Group mentoring f r junior Medical student : perceptions of mentees and mentors

Entering medical school can be associated with a number of difficulties that can hinder students' performance. Mentoring programs are designed to help students circumvent difficulties and improve their learning and personal development. The current study aimed to evaluate the perceptions of both students and mentors regarding a recently introduced, group-based mentoring program designed to support first-year students. After one year of regular meetings, students and mentors' perceptions of the program were assessed by means of structured questionnaires. Response content categories were identified through multiple readings. Both regular attendees and non-participating students had positive opinions about the program. Mentors were highly satisfied at having participated and acknowledged that the program has been useful not only for assisting students, but also for fostering their own personal and professional development. In conclusion, the group-based mentoring program is feasible and can elicit positive views from both mentors and students. In addition, faculty members' participation as mentors can also be beneficial, since the program appears to contribute to their own personal and professional development


INTRODUCTION
En ter ing med i cal school can be as so ci ated with a num ber of dif fi cul ties that can hin der stu dents' per for mance and per sonal de vel op ment.Re cently ad mit ted med i cal stu dents rou tinely face dif fer ent types of pres sure, such as the need to adapt to a new en vi ron ment and cre ate a so cial net work.New stu dents also have to cope with the stress ful na ture of med i cal train ing 1,2 , deal ing with and as sim i lat ing vast amounts of sci en tific con tent in the first years of med i cal school.In many coun tries, stu dents are ad mit ted into un der grad u ate med i cal train ing when they are still just teen ag ers, thus mak ing them par tic u larly vul ner a ble to such dif fi cul ties.There fore, many med i cal schools have im plemented stu dent sup port and coun sel ing sys tems [3][4][5][6][7][8][9][10][11] .How ever, many of the pro posed pro grams work mainly on an in di vid ual ba sis and there fore as sist only a lim ited share of stu dents.
In re cent de cades, much em pha sis has been placed on mentoring in un der grad u ate med i cal ed u ca tion [9][10][11][12][13][14] , which may be struc tured or in for mal 10,15 , de signed for per sonal or ac a demic devel op ment, and made avail able to the en tire stu dent body or merely to underrepresented mi nor i ties 16 .Nev er the less, knowl edge of stu dents' and men tors' per cep tions to wards mentoring programs is still lim ited, since opin ions from non-par tic i pat ing students have not of ten been elic ited, and many stud ies fail to re port on the ef fect par tic i pa tion as men tors has on fac ulty mem bers.
At our in sti tu tion, the Ribeirão Preto School of Med i cine in the State of São Paulo, Brazil, a group-based, elec tive mentoring pro gram aimed at sup port ing first-year med i cal stu dents and fos ter ing their per sonal de vel op ment was re cently in tro duced and has slowly gained in creas ing stu dent ad her ence.The present study de scribes the find ings con cern ing eval u a tion of mo tiva tional as pects and per cep tions of the pro gram by stu dents and men tors who par tic i pated in reg u lar group meet ings for at least one ac a demic year.For stu dents, we com pared re sponses by regu lar at ten dees to those of class mates who ei ther did not en roll in the pro gram or only at tended meet ings oc ca sion ally.

Setting
The Ribeirão Preto School of Med i cine is lo cated on a cam pus of the Uni ver sity of São Paulo in South east Brazil.Fac ulty members are highly qual i fied, and the vast ma jor ity, in clud ing those in clin i cal de part ments, work fulltime for the in sti tu tion.Al though they are highly com mit ted to ac a demic du ties, the amount of in divid ual time de voted to clin i cal, re search, and ad min is tra tive work is gen er ally more than that ded i cated to teach ing.Per sonal contact with stu dents is thus lim ited, and an o nym ity is a mat ter of in -creas ing con cern.Each year the med i cal school re ceives 100 incom ing stu dents aged 17-19 years, who en ter shortly af ter fin ishing high school.The cur rent cur ric u lum is rather tra di tional and com prises two years of ba sic sci ences, one se mes ter (third year) of pre-clin i cal dis ci plines, and three se mes ters (third and fourth years) of clin i cal dis ci plines.The two fi nal years (fifth and sixth years) are spent in in tern ships pro grams in ma jor clin i cal ar eas, such as In ter nal Med i cine, Gen eral Sur gery, Pe di at rics, Ob stet rics and Gy ne col ogy, and Com mu nity Med i cine.

