmes	^{1,36,39,91,92,95,107}

Possible solutions

The role of the host organisation is key to addressing ethical issues affecting mentoring relationships. The proposed solutions are summarised in Table 7.

Table 7.

Proposed solutions to ethical issues at the level of host organisation.

Root causes of ethical issues faced	Recommendations
Lack of mentors	1. Web-based system for pairing of appropriate mentors and mentees and virtual telementoring system^4,109 2. Identify a number of people with the skills and motivation to be mentors, personality and enthusiasm for the process, thereby creating a pool from which to draw on⁸ 3. Co-mentoring, peer-group mentoring, and long-distance mentoring can be successful when clear roles and goals are established for each mentor relationship^11,107,108 4. Near-peer mentoring can be suitable to mentor individuals through social, teaching, and academic activities⁹⁴ 5. Provide performance improvement and continuing medical education credits to faculty as incentives to mentor research activities¹⁰⁸
Lack of same-sex mentors	1. Recruit additional experienced female surgeons for the mentor pool⁹ 2. Mentors and mentees to understand and reconcile their differences to allow surgeon to mentor mentees of any profile⁵ 3. Employ sex-mindful mentorship with scarcity of female mentors by establishing networks for connecting female faculty with regional and international surgical women’s groups¹⁰¹ 4. Use of social media allows female surgeons to build a larger network of same-sex mentors or mentees who may be remote from where they live or work⁹¹
Lack of institutional support	1. Design a dedicated mentoring programme^{1,4,8,10,89,92,98,105} 2. Define a set of standardised criteria for mentoring scheme^8,31,41 3. Pairing of mentors and mentees^{8,10,31,105,106} 4. Training of mentors^{3,8-10,31,41,100,103,105,106} 5. Training of mentees³¹ 6. Clarification of goals and roles, eg, mentor-mentee contract^{3,8-10,31,89,105} 7. Monitoring and evaluation^3,8,31,41 8. Give financial incentives to mentors^8,10 9. Provide incentives such as recognition for mentors^{10,18,36,97,103,105} 10. Institution to provide economic support for mentorship programme^10,105 11. Protected time for mentoring^{1,34,36,96,97,100,103,104,108}
Imbalance between self-identification and formal assignment of mentors	1. Adopting a mixed approach to matching^2,3,7,31,36 2. Establish formal mentorship initially to provide support and structure during formative years and subsequently allow residents to self-identify mentors who better align with their current goals⁹⁵

Stage 6: Undertaking Consultations With Key Stakeholders

Stakeholders were consulted on the findings of this scoping review to gather their opinions regarding the findings, the cost effectiveness and feasibility of actualising changes, and what they thought were other ethical concerns not discussed in this study. These findings together with limited studies on the downsides of mentoring^124-126 and a lack^127-129 of quality^126,130-135 and comprehensive^124,136-142 evaluations of mentoring processes, relations, and programmes also helped focus future studies.

Discussion

This systematic scoping review succeeds in highlighting and defining the concept of mentoring abuse in surgery that must consider the nature and conduct within mentoring relationships, the roles and responsibilities of the host organisation, the specific clinical setting, and the mentoring environment. This wider concept of lapses in ethical practice is referred to as ‘mentoring malpractice’. Mentoring malpractice underlines the need for a holistic, multisource, and longitudinal view of ethical practice in mentoring that should alert programme designers and administrators to lapses in practice.

There are a number of aspects to mentoring malpractice. The first 3 pertain to the matching process, evaluations of mentoring relationships, and oversight and structuring of the mentoring process. All 3 practices emphasise the central role of mentoring relationships at the heart of mentoring and the role of matching and structuring the mentoring process to nurture effective mentoring relationships. These considerations draw attention to the role of the host organisation, which is tasked with supporting and evaluating the matching, assessment, policing, and structuring of recruitment, matching, appraisal, and support systems within the mentoring process. To begin, despite its central role in overseeing mentoring practice, the constituents, structure, roles, and responsibilities of the host organisation remain poorly described. This gap impacts the ability of the host organisation to consistently assess and oversee mentoring processes.

It is also apparent that failure to consider contextual factors and their influence on the mentoring process, approach, and programme^12-15 and the impact of mentoring’s goal-sensitive, context-specific, mentee-, mentor-, host-organisation-, mentoring-approach-, mentoring-relationship-dependent nature^{12-15,48,49,51-53,72,143-147} underline the limitations of prevailing tools. Inconsistencies in the mentoring approach make it difficult to assess the selection, matching, and training and mentoring processes. These variabilities compromise alignment of expectations that then endanger mentoring relationships and hinder effective policing of expectations, roles, and responsibilities and compromise mentoring standards. These considerations impair the ability of the host organisation to evaluate and support programmes.

Limitations to mentoring tools also arise due to failure to account for the culture of the programme that stem from the manner that breaches in mentoring practice are perceived.^47,148 Larkin’s¹⁴⁹ characterisation of unacceptable behaviour which includes discrimination of patients and colleagues based on race, sex, or creed, performing procedures without consent and/or appropriate indications, and breaking patient confidentiality would in the present climate be viewed as egregious lapses warranting censure.^47,148 Similarly, many practices deemed egregious by Larkin¹⁴⁹ would in the present day be worthy of dismissal.^47,148 Such shifts in conceptions reflect changes in thinking and underline the influence of regnant social, professional, and academic norms, values, and beliefs which warrant further evaluation.^47,148 This indicates the need for context-dependent, culturally appropriate understanding of mentoring and professional standards and culture given changes in guidelines, codes of conduct, and standards of practice.

