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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 6  |  Issue : 4  |  Page : 195-200

Acceptability of clinical teaching by mentorship among medical students in Nigeria


1 Department of Obstetrics and Gynecology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Date of Web Publication8-Dec-2017

Correspondence Address:
Marliyya S Zayyan
Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.220328

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  Abstract 

Background: Mentoring is “a process whereby an experienced, highly regarded, empathetic person guides another individual in the development and reexamination of their own ideas, learning, and personal and professional developments.” We determine the acceptability of mentoring by undergraduate medical students in obstetrics and gynecology and the challenges of mentoring as perceived by the mentees.
Patients and Methods: All undergraduate students of obstetrics and gynecology for 2009/2010 sessions were assigned to a mentor according to their admission numbers for clinical teaching. Guidelines were drawn for the scope, mode of teaching as well as the timing of contact for 16 weeks. Structured questionnaires were administered to assess their acceptability of the scheme as well as the problems of mentoring. The data were analyzed by the statistical package for social sciences.
Results: One hundred and twenty 5th year medical students were interviewed. They were aged 22-32 years with a mean of 25.7 years. There were 82 (73.2%) males and 30 (26.8%) females. The students were in medical schools for an average of 6.1 years. Eighty-two students (73.2%) assessed the scheme as good while 4 (3.7%) assessed it as poor. The teaching objectives were judged to be satisfactorily met by 99 (88.6%) students and 91 (81.3%) assessed contact with teachers as satisfactory. The clinic facilities were thought to be good for learning by 102 (91.1%) and 79 (70.5%) considered the facilities provided to be conducive for individual private learning. Facilities for research were considered to be adequate by 53 (47%). The main drawback of the scheme was lack of uniformity in standard by the mentors, as reported by 87 (77.6%).
Conclusion: Mentoring in clinical medicine is both convenient and acceptable by medical students.

Keywords: Clinical teaching, medical students, mentoring


How to cite this article:
Zayyan MS, Madugu HN, Ameh N, Oguntayo OA, Adesiyun AG, Saad AA. Acceptability of clinical teaching by mentorship among medical students in Nigeria. Arch Int Surg 2016;6:195-200

How to cite this URL:
Zayyan MS, Madugu HN, Ameh N, Oguntayo OA, Adesiyun AG, Saad AA. Acceptability of clinical teaching by mentorship among medical students in Nigeria. Arch Int Surg [serial online] 2016 [cited 2018 Apr 19];6:195-200. Available from: http://www.archintsurg.org/text.asp?2016/6/4/195/220328


  Introduction Top


Mentorship took origin from ancient Greece when Ulysses (Odysseus), King of Ithaca left his son Telemachus in the hands his friend as a “mentor” who eventually not only educated but also shaped his character.[1] Mentoring is “a process whereby an experienced, highly regarded, empathetic person (the mentor) guides another (usually younger) individual (the mentee) in the development and reexamination of their own ideas, learning, and personal and professional development.

The mentor, who often (but not necessarily) works in the same organization or field as the mentee, achieves this by listening or talking in confidence to the mentee”.[2]

The first profession to take to mentoring was business where executives who had been mentored earned more money at a younger age, were better educated, and more likely to follow their initial career paths with an experience of greater career satisfaction than those who did not have mentors.[3],[4],[5] Studies have shown that strong mentoring relationship is associated with many positive career outcomes.[6],[7],[8]

Since the 1990s, mentoring schemes have been introduced in medicine, specifically in nursing [9],[10],[11] but formal mentoring programs for doctors and medical students were not established until the late 1990s when its use became widespread.[12],[13],[14]

There is no uniformity of the standard regarding how and when mentorship should be applied in clinical medicine but it is widely practiced in various parts of the world with varying results.[1],[9]

The Ahmadu Bello University Medical School was established in 1967 about 5 years after the inception of the university. Intake of medical students increased from 20 students at inception to 180 in 2010. Training was carried out in three clinical locations until November 2005 when the staff in all three locations where merged in a newly constructed 500-bed hospital at Shika Zaria. This resulted in overcrowding of both staff and students. The clinical departments of the university particularly faced important challenges of crowding around patients and loss of patients' privacy.

Medical students in this university are taught clinical skills on real patients, as manikins are not available for use due to high cost. Patients often feel the loss of privacy when faced with a large crowd of students who could easily play truant without being noticed. These problems are especially pronounced in the Department of Obstetrics and Gynecology because of the sensitive nature of clinical obstetric and gynecologic examinations.