The mentoring program
For nearly two de cades, the in sti tu tion has main tained a formal coun sel ing sys tem for in di vid ual, on-de mand sup port for med i cal stu dents, in clud ing a psy chol o gist and edu ca tion al ist 3 .The per cep tion that such as sis tance could be ex tended to larger groups of stu dents and also be more ef fec tive in pre vent ing in divid ual prob lems prompted the in tro duc tion of the mentoring pro gram.The pro gram aimed to as sist re cently ad mit ted first-year med i cal stu dents.Fol low ing a suc cess ful ex pe ri ence in the first med i cal school of the same uni ver sity 9 , a group-based, ho lis tic mentoring model was adopted 17 , in which mentoring was de vised as a way not only of pro vid ing emo tional sup port, but also of fos ter ing per sonal and pro fes sional de vel op ment.A group-based scheme was pro posed, so that stu dents could estab lish per sonal con tact with class mates and share their views and ex pe ri ences with peers, be sides con nect ing with fac ulty mem bers and staff phy si cians act ing as men tors.Stu dents enrolled vol un tarily (as an ex tra cur ric u lar ac tiv ity) and were randomly as signed to mentoring groups, with reg u larly sched uled meet ings (at least ev ery other week).Mentoring groups consisted of 6-8 ju nior stu dents plus the men tor, who was as sisted by one or two se nior stu dents es pe cially re cruited on the ba sis of their in ter est in im prov ing stu dent con di tions.Men tors were also re cruited on a vol un tary ba sis from fac ulty and med i cal staff and trained by a su per vi sory com mit tee con sist ing of the for mer sup port team and a small group of se nior fac ulty mem bers with ex pe ri ence in stu dent af fairs.In clu sion cri te ria were mo ti va tion, sched ule avail abil ity, and reg u lar par tic i pa tion as teach ers in the un der grad u ate med i cal pro gram.Men tor train ing aimed primar ily to pro vide a clear un der stand ing of the pro gram's main ob jec tives, as well as to clar ify the men tor's role as group fa cil i tator and role model.Men tors were also ex pected to of fer in di vidual per sonal sup port and coun sel ing out side the group ac tiv ities, when ever re quired.The pro fes sional de vel op ment com ponent was de signed as pro grammed dis cus sions of spe cial themes, such as med i cine as a ca reer choice, as pects of phy sician-pa tient re la tion ships, the med i cal work place, eth i cal is sues, etc. Reg u lar monthly meet ings with the su per vi sory com mit tee as sured that men tors were as sisted in deal ing with per sonal or group dif fi cul ties, as well as re ceiv ing feed back re gard ing their roles.Men tors also re ceived reg u larly se lected texts on the students' de vel op ment, which were dis cussed with mem bers of the su per vi sory com mit tee.

Study design
Af ter par tic i pat ing in reg u lar group meet ings for at least one ac a demic year, stu dents and men tors' per cep tions of the program were as sessed through a cross-sec tional, de scrip tive study with qual i ta tive data col lected by means of struc tured ques tionnaires.At the time data were col lected, ac cord ing to the su per visory com mit tee, 50 of the 100 first-year stu dents were reg u larly at tend ing the meet ings.All first-year stu dents (N=100) were invited to an swer a writ ten ques tion naire con tain ing de mo graphic items, de gree of par tic i pa tion in the mentoring pro gram, and open ques tions on: a) over all per cep tion of the pro gram; b) mo tiva tion to par tic i pate; and c) rea sons for not par tic i pat ing.Students were also in vited to ex press crit i cism or free opin ions, as well as to pres ent com ments and sug ges tions for pro gram improve ment when ever per ti nent.Re sponses from stu dents report ing reg u lar at ten dance (at least one meet ing per month) were com pared to those from peers who ei ther did not en roll in the pro gram or only at tended the meet ings oc ca sion ally (fewer than two meet ings per year).
All men tors (N=10) in volved in the pro gram re ceived an e-mail re quest ing them to an swer a struc tured ques tion naire con tain ing open ques tions on the fol low ing: a) over all per ception of the pro gram; b) mo ti va tion for par tic i pat ing; c) per ceived gains from reg u lar par tic i pa tion; and d) per ceived prob lems related to the mentoring pro gram ac tiv i ties.
In di vid ual re sponses to the open ques tions by both stu dents and men tors were an a lyzed qual i ta tively.Re sponse con tent cat e go ries were iden ti fied through mul ti ple read ings.All in di vid ual an swers were in cluded, even those ex pressed by a sin gle re spon dent.

