Being a mentor for undergraduate medical students enhances

2010; 32: 148–153
Being a mentor for undergraduate medical
students enhances personal and
professional development
TERESE STENFORS-HAYES, SUSANNE KALE´N, HA˚KAN HULT, LARS OWE DAHLGREN, HANS HINDBECK
& SARI PONZER
Karolinska Institutet, Stockholm, Sweden
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Abstract
Background: There is increasing evidence of the positive effects of mentoring in medical undergraduate programmes, but as far
as we know, no studies on the effects for the mentors have yet been described in the field of medicine.
Aim: This study aims to evaluate an undergraduate mentor programme from the mentors’ perspective, focusing particularly on the
effect of mentorship, the relationships between mentoring and teaching and the mentors’ perceived professional and personal
development.
Methods: Data was gathered through a questionnaire to all 83 mentors (response rate 75%) and semi-structured interviews with a
representative sample of 10 mentors.
Results: Findings show, for example, that a majority of respondents developed their teaching as a result of their mentorship and
improved their relations with students. Most respondents also claimed that being a mentor led to an increased interest in teaching
and increased reflections regarding their own values and work practices.
Conclusion: Being a mentor was perceived as rewarding and may lead to both personal and professional development.
Introduction
Practice points
There is increasing evidence of the positive effects of
mentoring in medicine (Morzinski et al. 1996; Connor et al.
2000; Schrubbe 2004; Sambunjak et al. 2006) and in medical
undergraduate training programmes (Dorsey & Baker 2004;
Buddeberg-Fischer & Herta 2006). Mentoring is a means of
professional (Kalet et al. 2002; Murr et al. 2002; Sambunjak
et al. 2006) and personal (Murr et al. 2002; Sambunjak et al.
2006) development and the positive effects of mentorship
thereby match desired outcomes in many undergraduate
programmes. A mentor may, for example, help the mentee
to develop implicit knowledge about the hidden curriculum of
professionalism, ethics, values and the art of medicine which
cannot be learned from a text (Rose et al. 2005). A mentor may
also facilitate skills development and provide guidance and
strategic advice (Jackson et al. 2003).
The aims of the mentor programme at So¨dersjukhuset, a
Karolinska Institutet teaching hospital, were to facilitate the
students’ professional development and to provide tools for
this. The mentor programme further aimed to provide the
students with a channel into the part of the medical profession
not covered by factual knowledge and to discuss topics not
covered in the educational programme such as equality,
ethical dilemmas, their future professional role, combination of
work and private life, etc. All students starting semester five
(the first clinical course) 2005 and 2006 were offered a mentor
for 2 years. All mentors were medical doctors (MDs) at the
. There is an increasing evidence of the positive effects of
mentoring in medical undergraduate programmes.
. The studies focusing on the effects for the mentors are
rare.
. Being a mentor is perceived as being rewarding in many
different ways.
. Being a mentor may lead to personal as well as
professional development such as improved teaching
and improved relations to students.
hospital. A training programme for people taking on the
mentor role is often recommended (Woessner et al. 1998;
Woessner et al. 2000; Hauer et al. 2005; McArthur-Rouse 2007)
and all MDs were offered the opportunity to participate in a
2-day course before they became mentors. The training
included among other issues, the aims and objectives of the
mentor programme, the role of the mentor, different learning
strategies, equality issues and creative thinking. Follow-up
meetings for all mentors were also provided each semester.
Most mentors had one mentee, but some had two.
Most publications on mentorship focus on the benefits for
the mentee and only a few research studies have investigated
the effect of mentoring for the mentor: Within medicine, no
such study has yet been identified (Buddeberg-Fischer & Herta
2006). This study aimed to evaluate the mentor programme
Correspondence: Terese Stenfors-Hayes, Centre for Medical Education (CME), Department of Learning, Informatics, Management and Ethics
(LIME), Karolinska Institutet, SE-171 77 Stockholm, Sweden. Tel: 0046-8-524 837 37; fax: 0046-8-34 51 28; email: [email protected]
148
ISSN 0142–159X print/ISSN 1466–187X online/10/020148–6 ! 2010 Informa Healthcare Ltd.
DOI: 10.3109/01421590903196995
Being a mentor
from the mentors’ perspective, focusing particularly on the
effect of mentorship on the mentor’s perceived professional
and personal development. By doing so, this study further
aimed to meet the needs of research on mentoring in medicine
(Buddeberg-Fischer & Herta 2006; Sambunjak et al. 2006,),
describing, for example, the characteristics of the mentoring
relationship (Berk et al. 2005, Straus et al. 2009).
