Medical Student Mentorship in the COVID-19 Era

Abstract

Background

The Covid-19 pandemic led to a reduction of in-person, guided mentorship due to social distancing and an emphasis on virtual meetings. The effect of these changes on medical students’ experiences and specialty choice has yet to be studied in a large-scale manner.

Objective

To determine the perspective of third- and fourth-year medical students regarding the impact of the COVID-19 pandemic on mentorship.

Design

The authors distributed a modified Likert scale questionnaire (score: 1–10) to assess responses.

Participants

Third- and fourth-year medical students at two large US allopathic medical schools.

Main Measures

Responses to each survey item were analyzed to characterize the impact of the COVID-19 pandemic on mentorship relationships in medical school. A score of 1–5 was considered “disagree” and a score of 6–10 was considered “agree.”

Key Results

A total of 144 responses were collected with a response rate of 16.2%. Overall, 80.6% (n = 116) of respondents agree that the COVID-19 pandemic has had a negative impact on their medical school experience. Nearly half (41.0%, n = 59) expressed concern over the lack of mentorship opportunities, and 66.0% (n = 95) reported that the pandemic has made it more difficult to form or maintain connections with their mentors. Importantly, 43.6% (n = 61) of respondents reported that having close mentoring relationships reduced the impact of the pandemic on their medical training. While many respondents (79.9%, n = 114) did not change career plans due to the pandemic, most students are concerned about evaluating prospective residency programs (88.9%, n = 128). Notably, M3s have much lower confidence than M4s in their ability to choose a specialty (5.9 vs. 8.2, p = 6.43e − 08).

Conclusions

This investigation illustrates the concerns that medical students have regarding access to mentorship opportunities due to the COVID-19 pandemic. We hope that these findings encourage medical schools to evaluate and expand their current mentorship programs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01838-4.

Introduction

In recent years, the residency application process has become increasingly competitive for medical students, especially for those applying to surgical subspecialties [1, 2]. Based on the proportion of US MD seniors who matched into their preferred specialty in 2020, the most competitive specialties include Plastic Surgery (72.1% matched), Otolaryngology (74.9% matched), Neurological Surgery (75.2% matched), Vascular Surgery (78.2% matched), and Orthopedic Surgery (79.7% matched) [3]. In addition to high academic achievement, matching into these specialties typically requires relevant research experience and strong letters of recommendation which require the development of close relationships with physicians in the applicant’s preferred specialty.

To facilitate these relationships, many medical schools have instituted both formal and informal mentorship programs [4]. The design of an effective medical student mentorship program varies across medical institutions; according to Farkas et al., typically, programs will adopt a dyad model which includes one mentor and one mentee, allowing the development of a close relationship that supports the growth of the medical student. Additionally, programs will use a group mentorship approach that can vary from a single faculty mentoring multiple students at a time or a group of faculty, residents, and medical students. Despite the success of these programs, it was concluded that the literature has yet to find a consistent best practice to structure these mentoring initiatives [4]. Additionally, these relationships are not necessarily with a physician in a student’s area of interest and therefore are not designed to enable early exposure and engagement with a particular specialty. In recent years, the ENT Mentorship Program was instituted at The Ohio State University College of Medicine. This program introduces students early in the curriculum to the field of Otolaryngology-Head and Neck Surgery and provides for one-on-one mentorship relationships. The program is targeted towards rising second-year medical students with an interest in any surgical specialty. The number of students involved in the program has grown from an average of nearly nine students per year between 2015 and 2019 to eighteen students in 2021. Since its inception, this program has been successful at preparing participants for clinical rotations, for the Otolaryngology match process, and for residency itself [5]. A broader goal of this program is to serve as a template in the development of other specialty-specific mentorship programs in order to expand access to a larger number of students. As such, the ENT Mentorship Program has been used to guide the development of mentorship programs in other competitive specialties such as Plastic Surgery and Dermatology at The Ohio State University College of Medicine. In 2015, the Department of Emergency Medicine at Yale University School of Medicine piloted a mentorship initiative targeted towards benefiting medical students and Emergency Medicine residents interested in medical education. Each academic year a “resident liaison” was selected by the clerkship director to serve as a point-of-contact for medical students, conduct workshops, and address any questions or concerns as a mentor not involved in the grading process [6]. Programs such as these, which display an example of a mentorship program structure, have found success in providing medical students with an avenue to develop close relationships with mentors in their field of interest. Yet, as of now, these types of programs are scarce on the nationwide scale, and students face significant challenges when attempting to identify a mentor [7].