Another aspect of mentoring malpractice regards distributive justice or ‘giving to each that which is his due’.^150,151 In the surgical mentoring context, it may be more apt to refer to ‘“her” due’ when it is women who often have little access to the benefits of mentoring. Although there are programmes focused on increasing access for women and learners from ethnic minorities through specific stipulations in the matching processes, how access to the limited resources within mentoring programmes is addressed remains unclear. Fair access to mentoring programmes may also be limited by the overall goals such as those that prioritise publications and successful grants. Such goals may place greater weight on the recruitment, selection, and matching of mentees with proven research and academic track records rather than prioritising equal access based on needs or on development of talent. Rationing of mentoring resources is also inevitable in the face of funding restrictions raising questions about how transparent recruitment decisions are.¹⁵² This ought not to be tied to waste management which similarly imposes stricter matching processes to minimise the potential for failed relationships.¹⁵² The notion that mentees and mentors can have a ‘trial period’ to work together before confirming a match may be a luxury many programmes cannot afford making poor support of matching, assessment, and oversight an ethical concern.¹⁵³

No discussion of mentoring malpractice would be complete without due considerations of mentoring dynamics or interactions between mentee, mentor, and the host organisation within their particular mentoring relationship. Mentoring quality builds on effective mentoring dynamics^154-171 and on interactions facilitated by appropriate and personalised execution of mentoring responsibilities, effective responses on the part of the mentee, and the ability of host organisations to create and support mentoring environments and relationships. However, little is known about how these facets blend with one another, how the quality of mentoring relationships may be improved, and their impact on mentoring malpractice.

Limitations

Attenuating fears of ethical lapses in mentoring in surgery will also benefit from establishment and consistent policing of a code of conduct and standards of practice and clear delineation of the roles and responsibilities of mentors and mentees. The role of e-mentoring and other technology-based supplements to the mentoring process should also be a focus for further study.

It is apparent that there are substantial gaps in the primary data. First, most of the included articles focus on specific aspects of mentoring and confine their attention to specific ethical concerns rather than take a holistic perspective of ethical and professional concerns. This hampers the understanding of ethical issues in the mentoring process. Second, prevailing accounts of the mentoring process are rarely comprehensive and not longitudinal and accentuate insufficient insight into mentoring led in part by a lack of effective and validated assessment tools. A deeper understanding of the mentoring process will facilitate redesigning of mentorship tools to cater to the entangled nature of mentoring. Third, many solutions proposed are rudimentary and need to be contextualised and re-evaluated given the diversity of mentee, mentor, and host organisation populations, mentoring objectives, relationships and nature, and the respective educational and health care scenes. It is also crucial to recognise the principal goals, support, and inclination of the institution.

Conclusions

Although this systematic scoping review’s sketch of the ethical issues facing mentoring in surgery which will be of value to programme administrators, organisers, mentees, and mentors alike, there remain significant gaps. Absent are effective understanding of mentoring dynamics, the quality and nature of mentoring relationships, holistic mentoring environment and culture, and the predisposing factors behind mentoring malpractice. Missing too are longitudinal and consistent assessments of ethical issues in surgical mentoring.

It is only with better understanding of mentoring malpractice in surgery can effective assessment be designed to catch issues at an early stage. Drawing from lessons learnt from the closely related topic of assessments of professionalism,^172-176 mentoring malpractice must first be seen as a multidimensional construct that demands assessments of mentoring malpractice be longitudinal, multisource, multidimensional, and at an individual, interpersonal, and societal or institutional level.^172-176 Assessments also ought to consider the attributes and behaviours of positive ethical behaviours and include feedback from and to all parties.^171-175 It is only thus can mentoring in surgery be advanced and surgical training be better supported and evaluated.

Supplemental Material

Appendix_1a_xyz26591340a7d58 – Supplemental material for A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery

Supplemental material, Appendix_1a_xyz26591340a7d58 for A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery by Fion Qian Hui Lee, Wen Jie Chua, Clarissa Wei Shuen Cheong, Kuang Teck Tay, Eugene Koh Yong Hian, Annelissa Mien Chew Chin, Ying Pin Toh, Stephen Mason and Lalit Kumar Radha Krishna in Journal of Medical Education and Curricular Development

Supplemental Material

Appendix_1b_xyz26591071fc880_1 – Supplemental material for A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery

Supplemental material, Appendix_1b_xyz26591071fc880_1 for A Systematic Scoping Review of Ethical Issues in Mentoring in Surgery by Fion Qian Hui Lee, Wen Jie Chua, Clarissa Wei Shuen Cheong, Kuang Teck Tay, Eugene Koh Yong Hian, Annelissa Mien Chew Chin, Ying Pin Toh, Stephen Mason and Lalit Kumar Radha Krishna in Journal of Medical Education and Curricular Development

Footnotes

Acknowledgements

The authors would like to dedicate this paper to the late Dr S Radha Krishna whose advice and ideas were integral to the success of this study. The authors would like to thank all anonymous reviewers whose advice and feedback greatly improved this manuscript. The authors alone are responsible for the content and writing of this article. This work was carried out as part of the Palliative Medicine Initiative run by the Division of Supportive and Palliative Care at the National Cancer Centre Singapore.

