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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 26  |  Issue : 1  |  Page : 38-44

Mentoring in a resource-constrained context: A single-institutional cross-sectional study of the prevalence, benefits, barriers and predictors among post-graduate medical college fellows and members in South-Eastern Nigeria


1 Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State, Nigeria
2 Department of Family Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
3 Department of Anaesthesiology, Federal Medical Centre, Umuahia, Abia State, Nigeria

Date of Web Publication12-Mar-2019

Correspondence Address:
Gabriel Uche Pascal Iloh
Department of Family Medicine, Federal Medical Centre, Umuahia, Abia State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_173_18

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  Abstract 

Background: Globally, the post-graduate medical education has undergone tremendous changes with emphasis on training, services and research to equip trainees with competence for independent professional development. However, not all the fellows and members of the West African Post-graduate Medical College and the National Post-graduate Medical College of Nigeria recognise the values of mentoring in achieving the career success. Aim: The study was aimed at describing the prevalence, benefits, barriers and predictors of mentoring in a cross-section of the Post-graduate Medical College fellows and members in a tertiary health institution in South-Eastern Nigeria. Participants and Methods: A cross-sectional study was carried out among 168 study participants who were sampled from the Post-graduate Medical College fellows and members in the Federal Medical Centre, Umuahia, Nigeria. Data collection was done using a pre-tested, self-administered questionnaire that elicited information on awareness, prevalence, barriers and benefits of mentoring. Results: The age of participants ranged from 26 to 59 (41 ± 9.4) years. All the respondents were aware of the mentorship. The prevalence of mentoring was 33.3%. The most common benefit was personal and professional growth and development (100.0%). The most common barrier was the pressure of professional duties and personal exigencies (100.0%). The most significant predictor of mentoring had departmental mentoring programme participants who had departmental mentoring programmes were two times more likely to have mentoring relationships when compared to their counterparts who had none (adjusted odds ratio = 2.32; 95% confidence interval: 1.20–3.10; P = 0.002). Conclusion: The level of awareness of mentoring was very high but did not translate to appropriate involvement in mentoring. The most common benefit was personal and professional growth and development. The most common barrier was the pressure of professional duties and personal exigencies. The most significant predictor of mentoring relationship had departmental mentoring programme.

Keywords: Fellows, members, mentoring, Nigeria, post-graduate medical colleges, prevalence


How to cite this article:
Iloh GU, Chukwuonye ME, Onya ON, Godswill-Uko EU. Mentoring in a resource-constrained context: A single-institutional cross-sectional study of the prevalence, benefits, barriers and predictors among post-graduate medical college fellows and members in South-Eastern Nigeria. Niger Postgrad Med J 2019;26:38-44

How to cite this URL:
Iloh GU, Chukwuonye ME, Onya ON, Godswill-Uko EU. Mentoring in a resource-constrained context: A single-institutional cross-sectional study of the prevalence, benefits, barriers and predictors among post-graduate medical college fellows and members in South-Eastern Nigeria. Niger Postgrad Med J [serial online] 2019 [cited 2019 Jul 20];26:38-44. Available from: http://www.npmj.org/text.asp?2019/26/1/38/253977


  Introduction Top


Globally, the post-graduate medical education has undergone tremendous changes with emphasis on mentoring to equip the post-graduate medical trainees with competence for independent professional development and personal growth.[1],[2],[3] Mentoring has been variously defined in academic and professional medicine with no consensus definition.[4],[5] This could be a reflection of the wide scope of mentee–mentor relationships with every profession defining mentoring in the context of its own purpose and needs.[4],[6],[7] In general, mentorship is a personal and professional developmental relationship in which a more experience or knowledgeable person helps to guide a less experienced or less knowledgeable person with the mentor being an individual with expertise who can help develop the career of a mentee and ensure career success and satisfaction of the mentee.[4],[6] It is a dyadic relationship in which the more knowledgeable person, the mentor plays multiple roles in the personal and professional life of less knowledgeable person (the mentee).[4]

The role of mentoring has been variously construed as a guidance and counsellor,[7] coaching,[8] apprenticeship,[9] supervisor,[10] assessor[11] and preceptor[12] among other responsibilities.[3],[4],[7] The mentoring relationship, therefore, has professionally-related function which establishes the mentor as a guardian or preceptor who provides advice to enhance the mentee's professional development as well as psychosocial function that addresses the interpersonal aspects of the relationship to ensure a work-personal life balance.[4],[6] Mentoring, therefore, involves the role modelling, teaching, clinical practice supervision, coaching in research and presentation skill, guidance on setting career targets, personal and professional development plan and providing constructive feedback on formative and summative performances.[1],[2],[13]

