Elevating Mentorship Competency for Sustained Impact via the University of Zambia Mentor Training Program

ABSTRACT.

The University of Zambia (UNZA) Mentor Training Program is conducted annually to strengthen the mentorship capacity of postgraduate programs for the health professions. This intensive five-session course trains faculty members in the mentorship of students. Established by senior UNZA leaders and US-based collaborators, this program was designed to address gaps in mentorship identified at the institutional level. Faculty facilitators developed the course curriculum and used a train-the-trainer model to ensure program sustainability. Participants were faculty members who mentor PhD and Master of Medicine students. To assess the program’s impact, mentors and their mentees completed questionnaires on the mentor’s mentoring competencies at the end of the course and 1 year later. Competency scores were compared longitudinally to quantify potential changes in mentoring behaviors. Mentors and mentees alike noted mentor growth in all competency domains from postcourse to 1 year later, providing evidence of a trend toward improvement in mentorship and that the program may have sustainable and positive effects on mentoring behaviors over time. Salient areas of growth corresponded to emphasized topics and discussions, including addressing diversity, aligning expectations, assessing capacities, motivating mentees, and fostering independence. These findings suggest that mentors internalized this content and transferred it to behavior change. The behavior changes may reveal a larger change in the institutional environment around the mentoring of students. The UNZA Mentor Training Program appears to have sustained impact after a year and should bode well for future benefits to students, faculty, and the institution.

INTRODUCTION

Mentorship is a formal or informal relationship between experienced and less experienced individuals that promotes professional and personal growth.^1,2 Faculty research mentors provide invaluable support to the capacity-building components of research institutions given that mentorship plays a pivotal role in the academic progression and professional development of a doctoral student.³ Mentorship for trainees in health programs, particularly in low- and middle-income countries (LMICs), is an important factor in building new cadres of researchers and professionals equipped to address evolving health challenges.^3–5 Mentorship training provides mentors with requisite knowledge and skills to appropriately support mentees, and mentees report better experiences with trained mentors.^6–9 Ensuring that faculty are well equipped to mentor students is crucial for productivity and sustainability.

The University of Zambia (UNZA) Mentor Training Program—launched in 2018 in collaboration with the Vanderbilt Institute for Global Health and the University of North Carolina at Chapel Hill, with support from the US National Institutes of Health’s Fogarty International Center—was established to provide a structured approach to faculty training and support in mentorship.¹⁰ This intensive 5-day development program aimed to train faculty members in the mentorship of PhD students in the health professions. Prior to this program, doctoral students received mentorship support in which progress toward the doctorate was monitored rather than guided. Because mentorship occurs in a social context as a series of dynamic, reciprocal interactions,⁷ understanding the impact of this program on shifting mentorship behavior and culture was an essential step in developing the next generation of scientific medical leaders.

Few mentorship programs are evaluated using definitive parameters.¹¹ The Mentoring Competency Assessment (MCA) questionnaire, developed by Fleming et al.,¹² provides a systematic approach for outcome measurement and has been used to assess the efficacy of mentor-training interventions across diverse disciplines and in other mentorship initiatives.^13–16 However, the MCA had not been used to assess mentor-training programs in LMICs such as Zambia. In this study, we sought to evaluate the long-term impact of the UNZA Mentor Training Program on mentorship competency within the institution. Additionally, we assessed the feasibility of using the MCA in countries beyond those in high-income countries, where it was previously studied.

MATERIAL AND METHODS

Study site and population.