Funding:

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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.

Author Contributions

FQHL, WJC, CWSC, YPT, SM, and LKRK conceptualised the study. FQHL, WJC, CWSC, EKYH, AMCC, YPT, SM, and LKRK proposed the methodology. FQHL, WJC, CWSC, YPT, SM, and LKRK performed the formal analysis. FQHL, WJC, CWSC, KTT, YPT, SM, and LKRK performed the investigation. FQHL, WJC, CWSC, YPT, SM, and LKRK curated the data. FQHL, WJC, CWSC, YPT, SM, and LKRK prepared the original draft of the manuscript. All authors reviewed the paper. FQHL, WJC, CWSC, KTT, EKYH, YPT, SM, and LKRK edited the paper.

ORCID iDs

Clarissa Wei Shuen Cheong

Stephen Mason

Supplemental Material

Supplemental material for this article is available online.

References

Janis

Barker

. Medical student mentorship in plastic surgery: the mentor’s perspective. Plast Reconstr Surg. 2016;138:925e-935e.

Rashid

Narra

Woo

. Mentoring in surgical training. ANZ J Surg. 2015;85:225-229.

Flint

Jahangir

Browner

Mehta

. The value of mentorship in orthopaedic surgery resident education: the residents’ perspective. J Bone Joint Surg Am. 2009;91:1017-1022.

Jaffer

Pennell

Musonda

. General surgical trainee experiences of mentoring: a UK regional audit. J Surg Educ. 2010;67:19-24.

Entezami

Franzblau

Chung

. Mentorship in surgical training: a systematic review. Hand (N Y). 2012;7:30-36.

Toledo-Pereyra

. Mentoring surgeons. J Invest Surg. 2009;22:77-81.

Lin

Laeeq

Malik

, et al. Otolaryngology training programs: resident and faculty perception of the mentorship experience. Laryngoscope. 2013;123:1876-1883.

Memon

. Mentoring and surgical training: a time for reflection! Adv Health Sci Educ. 2010;15:749-754.

Zakrison

Polk

Dixon

, et al. paying it forward: four-year analysis of the eastern association for the surgery of trauma mentoring program. J Trauma Acute Care Surg. 2017;83:165-169.

10.

Kibbe

Pellegrini

Townsend

Jr Helenowski

Patti

. Characterization of mentorship programs in departments of surgery in the United States. JAMA Surg. 2016;151:900-906.

11.

Sanfey

Hollands

Gantt

. Strategies for building an effective mentoring relationship. Am J Surg. 2013;206:714-718.

12.

Wesley

Mohamad Ikbal

, et al. Towards a practice guided evidence based theory of mentoring in palliative care. J Palliat Care Med. 2017;7:296.

13.

Qiao Ting Low

Toh

Teo

SWA

Toh

Krishna

. A narrative review of mentoring programmes in general practice. Educ Prim Care. 2018;29:259-267.

14.

Tan

Teo

SWA

Pei

, et al. A framework for mentoring of medical students: thematic analysis of mentoring programmes between 2000 and 2015. Adv Health Sci Educ Theory Pract. 2018;23:671-697.

15.

Sng

Pei

Toh

Peh

Neo

Krishna

LKR

. Mentoring relationships between senior physicians and junior doctors and/or medical students: a thematic review. Med Teach. 2017;39:866-875.

16.

Singh

TSS

Singh

. Abusive culture in medical education: mentors must mend their ways. J Anaesthesiol Clin Pharmacol. 2018;34:145-147.

17.

Brown

Thorpe

Paquette-Warren

Stewart

Kasperski

. The mentoring needs of trainees in family practice. Educ Prim Care. 2012;23:196-203.

18.

Franzblau

Kotsis

Chung

. Mentorship: concepts and application to plastic surgery training programs. Plast Reconstr Surg. 2013;131:837e-843e.

19.

Byerley

. Mentoring in the era of #MeToo. JAMA. 2018;319:1199-1200.

20.

Walters

Simoni

Evans-Campbell

, et al. Mentoring the mentors of underrepresented racial/ethnic minorities who are conducting HIV research: beyond cultural competency. AIDS Behav. 2016;20:288-293.

21.

Soklaridis

Zahn

Kuper

Gillis

Taylor

Whitehead

. Men’s fear of mentoring in the #MeToo era: what’s at stake for academic medicine? N Engl J Med. 2018;379:2270-2274.

22.

Straus

Chatur

Taylor

. Issues in the mentor-mentee relationship in academic medicine: a qualitative study. Acad Med. 2009;84:135-139.

23.

Keyser

Lakoski

Lara-Cinisomo

, et al. Advancing institutional efforts to support research mentorship: a conceptual framework and self-assessment tool. Acad Med. 2008;83:217-225.

24.

Wang

Keow

Yoon

. Fostering mentorship for clinician-investigator trainees: overview and recommendations. Clin Invest Med. 2015;38:E1-E10.

25.

Blowing the whistle on intimidation of NHS whistleblowers. Lancet. 2011;378:458.

26.

Bolsin

. Whistle blowing. Med Educ. 2003;37:294-296.

27.

Sambunjak

Straus

Marusic

. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J Gen Intern Med. 2010;25:72-78.