Mentorship scheme was introduced in obstetrics and gynecology in order to improve teaching and maintain the quality of medical education. The objective of this study was to determine the acceptability of mentoring by undergraduate medical students in obstetrics and gynecology and the challenges of mentoring as perceived by the mentees


  Patients and Methods Top


One hundred and twelve students posted to the Department of Obstetrics and Gynecology in the 2009 and 2010 academic sessions were studied. The students were posted in two batches of sixty each.

The study was conducted over 16 weeks of their posting in the department. In the first 9 weeks, gynecology and the disorders of pregnancy are taught and the subsequent 7 weeks cover labor delivery and the puerperium. An assessment is conducted after each of the segments. Each segment is covered by different mentors. The mentors included 16 consultants, 20 senior registrars, and 10 experienced registrars.

The scheme

Each mentor was assigned one to three students. Six of the senior consultants who had administrative and other responsibilities were paired with senior registrars under their training to co-mentor the students. Students were assigned according to their admission numbers by the coordinator of undergraduate studies. No mentor was allowed to choose his or her mentee and vice versa. The students were swapped after 8 weeks to allow them to benefit from a second mentor or group during the posting.

Clinical teaching guidelines were defined and a logbook was assigned to the mentee to indicate if the mentors had covered the teaching. The mentors interacted with their mentees in practical clinical teaching such as ward rounds, antenatal, gynecology clinics, and emergency patient care at on-calls and in theater sessions. Mentor-mentee interactions average five times in 1 week. Standardization of teaching was done with the teaching guideline that covered essential clinical skills and subjects.

Students' attendance was monitored by filling a register of events against subjects and the skills covered by the mentors. They were certified to have attended the posting if at least 75% of the subjects outlined in the guideline were covered.

At the end of the posting, the students filled a self-administered pretested questionnaire as an instrument for data collection with the aim of assessing the acceptability of the scheme and the problems as perceived by the students. The questionnaire focused on personal data and medical education history of the students and their perception of the scheme in five critical areas. This included contact with and performance of the mentors, facilities and infrastructure, course content, organization of the scheme, and personal assessment of their performance with the scheme.

Data cleaning and editing were done after the data collection manually and then electronically by the use of a computer. The Statistical Package for Social Sciences version 20 (Chicago Illianois) was used for data analysis.


  Results Top


One hundred and twelve students were interviewed. They were aged 22-32 years [Figure 1]. Only 12 (11.4%) students were 22 years, which is the right age for their stage of study. The mean age was 25 years. There were 82 males (73.2%) and 30 females (26.8%). The male students were older than the female students.
Figure 1: Age distribution of the medical students

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The students were in medical schools for 5-10 years with a mean of 5.5 years [Figure 2]. Three students spent 9-10 years in medical school. Fifty-three (47.3%) students were in the 2nd year of clinical teaching, which is the right stage but 59 (52.7%) students had exceeded this time period.
Figure 2: Duration in medical school

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Assessment of the scheme

One hundred and four (92.9%) students were mentored for the first time while 8 had previous experience. A majority, i.e., 82 (73.2%) assessed the scheme as good or very good, four students (3.7%) assessed the scheme as poor, and the rest 26 (23.2%) rated it as fair [Figure 3]. Overall, 60/82 (74.3%) males and 22/30 (72.4%) considered the scheme to be well-organized. The age of the students did not influence the perception organization of the scheme. The teaching objectives as outlined in the guidelines were confirmed to be satisfactorily met by 71 (63.4%) students [Figure 4]. The remaining 13 (11.6%) wished that more topics were covered.
Figure 3: Assessment of the scheme by the students

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Figure 4: Achievement of outlined teaching objectives

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In terms of contact with teachers, 67 (59.9%) thought it to be satisfactory.

The mentors were said to be enthusiastic by 102 (91.1%) students and 91 (80.8%) students agreed that the mentors took time to explain the subject addressing individual concerns.

Assessment of facilities by the students

Clinical facilities as utilized by the mentors were thought to be good for learning by 102 (91.1%) while 98 (87.5%) agreed that the facilities were conducive for small peer group work. Only 79 (70.5%) considered the facilities to be provided to be conducive for individual private learning.

In the wards, 98 (87.5%) agreed that the facilities were conducive for small peer group work but only 79 (70.5%) thought that they were adequate for individual work. Seventy-five percent or more theater sessions were attended by 83 (74.1%) students and 78 (69.6%) thought that the teaching was adequate. Facilities for research were considered to be adequate by 53 (47.3%) students.

Overall, 100 (89.3%) recommended teaching by the mentoring method and did not wish to revert to the traditional method.

