gms | German Medical Science

Apart from imparting subject-specific knowledge and skills, guiding students towards self-organised and reflective learning should be a central goal of medical education. To achieve this goal, portfolio-based education is increasingly being developed both in training and CPD worldwide [1], [2], [3], [4], [5]. The reports on this form of learning repeatedly stress the importance of the learner having the support of a mentor [2], [6], [7], [8]. The mentor is meant to support and encourage both the professional and personal development of learner. Especially in the field of reflective learning, which is regarded as a central competence, the mentor is a key figure in the active support of the reflection process [9], [8], [10]. Supporting training by assigning mentors in recent years has been tried across the globe and evaluated with very good results [11], [8], [12]. At the Medical Clinic 1 of the University Hospital Erlangen-Nuremberg, training during the internal medicine tertial of the Practical Year has been structured as a portfolio since June 2003 [13]. The learning process is accompanied by mentors from the medical staff. In each case, a mentor supervises one, or at most two students. The authors interviewed the mentors about their activities one year after the start of the project. The analysis showed that the roles and responsibilities of a mentor was not clear to many member of the medical staff. As students to date have been perceived primarily as helpers, many mentors did not see the value of mentoring and felt it to be an additional burden in their daily routine.

Structured training of mentors should eliminate the ambiguities surrounding the task, increase the motivation of mentors and thus increase the quality of educational supervision the students are receiving. Through the associated added value and integration of the mentoring system, doctors in training will be encouraged to change their thinking (culture change). Over the next four years, the authors investigated whether the structured training of mentors impacted the contact frequency with students and whether the mentoring support experienced by students increases through the training. At the end of their tertial, students evaluated their mentor. These ratings were evaluated annually to determine whether long-term effects of mentor training can be measured.

One year after restructuring the educational unit of the tertial in interior medicine of the Practical Year, both mentors and students were asked about their contact with each other and their views on mentoring in general (structured questionnaire with free text answers).

After the first portfolio-based year of teaching, the evaluations of 14 mentors and 40 students were analysed. They were supplemented by interviews with the mentors. The most striking result was that the doctors involved in the mentoring were very uncertain about the role of a mentor and their duties. Of them expressed the wish for training. Subsequently, an external human resources development lecturer was tasked with the implementation of mentoring seminars for the medical staff. The seminar content was tailored towards the portfolio training concept and the needs expressed in the evaluations.

Contents of the seminars designed as a result:

• Role and responsibilities of a mentor
• Key qualifications
• Pedagogical basics
• Moderating as a mentor
• Communication guides
• Practical exercises

To test the effectiveness of the seminar, it was accompanied by a study. The following research questions were posed:

Target Outcome 1: Does training of mentors increase their contact frequency with students compared to untrained mentors?

Null hypothesis: The training of mentors has no effect on the contact frequency with students, compared with untrained mentors.

The descriptive hypothesis accordingly is: The training of mentors increased their contact frequency with the students they supervise.

Target Outcome 2: Do students feel better supported by their mentors in their studies if they have completed training?

Null hypothesis: Training of mentors has no influence on student support, compared with untrained mentors.

The descriptive hypothesis accordingly is: Students supervised by trained mentors feel better supported in their studies compared to students with untrained mentors.

At the end of the tertial, the students answered a questionnaire (see Appendix 1 [Attach. 1]), which looked at the contact with the mentor in detail. Two questions were asked all throughout in this study and evaluated:

1. How much contact did you have with your mentor on average? (No contact/less than once per month/1-3 times per month/1-2 times per week/more than 3 times per week)

Students were told that only the direct and conscious interaction which went beyond the usual daily encounters during normal work on the ward was to be counted.

2. Has the mentor supported you in your training to date? (5-point scale, from “no, not at all” to “yes, a lot”)

This information was coded with number, 1 (no contact/no, not at all) to 5 (> 3 times per week/yes, a lot) in the evaluation.

The data was analysed using the statistics programme SPSS 15.0. The significance test of the questions was performed using the t-test for independent samples, from inhomogeneous variations a correction of the t-value according to Welch was carried out. The significance test was based on a significance level of 5%.