UNZA faculty facilitators developed the course curriculum by selecting common and relevant topics from a review of the academic literature of mentorship curricula in African academia and other similar settings. The facilitators contextualized topics to the needs of UNZA students and faculty and created 10 thematic modules on common topics, challenges, and best practices in mentorship (Table 1). Further details about course development are described elsewhere.¹⁰ Senior UNZA faculty leaders taught the modules in dyads over 5 full-day workshops using a range of educational strategies including case studies, small group discussions, and simulations. The program was taught in a “flipped-classroom” model, in which trainees review content materials (e.g., peer-reviewed articles) before each workshop and then engage in conversations about the content topics through small group discussions, case studies, and other engaging activities. Because this model was new to many of the faculty facilitators, they participated in a 2-day workshop on the flipped-classroom model and curriculum development, led by the Vanderbilt Institute for Global Health. The mentorship program was first introduced in 2018 and the course was taught again in 2019 and 2021. In each iteration, the facilitators, who included the original instructors as well as alumni who had become instructors, tailored the workshops to address the evolving needs of trainees. The flipped-classroom model lends well to these contextual changes because the learning is trainee centered. All materials and activities could be easily accessed and used in LMICs.

Table 1.

Titles of modules in the University of Zambia Mentor Training Program

Module no.	Module title	Workshop day
1	Elements of effective leadership and mentorship	1
2	Diversity and personal frame of reference in mentorship
3	Goals and expectations	2
4	Effective communication
5	Identifying and resolving challenges and issues	3
6	Fostering independence in the mentorship relationship
7	Professional responsibilities in mentorship	4
8	Ethical dimensions of mentorship
9	Mentorship philosophies	5
10	Evaluating the mentorship relationship

The UNZA School of Medicine was opened in 1966 to train medical doctors. With the passage of time, the school introduced nursing programs and then pharmacy, physiotherapy, and biomedical science programs. The added programs, including public health, operated as departments within the School of Medicine. Because of the growth in these programs, a decision was made in 2016 to divide the expanded School of Medicine into four schools: the School of Medicine, School of Public Health, School of Nursing Sciences, and School of Health Sciences (comprising pharmacy, physiotherapy, and biomedical sciences). The four schools, commonly referred to as the Ridgeway Campus Schools (RCS), collaborate and share most of their resources such as transport, lecture space, staff, and professional development training. Participants of the Mentor Training Program were faculty members at the UNZA RCS. They were identified as current or future mentors of students in UNZA’s PhD and Master of Medicine programs. Participants were primarily junior faculty members, and program facilitators were senior faculty members at the UNZA RCS. Facilitators and participants are referred to as “mentors” for the remainder of this manuscript. “Mentees” were current PhD students and junior faculty members who were current mentees of the individuals who participated in the program.

Study design.

We analyzed longitudinal data from the 2018 and 2019 cohorts. To assess change in mentorship behaviors among participants and facilitators in the year following the workshops, we queried mentors and their mentees about mentorship behaviors at the end of a mentor’s participation in the course and 1 year later. We used the MCA questionnaire to gather self-reports from mentors and observations from mentees about mentorship behavior from the time of course completion to 1 year later. Mentors completed the MCA as a course activity that provided an initial assessment of their competencies. We contacted these individuals approximately 1 year later with the same instrument. We administered the questionnaire using research electronic data capture (REDCap), a secure web-based platform for survey development and database management hosted at Vanderbilt University.^17,18

In addition, as part of the workshop, we asked mentors to list their mentees, which generated the list used in the study. These mentees were contacted via e-mail from REDCap immediately after their mentors finished the course and 1 year after the conclusion of the course and asked to complete the MCA as well (see below). Mentees and mentors were assured of the anonymity and confidentiality of their responses. Questionnaires completed at the end of the course are referred to as “pretraining” and those completed 1 year after the course are referred to as “posttraining.”

The MCA instrument used in our evaluation assesses six mentorship competency domains, including maintaining effective communication, aligning expectations, assessing understanding, fostering independence, addressing diversity, and promoting professional development. It includes separate versions tailored for mentors and mentees. Both questionnaires include the same 26 items that query on specific mentorship behaviors aligned with the six competency domains. Mentors self-rate their mentorship behaviors and mentees rate their mentors’ behaviors. Respondents rate behavior descriptions on a seven-point Likert-type scale in which 1 equates to “not at all skilled,” 4 to “moderately skilled,” and 7 to “extremely skilled.” Respondents also have the option of 0 for “not applicable” (mentors) or “not observed” (mentees).