The challenge that students face in finding an appropriate mentor has been exacerbated by the current COVID-19 pandemic, as access to faculty has been particularly limited. A recent commentary published by the Society for Academic Emergency Medicine notes that social distancing measures, while essential, have made it difficult to maintain current mentorship relationships or to develop new ones [8]. With medical education and mentorship shifting to a virtual format, there is a need for a structured and well-studied approach to an online mentorship program. To begin this process, a deeper understanding of how the COVID-19 pandemic affected mentor and mentee relationships is required. However, it is apparent that the current literature lacks data representing the medical student perspective regarding mentorship relationships during the COVID-19 pandemic. These relationships have been consistently shown to be an essential part of medical trainees’ professional development [4]. Therefore, the aim of this investigation is to identify challenges medical students face as a result of the COVID-19 pandemic. We hope to further characterize the impact of the pandemic on mentorship relationships in order to determine methods to improve upon these issues for future medical students.

Materials and Methods

This study utilized a 12-item anonymous cross-sectional survey administered to medical students at two allopathic medical schools to investigate the impact of the COVID-19 pandemic on mentorship. Institutional Review Board (IRB) exemption was obtained prior to distribution of the survey. The study population included third- and fourth-year medical students from the class of 2021 and 2022 at two of the largest allopathic US medical schools, The Ohio State University College of Medicine and The University of Texas at Houston McGovern Medical School. The survey was administered using Google Forms (Google, Mountain View, CA) and was available for 2 weeks to allow for adequate response time. The survey was also sent multiple times. Respondent anonymity was ensured via software settings preventing collection of personal data.

The online survey consisted of 12 questions focused on students’ attitudes towards mentoring relationships and career development with respect to the pandemic. The survey was developed following review of other studies that investigated mentorship during medical education and survey design [9–13]. The complete survey is available as Supplemental Digital Appendix 1. A modified Likert scale was used for the first nine survey questions to determine the extent to which students agreed with various statements [14]. A score of 1–5 was considered “disagree” and a score of 6–10 was considered “agree.” These first statements focused on the quality and accessibility of mentorship opportunities as well as career preparedness. Survey responses were aggregated to determine current third- and fourth-year medical students’ overall beliefs regarding these issues. Responses were stratified by class and the Wilcoxon rank-sum test was used to evaluate for significant differences between collective responses from third-year vs. fourth-year students. Additionally, boxplots (Fig. 1a–d) were used to compare the distribution of responses from third-year vs. fourth-year students for the following categories: confidence in making specialty choice, negative impact of the pandemic on medical school, negative impact of the pandemic on mentorship, and negative impact of lack of mentorship on career. Question 10 asked respondents to identify the best way to improve mentoring relationships in medical school and may be used to guide future improvements in mentorship programs. Question 11 allowed for narrative response to provide additional clarification regarding the previous items or to identify any additional concerns not otherwise covered in the survey. The final question asked participants to identify their current year in medical school. Descriptive statistics were used to analyze the data and draw conclusions regarding medical students’ attitudes towards mentorship and residency preparedness regarding the impact of COVID-19.