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Research method
A mixed methods approach was used to provide breadth in the
findings. Initially, two focus group interviews were held with
five and four mentors, respectively. These interviews aimed to
provide insight into the mentors’ thoughts about being a
mentor and to explore themes for further data collection.
Moreover, the focus groups aimed to provide the authors with
information about the mentor programme and how it had been
working. The interviews were recorded, listened to repeatedly
and transcribed (with the exception of sections containing only
programme information). A brief inductive thematic analysis
(Braun & Clarke 2006) was made. The information provided
from the focus groups regarding the programme and the
context, along with the findings from the analysis were
used together with an extensive literature review focusing on
mentor programmes in health care sciences and particularly
undergraduate programmes in medicine, to develop a questionnaire. In the literature, some confusion around the concept
of mentoring can be found as supervisors or others in an
assessing or teaching role are sometimes referred to as mentors
(Bray & Nettleton 2007). For this study, such references were
excluded. Themes used in the questionnaire included the
mentor’s personal and professional development, the link
between teaching and mentoring, the mentor role, what a
mentor does and what it means to be a mentor. The
questionnaire was piloted with a group of seven former
mentors that at the time of the study had left the hospital.
Feedback on the pilot questionnaire was also provided by
expert colleagues in the field, responsible for running and
developing other mentor programmes and mentor training.
The questionnaire was distributed electronically to all 83
mentors that were or had been involved in the programme.
The questionnaire included a mix of open ended and fixed
response questions, some used an ordinal scale (e.g. Has
being a mentor increased your interest for teaching and
supervision? with the response categories not at all, to some
extent, to a high extent and to a very high extent). Other
questions used a nominal scale such as What do you think you
do in your role as a mentor? For this question, a framework of
undergraduate medical teaching activities (Ross &
Stenfors-Hayes 2008) was used to capture the mentors’
perceptions. The mentors responded anonymously online.
Two reminders were sent out and the questionnaire was open
for a few weeks. Opportunity for the respondents to provide
feedback on the questionnaire was given. The Mann–Whitney
U test was applied to the ordinal data to identify significant
differences in the data between the mentors who participated
in the mentor training and the ones who did not. The open
ended questions as well as the respondents’ comments to the
other questions were analysed individually using theoretical
thematic analysis (Braun & Clarke 2006).
To follow up the questionnaire, 10 mentors were interviewed. These were systematically selected from a list of all
mentors. The interviewees were selected to represent the
variations (Larsson 2009) in the mentor group in terms of sex
and age and the mentor had to have met their mentee at least
three times. The interviews aimed to facilitate the analysis of
the questionnaire, in terms of illustrating, contextualising and
facilitating a deeper understanding of the answers. The main
themes of the interview guide concerned the mentor programme, what mentors do, what it means to be a mentor and
what being a mentor had given the respondent in terms of, for
example, teaching and their own development. The
semi-structured interviews lasted 30–45 min each and were
recorded and later transcribed in extenso. As the interviews
were linked to the questionnaire, a theoretical thematic
analysis (Braun & Clarke 2006) was made, where the data is
coded for specific research questions. Firstly, all transcripts
were read; secondly, meaningful units in the transcribed
interviews were identified and labeled using software for
qualitative analysis. The units were subsequently organised
into initial themes and sub-themes. The analysis focused
primarily on descriptive and interpretative levels (Braun &
Clarke 2006) and the interview transcripts were regularly
revisited to make sure that all relevant excerpts for each theme
were collated. The analysis of the interview data were made in
parallel to more interviews being made, which made it
possible to refine the interview guide and further explore
particular themes as deemed necessary.
Findings
The response rate for the pilot questionnaire was three of
seven (43%) and the response rate for the mentor questionnaire was 63 of 83 (75%). Fourteen mentors could not be
reached via telephone or email or declined to be interviewed
due to other work commitments or leave of absence. This
means that in total 24 mentors were approached for the ten
interviews. Due to the relation between the questionnaire and
interview data, the findings are presented thematically rather
than separating them. No significant differences in the
responses were found mentors that participated in the initial
training and mentors that did not participate.
The programme
The questionnaire data shows that all respondents who
participated in the initial training (58%) thought the training
was sufficient. Identified problems with the mentor programme were related either to time issues, such as finding a
time and place to meet their mentees or other commitments,
the mentee not being interested or that it was too easy to slip
out of touch with each other. However, 21% of the mentors
had stayed in touch with their mentees after the programme
finished. Most responding mentors (58%) spent 1–5h per
semester on their mentorship (excluding follow-up meetings
for mentors and the initial training), 35% spent 6–10 h and 6%
spent 11–15 h.
