Jun Kiat LUA1,2*, Rachelle Qi En TOH1,2, Kai Kee KOH1,2, Ruth Si Man WONG1,2, Elaine Li Ying QUAH1,2, Aiswarya PANDA1,2, Chong Yao HO1,2, Nicole‐Ann LIM1,2, Yun Ting ONG1,2, Keith Zi Yuan CHUA1,2, Victoria Wen Wei NG1,2, Sabine Lauren Chyi Hui WONG1,2, Luke Yu Xuan YEO1,2, Sin Yee SEE1,2, Jolene Jing Yin TEO1,2, Yaazhini RENGANATHAN1,2, Annelissa Mien Chew CHIN3 and Lalit Kumar Radha KRISHNA1,2,4,5,6,7,8
1Yong Loo Lin School of Medicine (YLLSOM), National University Singapore (NUS)
2Division of Palliative and Supportive Care, National Cancer Centre Singapore
3Medical Library, NUS Libraries
4Division of Cancer Education, National Cancer Centre Singapore
5Duke‐NUS Medical School
6Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool
7Centre for Biomedical Ethics, NUS
8PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice
*e0638946@u.nus.edu
Lua, J. K., Toh, R. Q. E., Koh, K. K., Wong, R. S. M., Quah, E. L. Y., Panda, A., Ho, C. Y., Lim, N.-A., Ong, Y. T., Chua, K. Z. Y., Ng, V. W. W., Wong, S-L. C. H., Yeo, L. Y. X., See, S. Y., Teo, J. J. Y., Renganathan, Y., Chin, A. M. C., & Krishna, L. (2023). The role of mentoring, supervision, coaching, teaching and instruction on professional identity formation: A systematic scoping review [Paper presentation]. In Higher Education Campus Conference (HECC) 2023, 7 December, National University of Singapore. https://blog.nus.edu.sg/hecc2023proceedings/the-role-of-mentoring-supervision-coaching-teaching-and-instruction-on-professional-identity-formation-a-systematic-scoping-review/
SUB-THEME
Communities and Education
KEYWORDS
Communities of practice, mentoring, supervision, coaching, professional identity formation
CATEGORY
Paper Presentation
BACKGROUND
The crucial role of mentoring in fostering professional identity formation (PIF) is greatly influenced by its integration with supervision, coaching, tutoring, instruction, and teaching. Yet, the impact of this comprehensive approach, the ‘mentoring umbrella’ (MU), lacks clear understanding. This is especially so in the healthcare setting which has constant interplay between various healthcare professionals, families, and patients. This systemic scoping review (SSR) thus provides an overview of the present state of knowledge and proffers new insights into better application of MU for educational purposes.
INTRODUCTION
Mentoring is vital for facilitating the development of PIF in medical students and physicians in training (henceforth mentees), helping them “think, act and feel like physicians” (Merton, 2013). The personalised, long-term, and comprehensive support provided by mentors assists the assimilation of professional values, beliefs, standards, codes of conduct, and culture of the medical profession into their own identities (Cruess & Cruess, 2018). However, understanding of the specific roles of mentoring in PIF has been limited due to the presence of various mentoring forms (Krishna et al., 2020; Krishna et al., 2019; Radha Krishna et al., 2019) and its association with other practices such as role modelling, supervision, coaching, tutoring, teaching, and instruction (Wahab et al., 2016). Two recent developments offer potential solutions to this challenge and can provide fresh perspectives into the impact of mentoring on PIF.
First, recent evidence suggests that when applied longitudinally, practices such as role modelling, supervision, coaching, tutoring, teaching, and instruction create the effects currently attributed to mentoring (Buddeberg-Fischer & Herta, 2006). Krishna et al. (2019) suggests that role modelling, supervision, coaching, tutoring, teaching, and instruction are part of a broader concept that can be referred to as the MU.