Fig. 1.

a–d Boxplots detailing the differences in mean response to select survey items between third- and fourth-year medical students. a Student self-reported confidence in their ability to make an informed decision regarding a medical specialty. b Negative impact of the COVID-19 pandemic on student’s overall experience in medical school. c Negative impact of the COVID-19 pandemic on mentorship relationships in medical school. d Negative impact of the COVID-19 pandemic on mentorship relationships affecting future career prospects

Results

Of the 890 students who received the survey, 144 responses were received, yielding a 16.2% response rate despite distributing the survey multiple times. Among these respondents, 78 (54.2%) were fourth-year students and 66 (45.8%) were third-year students. The overall responses are detailed in Table 1. The most significant concern was in the ability to evaluate prospective residencies given the impact of the pandemic (mean = 8.0). Conversely, students had the least concern regarding changing career plans because of the pandemic (mean = 3.4).

Table 1.

Mean, median, and range of 144 survey responses from third- and fourth-year medical students

Questions	Mean	Median	Range
Negative impact on medical school	7.1	7	1–10
Concerned about mentorship opportunities	4.9	4	1–10
Covid-19’s impact on mentorship	6.4	7	1–10
Ease of transition to virtual mentorship	4.9	4	1–10
Mentorship helped alleviate the impact of the pandemic	5.4	5	1–10
Confidence in making specialty choice	7.1	7	1–10
Concerned about evaluating residencies	8.0	8	1–10
Changed career plans due to pandemic	3.4	3	1–10
Lack of mentorship causing negative career impact	4.4	5	1–10

Importantly, many medical students “agree” that the pandemic has had negative impacts on their medical school education (80.6%), mentorship (66.0%), and their ability to evaluate prospective residency programs (88.9%). Furthermore, the majority of medical students “disagree” that the transition to virtual mentorship has been easy (67%) and almost one-third believe that this lack of mentorship will have a negative impact on their career prospects (32.9%) (Table 2).

Table 2.

Percentage agreement (Likert scale ≥ 6) and disagreement (< 6) of 144 survey responses from third- and fourth-year medical students

Questions	Agree (%)	Disagree (%)
Negative impact on medical school	81	19
Concerned about mentorship opportunities	41	59
Covid-19’s impact on mentorship	66	34
Ease of transition to virtual mentorship	32	68
Mentorship helped alleviate the stress of the pandemic	44	56
Confidence in making specialty choice	69	31
Concerned about evaluating residencies	89	11
Changed career plans due to pandemic	20	80
Lack of mentorship causing negative career impact	33	67

When comparing responses between third-year and fourth-year medical students, multiple differences emerged and are depicted in Table 3 with associated boxplots in Fig. 1a–d. The largest difference was seen in students’ confidence in their ability to choose a medical specialty, as M3s on average felt much less confident than M4s (5.9 vs. 8.2, p = 6.43e − 08). Additionally, M3s and M4s also differed when asked to grade the negative impact of the pandemic on medical school, the pandemic’s impact on mentorship, and the negative impact this lack of mentorship will have on their career prospects (Table 3 and Fig. 1a–d).

Table 3.

Differences in mean response between third-year and fourth-year medical students

Questions	M3	M4	Total	p-value
Negative impact on medical school	7.6	6.5	7.1	0.001
Concerned about mentorship opportunities	5.2	4.4	4.9	0.07
Covid-19’s impact on mentorship	6.9	5.8	6.4	0.009
Ease of transition to virtual mentorship	4.6	5.3	4.9	0.03
Mentorship helped alleviate the stress of the pandemic	5.4	5.4	5.4	0.8
Confidence in making specialty choice	5.9	8.2	7	6.43e − 08
Concerned about evaluating residencies	8.0	8.0	8.0	0.8
Changed career plans due to pandemic	3.7	3.0	3.4	0.02
Lack of mentorship causing negative career impact	5	3.7	4.4	0.001

Discussion

This study highlights the attitudes of current medical students towards mentorship and career planning in the context of the COVID-19 pandemic. Our results demonstrate that medical students have concerns about maintaining relationships with their mentors as well as their ability to make decisions regarding residency programs. Perhaps unsurprisingly, most students believe that the pandemic had a negative effect on their medical school experience. This appears to be at least in part due to the loss of mentorship, but also likely involves a multitude of factors including increased anxiety regarding the health and safety of themselves and those around them, decreased elective time and training experiences, and the loss of opportunities to enjoy time spent outside of school, among other considerations.