The study procedures and instruments were approved by the University of Zambia Biomedical Research Ethics Committee and the Vanderbilt University Institutional Review Board.

Statistical analysis.

To determine mentor competency levels and change from pretraining to posttraining, we calculated the mean score and standard deviation (SD) for each of the 26 items as scored by mentors and mentees at both time points using Microsoft Excel. All 0 responses (i.e., not applicable) were excluded from the calculations. We calculated changes from pretraining to posttraining by subtracting the posttraining mean from the pretraining mean and calculated percent changes by dividing changes by pretraining means. We calculated the means, SDs, changes, and percent changes for each of the six competency domains in the same manner using the means of the corresponding behaviors. To assess the internal consistency (reliability) of the mentor and mentee instruments, we calculated the coefficient alpha for each group. We used Cronbach’s coefficient alpha, a measure of internal consistency, to measure the psychometric properties of the items within the MCA questionnaire.

RESULTS

In total, 34 mentors participated in the program; 32 completed the pretraining questionnaire and 19 completed the posttraining questionnaire (response rates 94 and 56%, respectively). Mentors identified a total of 115 mentees, of whom 54 completed the pretraining questionnaire and 28 completed the posttraining questionnaire (response rates 47 and 24%, respectively). Demographic information about mentors was collected as part of the program. However, to maintain full anonymity for mentors and mentees, no demographic information was collected in the questionnaire nor was there matching of pretraining and posttraining questionnaires within the groups or between mentors and mentees.

More men participated as mentors (N = 24; 71%). Distribution among UNZA RCS programs varied: 16 (47%) were from the School of Medicine; 8 (24%) were from the School of Health Sciences; 7 (21%) were from the School of Public Health; and 3 (9%) were from the School of Nursing Sciences. Mentors had a mean of 5.2 mentees (range, 1–8 mentees). Mentors indicated they had been mentoring for a mean of 4.2 years (range, 0–21 years).

Psychometric properties of the MCA.

The coefficient alpha scores for the 26 items rated by the mentors and mentees were both 0.98 when rounded to the nearest hundredth. The coefficient alpha scores for the six competencies as rated by the mentors versus mentees, shown below, reflected high internal consistency.

• Managing effective communication (6 items), 0.91 versus 0.87

• Aligning expectations (5 items), 0.95 versus 0.91

• Assessing understanding (3 items), 0.93 versus 0.94

• Addressing diversity (2 items), 0.94 versus 0.95

• Fostering independence (5 items), 0.93 versus 0.92

• Promoting professional development (5 items), 0.81 versus 0.92

Mentors’ results.

At the end of the course (pretraining), the mentors’ mean self-rating (SD) for the 26 competency items was 4.75 (1.38) compared with 5.71 (0.91) 1 year later (posttraining), a 20% increase over time in perceived competency from pretraining (Table 2). Mentors’ greatest domains of growth were in “addressing diversity” (31% increase from pre- to posttraining), “aligning expectations” (26% increase), and “assessing understanding” (24% increase). Top competency item growths were “aligning expectations” (37% increase), “accounting for biases and prejudices” (33% increase), and “helping establish a work–life balance/understanding impact as a role model” (31% increase).

Table 2.

Mean scores, SDs, and change over time of mentors’ and mentees’ skills evaluated using the Mentor Competency Assessment