Student response
A to tal of 74 ques tion naires were re turned, in clud ing 20/50 from reg u lar at ten dees and 41/50 from non-par tic i pants.
Con cer ning ove rall per cep ti on of the pro gram, all res pon dents from the par ti ci pant sub group were ex pli citly po si ti ve and ex pressed agre e ment with the pro gram's ob jec ti ves and sup port for ma inta i ning it.Ne vert he less, three par ti ci pants ex pres sed opi ni ons that "the pro po sal is still va gue..." and that "the me e tings need bet ter or ga niza ti on..." Twenty-nine of 41 non-par ti ci pa ting stu dents also ex pres -sed po si ti ve per cep ti ons, in clu ding five who re por ted that non-parti ci pa ti on was due ex clu si vely to lack of time.The re ma i ning non-par ti ci pa ting stu dents ex pres sed lack of in for ma ti on on the men to ring pro gram and the per cep ti on that the pro gram was desig ned for stu dents with spe ci fic ne eds; in ad di ti on, the se non-parti ci pants did not agree with or sup port the pro gram.
Re gar ding mo ti va ti on to par ti ci pa te in the men to ring program, res pon ses were col lec ted from 18 of the 20 par ti ci pa ting res pon dents.Char te 1 shows the con tent ca te go ri es iden ti fi ed in the se res pon ses.Chart

Mentors' perceptions
All men tors pro vided an swers to all the ques tions, and they all ex pressed an ex plic itly pos i tive per cep tion of the pro gram. 5. Make a contribution to students' personal, social, and professional development; 6. Help students cope with day-to-day difficulties, including those related to future participation in the medical profession; 7. Make a contribution to preparing more compassionate physicians.
8. Improve students' perception of the contribution of basic sciences to clinical skills; 9. Gain insight on how undergraduate students perceive teaching in general and the institution in particular; 10. Become a better and more well-rounded teacher; 11. Explore other teaching roles; 12. Have fun working with students in an academic environment.
There was a clear pre dom i nance of rea sons re lated to ac ademic is sues, such as "...help ing stu dents adapt to a new en vi ron ment and of fer ing sup port for those ex pe ri enc ing dif fi cul ties", which were directly re lated to the mentoring pro gram's ob jec tives.How ever, a few men tors ex pressed per sonal or pro fes sional rea sons such as "...be com ing a better and more well-rounded teacher" or "...gain ing insight on how un der grad u ate stu dents per ceive teach ing in gen eral and the in sti tu tion in par tic u lar".This as pect of the teacher's per sonal or pro fes sional growth dom i nated all the men tors' an swers to the ques tion re gard ing per ceived gains from par tic i pat ing in the program, as shown in chart 4. Chart 5 shows the re sponse cat e go ries to the men tors' per ceived prob lems with the pro gram, which mainly in cluded those re lated to stu dent par tic i pa tion, such as "lack of punc tu al ity" or "dif fi cul ties in mo ti vat ing stu dents to at tend".

