A systematic scoping review of mentoring support on professional identity formation

Abstract

Background

Mentoring’s success in nurturing professional identity formation (PIF) has been attributed to its ability to build personalised and enduring mentoring relationships. However, beyond functioning as communities of practice (CoPs) supporting socialisation processes, how mentoring integrates programme values and instils a shared identity amongst mentees remains unclear. The need for personalised guidance and timely attention to a mentee’s unique needs in evolving mentoring relationships point to the critical role of support mechanisms (‘mentoring support’). We conducted a systematic scoping review (SSR) studying “What is known about mentoring support’s role in nurturing PIF?”.

Methods

Adopting PRISMA-ScR guidelines, this SSR was guided by the Systematic Evidence-Based Approach (SEBA). Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2023 in PubMed, Embase, ERIC and Scopus databases. The Split Approach saw concurrent, independent thematic and content analyses of the included articles. The Jigsaw Perspective combined complementary themes and categories, creating broader themes/categories. The subsequent Funnelling Process formed key domains that platformed the synthesis of the discussion.

Results

Two thousand three hundred forty-one abstracts were reviewed, 323 full-text articles were appraised and 151 articles were included and analysed. The key domains identified were (1) definitions and roles; (2) personalisation; (3) shepherding; and (4) PIF.

Conclusion

The success of mentoring in PIF lies in its ability to blend role modelling, supervision, mentoring, coaching and teaching, with self-care, guided reflection, apprenticeship and assessment to meet the individual needs of the mentee and their changing circumstances. Blending the contents of the mentoring umbrella emphasises the critical role of the mentor and host organisation in supporting mentor training, communications, support and assessment mechanisms. Mentee engagement and its active role in support measures complement the CoP-like mentoring programme’s use of blending mentoring support to advance the socialisation process. These insights reflect a complex interactive process scaffolding the development of mentoring relationships and PIF. The effect of the mentoring umbrella on clinical practice requires further study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-024-06357-3.

Background

Mentoring plays an expanding role in medical education by virtue of its ability to personalise learning experiences and adapt to a mentee’s wide-ranging needs [1–8]. Krishna et al. [9] suggest that much of mentoring’s success is attributed to its relationships and their capacity to build enduring and personalised mentoring interactions that steer how medical students and physicians think, feel and act like professionals, or their professional identity formation (PIF). The two are increasingly seen as interlinked.

Supporting mentoring relationships’ ability to shape PIF is the mentoring programme’s ability to function like a community of practice (CoP) and support the socialisation process. Meeting these two Cruess-ian requirements for the nurturing of PIF has hailed the role of mentoring in fostering PIF. Here, Cruess-ian requisites relate to Cruess et al.’s [10] posit that PIF requires a CoP to scaffold the socialisation process, described as the internalisation of programme belief systems.

However, more recent studies have suggested that there is more to mentoring than functioning as a CoP, or a “persistent, sustaining social network of individuals who share and develop an overlapping knowledge base, set of beliefs, values and history and experiences focused on a common practice and/or enterprise” [11]. Questions about the mentoring relationship’s operationalisation of supporting the socialisation process, the second Cruess-ian requirement, are increasingly being asked. This is due to greater recognition that the instillation of programme beliefs, norms, principles and expectations (belief systems) along the mentee’s journey that moves the mentee from layperson to skilled professional can be met when this process is so highly individualised.

A clue to this missing link lies with Cruess et al.'s [10] acknowledgement that as a personalised process affected by “who they are” at the beginning and “who they wish to become,” PIF requires an individualised approach [12]. The mentoring relationship provides just such a personalised approach through use of the mentoring umbrella [6, 9]. The mentoring umbrella blends role modelling, teaching, tutoring and guided immersion; shepherds meaning-making and psycho-emotional states; fosters coping strategies; supports maturing relationship; supervises developing competencies; guides reflections; and coaches desired competencies and timely remediation [6, 9]. This personalised blend is called Personalised, Appropriate and Longitudinal mentoring support (PAL mentoring support) [6, 9].