Only results for which a sufficient number of responses had been received for were published.

2005 Questionnaire: 52 questionnaires were evaluated (Response rate = 98%), of these 23 for trained and 29 for untrained mentors.

2006 Questionnaire: 50 questionnaires were evaluated (Response rate = 88%), of these 9 for trained and 41 for untrained mentors.

2007 Questionnaire: 46 questionnaires were evaluated (Response rate= 100%), of these 14 for trained and 32 for untrained mentors.

2008 Questionnaire: 38 questionnaires were evaluated (Response rate= 86%), of these 21 for trained and 17 for untrained mentors.

One year after the initial training (2005), the contact frequency with trained mentors tended to be higher than with untrained mentors (4.87 vs. 4.55) according to the students but the difference was not significant due to the high dispersion of the values and the influence of a small sample size. For trained mentors, the support experienced by students was significantly higher than for untrained mentors (p <0.01) (see Table 1 [Tab. 1] and Figure 1 [Fig. 1]).

Between 2006 and 2008, no significant difference between the assessment of trained and untrained mentors is measurable anymore. The support by the mentors experienced by the students rose from 2005 to 2007 for all mentors (both trained and untrained) but without being significant. Here also the individual grades are widely dispersed. In 2008 it dropped slightly (see Table 1 [Tab. 1] and Figure 1 [Fig. 1]).

Thus the descriptive hypothesis of the target criterion “Training of mentors increases their contact frequency with students compared to untrained mentors” must be rejected (see Table 2 [Tab. 2]).

The descriptive hypothesis of the target criterion 2: “Students feel better supported by their mentors in their studies if they have completed training” can be supported for the first year after the first training but for the next three years it must be, however, rejected (see Table 1 [Tab. 1]).

In the year after the first mentor training, students with trained mentors felt significantly better supported than those with untrained mentors (4.17 vs. 3.52), the contact frequency in both groups studied was given as being between three or more contacts per week and did not differ. Especially because medical staff at the clinic in general has little time to care for the students, this result is interesting. Trained mentors were able to provide the students with significantly greater support in the first year after training with not extra time expenditure. In the following two years, all medical staff displayed a trend towards more intensive support for students independent of their training status. We interpret our results with the following theory: The structured mentor training keyed the medical staff to step up their role in teaching and gradually this behaviour was adopted by staff who had received no training. It should be borne in mind that while all members of the medical staff at the Medical Clinic 1 were classified as mentors, participation in mentor training was voluntary. It seems likely that staff who attended the training courses were more interested in the subject from the outset and that this fact must be considered when interpreting the study results. But more remarkable is the finding that measured two years after the first training was no difference in the evaluated support from trained and untrained mentors. It is all the more remarkable that two years after the first training there was no difference anymore in the support evaluation between trained and untrained mentors. We interpret the trend towards more intensive support for students which continued for three years as the success of our goal of culture change amongst the staff.

The instrumental reliability is limited because the properties of “direct contact with the mentor” and “support from the mentor” were only tested with one item each and these properties can only be measured subjectively. One question in the questionnaire which was supposed to break down the nature of the contact was answered very inconsistently by the students and was therefore not evaluated (see Appendix 1 for the questionnaire [Attach. 1]). To examine these properties more closely, an investigation using semi-structured interviews and qualitative analysis could be useful. The interpretability of the data collected is also limited by the small sample size.

Our observations suggest that internal training of mentors has a measurable positive effect on the training students receive. This applies even if the training lasts is relatively short (one day) and even if only part of the staff involved. Nevertheless, it could be noted that we were not able to show a consistent effect on the contact frequency and support in a portfolio-based training module without regularly recurring training because in 2008, the assessment of the mentoring support dropped slightly, which suggests that one-off training is not sufficient to achieve a lasting effect. Repeated training offers once a year should be the consequence. The analysis of student evaluation in the following years will show if this can achieve a renewed improvement of the ratings.

The authors declare that they have no competing interests.