Skills by domain* and competency	Mentors			Mentees
	Mean score (SD)		Change (%)	Mean score (SD)		Change (%)
	Pretraining	Posttraining		Pretraining	Posttraining
Overall	4.75 (1.38)	5.71 (0.91)	20	5.55 (1.46)	5.92 (1.37)	7
Maintaining effective communication*	5.14 (1.16)	5.74 (0.95)	12	5.81 (1.25)	6.03 (1.19)	4
Active listening	5.47 (0.97)	5.89 (1.02)	8	5.93 (1.14)	6.36 (0.89)	7
Providing constructive feedback	5.41 (1.00)	5.89 (0.64)	9	6.26 (0.91)	6.50 (1.05)	4
Developing a trusting relationship	5.48 (0.98)	5.68 (0.98)	4	5.98 (1.14)	6.14 (1.06)	3
Accommodating communication styles	4.87 (1.24)	5.37 (0.87)	10	5.66 (1.32)	6.04 (1.14)	7
Pursuing strategies to improve communication	4.58 (1.39)	5.68 (0.92)	24	5.56 (1.33)	5.69 (1.59)	3
Coordinating with other mentors	5.00 (1.37)	5.89 (1.25)	18	5.46 (1.68)	5.48 (1.41)	0.4
Aligning expectations*	4.51 (1.57)	5.67 (0.77)	26	5.31 (1.51)	5.92 (1.39)	11
Setting clear relationship expectations	4.56 (1.66)	5.58 (0.88)	22	5.31 (1.45)	6.00 (1.54)	13
Aligning expectations	4.25 (1.41)	5.84 (0.49)	37	5.31 (1.51)	5.84 (1.46)	10
Considering mentor–mentee differences	4.72 (1.62)	5.58 (0.94)	18	5.31 (1.57)	5.92 (1.15)	11
Setting research goals	4.94 (1.41)	6.21 (0.61)	26	5.78 (1.40)	6.18 (1.31)	7
Developing strategies to meet goals	4.75 (1.44)	5.79 (0.77)	22	5.57 (1.50)	6.00 (1.51)	8
Assessing understanding*	4.74 (1.40)	5.87 (0.84)	24	5.57 (1.46)	6.11 (1.32)	10
Assessing mentee knowledge	4.71 (1.49)	5.68 (1.03)	21	5.64 (1.39)	6.12 (1.15)	8
Estimating mentee ability	4.81 (1.45)	5.95 (0.89)	23	5.54 (1.47)	6.22 (1.17)	12
Enhancing mentee skills	4.47 (1.22)	5.74 (0.91)	28	5.34 (1.55)	6.04 (1.45)	13
Fostering independence*	5.04 (1.39)	5.95 (0.84)	18	5.73 (1.44)	6.23 (1.19)	9
Motivating mentees	5.29 (1.35)	6.26 (0.91)	18	5.85 (1.38)	6.52 (0.83)	11
Building confidence	5.32 (1.38)	6.21 (0.83)	17	5.92 (1.39)	6.46 (1.05)	9
Stimulating creativity	4.84 (1.46)	5.58 (0.94)	15	5.62 (1.51)	6.04 (1.16)	7
Acknowledging mentees’ professional contributions	5.19 (1.38)	6.26 (0.44)	21	5.96 (1.23)	6.07 (1.39)	2
Negotiating path to independence	4.55 (1.36)	5.42 (1.09)	19	5.27 (1.68)	6.04 (1.54)	15
Addressing diversity*	4.47 (1.45)	5.87 (0.92)	31	5.37 (1.46)	5.56 (1.59)	4
Accounting for biases and prejudices	4.20 (1.30)	5.58 (0.94)	33	5.14 (1.52)	5.41 (1.70)	5
Accounting for different backgrounds of mentors and mentees	4.73 (1.59)	6.17 (0.90)	30	5.60 (1.40)	5.72 (1.48)	2
Promoting professional development*	4.28 (1.46)	5.25 (1.11)	23	5.27 (1.71)	5.43 (1.70)	3
Helping network effectively	4.55 (1.43)	5.26 (1.16)	16	5.51 (1.66)	5.72 (1.43)	4
Setting career goals	4.50 (1.31)	5.47 (0.94)	22	5.19 (1.79)	5.54 (1.76)	7
Helping establish a work–life balance	3.97 (1.20)	5.21 (1.06)	31	5.04 (1.60)	5.32 (1.55)	6
Understanding impact as role model	4.59 (1.59)	6.00 (0.86)	31	5.70 (1.47)	5.85 (1.32)	2
Helping mentees acquire resources	3.79 (1.79)	4.32 (1.52)	14	4.90 (2.03)	4.74 (2.45)	−3

Respondents rated items on a 7-point Likert-type scale, where 1 = “not at all skilled,” 4 = “moderately skilled,” and 7 = “extremely skilled.” Respondents could also select 0 for “not applicable” (mentors) or “not observed” (mentees). All 0 responses were not included in the mean. SD = standard deviation.