28.

Lorenzetti

Powelson

. A scoping review of mentoring programs for academic librarians. J Acad Libr. 2015;41:186-196.

29.

Steinert

Boudreau

Boillat

, et al. The Osler Fellowship: an apprenticeship for medical educators. Acad Med. 2010;85:1242-1249.

30.

Burlew

. Surgical education: lessons from parenthood. Am J Surg. 2017;214:983-992.

31.

Patel

Warren

Ahmed

, et al. How can we build mentorship in surgeons of the future? ANZ J Surg. 2011;81:418-424.

32.

Tsai

Helsel

. How to build effective mentor-mentee relationships: role of the mentee. J Thorac Cardiovasc Surg. 2016;151:642-644.

33.

Holt

. Idealized mentoring and role modeling in facial plastic and reconstructive surgery training. Arch Facial Plast Surg. 2008;10:421-426.

34.

Caine

Schwartzman

Kunac

. Speed dating for mentors: a novel approach to mentor/mentee pairing in surgical residency. J Surg Res. 2017;214:57-61.

35.

Thoma

Haines

Duku

McKnight

Goldsmith

. How to become a successful clinical investigator. Clin Plast Surg. 2008;35:305-311.

36.

Barker

Rendon

Janis

. Medical student mentorship in plastic surgery: the mentee’s perspective. Plast Reconstr Surg. 2016;137:1934-1942.

37.

Birch

Asiri

de Gara

. The impact of a formal mentoring program for minimally invasive surgery on surgeon practice and patient outcomes. Am J Surg. 2007;193:589-591.

38.

Cloyd

Holtzman

O’Sullivan

Sammann

Tendick

Ascher

. Operating room assist: surgical mentorship and operating room experience for preclerkship medical students. J Surg Educ. 2008;65:275-282.

39.

Gurgel

Schiff

Flint

, et al. Mentoring in otolaryngology training programs. Otolaryngol Head Neck Surg. 2010;142:487-492.

40.

Thakur

Fedorka

Buchmiller-Crair

Atkinson

Fonkalsrud

. Impact of mentor guidance in surgical career selection. J Pediatr Surg. 2001;36:1802-1804.

41.

Sachdeva

Flynn

Brigham

, et al. Interventions to address challenges associated with the transition from residency training to independent surgical practice. Surgery. 2014;155:867-882.

42.

Nguyen

Divino

. Surgical residents as medical student mentors. Am J Surg. 2007;193:90-93.

43.

Konstantakos

. Surgical education and the mentor-student relationship. Curr Surg. 2003;60:547-548.

44.

Tornetta

III Bogdan

. CORR ((R)) curriculum: orthopaedic education: mentorship in surgical training: can personality assessment help. Clin Orthop Relat Res. 2016;474:1125-1128.

45.

Berman

Rosenthal

Curry

Evans

Gusberg

. Attracting surgical clerks to surgical careers: role models, mentoring, and engagement in the operating room. J Am Coll Surg. 2008;207:793-800.

46.

Das

Sil

. Evolution of ethics in clinical research and ethics committee. Indian J Dermatol. 2017;62:373-379.

47.

General Medical Council. Good medical practice. https://www.gmc-uk.org/-/media/documents/good-medical-practice—english-1215_pdf-51527435.pdf. Updated 2014. Accessed February 3, 2019.

48.

Lin

Chew

Toh

Radha Krishna

. Mentoring in nursing: an integrative review of commentaries, editorials, and perspectives papers. Nurse Educ. 2018;43:E1-E5.

49.

Toh

Lam

Soo

Chua

KLL

Krishna

. Developing palliative care physicians through mentoring relationships. Palliat Med Care. 2017;4:1-6.

50.

Yeam

Loo Wesley

Ee Margaret

Kanesvaran

Krishna

. An evidence-based evaluation of prevailing learning theories on mentoring in palliative medicine. Palliat Med Care. 2016;3:1-7.

51.

Jingting

Wahab

Ikbal

MFBM

Wesley

LTW

Kanesvaran

Krishna

LKR

. Toward an interprofessional mentoring program in palliative care: a review of undergraduate and postgraduate mentoring in medicine, nursing, surgery and social work. J Palliat Care Med. 2016;6:292.

52.

Wahab

Ikbal

MFBM

Wesley

LTW

Kanesvaran

Krishna

LKR

. Creating effective interprofessional mentoring relationships in palliative care – lessons from medicine, nursing, surgery and social work. J Palliat Care Med. 2016;6:290.

53.

Tan

Toh

Kanesvaran

Krishna

LKR

. Extending mentoring in palliative medicine – systematic review on peer, near-peer and group mentoring in general medicine. J Palliat Care Med. 2017;7:323.

54.

Lewellen-Williams

Johnson

Deloney

Thomas

Goyol

Henry-Tillman

. The POD: a new model for mentoring underrepresented minority faculty. Acad Med. 2006;81:275-279.

55.

Alleyne

Horner

Walter

Hall Fleisher

Arzubi

Martin

. Mentors’ perspectives on group mentorship: a descriptive study of two programs in child and adolescent psychiatry. Acad Psychiatry. 2009;33:377-382.

56.

Buddeberg-Fischer

Vetsch

Mattanza

. Career support in medicine: experiences with a mentoring program for junior physicians at a university hospital. Psychosoc Med. 2004;1:Doc04.