The reasons advanced for preference of the mentoring system over traditional system included acceptability [24 students (21.4%)], better learning with the mentorship [36 students (32.1%)], and close contact with the mentor [66 students (58.9%)].

Challenges

As regards shortcomings, 87 (77.6%) students agreed that clinical teaching was not uniform with the different mentors and identified this to be the most important challenge with the scheme [Figure 5]. Other challenges identified by the students included nonavailability of the mentors [22 (19.6%)] and poor commitment of the mentees [12 (10.7%)]. The lack of regular Internet facilities was considered to be an important drawback by 75 (67%) students while 14 (12.5%) thought that more books were required.
Figure 5: Challenges of the scheme as perceived by the students

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On ways to improve the system, students suggested more commitment by the mentees [50 (44.6%)], improved punctuality [5 (4.5%)], and more rotation of the students among the mentors [3 (2.7%)] [Figure 6]. The remaining 64 (57.1%) students thought that the system should be continued without any alteration.
Figure 6: Suggested ways of improving the scheme

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  Discussion Top


Organized training with mentorship in undergraduate medicine is well-established in America, Europe, and the Far East but not in Africa [2],[7] where the need for qualitative medical training is fundamental. The introduction of formal training by mentorship in this medical school though born out of necessity has proven to be feasible and acceptable to both the students and teaching staff. In Switzerland, similar circumstances of high medical students' intake of 220 students per university per year reported improved training outcomes using mentorship.[15]

The average age of students in this study was 25 years at 5th year medical school showed a significant delay in the education of young persons based on the age of school entry in Nigeria. More than half of the group (52.7%) had experienced a delay in their study particularly in clinical medicine. Educational surveys from Nigeria often show similar findings of a significant delay in the educational achievement.[16],[17] This delay in school can be associated with loss of self-confidence and self-esteem. It can also be counterproductive for the labor market.

Improvement of teaching methods may result in an earlier age of completion of studies. Investigators have shown that executives who were mentored earned more money at a younger age, were better educated, and were more likely to follow their career paths and had better career satisfaction than those who did not have mentors. In a survey of faculty from 24 US medical schools, 31 faculty members with mentors had significantly higher career satisfaction scores than those without mentors (mean score 62.6 vs. 59.5 on a scale range of 20-100; P < 0.003).[3] A study of Canadian obstetrics and gynecology fellows found that those who reported that they had a mentor were more likely to achieve a promotion [hazard ratio 2.33; 95% confidence interval (CI), 1.36-3.99].[18]

In this study, over 70% of the students perceived the scheme as good and there was no difference in this perception with age or sex of the students (P < 0.5).

The acceptability of mentoring is well-established in various studies and systemic reviews;[2],[3] however, difficulty of mentees finding mentors on their own is a recurrent challenge in both undergraduate and postgraduate medical educations. In a survey of medical schools in the University of California, San Francisco, California, USA 22% of the women junior faculty and 21% of the women on-house staff never had a professional mentor. There was no mentor reported in their current position at the university for 43% of the house staff (the same for men and women) and 45% of the women junior faculty.[19]

This challenge was averted by the method used in this institution as mentors were assigned to the mentees without the option of selection given to either. While some authors opined that encouraging mentees to find mentors would give them the required career support,[3] organized mentorship taken up by education providers in undergraduate medicine may be more reliable and certain. In a review by Marrett, mentorship programs that are designed with specific goals in mind specifying approximate contact between the mentor and mentee are more likely to succeed than those that do not.[20]

In the present study, the program set out teaching goals and objectives and the timing of contacts with the mentee. The students particularly agreed on the efficiency of the system in covering clinical teaching guidelines as 88% thought that the clinical teaching guidelines were satisfactorily covered and 92% of the students agreed that their expectation of the scheme was met, which means that even the students who did not rate the scheme well agreed that it met their expectation. These assessments though neither objective nor quantifiable will be best ascertained by more measurable tasks.

Small group mentoring of two to three mentees per mentor could abolish the need for same sex mentoring, which is being recommended by some authors.[19] No specific attempt was made to achieve same sex mentoring in this group. The only guide to assigning a mentor is the serial admission number.

The main drawback of the teaching method was nonuniformity in the standards between different mentors. Even though a guide was given, it seemed that the depth to which the various mentors covered the subject differed. This nonuniformity was confirmed by 77.6% students. This may have been due to differences in the experience of the mentors or differences in their commitments. In an attempt to reduce this effect on the outcome of teaching, the mentees were rotated to other mentors but the duration of the posting was too short for all the students to be mentored by more than two groups of mentors. The mentors' attitude toward the student has been noted to be most critical to success.