Mentorship can be informal or formal.[4],[6],[7] Informal mentoring is the oldest form of mentorship which evolves naturally from shared interests, values, admiration and aspiration, where a mentor subjectively chooses mentee who is considered to have certain qualities.[6] The formal mentoring is a structured mentoring that is created as part of organisation system policy as well as mentee training and development programmes. They are formed through a structured assignment of mentors and mentees by the organisation with fixed rules and regulations. Different models of mentorships[5],[14],[15] have been described to suit different purposes and change with time and need. These include apprenticeship, cloning, nurturing and friendship models. In any of these mentorship models, the mentee and mentor can work out the details of mentoring. However, in a formal apprenticeship or cloning model of mentoring, the dyad should invest more energy and stick to the prescribed structure to avoid jeopardizing the purpose of the mentorship programme.[5]

Research studies have revealed that successful mentorship is vital to career satisfaction for both mentors and mentees.[5],[8],[16],[17],[18],[19] Mentoring that is successful is characterised by reciprocity, clear expectations, personal connections and shared values, whereas failed mentoring is dominated by poor communication, lack of commitment, personality differences, perceived (or real) competition, conflicts of interest and the mentor's lack of experience.[14] Functional mentorship has been reported as the key to personal life and professional practice leading to career growth,[16],[17] academic success,[8] professional promotion[18] and job satisfaction.[19]

Mentoring whether formal or informal is prone to some constraints that may undermine its effectiveness.[3],[14],[17],[20],[21] These challenges have continued to inhibit effective mentorships within and across mentoring in academic medicine.[3],[14] These reported challenges include difficulties developing relationships,[3],[7] lack of formal structure to foster mentoring,[3] inadequate knowledge of mentoring precepts, principles and process,[20] lack of time,[3],[4] pressure of clinical and personal workload for the mentor or mentee,[3],[4] inability to measure up to the standard set by mentor,[3] non-availability of mentee or mentor,[3],[4],[21] lack of reverence for the expertise of mentors[3],[14] and self-withdrawal of mentees or mentors.[22]

Systematic reviews of published studies have shown that mentoring is vital for the professional development of physicians[23] and surgeons[24] and have been reported in different specialities of Surgery,[25],[26],[27] Family Medicine,[28],[29],[30] Internal Medicine,[31] Emergency Medicine,[32] Paediatrics,[10],[33] Obstetrics and Gynaecology,[34] Anaesthesia,[35] Ophthalmology[36] and Gastroenterology.[37] However, in Nigeria, there is a paucity of research studies on mentoring involving faculty fellows and members of the West African Post-graduate Medical College (WAPMC) and the National Post-graduate Medical College of Nigeria (NPMCN). Admittedly, there is likelihood of similarities and differences between mentoring in the post-graduate medical training in developed nations and Nigeria, particularly in terms of capacity, pattern, benefits, predictors and barriers. There is, therefore, the need to examine mentoring as experienced by faculty fellows and members at the clinical departments of a health institution with a registrable post-graduate medical training since mentorship at this level is largely unreported in Nigeria. Mentoring of college members is vital in creating an optimal environment for building regional and diverse human resources for health. The present study explored the prevalence, benefits, barriers and predictors of mentoring in a cross-section of the Post-graduate Medical College faculty fellows and members in Federal Medical Centre, Umuahia, Nigeria.


  Participants and Methods Top


This was a descriptive cross-sectional study carried out on 168 fellows and members of NPMCN and/or WAPMC under the employment of Federal Medical Centre, Umuahia, a tertiary health institution in South-Eastern, Nigeria. In Nigeria, the post-graduate medical residency training is anchored by NPMCN and WAPMC. The two post-graduate medical colleges offer residency training in medical and surgical specialities and sub-specialities in several training institutions across Nigeria. The two post-graduate medical colleges in Nigeria have stipulated ratio of faculty member to fellow which are verified during accreditation visits. Every collegiate fellow and member are eligible to be assigned as a mentee or mentor, respectively, with institutional departments making decisions on assigning and number of mentees per mentor.

Federal Medical Centre, Umuahia, is a Federal Tertiary Health Institution located in Umuahia metropolis, Abia State, Nigeria. The medical centre is accredited for the post-graduate medical education by West African and National Post-graduate Medical Colleges in core medical and surgical specialities. The speciality clinics are run by fellows and members of both colleges.