DISCUSSION
One of the rea sons for in tro duc ing a mentoring pro gram for ju nior stu dents in our in sti tu tion was the per cep tion that the stress ful ex pe ri ence of en ter ing med i cal school could be coun terbal anced by of fer ing an ostensive sup port sys tem ex tended to all in di vid u als wish ing to par tic i pate.It was ac knowl edged that un treated stress can lead to se ri ous in di vid ual con se quences, such as sub stance abuse and de pres sion, as well as oc ca sional dys func tional be hav ior to wards fac ulty mem bers and pa tients, as pointed out by other au thors 2 .Pub lished data show ing that first-year stu dents are par tic u larly vul ner a ble to stress 1 , con sistent with the cur rent per cep tion of the lo cal sup port and counsel ing team, were crit i cal for de sign ing the mentoring pro gram so as to as sist new stu dents.These as sump tions for cre at ing the mentoring pro gram ap pear to have been con firmed, since the most fre quent re sponse cat e gory to the ques tion on mo ti va tion to en roll in the pro gram was the need to over come ini tial dif fi culties re lated to ei ther psy cho log i cal or scho las tic is sues.
Our re sults show that the cur rent stu dents' opin ions on the mentoring pro gram re cently in tro duced in our in sti tu tion are highly pos i tive.This was ex pressed not only by stu dents reg ularly at tend ing the mentoring meet ings, but also by those not enrolled or those that only at tended the group meet ings oc ca sionally, a find ing con sis tent with other pub lished re sults 15 .Rea sons un der ly ing this pos i tive view were not spe cif i cally in ves ti gated, but ap pear to be linked to the ful fill ing of one of the pro gram's main ob jec tives, namely to sup port and as sist stu dents in a new per sonal and ed u ca tional set ting.De spite this ap par ently success ful start, it is still un clear whether the mentoring pro gram will be ef fec tive in pre vent ing more se ri ous emo tional dif fi culties or men tal health prob lems.Fol low-up of the pro gram will be needed to an swer this ques tion.Like wise, whether the pro gram will suc ceed in fos ter ing the stu dents' per sonal and pro fes sional de vel op ment re mains to be ver i fied on a long-term ba sis.This con cern is con sis tent with data from a sys tem atic re view of the im pact of med i cal school mentoring on par tic i pants and in sti tutions, which con cluded that the ev i dence to sup port the per ception of ben e fit is not strong, so that fur ther re search on the is sue is needed 18 .
The men tors' per cep tions of the pro gram were also highly pos i tive, which was not sur pris ing, since cri te ria for re cruit ing fac ulty mem bers and med i cal staff for the men tor's role included high de grees of both mo ti va tion and com mit ment to the un der grad u ate med i cal pro gram.Ac cord ingly, most of the reasons cited by men tors for join ing the mentoring pro gram (chart 3) ap pear to con firm these ex pec ta tions.
One in ter est ing and im por tant find ing of our study was the men tors' per cep tions that en gag ing in the mentoring pro gram's ac tiv i ties was use ful not only to help stu dents, but also to fos ter their own per sonal and pro fes sional de vel op ment.This ap pears to be achieved in a va ri ety of ways (chart 4), in clud ing in creased knowl edge of stu dents' needs, shar ing with other men tors, and re flec tion on the teacher's roles.This mu tu ally ben e fi cial arrange ment was high lighted in a re cent re view 19 and had also been re ported pre vi ously by Murphy (2003), who pro posed an orig i nal "re verse mentoring pro ject" 20 .Nev er the less, the im pact of mentoring on fac ulty de vel op ment has not been ex ten sively stressed by other au thors 7,12,14 .
Mean while, per cep tions by both stu dents and men tors in dicated that spe cific mea sures are needed to im prove the pro gram.
These mea sures in clude spe cific strat e gies to pro vide stu dents with more pre cise in for ma tion on the pro gram's ob jec tives, besides en cour ag ing en rolled stu dents to at tend more reg u larly and to par tic i pate more ac tively in the group meet ings.Or ga niza tional as pects (on the in sti tu tional side) also need to be approached, which would in clude ne go ti at ing the pro gram into the reg u lar cur ric u lum so as to both re duce stu dent over load and cre ate free time slots for mentoring ac tiv i ties.Nev er the less, there is a sub group of stu dents who will never show the need for (or the in ter est in) par tic i pat ing in mentoring ac tiv i ties.This is in di cated by some opin ions from non-par tic i pat ing stu dents, con sis tent with other au thors' find ings 13 .
The men tors' train ing and su per vi sory ac tiv i ties also need to be im proved, in or der to en hance their skills and al low them to gain in creased aware ness of their role in the in sti tu tional context 21 .This train ing and su per vi sion should in clude not only improved skills in con duct ing group ac tiv i ties and deal ing with students ex pe ri enc ing emo tional dif fi cul ties, but also the de vel opment of stu dent eval u a tion skills, which would lead to in creased pro gram qual ity 21 .Mea sures are also needed to re ward men tors, since the cur rent pro gram does not pro vide ei ther fi nan cial compen sa tion or in sti tu tional credit for men tors' par tic i pa tion.
As ex plor atory re search, our study has a num ber of lim i tations.The pro por tion of par tic i pants an swer ing the ques tionnaire was rel a tively low and may have bi ased the re sults towards a pos i tive as sess ment of the mentoring pro gram.Per ceptions by both stu dents and men tors could also be in ves ti gated in greater depth, us ing more ac cu rate meth ods like in ter views or fo cus groups.This could lead to clar i fi ca tion of some is sues that were not ex plored in this study, such as the dif fer en tial role of men tors, se nior stu dents, and peer mentees on the par tic i pants' per cep tions.The im pact of the su per vi sory com mit tee on the men tors' per cep tions could also be ad dressed.Nev er the less, besides pro vid ing use ful data for the lo cal qual ity as sur ance process, the pres ent study's find ings in di cated that this kind of initia tive has a pos i tive im pact on the ed u ca tional set ting and may ben e fit not only new stu dents but also fac ulty mem bers that partic i pate as men tors.