149
Equality
Work
environment
Interprofessional
coop.
Ethical issues
Careeer
Comb. work
private life
The undergrad.
programme
Being a student
70
60
50
40
30
20
10
0
No of
resp.
Being a doctor
T. Stenfors-Hayes et al.
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Figure 1. What have you been discussing with your mentee?
Multiple answers accepted.
None of the interviewees or focus group participants
experienced any role conflicts in terms of being both a teacher
and a mentor. The interviewed respondents claimed to have
read the book (Hultman & Sobel 2005) about being a mentor
that was given to all mentors and most of them had also
reflected upon the new role and what they wanted it to entail
and how they wanted to approach their mentee before the
programme started. The reflections also concerned how they
wanted to be as mentors, what they wanted to discuss with
their mentees and what kind of support or advice they were
willing to offer. However, the mentorship was not discussed
with their colleagues at all.
The meetings
Based on a number of fixed responses in the questionnaire,
the most commonly discussed topics in the meetings were
being a doctor, being a medical student, the undergraduate
programme, how to combine work and private life and the
mentee’s future career (Figure 1).
Based on the interviews, most mentors seem to have met
their mentees regularly rather than on a need-basis. Some
mentees brought up more private issues with their mentors as
well, such as personal relationships. The relation with the
mentee was described as friendly, open, personal and nonprestigious. One mentor, however, described the relationship
with one of the mentees as one between an expert and a
novice and felt that the mentee did not feel comfortable
enough to ask about or discuss certain things. The reason for
this was believed to be cultural as the mentee was an
exchange student. There was also disappointment in that the
relationship with mentees did not become as deep as the
mentor had hoped for. The respondents believed this was
because they met too seldom. A common reaction from the
mentors when describing his/her mentorship was suggesting
that as the mentee did not have any problems, the job was
easy, implying that problem solving may be part of the
expectations on being a mentor.
common choice (n ¼ 13) was expressions related to it being
fun. Other examples include important, an honour, a privilege,
appealing, and stressful. The interviewees seemed to find it
rather difficult to describe what it was in being a mentor that
they found rewarding. One mentor pointed out that although
the direct effects were difficult to pinpoint, being a mentor was
still rewarding. All interviewed respondents, however, agreed
that being a mentor was fun, satisfying and rewarding. Some
claimed that they would have quit the programme if it had not
been so rewarding for them. Examples of what the mentors
found rewarding included an increased understanding for
younger colleagues, becoming more familiar with a new
generation and understanding how they think and following
the development of the curricula. One mentor appreciated the
possibility of using her professional knowledge regarding
things that are usually hard to communicate; another said it
made him reflect over how they handle students in his
department. One mentor believed the mentorship gave her
curiosity back; another claimed it helped him to see the person
behind different professions. One believed the mentor role
helped establish them in their role as a doctor and others
appreciated the feeling of having come so far in their career
that they could help. Others appreciated feeling important and
needed. Many mentors claimed that meeting the mentee and
discussing with him/her someled to increased self-insight and
development. Others appreciated the opportunity to sit back
and reflect over issues not commonly discussed.
I feel that I receive so much from the students, it is
fantastic to get to be a part of their journey (to
become doctors) and I think it is important that they
have a mentor, it must be incredibly valuable to them
and also for the mentors. We (the mentors) have so
much experience that is not strictly medical, there is
so much more to it (being a doctor) in some way and
as a mentor I am able to offer some of this and that
feels great.
When the interviewees described what they did as mentors,
they said that they functioned as sounding boards, role models
and showed what it is like to be a doctor. They sometimes
provided good advice, they supported, helped introduce the
mentee to the community of doctors, they encouraged
courage, independent thinking and decision making. They
furthermore functioned as catalysts or were there for their
mentee in case they needed them. One described her function
as a mentor as up to the mentee to design as he/she wished.
I think I fill a function as an example and as someone
to ask about a lot of things (someone), that she (the
mentee) can use a bit as she pleases. And she can to
be personal, I think that has been important.