The sample size for the study was determined using online sample size calculating software for descriptive study (www.surveysystem.com), accessed on 1, February, 2017. The input criteria for sample size estimation were set at 95% confidence level, confidence interval (CI) of 5 and population of 218 fellows and members. This gave a sample size estimate of 139 participants. The sample size calculating software assumed maximum possible proportion of 50% (0.50) which produced maximum possible sample size. To improve the precision of the study, the estimated sample size was increased by 5% desired precision, thus sample size = n/1-desired precision at 5%. This gave a sample size estimate of 146 respondents. However, to reduce sampling bias the sample size was further increased to 168 respondents which are within the limits of absolute precision, and these 168 respondents were used for the study.

The study instrument was designed by the researchers to suit Nigerian environment through robust review of appropriate literature on mentoring.[2],[3],[4],[5],[7],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39] The study tool consisted of sections on demographic data such as age and college status. Other information included awareness of mentoring, involvement in mentoring and barriers and benefits of mentoring.

The face, content, concept and construct validity of the instrument were evaluated by a consensus panel of knowledgeable experts in the hospital epidemiology, public health, public personnel management, health sociology and public administration who were not part of the study. The questionnaire was pretested using seven members and three fellows of the post-graduate medical colleges at the employment of Federal Medical Centre, Umuahia, Nigeria. The pre-testing was done to find out how the questions would interact with the respondents and ensure there were no ambiguities. However, no change was necessary after the pre-testing as the questions were interpreted with the same meaning as intended. The usability of the instrument was assessed to determine the administration, interpretation by the respondents and authors. The usability criteria for the use of an instrument where there is no existing pre-validated tool were met.[40] The questionnaire was self-administered since the participants were health literate. Fellows and Members of WAPMCs and/or NPMCN who participated in the general meeting of the Association of Resident Doctors, Federal Medical Centre, Umuahia, chapter for the members and the Medical and Dental Consultant Association of Nigeria, Federal Medical Centre, Umuahia, chapter general meeting for the fellows who gave informed consent for the study were used for the study.

A fellow is a physician or surgeon admitted into the post-graduate medical colleges (NPMCN; West African College of Physicians and West African College of Surgeons) on passing prescribed fellowship examinations, whereas a member meant a physician or surgeon admitted into the post-graduate medical colleges (NPMCN; West African College of Physicians and West African College of Surgeons) on passing prescribed membership examinations. A mentor is defined as a competent fellow who exert greater influence on the quality of the post-graduate medical college training through the building and modelling positive behaviours aimed at achieving career aspirations and personal development goals.

The data generated was analysed using the Statistical Package for Social Sciences software version 21 (IBM SPSS, New York, USA) for the calculation of frequencies and proportions for categorical variables and mean for continuous variables. The Chi-square test was used to test for the significance of the association between the categorical variables. Binary logistic regression was employed where appropriate. In binary logistic regression analysis, the dependent (outcome) variable was mentoring relationship status, and the independent variables were age, departmental mentoring programme, participation in research and publications and participation in conference and workshops. In all cases, a value of P < 0.05 was considered statistically significant.

Ethical certification was obtained from the Health Research and Ethics Committee of Federal Medical Centre, Umuahia, with reference number FMC/QEH/G.596/Vol. 10/308 dated 13/02/2018. Informed consent was also obtained from the respondents included in the study.


  Results Top


The age of the study participants ranged from 26 to 59 years with a mean of 41 ± 9.4 years. One hundred and thirteen (67.3%) were young adults aged 26–39 years, whereas 55 (32.7%) were middle-aged adults aged 40–59 years. All the respondents were aware of mentorship. Of the 168 study participants, 56 (33.3%) of them were involved in mentoring relationships with the most common type of mentoring being informal mentoring relationships (80.4%) [Table 1].
Table 1: Age, awareness, prevalence and type of mentoring among the study participants

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One hundred and thirty-three (79.2%) defined mentoring as trainer–trainee relationships, whereas 52 (31.0%) defined mentoring as personal and professional role modelling and relationships [Table 2].
Table 2: Definition of mentoring by the study participants* (n=168)

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All (100.0%) opined that mentoring relationships was beneficial to personal and professional growth and development while the least mentioned was that is a source of future professional support (48.2%) [Table 3].
Table 3: Benefits of mentoring relationship among the study respondents* (n=168)

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The most common barrier was pressure of professional duties and personal exigencies and was mentioned by all respondents (100.0%) while the least mentioned was self-withdrawal of mentor or mentee (24.4%) [Table 4].
Table 4: Barriers to mentoring among the study respondents* (n=168)

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At bivariate analysis having a departmental mentoring programme (χ2 = 7.80; P = 0.001); and participation in research and publications (χ2 = 5.29; P = 0.042) was significantly associated with involvement in mentoring relationship while other explanatory variables were not significantly associated [Table 5].
Table 5: Association between selected characteristics of participants and involvement in mentoring