57.

Andre

Deerin

Leykum

. Students helping students: vertical peer mentoring to enhance the medical school experience. BMC Res Notes. 2017;10:176.

58.

Bussey-Jones

Bernstein

Higgins

, et al. Repaving the road to academic success: the IMeRGE approach to peer mentoring. Acad Med. 2006;81:674-679.

59.

Chen

Sandborg

Hudgins

Sanford

Bachrach

. A multifaceted mentoring program for junior faculty in academic pediatrics. Teach Learn Med. 2016;28:320-328.

60.

Files

Blair

Mayer

. Facilitated peer mentorship: a pilot program for academic advancement of female medical faculty. J Womens Health (Larchmt). 2008;17:1009-1015.

61.

Fleming

Simmons

, et al. A facilitated peer mentoring program for junior faculty to promote professional development and peer networking. Acad Med. 2015;90:819-826.

62.

Kashiwagi

Varkey

Cook

. Mentoring programs for physicians in academic medicine: a systematic review. Acad Med. 2013;88:1029-1037.

63.

Kman

Bernard

Khandelwal

Nagel

Martin

. A tiered mentorship program improves number of students with an identified mentor. Teach Learn Med. 2013;25:319-325.

64.

Lord

Mourtzanos

McLaren

Murray

Kimmel

Cowley

. A peer mentoring group for junior clinician educators: four years’ experience. Acad Med. 2012;87:378-383.

65.

Pololi

Evans

. Group peer mentoring: an answer to the faculty mentoring problem? A successful program at a large academic department of medicine. J Contin Educ Health Prof. 2015;35:192-200.

66.

Pololi

Knight

. Mentoring faculty in academic medicine. A new paradigm? J Gen Intern Med. 2005;20:866-870.

67.

Welch

Jimenez

Walthall

Allen

. The women in emergency medicine mentoring program: an innovative approach to mentoring. J Grad Med Educ. 2012;4:362-366.

68.

Singh

Dhaliwal

. Near-peer mentoring to complement faculty mentoring of first-year medical students in India. J Educ Eval Health Prof. 2014;11:12.

69.

Bhagia

Tinsley

. The mentoring partnership. Mayo Clin Proc. 2000;75:535-537.

70.

Levy

Katz

Wolf

Sillman

Handin

Dzau

. An initiative in mentoring to promote residents’ and faculty members’ careers. Acad Med. 2004;79:845-850.

71.

Sheri

Too

JYJ

Chuah

SEL

Toh

Mason

Krishna

LKR

. A scoping review of mentor training programs in medicine between 1990 and 2017. Med Educ Online. 2019;24:1555435.

72.

Ikbal

Wahab

Kanesvaran

Krishna

LKR

. Mentoring in palliative medicine: guiding program design through thematic analysis of mentoring in internal medicine between 2000 and 2015. J Palliat Care Med. 2017;7:318.

73.

Chopra

Edelson

Saint

. Mentorship malpractice. JAMA. 2016;315:1453-1454.

74.

Peters

Godfrey

McInerney

Soares

Khalil

Parker

. The Joanna Briggs Institute Reviewers’ Manual 2015: Methodology for JBI Scoping Reviews. Adelaide, SA, Australia: The Joanna Briggs Institute; 2015.

75.

Osama

Brindley

Majeed

, et al. Teaching the relationship between health and climate change: a systematic scoping review protocol. BMJ Open. 2018;8:e020330.

76.

Du Mont

Macdonald

Kosa

Elliot

Spencer

Yaffe

. Development of a comprehensive hospital-based elder abuse intervention: an initial systematic scoping review. PLoS ONE. 2015;10:e0125105.

77.

O’Donovan

Kuhn

Sachs

Winters

. Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature. BMJ Open. 2018;8:e021467.

78.

Levac

Colquhoun

O’Brien

. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69.

79.

Arksey

O’Malley

. Scoping studies: towards a methodological framework. Int J Soc Res Method. 2005;8:19-32.

80.

Chambers

Wilson

Thompson

Harden

. Social network analysis in healthcare settings: a systematic scoping review. PLoS ONE. 2012;7:e41911.

81.

Colquhoun

Levac

O’Brien

, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67:1291-1294.

82.

Thomas

Menon

Boruff

Rodriguez

Ahmed

. Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review. Implement Sci. 2014;9:54.

83.

Mays

Roberts

Popay

. Studying the Organisation and Delivery of Health Services: Research Methods. London, England: Routledge; 2001.

84.

Boden

Ascher

Eldredge

. Learning while doing: program evaluation of the Medical Library Association Systematic Review Project. J Med Libr Assoc. 2018;106:284-293.

85.

Grant

Booth

. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26:91-108.

86.

Braun

Clarke

. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77-101.

87.

Abdullah

Rossy

Ploeg

, et al. Measuring the effectiveness of mentoring as a knowledge translation intervention for implementing empirical evidence: a systematic review. Worldviews Evid Based Nurs. 2014;11:284-300.

88.

Yang

Kalinitschenko

Helmert

Weitz

Reissfelder

Mees

. Transferability of laparoscopic skills using the virtual reality simulator. Surg Endosc. 2018;32:4132-4137.

89.