Mentoring and teaching
Being a mentor
When asked in the questionnaire to describe what they
thought it was like to be a mentor, words related to rewarding
(n ¼ 24) such as ‘stimulating’ or ‘developing’ were most
common among the respondents (n ¼ 36). The second most
150
All teaching activities that related to facilitating learning, in the
framework of learning and teaching (Ross & Stenfors-Hayes
2008), were found to be included in being a mentor. Most
strongly linked were ‘relating to learners and providing
perspectives’ and ‘facilitating personal and professional
development’. Most mentors also believed that they were
functioning as a role model for the student (Figure 2).
The questionnaire findings furthermore showed that 68% of
the mentors believed their interest for teaching and supervision had increased through the mentor programme (to some
extent, to a high extent and to a very high extent) and a
majority of respondents believed that the mentorship had led
to some development of their teaching. Half of the respondents discussed pedagogical issues somewhat more after they
became mentors than before. Furthermore, a tendency was
found showing that it was mainly the respondents who
participated in the mentor training who had increased these
discussions ( p ¼ 0.10). Most mentors believed that the mentorship developed their view on what it means to be a good
teacher and what is important to them as teachers. The
mentorship also led to increased reflections regarding their
own teaching. Most respondents claimed that being a mentor
increased their understanding of the students’ situation and
improved their relations to students to some extent. The
median for all questions in Table 1 was ‘to some extent’.
The link between teaching and mentoring was brought up
by several respondents as something positive. Their interest for
60
50
40
30
teaching had for most respondents increased to some extent
through their mentorship. One respondent said that the
mentorship provided him with fresh eyes to view his teaching
with and another mentor became encouraged to become a
better supervisor. The personal link to a student made it easier
to understand what it is like to be a student today for some
respondents. An increased understanding of the students’
situation had also led to changes in some of the respondents’
teaching approach, and one mentor claimed to now approach
students in a different way and involve them more. One
mentor explained had being a mentor led to increased
reflections regarding his/her teaching.
My mentee gives an example (of teaching that he/
she has experienced) and then I think; what do I do
when I teach?
The responses to open questions in the questionnaire, as
well as interview data, showed that feedback from the students
in terms of, for example, their progress or increased demands
also motivated respondents to develop their teaching. Other
factors motivating development were: Wanting to share
knowledge and get people interested in ones field, inspiring
teaching courses and a personal drive to want to become a
better teacher. Most respondents, however, wanted more
managerial support for their teaching, more time and a salary
increase and claimed that this would motivate them to develop
their teaching further.
20
10
Give info and
demonstr.
Assess and
give
feedback
Being a role
model
Facilitate
personal and
prof dev.
No of
resp.
Facilitate
content
learning
Mentoring and personal/professional development
0
Relate and
provide
perspectives
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Being a mentor
Figure 2. What do you think you do in your role as a
mentor? Multiple answers accepted.
Seventy-four percent of the questionnaire respondents
believed that the mentorship led to personal development
for (to some extent, to high extent or to a very high extent),
whilst 50% of the respondents claimed that the mentorship led
to professional development, when answering direct questions
about this. However, when asked if being a mentor led to
Table 1. The effect of mentorship on issues related to the respondents’ teaching.
Question
Has being a mentor increased your interest for teaching and supervision?
Has being a mentor lead to a development of your teaching and supervision?
Do you discuss pedagogical issues (including the mentorship) more now than before
you were a mentor?
Has being a mentor developed your view on what it means to be a good teacher?
Has being a mentor developed your view on what is important to you as a teacher?
Has being a mentor led to increased reflections regarding your teaching?
Has being a mentor increased your understanding of the students’ situation?
Has being a mentor improved your relations with students?
Not
at all
To some
extent
To a high
extent
To a very
high extent
19
11
29
33
44
30
7
3
2
2
0
0
7
6
10
10
18
44
43
41
27
35
7
8
8
22
6
0
2
0
1
1
Table 2. The effect of mentorship on issues related to the respondents’ personal and professional development.
Question
Has
Has
Has
Has
being
being
being
being
a
a
a
a
mentor
mentor
mentor
mentor
led
led
led
led
to personal development for you?
professional development for you?
to increased reflections regarding your own values?
to increased reflections regarding own work practices as an MD?
Not
at all
To some
extent
To a
high extent
To a very
high extent
13
31
11
15
37
26
43
39
8
3
6
6
1
0
0
0
151
T. Stenfors-Hayes et al.
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increased reflections regarding their own values and work
practices, a majority of the respondents claimed this to be the
case. The median value for all responses apart from professional development was ‘to some extent’ and for professional
development it was ‘not at all’ (Table 2).