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On binary logistic regression analysis of the variables found to be significantly associated with mentoring, the most significant predictor of mentoring relationship had departmental mentoring programme (adjusted odds ratio = 2.32; 95% CI 1.20–3.10; P = 0.002). Of the 56 participants who were involved in mentoring relationships, 39 (69.6%) had departmental mentoring programme whereas 17 (30.4%) had none. Participants who had departmental mentoring programmes were two times more likely to have mentoring relationships when compared to their counterparts who had none [Table 6].
Table 6: Logistic regression analysis of significant variables associated with mentoring

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  Discussion Top


The finding of this study showed that all the faculty fellows and members were aware of mentoring relationships in the post-graduate medical education and training in Nigeria. However, mentoring relationships were variously defined by the respondents as supervisor–supervisee role, trainer–trainee functions, adviser–advisee duties, guidance and counselling, coach–coachee relationships with only a few describing it as personal and professional role modelling and relationships with the predominant roles being provision of academic guidance and success. This finding lent credence to reports from other studies in Nigeria[28],[38],[39] and other parts of developing[41] and developed[1],[3],[5],[23],[24] countries on the variability in the understanding and interpretations of mentoring across various specialities in academic medicine. Although mentee–mentor relationship, trainer–trainee, supervisor–supervisee roles and coach–coachee duties have overlapping roles as documented in previous studies,[1],[3],[5],[8],[12],[20],[38] mentorship relationship involves sharing of both professional challenges in addition to the personal development plan and need assessment.[12],[28] However, in resource-limited settings and institutional departments, a faculty fellow can perform the multiple roles of mentoring, supervision, coaching and training among other diverse professional roles and responsibilities. Mentoring is, therefore, an invaluable method of stimulating critical thinking and appraisal that are keys to developing productive and fulfilling career success and personal satisfaction.[18],[19] It is quintessential for faculty fellows and members to understand that mentoring is more than just supervision or coaching.[42] It involves investment in the growth and development of the mentee, providing personal and professional guidance, counselling and other diverse supports as well as opportunities for career choices, promotion and progression.

The prevalence of mentoring in this study was 33.3% with the most common type being informal mentee–mentor relationships. The high prevalence of informal mentoring relationships has been reported among faculty fellows and members in developed[27],[30] and developing countries such as Nigeria[39] and Kenya.[41] The informal mentoring among the respondents was predominantly developed on the basis of inclusion of mentee in research studies, publications, delegation of work activities, conferences, workshops and seminars, preparation and supervision of mentees theses and dissertations. Of great concern in Nigeria is that the managers of the post-graduate medical institutional training centres are preferentially interested in service delivery with minimal attention paid to institutional mentoring in the post-graduate medical training, while the majority of faculty members are highly interested in completing their postings and passing the exit examinations and faculty fellows in academic medicine are much interested in publications due to 'publish or perish syndrome' for career appointment, advancement and promotion with minimal time and attention allotted to mentee–mentor interactions. The implication is that mentee–mentor interactions will be deficient with the suboptimal outcome since the post-graduate residency training programme requires close and regular contact between mentee and mentor for the appropriate acquisition of professional competence and personal orientations. There is need for a renewed interest in the operations of mentorship in the post-graduate medical education through establishing formal mentoring relationships with greater emphasis on experience and exposure to organised mentoring relationship. In addition, bearing in mind that the faculty fellows will get old and retire someday from the post-graduate medical education there is the need for succession planning if the standard of the post-graduate medical training is to be optimised, maintained and sustained. This disposition has the potential of creating and establishing mentoring climate and culture in the collegiate institutional departments and faculties of the post-graduate medical colleges in Nigeria. Formal mentoring programme should be established, whereas informal mentoring should be encouraged since both benefit the mentee and mentor.

The most common benefit of mentoring mentioned by the study participants was personal and professional growth as well as development. This finding is in consonance with reports from developed[42],[43] and resource-poor settings.[38],[41] According to these reports,[38],[41],[42],[43] mentoring in the post-graduate medical education is keys to developing personal and professional skills and competencies with the relationship being symbiotic and the benefits are bi-directional.[2],[4],[6] The explanation of the concept of mentoring may vary, but core expectations of mentors are that they encourage the professional development of the mentee and offer psychosocial support to the mentee within a longitudinal relationship. Mentoring, therefore, affords transfer of competence which mentee can apply in diverse personal and professional circumstances to promote personal and professional growth, success and satisfaction.[7],[19],[44] Practically speaking, despite the phenomenal benefits of the mentoring relationship, research studies[28],[38],[41] have shown that mentoring whether formal or informal is easier said than done, especially in the resource-constrained environments. The faculty member should take responsibility for this collaborative personal and professional alliance to create a productive, fulfilling and successful relationship with faculty fellows. There is, therefore, need for collegiate wide workshops and seminars for fellows and members on mentoring in addition to the provision of necessary support and climate for both formal and informal approach to mentoring. Mentoring should, therefore, be seen as one of the best tool for creation of better norms for collegiate collaborative training and should be considered the need of the hour and today's times in the post-graduate medical education in Nigeria.