CONCLUSION
This short-term re port on a re cently in tro duced, group-based mentoring pro gram de signed to as sist ju nior med i cal stu dents in di cates that both par tic i pat ing and non-par tic i pat ing stu dents shared pos i tive opin ions of the pro gram and high lighted the men tors' sup port ive role, viewed as fa cil i tat ing ad ap ta tion to a new set ting.Fac ulty mem bers and staff phy si cians were also satis fied with mentoring in the pro gram, which ap peared to meet their ex pec ta tions.In par tic u lar, men tors ac knowl edged that par tic i pat ing in the pro gram was a use ful way of fos ter ing their own per sonal and pro fes sional de vel op ment.

chart 3 CONTENT 1 . 2 . 3 .
shows the re sponses re gard ing mo ti va tion for en roll ing in the pro gram as a men tor.Chart 3 Content of responses by mentors to an open-ended question related to motivation for enrolling in the mentoring program.Help students adapt to a new environment and offer support for those experiencing difficulties; Improve faculty-student relations; Make a personal contribution to a program that deserves to be successful; 4. Have the possibility of working objectively on problems related to the undergraduate program; 1 Content of responses by participating students to an open-ended question related to motivation for participating in the mentoring program.fre quent re sponse cat e gory.Re sponses from a few par tic i pants re lated to a de sire to dis cuss gen eral is sues, so cial ize with peers and teach ers, learn more about what was hap pen ing in the group meet ings, or sim ply oc cupy spare time.Rea sons for not par tic i pat ing in the mentoring pro gram were of fered by 37 of the 41 non-par tic i pat ing stu dents.chart 2 shows the cat e go ries of re sponses to this is sue.Nearly half (18/37) of these re spon dents men tioned lack of time due to cur ric u lar or ex tra cur ric u lar over load.In ad di tion, 12 re spon dents ex plic itly men tioned lack of in ter est or in for ma tion or failed to per ceive a CONTENT 1. Overcome initial difficulties related to medical school, such as course content, extracurricular activities, different teaching/learning methods, etc.; 2. Overcome initial difficulties related to psychological adaptation, such as homesickness, and to get acquainted with new classmates; 3. Discuss general social, cultural, and professional issues; 4. Opportunity for personal contact with teachers, physicians, and other students; 5. Occupy lunch time; 6. Curiosity about a new extracurricular activity and learning more about the program.The need to over come ini tial psy cho log i cal or scho las tic diffi cul ties, men tioned by one-third (6/18) of re spon dents, con stituted the most need to par tic i pate in the mentoring pro gram.Very few non-partic i pat ing stu dents ad mit ted they were un able to share per sonal is sues with peers.