Our results show that nearly half of the students have concerns about a lack of available mentorship opportunities and two-thirds of students noted that the COVID-19 pandemic has exacerbated this issue. Many have found the transition to virtual relationships difficult, with one student remarking that “it’s become more difficult to maintain relationships when we can’t physically speak face-to-face. We have figured out other communication, but office visits are sorely missed.” This is especially worrisome, as mentoring relationships have consistently been shown to be an essential process in medical training with benefits for the mentor, the mentee, and the institution. Previous studies have identified high-quality mentorship to be a key factor in the mentee’s career satisfaction and professional achievement [15], in mitigating stress and burnout [16], and in improving academic productivity [17].

As a further benefit of effective mentor–mentee relationships, nearly half of these students indicated that these contacts have mitigated the effect of the pandemic on their training. It is unclear whether those who disagreed with this statement believe that their connections have been unsuccessful in decreasing the impact of the pandemic, or whether they simply have not developed close mentorship relationships. However, having an established mentorship relationship may allow for students to maintain some semblance of normalcy about longitudinal projects and connection to their specialty of interest. Thus, we would argue that our data supports the idea that mentorship can alleviate the impact of adverse events on medical student training.

Additionally, our results show that nearly a third of students believe that the lack of mentorship opportunities caused by the pandemic will result in negative implications for their career. This may be due to an inability to develop a competitive residency application with strong letters of recommendation and adequate research experiences. Alternatively, this may be due to a decrease in networking opportunities that are particularly helpful when starting a career. To combat this issue, students offered insight into improving access to mentorship. One student commented, “I think more formal programs with mentors who are wanting connections with students and are signing up for the process would help improve access, especially during the pandemic.” Another student wrote, “Allowing formal preceptor programs within areas of interest in MS1/MS2 would be really helpful to help people develop long term relationships.”

Interestingly, our data shows that despite the limitations imposed by the pandemic, most students believe that they have enough experience to decide regarding a medical specialty and have not adjusted their career plans. However, nearly nine in ten students are concerned about being unable to adequately assess prospective residency programs. Between virtual interviews and cancelled away rotations, students have had little opportunity to evaluate different training institutions in-person to make an informed decision regarding their residency training program. With the uncertainty surrounding the future of virtual residency interviews in the post-COVID era, more investigation into maximizing the effectiveness of these methods must be performed. While much of the pandemic has passed, interviews for residency are still largely performed virtually. Meanwhile, close mentoring relationships may help alleviate student concerns about evaluating residency programs, as mentors can provide better insight into the training process as well as personalized advice.

When comparing the responses between classes, third-year students’ experiences were more adversely affected by the pandemic overall. Their particularly strong negative feelings about their medical school experience may be attributed to delayed or cancelled board exams or the loss of early clinical rotations. This lack of clinical experience due to the pandemic can also explain the results that third-year students also report significantly lower confidence in their ability to make an informed specialty decision than that reported by fourth-year students. This group also appears more concerned about the detrimental effect on mentor relationships and the transition to virtual relationships. With less time to develop connections with faculty, these relationships may be more vulnerable to the disturbances caused by unfortunate circumstances and could also explain the more negative perceived impact on future career prospects seen in third-year students.

Mentorship for medical trainees has been the subject of much research. While several studies have highlighted the benefits of mentorship during residency training, fewer have investigated the implications for medical students. A cross-sectional study of 61 fourth-year osteopathic medical students demonstrated that 59% of respondents believe that they did not receive enough mentorship in medical school. Despite this, most respondents agreed that the quantity and quality of mentorship influenced their decisions regarding residency programs and career trajectory [7]. Similarly, a recent systematic review identified thirty articles describing mentorship programs in medical school. All 29 programs studied reported a high level of student satisfaction, while seven programs provided objective data that support the ability of these programs to promote academic success. This included increased research productivity, clinical honors, and match rates [4]. These studies support the idea that mentoring relationships have a profound impact on medical student development.