The most common barrier to mentoring among the study participants was pressure of professional duties and personal exigencies. This finding is in tandem with reports from the post-graduate medical education in the developed[23],[24],[30] and developing nations.[28],[39],[41] This is attributed to a number of personal and professional obstacles that becloud mentoring relationships and tend to erode the expected benefits.[45],[46] According to these reports,[23],[24],[28],[30],[39],[41] the post-graduate medical education exposes the faculty fellows and members to work and life-related stress and distress. However, these work and life-related demands are exacerbated in developing countries like Nigeria where there are limited options for improved standard of living and upkeep of faculty members and fellows in the health-care settings. Mentoring can, therefore, be a means of honing the cognitive, affective and psychomotor domains of professional growth as well as the humanitarian instincts on work-life balance, fulfillment, and satisfaction.[4],[19],[30],[44] Effective mentoring provides broad-based professional-related functions, implicit and explicit psychosocial functions to ensure work-life balance as well as fostering a successful and satisfied professional workforce for institutional and collegiate growth and development. Although the lives of faculty fellows and members are filled with different levels of personal and professional exigencies depending on individual perception, the situation in Nigeria is mindboggling due to the poverty of health-care resources amidst a chaotic health-care delivery system and economic depression. It is pertinent for faculty members and fellows to understand that mentorship is transformative in nature and involves reciprocity and finding the right balance in mentee–mentor relationships, including responding creatively to drawbacks to successful mentoring. The findings of this study imply a clarion call for training interventions to enable potential and current mentors adapt to setbacks and for current and prospective mentees to cultivate right mentoring attributes. Faculty fellows and members should, therefore, brace up with current challenges in mentoring for sustainable professional and personal growth. This will help to improve the quality and quantity of mentoring in the post-graduate medical education in the region as well as impart on the necessary competence required for the 21st century medical and surgical specialists.

The most significant predictor of mentoring relationship had departmental mentoring programme. This finding corroborates reports on mentoring in the post-graduate medical education from developed countries with established and functional mentoring programme.[8],[23],[24],[34],[36],[47] According to these research studies,[8],[23],[24],[34],[36],[47] mentoring whether formal or informal relationship requires high level of dedication, commitment and altruism. The successful mentoring programme requires commitment of collegiate departments in facilitating fellow-member interactions in an environment favourable for mentoring as well as promoting the creation of better mentee–mentor relationships for collegiality and collaboration.[3],[14] The departmental mentoring programme should, therefore, aimed at the transmission of positive attitude and other attributes as faculty fellows provide valuable information to faculty members on the mission, vision, core values and philosophies of the National and WAPMCs. A clear understanding of what constitutes mentoring relationships and the factors associated with mentoring will enable the post-graduate medical college fellows and members to take appropriate and dedicated action to establish mentoring programmes to improve the quality of the post-graduate medical education and training. There is, therefore, the need to ensure that mentoring whether formal or informal gets to all faculty members and involving all the faculty fellows of National and WAPMCs.

Limitations of the study

First and foremost, the study was based on the subjective self-report with tendency to over-report the prevalence of mentoring relationships in addition to social desirable responses. Second, the study was on members and fellows from a single institutional centre and the modest sample size thus generalization of the results to other collegiate institutions should be done with caution. Despite these limitations, the study provides valuable data with implications for the post-graduate medical education in the region for comparative and consultative purposes.


  Conclusion Top


The level of awareness of mentoring was very high but did not translate to appropriate involvement in mentoring relationships. The most common benefit of mentoring was personal and professional growth and development. The most common barrier to the mentoring relationship was the pressure of professional duties and personal exigencies. The most significant predictor of mentoring relationship had departmental mentoring programme.

Recommendations

Mentoring should be the focus of sensitisation workshops and seminars for collegiate members, fellows, departments and faculties to enhance productivity, efficiency and effectiveness of college fellow-member mentoring interactions and relationship. Formative and summative assessment of mentoring should include feedback from fellows to improve the quality of mentoring.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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