Toh et al. [13] suggest that the PAL mentoring support system [14, 15] integrates the programme’s shared values, principles and identity (belief systems) into their self-concepts of personhood, or ‘what makes you, you,’—changing the mentee’s self-identity [8, 16, 17]. However, there is little known about PAL mentoring support [18–23]. To address this gap and guide the design of education programmes beyond mentoring programmes, a systematic scoping review (SSR) on “What is known about mentoring support’s role in nurturing PIF?” was conducted.

Methods

Theoretical lens

We employed the Systematic Evidence-Based Approach (SEBA) to guide our SSR, given its established role in evaluating mentoring practice in medical education [24, 25] and its compliance with the PRISMA-ScR guidelines. The SSR in SEBA is guided by a constructivist ontological lens, a paradigm that explores how our perceptions of realities or identities are constructed and understood. This encapsulates the psychosocial, cultural and historical influences that underpin the creation of individual concepts of PIF. Further, the SEBA methodology is supplemented by a relativist epistemological perspective, an approach to understanding knowledge that suggests our viewpoints and beliefs are shaped by unique cultural, social or personal contexts, rather than by any universal, objective truth. Our use of the SEBA methodology thus considers multiple perspectives from quantitative and qualitative data and knowledge synthesis articles in this review [26, 27].

The SEBA methodology’s constructivist ontological and relativist epistemological lens also serves another critical role. It supports the idea that a developing sense of identity is the product of the inculcation of new belief systems into self-concepts of personhood. This process can be visualised through the use of the Ring Theory of Personhood (RToP) that captures the integration of new belief systems into the mentee’s current belief systems contained within the four aspects of their sense of personhood. The effects of these changes in belief systems in one or more aspects of the mentee’s sense of personhood lead to changes in their identity. These changes are captured by the Krishna-Pisupati Model for Professional Identity Formation (henceforth KPM).

The ring theory of personhood

The mentoring relationship’s ability to shape PIF lies in the intimate relationship between belief systems, self-concepts of personhood and notions of self-identity. The RToP captures changes in an individual’s belief systems during the socialisation process. Progressing through the structured mentoring trajectory across competency-based mentoring stages and within the curated mentoring environment of the CoP-like mentoring programme introduces the mentee to new belief systems. Guided immersion into the practice and along the mentoring trajectory; guided reflections; mentored meaning-making; timely and personalised feedback; and supervised debriefs enable the integration of these new experiences, insights and reflections into the mentee’s current belief systems.

The RToP [2, 13, 28] suggests that there four aspects of personhood—the Innate, Individual, Relational and Societal aspects of personhood (Fig. 1). Each aspect is accompanied by a corresponding belief system [28].

Fig. 1.

The Ring Theory of Personhood

Changes in the belief systems surrounding existentiality and spirituality in the Innate Ring; emotions, thoughts and thinking in the Individual Ring; the nurturing of close personal ties in the Relational Ring; and the maintenance of social expectations, cultural norms and professional standards in the Societal Ring, shape the mentee’s self-concepts of personhood [28]. In turn, modifications to the individual’s sense of self are quintessential in ensuring congruence, which is the unity between current belief systems, self-perceptions of personhood and identity, and social validation which involves current practice settings, programme culture and academic structure.

The KPM (Fig. 2) captures the nuances of the complex ‘balancing’ process behind what and how these new belief systems are integrated. Awareness of ‘sensitivity’ to these changes or an ‘event’ triggers a determination as to the significance of the ‘event’ (‘judgement’), as well as an internal evaluation of the ‘willingness’ to address the ‘event’ and the individual’s ability, experience, and opportunity to do so [3]. ‘Balancing’ these sometimes-competing considerations behind the development of a context-specific self-concept of identity [2, 3, 16] is impacted by access to PAL mentoring support [3, 16]. The shifts in context-specific identity reflect the developing professional identity [28].

Fig. 2.