One interviewee respondent believed that the mentee’s
experiences provided her with perspectives on her own life
situation. The mentorship also seems to have led to reflections
regarding approaches and relations to colleagues in other
professions and patients. Some mentors have also reflected
upon gender issues and ethical dilemmas brought up by their
mentees. These reflections did not only take place in the
meetings with the mentees but also in-between meetings.
Some mentors claimed that their professional development
mainly concerned their teaching and not so much their role as
a doctor.
Discussion
Based on the findings of this study, the presented programme
appears to be similar to many others regarding the issues
discussed, the mentor role (Abernethy 1999; Connor et al.
2000) and problems regarding lack of time (Abernethy 1999;
Ehrich et al. 2002; Straus et al. 2009). The problems related to
lack of training are also common in mentor programmes
(Abernethy 1999; Andrews & Wallis 1999; Woessner et al.
2000; Ehrich et al. 2002; Bray & Nettleton 2007; Straus et al.
2009). The respondents of this study appreciated the training
given and found it sufficient as well as beneficial within other
areas, as previously found by Connor et al. (2000).
There is likely to be some variation in what the respondents
include in the concept of professional development. For some,
this may refer primarily to hands-on medical skills or knowledge. Others may include increased reflections regarding their
own values and work practices, as well as reflections
regarding, for example, approaches and relations to colleagues
and patients or ethical dilemmas in the concept, all which are
found as the results of the mentorship. This somewhat unclear
definition of professional development makes it difficult to
draw any conclusions and is a weakness of this study.
Many clinical teachers do not really consider themselves
teachers, since their main responsibility is patient care and not
education (Stark 2003; MacDougall & Drummond 2005; Taylor
et al. 2007). Teaching as well as mentoring, is furthermore
viewed by the respondents as an individual task, often
unnoticed or unsupported by others. The findings of this
study show that being a mentor led to changes that may be
related to professional development as a teacher, and therefore, the mentorship may provide a link between teaching and
clinical practice and be a way to support and enhance the
teacher role.
Many of the responses in the interviews illustrate a difficulty
in capturing the essence of the benefits of being a mentor.
Nevertheless, it has become clear that benefits exist, not only,
as traditionally focused on, for the mentee, but also for the
mentors. These may, however, not be easy to verbalise as they
mainly concern changes in attitudes or approaches and
increased reflections. Another reason why the benefits are
hard to capture may be that the mentors looked upon their
152
task as something they do for the students and not for their
own development. However, an increased awareness of the
potential opportunities involved may facilitate further personal
and professional development for all mentors. The advantages
of being a mentor have not previously been explored in
medicine (Buddeberg-Fischer & Herta 2006) and this leaves us
with a field too big to cover in one study. This study focused
on the relationship between mentorship and teaching. Other
studies are needed to further explore transferability of our
findings (Graneheim & Lundman 2004), that is if similar
relationships and benefits of being a mentor exist in other
areas.
Acknowledgements
T. Stenfors-Hayes set up the study and gathered all data from
respondents and literature and wrote the article. All co-authors
provided feedback to the research design and H. Hult, L.O.
Dahlgren and S. Ponzer also provided valuable feedback to
drafts of the article. S. Ponzer initiated the mentor programme.
The authors would like to thank all mentors in the project.
Declaration of interest: The authors report no conflicts of
interest. The authors alone are responsible for the content and
writing of the article.
Notes on contributors
TERESE STENFORS-HAYES is an educational developer at Centre for
Medical Education (CME) Karolinska Institutet.
SUSANNE KALE´N is a PhD student, RN, BSc(Med) at the Department of
Clinical Science and Education, So¨dersjukhuset.
SARI PONZER, MD, is a Professor of Orthopaedic Surgery and Dean of
Higher Education at Karolinska Institutet. Her research focus on orthopaedic trauma with special interest in psychosocial factors and outcome in
terms of quality of life. Her medical education research focus on
interprofessional education, professional development and curriculum
development.
LARS OWE DAHLGREN is a Professor of Education, Linko¨ping University
and visiting professor, part-time of Medical Education at Karolinska
Institutet, Stockholm. His research interests comprise higher education in
general, medical education, inter-professional education, problem-based
learning, patient communication, qualitative analysis ( phenomenography).
HA˚KAN HULT is an Associate Professor of Education, Linko¨ping University
and visiting professor, part-time of Medical Education at Karolinska
Institutet, Stockholm.
HANS HINDBECK, MA, is an educational consultant specialised in
evaluation of medical education at the Centre for Medical Education
(CME), director of the Medical Statistics Unit (MedStat) at the Department of
Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet.
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