^*Domain.

Mentees’ results.

Regarding mentees’ ratings of their mentors’ competencies, the mean score for the 26 items was 5.55 (1.46) at pretraining and 5.92 (1.37) at posttraining, a 7% increase in competency (Table 2). Similar to the mentors’ self-ratings, “aligning expectations” and “assessing understanding” were two of the top three domains of growth (11 and 10%, respectively). The third area of top growth was “fostering independence” (9%). Top competency item growths were “setting clear relationship expectations” (13% increase from pre- to posttraining), “considering mentor–mentee differences” (11% increase), and “motivating mentees” (11% increase). Mentees rated their mentors higher in all but one competency, “helping mentees acquire resources.” Although “addressing diversity” was the highest area of growth among mentors’ self-assessments (31% increase), it was one of the lowest areas of their growth as assessed by mentees (4% increase).

Mentors and mentees.

Overall, mentors and mentees noted mentor growth in all mentorship competency domains from course end to 1 year later. Mentors reported larger mean growth (0.96 points, 20% increase) than was perceived by mentees (0.37, 7% increase). However, it is important to note that because mentees consistently scored their mentors higher at pretraining, their scores had less room for growth. Furthermore, mentees’ pretraining rating was higher than mentors’ posttraining rating in the items of “maintaining effective communication” and “promoting professional development.”

DISCUSSION

The mentorship program was innovative and important locally. We show evidence that there was a trend toward improvement on mentor assessment and the program may have sustainable and positive effects on mentorship behaviors over time. We found that salient areas of growth reflected areas of the course in which time and content were emphasized. It appears that mentors internalized content and transferred it to behavior change. The program may catalyze change that contributes to and reveals a larger change in the institutional environment from supervising to mentoring of doctoral students.

“Addressing diversity” was the largest domain of growth for mentors. This finding aligned with course content dedicated to diversity, including a module and rich conversation about issues related to differences in gender, region of origin, tribe, dialect, and class. Zambia has more than 70 tribes that contribute to individuals’ cultural and political identities.¹⁹ Gender inequality is a major issue that can be deduced from policies promoting equal opportunities in education and employment. People with disabilities in Zambia face many challenges because buildings, roads, and transport have no provision for the disabled. The country has come to realize the need to ensure that such groups are not disadvantaged. There are also disparities between rural and urban areas in terms of access to social amenities and economic resources. These issues of diversity framed conversations during the workshop.

Further supporting the efficacy of diversity discussions, “taking into account the biases and prejudices you bring to the mentor–mentee relationship” was an item of large growth among mentors in 2019. These findings indicated that the time and emphasis placed on diversity were important to the mentors’ development in mentorship competency. Discussions among faculty during program planning indicated that diversity was an area where growth could occur. As awareness grows worldwide about the need to incorporate and respond appropriately to diverse populations, it is hopeful to see large changes in trainees’ perceived ability to address diversity in mentoring relationships. Diversity is a relatively new area of focused discussion in Zambia, and these trainees could be poised to lead other faculty in discussions about diversity in ways that it is relevant to the university and country. Mentees rated “addressing diversity” as the lowest domain of growth for their mentors, demonstrating a need for additional diversity training.

“Aligning expectations” and “assessing capacities” were agreed upon by both mentors and mentees as high areas of growth. Prior to the course, UNZA had a culture of “supervision” that provided for a more structured, formal interaction of monitoring between the supervisor and student,²⁰ as has been reported in other LMICs.²¹ However, there is a growing cultural trend toward mentorship in which mentees should be guided and not monitored. Therefore, considerable time in the course was dedicated to defining the emerging idea of mentorship relationships and expectations, which is reflected in this finding.