The Krishna-Pisupati Model for Professional Identity Formation

Stage 1 of SEBA: systematic approach

The stages of SEBA are outlined in Fig. 3.

Fig. 3.

The Systematic Evidenced-Based Approach (SEBA)

The Population, Intervention, Comparison, Outcome and Study Design (PICOS) framework [29] was used to navigate the primary research question, “What is known about mentoring support?” and secondary question, “What is known of the features scaffolding the use of mentoring support and its impact on PIF?” (Table 1).

Table 1.

Population, Intervention, Comparison, Outcome and Study Design (PICOS) Framework, Inclusion and Exclusion Criteria Applied to Database Search

PICOs	Inclusion	Exclusion
Population	Junior physicians, residents and medical students	Allied health specialties (e.g. nursing, physiotherapy, occupational therapy)
Intervention	Accounts of mentoring support involving junior physicians, residents and/or medical students mentored by seniors aimed at advancing professional and/or personal development of the mentee • Mentoring processes • Mentor factors • Mentoring relationship • Role of stakeholders and organizations • Outcomes of mentoring • Barriers to mentoring	Peer mentoring, mentoring patients, or mentoring by patients.
Comparison	Comparisons between mentoring programmes, editorials, perspectives, reflective, narratives and opinion pieces
Outcome	Personal, professional, research and academic outcomes and impact on PIF
Study design	All study designs are included	Systematic review, literature reviews and narrative reviews

In view of time and manpower limitations, the research team conducted searches independently between 18th October 2023 and 17th January 2024 on PubMed, Embase, ERIC and Scopus databases for articles published between 1st January 2000 and 31st December 2023 (refer to Additional File 1 for the full database search strategy). Upon agreement on the shortlisted articles, the research team subsequently reviewed and summarised the articles to capture pertinent details of mentoring support mechanisms [30].

A total of 2341 abstracts were reviewed, 323 full-text articles were appraised and 151 articles were included and analysed (Fig. 4).

Fig. 4.

PRISMA Flowchart

Stage 2 of SEBA: split approach

Data analysis of the shortlisted articles was divided between two independent teams of researchers. The first team performed Braun and Clarke’s [31] approach to thematic analysis to identify key themes in the data [32]. Simultaneously, the second team employed Hsieh and Shannon’s [31] method to directed content analysis to determine and operationalise a priori coding categories from mentoring studies by Krishna et al. [6] and Toh et al. [13]. This dual approach accounted for the limitations of each method of data analysis, including the subjectivity in thematic analysis and the lack of depth in directed content analysis [2, 33]. Resultantly, a more holistic and refined analysis of the data was captured.

Stage 3 of SEBA: jigsaw perspective

Like pieces of a jigsaw puzzle, overlapping or complementary findings from both methods were combined to create bigger puzzle pieces, called themes/categories [34, 35].

Stage 4 of SEBA: funnelling process

The identified themes/categories were then compared with the aforementioned article summaries to ensure that the research teams effectively retained pivotal information and curtailed omissions [13]. This process directed the funnelling of key domains that formed the basis of the ensuing discussion.

Stage 5 of SEBA: analysis of evidence-based and non-data-driven literature

To ameliorate concerns about the non-data-based literature biasing the study, the research team compared the themes from evidenced-based publications with those from non-data-based articles [13]. Similar themes found in both groups suggest the analysis was not biased by non-data-based literature.

Results

The themes identified were (1) constituents, and (2) approaches. The categories were (1) PIF; (2) approach; (3) role; and (4) shepherding.

The domains created by combining the subthemes and subcategories identified were (1) definitions and roles; (2) personalisation; (3) shepherding; and (4) professional identity formation. These domains draw a relationship between mentoring and PIF.

Domain 1. Definitions and roles

Current definitions of the various elements ascribed to mentoring support are summarised in Table 2.

Table 2.