Montero

Powell

Travis

Nehler

. Selection, mentorship, and subsequent placement of preliminary residents without a designated categorical position in an academic general surgery residency program. J Surg Educ. 2012;69:785-791.

90.

Ting

DSJ

Vrahimi

Varma

Steel

DHW

. Research attitudes and perceived barriers to conducting research among ophthalmology trainees. Eye (Lond). 2018;32:653-655.

91.

Luc

JGY

Stamp

Antonoff

. Social media in the mentorship and networking of physicians: important role for women in surgical specialties. Am J Surg. 2018;215:752-760.

92.

Janko

Smeds

. Burnout, depression, perceived stress, and self-efficacy in vascular surgery trainees. J Vasc Surg. 2019;69:1233-1242.

93.

Leschke

Hunt

. Electronic residency application service application characteristics associated with successful residency matching in neurosurgery in 2009-2016. World Neurosurg. 2018;113:e529-e534.

94.

Morganstern

Vasudevan

Mistry

Howe

Palmer

. Influential factors in pursuit of pediatric urology fellowship training. Urology Prac. 2019;6:64-68.

95.

Oladeji

Ponce

Worley

Keeney

. Mentorship in orthopedics: a national survey of orthopedic surgery residents. J Surg Educ. 2018;75:1606-1614.

96.

Haggerty

Kishiki

Ujiki

Wang

Schindler

. Moving skills training closer to application: in-rotation skills curriculum is feasible and effective. Am J Surg. 2018;215:272-276.

97.

Patel

Tomich

Kent

Chaikof

Rodrigue

. A program for promoting clinical scholarship in general surgery. J Surg Educ. 2018;75:854-860.

98.

Stephens

Goldstone

Fiedler

, et al. Appraisal of mentorship in cardiothoracic surgery training. J Thorac Cardiovasc Surg. 2018;156:2216-2223.

99.

Healy

Glynn

Malone

Cantillon

Kerin

. Surgical mentors and role models: prevalence, importance and associated traits. J Surg Educ. 2012;69:633-637.

100.

Lindeman

Ibrahim

Stadler

Archuleta

Cofrancesco

Jr . Characterization and perceptions of surgical clinician educators: an international survey. J Surg Educ. 2018;75:1513-1519.

101.

Lin

Kansayisa

Costas-Chavarri

. A qualitative study on perceptions of surgical careers in Rwanda: a gender-based approach. PLoS ONE. 2018;13:e0197290.

102.

Carter

Liew

Brown

Moaveni

. Barriers to completion of research projects among orthopaedic trainees. J Surg Educ. 2018;75:1630-1634.

103.

Sutton

Beamish

Rashid

Elsey

Mohan

O’Regan

. Attributes of excellent surgical trainers: an analysis of outstanding trainers. Int J Surg. 2018;52:371-375.

104.

Solaja

Skinner

TAA

Mcgregor

Siemens

. CanMEDS scholars: a national survey on urology residents’ attitudes towards research during training. Can Urol Assoc J. 2018;12:E191-E196.

105.

Britt

Hildreth

Acker

Mouawad

Mammen

Moalem

. Speed mentoring: an innovative method to meet the needs of the young surgeon. J Surg Educ. 2017;74:1007-1011.

106.

Deal

Seabott

Chang

Alseidi

. The program evaluation committee in action: lessons learned from a general surgery residency’s experience. J Surg Educ. 2018;75:7-13.

107.

Healy

Cantillon

Malone

Kerin

. Role models and mentors in surgery. Am J Surg. 2012;204:256-261.

108.

Hajjar-Nejad

Kubicki

Morales

Kavic

. Multilevel quality improvement teams: an alternative approach for surgical academic training programs to meet ACGME core competency milestones. J Surg Educ. 2019;76:785-794.

109.

Hay

Khan

Van Poppel

, et al. Current status and effectiveness of mentorship programmes in urology: a systematic review. BJU Int. 2015;116:487-494.

110.

Lingard

Vanstone

Durrant

, et al. Conflicting messages: examining the dynamics of leadership on interprofessional teams. Acad Med. 2012;87:1762-1767.

111.

Voloch

Judd

Sakamoto

. An innovative mentoring program for Imi Ho’ola Post-Baccalaureate students at the University of Hawai’i John A. Burns School of Medicine. Hawaii Med J. 2007;66:102-103.

112.

Stenfors-Hayes

Kalén

Hult

Dahlgren

Hindbeck

Ponzer

. Being a mentor for undergraduate medical students enhances personal and professional development. Med Teach. 2010;32:148-153.

113.

Bhatia

Singh

Dhaliwal

. Mentoring for first year medical students: humanising medical education. Indian J Med Ethics. 2013;10:100-103.

114.

Gotterer

O’Day

Miller

. The Emphasis Program: a scholarly concentrations program at Vanderbilt University School of Medicine. Acad Med. 2010;85:1717-1724.

115.

Buddeberg-Fischer

Herta

. Formal mentoring programmes for medical students and doctors: a review of the Medline literature. Med Teach. 2006;28:248-257.

116.

Boninger

Troen

Green

, et al. Implementation of a longitudinal mentored scholarly project: an approach at two medical schools. Acad Med. 2010;85:429-437.

117.

Miedzinski

Wong

Morrison

. Perceptions of a faculty mentorship programme. Med Educ. 2009;43:1084.

118.