Second, on their own or in tandem within MU, these educational approaches shape professional identity by changing the mentee’s values, beliefs and principles (henceforth belief systems). Krishna’s Ring Theory of Personhood (RToP) suggest that the four domains of the belief system are contained within the Innate, Individual, Relational, and Societal Rings of the RToP (Figure 1) (Chan et al., 2021; Ho et al., 2020; Vig et al., 2021). Exposure, reflection, and inculcation of new experiences and beliefs systems over the course of a training programme changes parts of mentees’ belief systems within the four rings of the RToP. These changes inform self-concepts of personhood or “what makes you, you” (Krishna & Alsuwaigh, 2015), which in turn reshapes personal and professional identities. It is this link that allows the RToP to be utilised to sketch changes in PIF. Critically, the RToP also captures the impact of changing roles, and obligations, within the team, family unit, professional community, and society, and offers a deeper understanding of their thought patterns, actions, and capacity to adapt to diverse influences (Alsuwaigh, 2015; Arai et al., 2017; Ho et al., 2020; Khandelwal et al., 2015; Kim & Choi, 2015; Krishna, Alsuwaigh, et al., 2014; Krishna, Yong, et al., 2014; Kuek et al., 2020).
METHODOLOGY
Systematic Evidence‐based Approach (SEBA) (Figure 2) guided SSR seeks to map current understanding of the MU and its effects on PIF on mentees (Bok et al., 2020; Kow et al., 2020; Krishna et al.; Ngiam et al.). The primary research question was identified:
“What is known about the effect of mentoring, supervision, coaching, tutoring, teaching, and instruction on professional identity formation amongst medical students, residents, and junior doctors?”
It is hoped that insights provided will guide structuring, support, and oversight of the MU in nurturing PIF. Articles published between 1st Jan 2000 and 31st Dec 2021 in PubMed, Scopus, ERIC and the Cochrane databases were scrutinised. The included articles were concurrently summarised and tabulated, and concurrently analysed using content and thematic analysis and tabulated. The themes and categories identified were compared with the summaries of the included articles to create accountable and reproducible domains that guide the discussion.
RESULTS
A total of 12201 abstracts were reviewed, 657 full text articles evaluated, and 207 articles included (Figure 3).
The three domains identified were definitions; impact on PIF; and enablers and barriers.
The MU shapes PIF in three stages. To begin it builds a cognitive base of essential knowledge, skills, and professional attitudes. The cognitive base informs thinking, conduct, and opinions in early supervised clinical exposure in Communities of Practice (COP). The COPs’ individualised approach to the inculcation of desired professional characteristics, goals, values, principles, and beliefs reshapes the individual’s identity, whilst the socialisation process sees to their integration into current identities.
DISCUSSION
In this SSR, we highlight the impact of the MU on PIF, shedding light on its effects on different stages of PIF development and the role of the host organisation. When implemented over time in personalised learning relationships, involving individual or small groups of learners with shared goals, abilities, and experiences, the MU offers customised, prompt, and comprehensive support to the developing professional.
The overlapping elements within the MU provide synergistic support in tackling the influences of societal, professional, clinical, academic, research, and personal factors, as well as the prevailing sociocultural considerations and the impact of the healthcare and educational systems, including the local hidden, informal, and formal curriculum, on PIF. This highlights the wide applicability and stage-based nature of the MU in fostering PIF.
CONCLUSION
This SSR underscores the crucial role of MU in the development of PIF. Additionally, it emphasises the importance of conducting long-term and comprehensive evaluations to assess the impact of MU on PIF, as PIF significantly influences the personal growth and education of mentees during their interactions with diverse healthcare communities.
REFERENCES
Alsuwaigh, R. (2015). How do English-speaking cancer patients conceptualise personhood? Ann Acad Med Singapore, 44. https://doi.org/10.47102/annals-acadmedsg.V44N6p207
Arai, K., Saiki, T., & Imafuku, R. (2017). What do Japanese residents learn from treating dying patients? The implications for training in end-of-life care. BMC Med Educ, 17. https://doi.org/10.1186/s12909-017-1029-6
Bok, C., Ng, C. H., & Koh, J. W. H. (2020). Interprofessional communication (IPC) for medical students: a scoping review. BMC Med Educ, 20. https://doi.org/10.1186/s12909-020- 02296-x
Buddeberg-Fischer, B., & Herta, K. D. (2006). Formal mentoring programmes for medical students and doctors–a review of the Medline literature. Med Teach, 28. https://doi.org/10.1080/01421590500313043
Chan, N., Chia, J., & Ho, C. (2021). Extending the ring theory of personhood to the care of dying patients in intensive care units. Asian Bioethics Rev, 14. https://doi.org/10.1007/s41649-021-00192-0
Cruess, S. R., & Cruess, R. L. (2018). The development of professional identity. Vol. 17. In T. Swanwick, K. Forrest, & B. C. O’Brien (Eds.), Understanding Medical Education: Evidence, Theory, and Practice, Third Edition.