Definitions/Descriptions of mentoring support elements

Elements of Mentoring Support	Definitions
Mentoring	▪ “Dynamic, context-dependent, goal-sensitive, mutually-beneficial relationship between an experienced clinician and junior clinicians and/or undergraduates that is focused upon advancing the development of the mentee” [36].
Teaching	▪ Impart knowledge and guide studies by precept, examples or experience [36]. ▪ Teaching in the clinical environment is defined as teaching and learning focused on and usually directly involving patients and their problems [37].
Role Modelling	▪ Active observation of the role model’s personal, clinical and/or social circumstances; practice, attitudes, decisions and skills; reflection on these observations; translation of these insights into principles and actions; and integration of these insights into practice, thinking, attitudes, skills, deliberations and conduct [26].
Coaching	▪ An inherently creative activity of bringing forth knowledge, wisdom and insight [38]. ▪ A coach works with a student to continually improve his/her performance, usually on areas that the student deems weak [39]. ▪ Involves asking questions [39]; listening deeply [38]; keenly observing [38, 40]; evaluating and identifying gaps [41]; providing specific and concrete feedback [40, 41]; creating goals; exploring solutions and holding the individual accountable [41]; supporting reflection [38, 42]; setting goals [42]; developing a comprehensive study plan [42]; and ensuring a commitment to learning [38]. ▪ May improve emotional intelligence, durability, wellbeing and resilience [39] . ▪ In medical education, two main types of coaching have been described [41]: (a) Coaching in clinical skills: coach directly observes the learner in the clinical setting and then engages in the coaching process for the improvement of a specific skill, such as procedural training [41]. (b) Academic coaching: coaches guide learners to achieve their fullest potential by indirectly evaluating performance via review of objective assessments [41], such as: o self-reflection o specific, measurable, achievable, relevant and time-based (SMART) goal setting o the development of comprehensive study plans with deliberate use of effective learning strategies, including spaced retrieval practice and elaboration o self-care ▪ Teaching faculty members supported the streamlined and collaborative approach. Academic coaches offered timely oversight and early identification of students requiring support [42].
Instruction	▪ None of the articles defined instruction. ▪ According to the UNESCO International Bureau of Education, instruction is defined as “the creation and implementation of purposefully developed plans for guiding the process by which learners gain knowledge and understanding, and develop skills, attitudes, appreciations and values” [43].
Supervision	▪ May be viewed as “an intervention, a working alliance, a method, a process and a professional activity” [44]. ▪ May also be conceived of as “a joint endeavour in which a practitioner, with the help of a supervisor, attends to their clients, themselves as part of their client practitioner relationships and the wider systemic context, and by so doing, improves the quality of their work, transforms their client relationships, continuously develops themselves, their practice and the wider profession” [45]. ▪ Clinical supervision has been defined as the “provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainee’s experience of providing safe and appropriate patient care” [46].
Reflective Writing	▪ Allows physicians the opportunity to reflect on their actions, recognise how their thoughts, feelings and emotions affect decision-making processes, clinical reasoning and professionalism that impact belief systems and shape PIF [47, 48].
Group Reflections	▪ Enhance holistic and collaborative learning [49, 50]. ▪ A means of determining the nature of the ‘takeaway’ from a specific learning interaction and boosting engagement. ▪ Access the hidden curriculum through facilitating discussions and self-reflection, providing insight into unspoken norms and values which influence clinical reasoning. ▪ Integrate diverse viewpoints into individual understandings of medical practice.
Reflexivity	▪ Described as a level of consciousness of ‘cultural, political, social, linguistic and ideologic’ origins of one’s own and others’ voice and perspective. ▪ Increases awareness of how personal values and beliefs interconnect with social and environmental contexts.

More recent notions of the mentoring umbrella suggest that it also contains assessment elements and support of self-care.

These constituent parts are prioritised according to their ability to meet the mentees needs, goals and individual and contextual considerations over the course of the mentoring process. Each element of the mentoring umbrella plays a particular role, not simply in the development of clinical knowledge and skills, but also in shaping their belief systems and moulding thinking. We use a heat map (Fig. 5) to illustrate the part played by the different aspects of the mentoring umbrella on the Individual, Relational and Societal Rings.