Dobie

Smith

Robins

. How assigned faculty mentors view their mentoring relationships: an interview study of mentors in medical education. Mentor Tutoring Partnersh Learn. 2010;18:337-359.

119.

Ludwig

Turk

Seitz

Klaus

Loffler-Stastka

. The search for attitude – a hidden curriculum assessment from a central European perspective. Wien Klin Wochenschr. 2018;130:134-140.

120.

Mark

Link

Morahan

Pololi

Reznik

Tropez-Sims

. Innovative mentoring programs to promote gender equity in academic medicine. Acad Med. 2001;76:39-42.

121.

Goldszmidt

Zibrowski

Watling

. Fostering education scholarship: the mentored research group. Med Educ. 2009;43:1084-1085.

122.

Fraser

. Mentoring resident doctors. N Z Med J. 2004;117:U1124.

123.

Davis

Nakamura

. A proposed model for an optimal mentoring environment for medical residents: a literature review. Acad Med. 2010;85:1060-1066.

124.

Frei

Stamm

Buddeberg-Fischer

. Mentoring programs for medical students: a review of the PubMed literature 2000-2008. BMC Med Educ. 2010;10:32.

125.

Han

Chung

Woo

Hitchcock

. Mentoring experience and its effects on medical interns. Singapore Med J. 2014;55:593-597.

126.

Straus

Johnson

Marquez

Feldman

. Characteristics of successful and failed mentoring relationships: a qualitative study across two academic health centers. Acad Med. 2013;88:82-89.

127.

Usmani

Omaeer

Sultan

. Mentoring undergraduate medical students: experience from Bahria University Karachi. J Pak Med Assoc. 2011;61:790-794.

128.

Meinel

Dimitriadis

von der Borch

Stormann

Niedermaier

Fischer

. More mentoring needed? A cross-sectional study of mentoring programs for medical students in Germany. BMC Med Educ. 2011;11:68.

129.

Stamm

Buddeberg-Fischer

. The impact of mentoring during postgraduate training on doctors’ career success. Med Educ. 2011;45:488-496.

130.

Toklu

Fuller

. Mentor-mentee relationship: a win-win contract in graduate medical education. Cureus. 2017;9:e1908.

131.

Kukreja

Chhabra

Kaur

Arora

Singh

. Introducing mentoring to 1(st)-year medical students of a private medical college in North India: a pilot study. Int J Appl Basic Med Res. 2017;7:S67-S71.

132.

Kwan

Prokubovskaya

Hopman

Carpenter

. Mentoring for female medical trainees in a dual-setting group. Med Educ. 2015;49:540.

133.

Thomas-Squance

Goldstone

Martinez

Flowers

. Mentoring of students from under-represented groups using emotionally competent processes and content. Med Educ. 2011;45:1153-1154.

134.

Schafer

Pander

Pinilla

Fischer

von der Borch

Dimitriadis

. The Munich-Evaluation-of-Mentoring-Questionnaire (MEMeQ): a novel instrument for evaluating protégés’ satisfaction with mentoring relationships in medical education. BMC Med Educ. 2015;15:201.

135.

Shamim

. Mentoring programme for faculty in medical education: South-Asian perspective. J Pak Med Assoc. 2013;63:619-623.

136.

Guraya

Almaramhy

. The legacy of teaching medical professionalism for promoting professional practice: a systematic review. Biomed Pharmacol J. 2016;9:809-817.

137.

Harrison

Anderson

Laloe

Santillo

Lawton

Wright

. Mentorship for newly appointed consultants: what makes it work. Postgrad Med J. 2014;90:439-445.

138.

Hauer

Teherani

Dechet

Aagaard

. Medical students’ perceptions of mentoring: a focus-group analysis. Med Teach. 2005;27:732-734.

139.

Kalén

Ponzer

Seeberger

Kiessling

Silén

. Longitudinal mentorship to support the development of medical students’ future professional role: a qualitative study. BMC Med Educ. 2015;15:97.

140.

von der Borch

Dimitriadis

Stormann

, et al. A novel large-scale mentoring program for medical students based on a quantitative and qualitative needs analysis. GMS Z Med Ausbild. 2011;28:Doc26.

141.

Kalén

Ponzer

Silén

. The core of mentorship: medical students’ experiences of one-to-one mentoring in a clinical environment. Adv Health Sci Educ Theory Pract. 2012;17:389-401.

142.

Kwon

Park

Yoon

. A study of satisfaction of medical students on their mentoring programs at one medical school in Korea. Korean J Med Educ. 2017;29:253-262.

143.

Yap

Chua

Toh

, et al. Thematic review of mentoring in occupational therapy and physiotherapy between 2000 and 2015, sitting occupational therapy and physiotherapy in a holistic palliative medicine multidisciplinary mentoring program. J Palliat Care Pain Manage. 2017;2:46-55.

144.

Toh

Karthik

Teo

Suppiah

Cheung

Krishna

. Toward mentoring in palliative social work: a narrative review of mentoring programs in social work. Am J Hosp Palliat Care. 2018;35:523-531.

145.

Chang

Lim

Tay

, et al. The influence of evolving Confucian beliefs in the selection of proxy decision-makers at the end of life in Singapore. Asian Bioeth Rev. 2017;9:117-128.

146.