Ho, C. Y., Kow, C. S., & Chia, C. H. J. (2020). The impact of death and dying on the personhood of medical students: a systematic scoping review. BMC Med Educ, 20. https://doi.org/10.1186/s12909-020-02411-y
Khandelwal, A., Nugus, P., & Elkoushy, M. A. (2015). How we made professionalism relevant to twenty-first century residents. Med Teach, 37. https://doi.org/10.3109/0142159X.2014.990878
Kim, S., & Choi, S. (2015). The medical professionalism of Korean physicians: Present and future.
BMC Med Ethics, 26. https://doi.org/10.1186/s12910-015-0051-7
Kow, C. S., Teo, Y. H., & Teo, Y. N. (2020). A systematic scoping review of ethical issues in mentoring in medical schools. BMC Med Educ, 20. https://doi.org/10.1186/s12909-020- 02169-3
Krishna, L., K. T, T., & Yap H. W., e. a. (2020). Combined novice, near-peer, e-mentoring palliative medicine program: A mixed method study in Singapore. PLoS One, 15(6), e0234322. https://doi.org/10.1371/journal.pone.0234322
Krishna, L., Tan L. H. E., & Ong Y. T., e. a. (2020). Enhancing mentoring in palliative care: An evidence-based mentoring framework. J Med Educ Curric Dev. https://doi.org/10.1177/2382120520957649.
Krishna, L., Toh, Y. P., & Mason, S. (2019). Mentoring stages: A study of undergraduate mentoring in palliative medicine in Singapore. PLoS One, 14. https://doi.org/10.1371/journal.pone.0214643
Krishna, L. K., & Alsuwaigh, R. (2015). Understanding the fluid nature of personhood – the ring theory of personhood. Bioethics., 29. https://doi.org/10.1111/bioe.12085
Krishna, L. K., Alsuwaigh, R., & Miti, P. T. (2014). The influence of the family in conceptions of personhood in the palliative care setting in Singapore and its influence upon decision making. Am J Hosp Palliat Care, 31. https://doi.org/10.1177/1049909113500136
Krishna, L. K., Yong, C. Y., & Koh, S. M. (2014). The role of palliative rehabilitation in the preservation of personhood at the end of life. BMJ Case Rep, 9.
Kuek, J. T. Y., Ngiam, L. X. L., & Kamal, N. H. A. (2020). The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review. Philos Ethics Humanit Med, 15. https://doi.org/10.1186/s13010-020-00096-1
Merton, R. Κ. (2013). In R. K. Merton, G. G. Reader, & P. Kendall (Eds.), The Student-Physician: Introductory Studies in the Sociology of Medical Education. Harvard University Press.
Ngiam , L., Ong YA-O, & Ng JX, e. a. (2021). Impact of caring for terminally ill children on physicians: A systematic scoping review. Am J Hosp Palliat Care, 38(4), 396-418. https://doi.org/10.1177/1049909120950301
Radha Krishna, L. K., Renganathan, Y., & Tay, K. T. (2019). Educational roles as a continuum of mentoring’s role in medicine – a systematic review and thematic analysis of educational studies from 2000 to 2018. BMC Med Educ, 19. https://doi.org/10.1186/s12909-019-1872- 8
Vig, P. S., Lim, J. Y., & Lee, R. W. L. (2021). Parental bereavement – impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review. BMC Palliat Care, 20. https://doi.org/10.1186/s12904-021-00831-1
Wahab M. T., Ikbal M. F. M., Jingting W., Wesley L. T. W., Kanesvaran R., et al. (2016) Creating effective interprofessional mentoring relationships in palliative care- Lessons from medicine, nursing, surgery and social work. J Palliat Care Med 6:290. http://dx.doi.org/10.4172/2165-7386.1000290