Fig. 5.

A heat map of the impact of key elements of the Mentoring Umbrella on the Individual, Relational and Societal rings

The darker colours correspond to greater frequency of use whilst lighter colours reflect a less significant role in the blend of support. For example, instruction dominated the blend of support from the mentoring umbrella in the moulding of conduct with smaller roles for coaching and supervision. Similarly, an equal mix of coaching and role modelling dominated the inculcation of professional beliefs with lesser effects on supervision and a very small role for teaching. We will show that this blend evolves over time and with mentee development.

Domain 2. Personalisation

The heat map suggests that in each stage of development, there is a ‘standard’ mix to address each aspect of the mentee’s development. Each stage of the mentoring process, defined by particular goals and required competencies, begin with a ‘standard’ mix of constituent factors of the mentoring umbrella. This blend is personalised to meet the evolving needs of the mentee and their individualised and contextualised considerations [7, 10]. We detail this in Table 3 for ease of review.

Table 3.

Individualised and contextual considerations influencing the blending of the Mentoring Umbrella

Individualised

Contextual

• Belief systems [51] • Discernment: Willingness, judgment and balancing [51, 52] • Narratives: Working styles, opportunities [53], attitudes, emotions [54], experience, skills and goals, as well as demographic [54, 55], socio-cultural [56–58], ideological, contextual, and psycho-emotional features • Coping strategies: Psycho-emotional well-being and the adoption of reflective practice [59–61], as well as personal coping strategies [62–68], including level of resilience [21, 69] and the ability to cope with emotionally-rich experiences [70], failures [71], moments of crisis [72], disorienting experiences [73] and transitions [71, 74–80] • Developing competencies: Skills, knowledge, levels of engagement, decision-making and practice • Maturing relationship: Nature, quality, setting and progress of patient interactions • Meaning-making and psycho-emotional state: Reflections, insights, adaptation, development [81, 82] and available support [83]

• The formal curriculum, or “the actual course of study, the planned content, teaching, evaluation methods, syllabi, and other materials used in any educational setting, formal policy statements, regulations, expectations, and competencies for every educational cohort conceivable” [51, 84] • Clear ‘membership’ criteria [85] • Competency-based mentoring stages [85] • Curricula: Hidden, formal and informal curriculum [76, 86–95], working hours [96], rules [97], disciplinary consequences [98], programmes [99, 100], attention to PIF [95, 101, 102], administrative support [103], faculty training and evaluation [103, 104], access to personalised support and communication networks [72, 90, 105–107] • Desired characteristics: Organisational, training, professional and speciality expectations on norms, skills, values, objectives, support and assessment systems [3, 108] • Host organisation-related facets: Practice differences across different training sites; evolving expectations and stages of training; differences in support and assessment systems; and the programme’s belief systems and shared identity [108] • Practice standards: The programme’s timelines, professional standards [109, 110], codes of conduct, expectations [111, 112], implicit norms [113], sociocultural norms and legal requirements [47, 114–117] • Practice culture that is shaped by the programme’s hidden curriculum [76, 86–95], prevailing discourses [72, 90, 105–107], daily activities [88, 118, 119] and rites of passage [10, 76, 93, 120–125] • PAL mentoring support: Access to timely, individualised, context-specific and appropriate role modelling [126]; clinically-relevant tutoring catering for individual consideration; supervised immersion into the clinical practice that accommodates the individual’s narratives, experiences, contextual considerations and goals; timely and comprehensive guided reflections; individualised, necessary [127], prompt and constructive feedback that impact meaning-making; context-specific advice; stage-specific assessment-led coaching; and longitudinal, personalised, appropriate, timely, holistic mentored support and ‘instructional scaffolding’ of a structured mentoring programme [3] • PAL support structures: Accessible communication; flexible and personalised support mechanisms [128–132]; longitudinal training support that caters to the physician’s personal needs [133, 134], abilities [135] and changing contextual considerations [130, 136–138]; quality of the apprenticeship relationship [130, 131, 136, 138–147]; and the learning environment [134, 136, 138, 147, 148] • Faculty selection, including the desired characteristics, [130, 134, 136, 138, 139, 143–145, 149–158], training and experience [128, 131, 132, 134, 138, 142–144, 147, 152, 159–161], commitment to training roles, openness to feedback [140, 147, 155, 162] and skills [95, 139, 148–150, 152, 163] • Peer support [3] • Intensity: Waxing and waning nature of the intensity of clinical practice [95, 137, 145, 150, 151] and the number of complex, morally and/or ethically challenging cases • Mentoring trajectory [2, 3] • Mentoring approach [19, 23, 164] • Mentor and peer-mentor training [13] • Stakeholder influences: Mentee, peer-mentor, mentor and host organisation influences [13] • Communication [165], feedback and remediation pathways • Longitudinal assessments