With respect to the COVID-19 pandemic, a study conducted by Guadix et al. found that medical students pursuing neurosurgery were increasingly concerned about the impact of the pandemic on their medical education. Specifically, respondents to their survey voiced concerns regarding conferences and networking opportunities, clinical experience, and board exam scores [18]. They also found that students are more likely to take a year off because of issues related to COVID-19 [9]. This study highlights some of the difficulties that medical students have faced as a result of the pandemic but is limited to students pursuing a particular subspecialty and thus may be problematic to apply to medical students in general.

Mentor–mentee relationships are a critical component of medical training that impacts career preparedness as well as medical student well-being. The COVID-19 pandemic has further emphasized their importance, and since the relevance of virtual medical education and telemedicine has remained beyond the pandemic, the lessons learned from this crisis may be leveraged to justify developing improved mentorship curricula. For example, in 2020, the Department of General Surgery at The University of Texas Southwestern Medical Center piloted a virtual mentoring program focused on assisting fourth-year medical students interested in general surgery in five areas: resume, interviewing skills, personal statement, letters of recommendation, and residency match rankings. The online program was structured to include monthly group meetings with general surgery faculty and students, as well as one-on-one meetings with a faculty member. Medical students’ confidence in all five areas of focus and ability to match into general surgery were significantly improved because of the program [19]. Based on the results of this study and ours, we propose that medical schools nationwide implement mentorship programs geared towards a wide breadth of specialties to increase targeted access to mentoring relationships. The general surgery virtual mentoring program at The University of Texas Southwestern Medical Center and the ENT Mentorship Program at The Ohio State University College of Medicine may serve as models in the development of these programs [5]. At our institutions, the results presented in this study will be used to guide the expansion of mentorship programs to include several subspecialty groups. Future studies will be conducted to characterize student attitudes towards these programs and investigate the overall impacts of these changes.

One limitation of our study is the potential for nonresponse bias, as students may be more motivated to complete the survey if they have been either strongly negatively or positively impacted by the pandemic. This may be of particular concern as this survey received only a 16.2% response rate. However, a recent study by Hendra et al. of 12,000 subjects who were fielded for 16 surveys demonstrated little relationship between response rate and nonresponse bias [20]. Because of the novel nature of our investigation, there are currently no standardized validated instruments to address the impact of the COVID-19 pandemic on mentoring relationships. As such, the development of our study was guided by previously published studies regarding mentorship during medical training and general survey design principles [9–13].

Conclusion

This study highlights the concerns of current medical students regarding the negative impact of the COVID-19 pandemic on mentorship. Modern educational environments have shifted towards utilizing virtual platforms more often than before, especially with the increase in usage of telemedicine to provide patient care. Telemedicine is an area that medical students do not have the same level of comfort as in-person patient visits, and therefore can be an important area of study for incorporating into future mentorship program design [21]. We advocate for the development of more robust mentorship infrastructure in medical school to better serve future students given the widespread implications of early medical student mentorship and the changing landscape of medical education and residency applications. The results of this study can serve as a guide in the design and expansion of these medical school mentorship programs.

Supplementary Information

Below is the link to the electronic supplementary material.

Author Contribution

Ryan Bishop helped conceptualize and design the study, administer the survey, analyze and interpret the data, and draft and revise the article. Dr. Rishabh Sethia helped conceptualize and design the study, analyze and interpret the data, and draft and revise the article. Dr. David Allen helped administer the survey for data collection, analyze and interpret the data, and draft and revise the article. Sameer Siddiqui helped analyze and interpret the data, and draft and revise the article. Dr. Soham Roy helped analyze and interpret the data and assisted with revising the article. Dr. Charles Elmaraghy helped conceptualize and design the study, analyze and interpret the data, and draft and revise the article. All authors approved the final version of this paper prior to submission.

Availability of Data and Material

Online survey was administered.

Declarations

Ethical Approval

This study was determined exempt from IRB approval by the Ohio State Institutional Review Board on 1/11/2021.

Consent for Publication

Yes.

Conflict of Interest

The authors declare no competing interests.