“Motivating mentees” was a top area of growth that mentees perceived in their mentors. We interpreted this perception to signify that mentees appreciated the shift of their mentors from supervisor to mentor. For example, improvement can mean mentees feel more supported, are more confident in their abilities, and produce higher-quality work. Similarly, “fostering independence” was a domain with items of high growth among mentees, further indicating that mentees felt the shift of their mentors from supervisor to mentor. “Understanding impact as a role model” was a large item of growth among mentors in 2018, which potentially signified that mentors now see themselves as role models rather than simply supervisors. These findings indicate that a year after participating in the course, there was noticeable growth in mentors’ mentorship behaviors that could reflect a cultural shift from supervision to mentorship at UNZA.

Mentees rated their mentors higher than mentors rated themselves in all but one competency, “helping mentees acquire resources.” Resource acquisition, which may include materials and space, can be challenging. This finding helps the program facilitators understand content areas for improvement, and further reflection illuminated types of resources and ways that mentors can help mentees in such access. Access to funding for higher education is a particular challenge for those pursuing higher degrees such as masters and doctoral training. Additionally, accessing reference materials is difficult because some articles can only be accessed by paying. Most mentors have trained abroad and maintained contact with their own mentors from whom they can get help for their mentees. Mentors, by virtue of their connections, sometimes have access to grants or projects in which they can include their mentees.

Our results showed that mentees’ ratings of mentors were higher than the mentors’ self-ratings, as was reported in Fleming et al.’s initial validation study.¹² The variation between how mentors and mentees evaluate behaviors reiterated the subjective aspect of the MCA, which has been acknowledged previously. However, mentees’ observations of behavior changes in mentors indicate that there was actual behavior change in mentors. Thus, the MCA measures can be valuable for determining behavior change in contexts beyond where it was originally tested. As the program expands across UNZA, MCA measures could be a simple way to ascertain behavior change.

Strengths.

We used an evidence-based, validated instrument in a new setting to learn how our program performed. Mentors’ competencies were assessed across 26 different areas, providing a comprehensive evaluation of the impact of the program. Using the MCA questionnaires for mentors and for mentees provided multiple data points for a well-rounded assessment of mentorship competency among program participants. This study showed that the MCA can be used in other contexts and over a longitudinal period. The ability to replicate this instrument has implications for its use in future mentor trainings in academic settings around the world.

Limitations.

We had poor response rates to the posttraining survey, especially among mentees. With a smaller sample size at posttraining, one or two scores could have a larger effect on the overall score. Additionally, we intended to match pretraining and posttraining surveys but not all individuals completed both surveys, so we analyzed scores in the aggregate. Furthermore, the small sample sizes made it difficult to calculate statistical significance. The data relied on mentors’ self-evaluation and mentees’ observations, both of which could have been subject to bias. In addition, we recognize that the MCA survey provides evidence for perceptions of change rather than for actual behavior change. This is in part due to the nature of behavioral studies but could be studied in more detail in the future. Adding open-ended questions to the survey, conducting interviews, or observing mentoring partnerships could provide specific examples of how mentoring behavior changed posttraining. These surveys collected only short-term data. Long-term data collection on trainees’ mentorship knowledge and skills is underway and will provide a more complete understanding of the impact of this training on mentorship. Assessment of the program’s impact on mentees’ career achievements is another avenue to explore. Although our results do show a change in perceived mentor behavior, future studies must be conducted to determine the significance. Finally, this program and analysis were conducted at a single institution, and results might be different in other contexts.

CONCLUSION

Based on this assessment, the UNZA Mentor Training Program has had sustained impact, and these early results bode well for future benefits to students, faculty, and the institution. A year after participating in the course, growth in mentorship competencies was noted by mentors and mentees. This growth reflected course content and dedicated time to discussing the topics, which appear to have translated into practice. Furthermore, the sustained behavior change signals a shift in institutional culture from supervising to mentoring of doctoral students.²⁰ This information can inform the design and implementation of other mentorship development programs seeking to enhance these essential competencies in settings such as UNZA. Such initiatives can enhance the local capacity to mentor students into researchers and professionals equipped to address evolving health challenges.