These considerations shift the standard mix of teaching, coaching, role modelling and supervision routinely employed to aid knowledge- and skills-building and the inculcation of belief systems [7, 10]. The mentee’s individualised and contextual considerations, shifting belief systems and developing mentoring relationships and competencies sees mentoring, counselling and guided reflective cycles taking more prominent roles as the mentoring journey progresses.

Domain 3. Shepherding

Personalisation of mentoring support must be contained within programme expectations [83] and consistent with the programme belief systems and contextual and current sociocultural considerations, or ‘social validation’ [2, 3, 27]. In addition, there must be ‘congruence’ with the mentee’s individual and contextual considerations and current self-concepts of identity and personhood [2, 3]. Supporting these value-based considerations and balancing ‘social validation’ [2, 3, 27] and ‘congruence’ is the mentoring tube. The mentoring tube is described as a “combination of a mapped training programme, the mentoring umbrella, trained faculty, structured assessments, guided reflections and supervised experiential learning within the curated learning environment aspects [that] support a structured and personalised Socialisation Process” [83]. The mentoring tube ushers PAL mentoring support and integrates longitudinal feedback [69], communication, guidance and assessment network data to guide the blending of the PAL mentoring support as mentoring relationships progress runs along the mentoring trajectory. This process is guided by stage-specific mentoring assessments and feedback loops [21] that call attention to the mentor’s skills, competencies, mentoring characteristics, experiences and training [108]. It also highlights the host organisation’s role [21, 166] in supporting mentor training, assessments [33] and longitudinal support of mentors and the mentoring project [167, 168].

Domain 4. Professional identity formation

Identified through SEBA’s reiterative process [83], PIF is shaped by PAL mentoring support [27, 51, 108, 169]. However, to consistently influence elements of the Individual, Relational and Societal Rings featured in Fig. 5, there are two essential components that were uncovered. The first is an adaptive mentoring tube that evolves with changing individual and contextual considerations (Table 3) and enhanced ‘sensitivity’ [170]; greater confidence [171–176] and self-efficacy [173, 175, 177–180]; better ability in navigating personal and professional networks [6, 7, 20, 21, 173–175, 177, 179, 181–192]; and enhanced decision-making [173, 174, 176, 181, 184, 185, 188, 190, 191, 193–198]. This process is also impacted by a deepening belief system, maturing mentoring relationships, competencies and the development of a shared identity that shapes a mentee’s PIF [13].

The second component is a structured CoP-like mentoring programme, replete with consistent mentoring borders, mentoring tube and access to PAL mentoring support provided by trained and informed mentors. This CoP-like mentoring programme attenuates the influence of external factors and allows the development of the programme’s own mentoring environment that supports the developing PIF and mentoring relationships.

Stage 6 of SEBA: synthesis of SSR in SEBA

Synthesis of this discussion is based on the four funnelled domains guided by the Best Evidence Medical Education (BEME) Collaboration guide and the STORIES (STructured apprOach to the Reporting In healthcare education of Evidence Synthesis) statement [199, 200].