Hee

Yap

Ong

, et al. Understanding the mentoring environment through thematic analysis of the learning environment in medical education: a systematic review. J Gen Intern Med. 2019;34:2190-2199.

147.

Sheri

Too

JYJ

Chuah

Toh

Mason

Krishna

LKR

. A framework for mentor training programs: a scoping review of mentor training programs in medicine between 1990 and 2017. Med Educ Online. 2019;24:1555435.

148.

American Medical Association. Chapter 9: opinions on professional self-regulation. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/code-of-medical-ethics-chapter-9.pdf. Updated 2016. Accessed November 7, 2019.

149.

Larkin

. Mapping, modeling, and mentoring: charting a course for professionalism in graduate medical education. Camb Q Healthc Ethics. 2003;12:167-177.

150.

McCormick

. Principles of bioethics. https://depts.washington.edu/bioethx/tools/princpl.html. Updated 2013.

151.

Beauchamp

Childress

. Principles of Biomedical Ethics. 7th ed. New York, NY: Oxford University Press; 2013.

152.

Brody

. From an ethics of rationing to an ethics of waste avoidance. N Engl J Med. 2012;366:1949-1951.

153.

Calman

. The ethics of allocation of scarce health care resources: a view from the centre. J Med Ethics. 1994;20:71-74.

154.

Morgan

. Cultivating critical reflection: educators making sense and meaning of professional identity and relational dynamics in complex practice. Teach Educ. 2017;28:41-55.

155.

Krishna

LKR

. Personhood within the context of sedation at the end of life in Singapore [published online ahead of print June 7, 2013]. BMJ Case Rep. doi:10.1136/bcr-2013-009264.

156.

Krishna

LKR

. Accounting for personhood in palliative sedation: the Ring Theory of Personhood. Med Humanit. 2014;40:17-21.

157.

Krishna

. Palliative care imperative: a framework for holistic and inclusive palliative care. Ethics Med. 2013;29:41-61.

158.

Krishna

Alsuwaigh

Miti

Wei

Ling

Manoharan

. The influence of the family in conceptions of personhood in the palliative care setting in Singapore and its influence upon decision making. Am J Hosp Palliat Care. 2013;31:645-654.

159.

Krishna

Alsuwaigh

. Understanding the fluid nature of personhood: the Ring Theory of Personhood. Bioethics. 2015;29:171-181.

160.

Krishna

LKR

Kwek

. The changing face of personhood at the end of life: the Ring Theory of Personhood. Palliat Support Care. 2015;13:1123-1129.

161.

Alsuwaigh

Krishna

LKR

. The compensatory nature of personhood. Asian Bioeth Rev. 2014;6:332-342.

162.

Krishna

LKR

Yong

Koh

. The role of palliative rehabilitation in the preservation of personhood at the end of life [published online ahead of print July 9, 2014]. BMJ Case Rep. doi:10.1136/bcr-2014-204780.

163.

Alsuwaigh

. How do English-speaking cancer patients conceptualise personhood? Ann Acad Med Singapore. 2015;44:207-217.

164.

Sachs

. Teacher professional identity: competing discourses, competing outcomes. J Educ Policy. 2001;16:149-161.

165.

Morgan

. Different Ways of Being Educator: A Sociocultural Exploration of Educator Identity and Development in Practice, in a System of Non-traditional Flexi Schools [unpublished doctoral dissertation]. Brisbane, QLD, Australia: Griffith University; 2013.

166.

Morgan

Brown

Heck

Pendergast

Kanasa

. Professional identity pathways of educators in alternative schools: the utility of reflective practice groups for educator induction and professional learning. Reflective Prac. 2013;14:258-270.

167.

Morgan

Pendergast

Brown

Heck

. The art of holding complexity: a contextual influence on educator identity and development in practice in a system of alternative ‘flexi’ schools. Reflective Prac. 2014;15:579-591.

168.

Morgan

Pendergast

Brown

Heck

. Relational ways of being an educator: trauma-informed practice supporting disenfranchised young people. Int J Inclusive Educ. 2015;19:1037-1051.

169.

Edwards

. Relational agency: learning to be a resourceful practitioner. Int J Educ Res. 2005;43:168-182.

170.

Pinilla

Pander

von der Borch

Fischer

Dimitriadis

. 5 years of experience with a large-scale mentoring program for medical students. GMS Z Med Ausbild. 2015;32:Doc5.

171.

Hawkins

Jones

Stanton

. A mentorship programme for final-year students. Clin Teach. 2014;11:345-349.

172.

Goldie

. Assessment of professionalism: a consolidation of current thinking. Med Teach. 2013;35:e952-e956.

173.

Hodges

Ginsburg

Cruess

, et al. Assessment of professionalism: recommendations from the Ottawa 2010 Conference. Med Teach. 2011;33:354-363.

174.

Ding

Zhang

Liu

Wen

. Assessing medical professionalism: a systematic review of instruments and their measurement properties. PLoS ONE. 2017;12:e0177321.

175.

Roberts

Wilkinson

Norcini

Patterson

Hodges

. The intersection of assessment, selection and professionalism in the service of patient care. Med Teac. 2019;41:243-248.

176.

Hodges

Paul

Ginsburg

. Assessment of professionalism: from where have we come – to where are we going? An update from the Ottawa Consensus Group on the assessment of professionalism. Med Teac. 2019;41:249-255.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.25 MB

0.15 MB