  Conclusion Top


Mentoring in clinical medicine is both convenient and acceptable by medical students. It is an efficient method of covering clinical teaching guidelines and satisfactorily meets students' expectations.

Organized mentoring undertaken by the teaching authorities not only removes bias in mentee selection but also provides equal opportunities to the students.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Eliza GC. Collins and Patricia Scott, “Everyone Who Makes It Has a Mentor.” HBR 1978;56:89-110.  Back to cited text no. 1
    
2.
Barondess JA. A brief history of mentoring. Trans Am Clin Climatol Assoc 1995;106:1-24.  Back to cited text no. 2
    
3.
Sambunjak D, Straus SE, Marusić A. Mentoring in academic medicine: A systematic review. JAMA. 2006;296:1103-15.  Back to cited text no. 3
    
4.
Roche GR. Much Ado about mentors. HBR 1979;57:14-28.  Back to cited text no. 4
    
5.
Frei E, Stamm M, Buddeberg-Fischer B. Mentoring programs for medical students — A review of the PubMed literature 2000-2008. BMC Med Educ 2010;10:32.  Back to cited text no. 5
    
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Kalet A, Krackov S, Rey M. Mentoring for a new era. Acad Med 2002;77:1171-2.  Back to cited text no. 6
    
7.
Bligh J. Mentoring: An invisible support network. Med Educ 1999;33:2-3.  Back to cited text no. 7
    
8.
Butters S. Authority and power in mentoring: Some comparisons between teaching, engineering, design and social work. In: Stephenson J, editor. Mentoring-the New Panacea. Norfolk: Peter Francis; 1997. p. 50.  Back to cited text no. 8
    
9.
National League for Nursing. Position Statement. Mentoring of Nurse Faculty. Board of Governors, January 28, 2006. Available from: http://www.nln.org/aboutnln/PositionStatements/mentoring_3_21_06.pdf. [Last accessed on 2016 Feb 10].  Back to cited text no. 9
    
10.
Jones M, Nettelton P, Smith L. The Mentoring Chameleon: A Critical Analysis of Mentors' and Mentees' Perceptions of the Mentoring Role in Professional Education and Training Programmes for Teachers, Nurses, Midwives and Doctors. Paper presented at the British Educational Research Association Annual Conference. University of Glamorgan; 2005. p. 14-17.  Back to cited text no. 10
    
11.
Cooper MD. Mentorship: The key to the future professionalism in nursing. J Perinat Neonatal Nurs 1990;4:71-7.  Back to cited text no. 11
    
12.
Scheckler WE, Tuffli G, Schalch D, MacKinney A, Ehrlich E. The class mentor program at the University of Wisconsin medical school: A unique and valuable asset for students and faculty. WMJ 2004;103-46-50.  Back to cited text no. 12
    
13.
Buddeberg-Fischer B, Herta KD. Formal mentoring programmes for medical students and doctors: A review of the medline literature. Med Teach 2006;28:248-57.  Back to cited text no. 13
    
14.
Coates WC, Crooks K, Slavin SJ, Guiton G, Wilkerson L. Medical school curricular reform: Fourth-year colleges improve access to career mentoring and overall satisfaction. Acad Med 2008;83:754-60.  Back to cited text no. 14
    
15.
Buddeberg-Fischer B, Stamm M, Buddeberg C. Academic career in medicine: Requirements and conditions for successful advancement in Switzerland. BMC Health Serv Res 2009;9:70.   Back to cited text no. 15
    
16.
Nigeria Demographic and Health Survey 2013. National Population Commission Federal Republic of Nigeria Abuja, Nigeria. Maryland, USA: ICF International Rockville; 2013. p. 7-35.   Back to cited text no. 16
    
17.
Friedrich Huebler International Education Statistics. Available from: http://huebler.blogspot.com/2005/12/. [Last accessed on 2016 Jan 17].  Back to cited text no. 17
    
18.
Wise MR, Shapiro H, Bodley J, Pittini R, McKay D, Willan A. Factors affecting academic promotion in obstetrics and gynaecology in Canada. J Obstet Gynaecol Can 2004;26: 127-36.  Back to cited text no. 18
    
19.
Osborn EH, Ernster VL, Martin JB. Women's attitudes toward careers in academic medicine at the University of California, San Francisco. Acad Med 1992;67:59-62.  Back to cited text no. 19
    
20.
Braimo H. Mentors and Proteges: A critical review of the literature. AEQ 1983;33:161.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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