Discussion

This SSR in SEBA affirms that successful programmes rely on PAL mentoring support to personalise the socialisation process within a CoP-like mentoring programme. The role of PAL mentoring support is complex and requires some delineation.

Perhaps most significantly, PAL mentoring support personalises the relatively rigid structures established by the CoP-like mentoring programme by providing the appropriate mix of elements of the mentoring umbrella to develop PIF and ensure an individualised mentoring experience within the confines of programme codes of conduct, legal and ethical principles and current sociocultural norms (practice standards) scaffolding the socialisation process.

On the surface, this personalisation of the mentoring process is most evident at the start of each mentoring stage. Standard use of teaching, coaching, role modelling and supervision in early mentoring stages are individualised and injected with purposeful role modelling, guided immersion into the work environment, supervised reflections, mentored meaning-making and timely feedback. Blending this support is in part guided by the competency assessments that bookend the mentoring stages, appraisal of the evolving mentoring relationships that platform mentoring progress and policing of practice standards. Uniquely, these assessments are intimately entwined and a part of PAL mentoring support. This is surmised from PAL mentoring support’s inclusion of remedial action and guidance on self-care that is interweaved with reflective cycles and debriefs. The incorporation of assessment, remedial and support measures within the PAL mentoring support system moves beyond attending to ‘social validation’ [2, 3, 27], ‘congruence’ and individual and contextual considerations and focuses upon maturation of the mentoring relationships and competencies that bring about better teamworking [6, 7, 20, 21, 173–175, 177, 179, 181–192] and patient care [173, 174, 176, 181, 184, 185, 188, 190, 191, 193–198]. These notions are made possible through six considerations.

One, mentors and host organisation share a common mental model and appreciation of the mentoring goals, timelines and progress. They must act in sync to blend the various elements of the mentoring umbrella. This blending process is possible, given the inherent overlap in the roles and functions of each of these facets of the mentoring umbrella (Table 2).

Two, personalising the constituent factors found at the start of each mentoring stage demands effective and longitudinal assessments that extend beyond merely the competency-based assessments that bookend the mentoring stages.

Three, to achieve the requisite heat map for each mentee at each stage of the mentoring process, there needs to be careful coordination of informal and formal, formative and summative assessments (Fig. 5). This requires that the mentors be trained, equipped with effective assessment tools and provided with time and resources to blend and direct personalised mentoring support and evaluations that account for individual and contextual considerations.

Four, the interplay between Cruess-ian requirements and PAL mentoring support brings to the fore the critical role of the host organisation. It is the host organisation that must provide mentors with training and protected time to meet their various responsibilities, ensure an effective mentoring environment and establish clear expectations and practice standards that mould mentoring practice. The host organisation must also ensure that the programme is well resourced, structured and able to contend with evolving demands.

Five, aligned expectations, common belief systems and a shared identity that grow with the instillation of professional, ethical, legal, societal, moral and programmatic belief systems accelerate the development of PIF. Sharing common beliefs systems built within a trusting mentoring relationship and nurturing environment hastens the adoption of new belief systems and expediates PIF. In turn, these changes feed back to the blending of the PAL mentoring support that seeks to support these changes.

Six, it is here that the CoP-like programme with its clear boundaries helps to attenuate the external influences on the evolving mentoring relationship. This also allows more effective assessments of progress and change and facilitates the direction and blending of the PAL mentoring support.

These features come together to bring about better teamworking [6, 7, 20, 21, 173–175, 177, 179, 181–192] and patient care [173, 174, 176, 181, 184, 185, 188, 190, 191, 193–198]. This, in turn, brings to fore six factors that blending depends on:

1. The mentor’s skills at assessing, blending and supporting the mentoring relationship, together with the mentee’s changing individualised and contextual considerations.

2. The mentee’s engagement with evaluations and their willingness to seek support, accept feedback and be guided over the course of their mentoring journey.

3. The quality and nature of mentoring relationships.

4. The availability and accessibility of communication, support and assessment channels to actuate changes.

5. The resources available and the role of the host organisation in investing, guiding and overseeing the mentoring process.

6. The nature and structure of the mentoring programme and environment.

However, the exact formula for effective blending remains elusive and does underline the role of the host organisation, mentor and mentee.

Mentor role and mentee engagement

Given that the success of the mentoring relationship depends on the mentor’s motivations, skills, experience, competency and availability to assess and diagnose the mentee’s needs and harness available support and communication structures to direct personalised support in a timely manner and review its effects, we adapt the KPM to scrutinise the mentor’s role (Fig. 6).

Fig. 6.

Adapted Krishna-Pisupati Model of the Mentor’s Role in the Blending of PAL Mentoring Support. This process is guided by the mentoring approach, belief systems, shared identity and the mentee’s current self-concepts of identity and personhood, narratives, individual and contextual considerations, congruence and social validations, mentoring resources, as well as the mentoring environment within the community of practice

The role of the mentor is key and is situated in a good understanding of the mentee’s self-concept of personhood, identity, belief systems, goals and abilities, as well as an appreciation of current contextual, resource and programmatic considerations. To understand the mentee and their evolving needs and individualised and contextual considerations, the mentor must be able to nurture a trusting and open mentoring relationship where the mentee is able to share and discuss their concerns openly. To do so, much is reliant upon the mentor’s ability to detect ‘events’ or subsequent shifts in belief systems and blend mentoring support accordingly. ‘Mentor sensitivity’ precipitates mentor ‘evaluation, judgement and support’ of the mentee’s identity work. This support is shaped by the mentor’s ‘judgement’ of processes, the mentee’s individualised and contextual considerations and their impact, as well as the feedback received from the various stakeholders. The mentor’s experience, practical ability and clinical judgement, in addition to their training, assessment skills and ability to blend the mentoring umbrella, are critical to building the mentoring relationship and nurturing PIF.

These findings also draw attention to the importance of mentee engagement. From a practical perspective, mentors cannot provide continuous assessments of the mentee’s changing individualised and contextual considerations without active mentee engagement and reporting. The mentee must be able and willing to seek input from mentors and the host organisation when facing significant events or individualised and contextual considerations that may impact decision-making, conduct and practice. Mentees also play an important role in working with mentors and host organisations in nurturing trusting mentoring relationships and a safe mentoring environment, replete with robust communication, support and feedback pathways. Effective support is shaped when both parties are engaged and open to the involvement of the other.

The host organisation and resources

The mentoring structure, culture and curation of the mentoring environment speak to the significant role played by the host organisation in ensuring that effective resources and support are available to mentors to meet their responsibilities. This includes ensuring robust mentoring boundaries, mentor training, protected time for mentoring and longitudinal support of mentors and mentees. The host organisation must ensure effective oversight of mentoring relationships, mentor development and the mentoring programme.

The success of the host organisation in supporting the mentoring relationship and mentee development relies on active engagement with the other stakeholders. The host organisation relies on the mentor to operationalise support and this relationship must be robust enough for the mentor to seek support from the host organisation. Data suggests that this support and effective blending of mentoring nurture a sense of belonging and affiliation with the profession, as well as buttress the acculturation and identification with “a particular society or group by internalising its values and norms” [12, 201]. These features and how they work together are summarised in Fig. 7.

Fig. 7.

The Mentoring Structure, its Key Elements and its Intertwined Relationships

• The orange funnel boundaries represent practice standards that confine mentoring support within programme expectations, professional standards and programme expectations.

• The yellow vertical arrow represents the longitudinal communication platform.

• The red vertical arrow represents the PAL mentoring support.

• The green vertical arrow represents the mentee’s PIF.

• The pink spiral line reveals the mentoring trajectory.

• The assessment points inform the programme’s support mechanisms.

However, how mentors assess and determine the blend of support to be provided and a clear appreciation of how elements of the mentoring umbrella influence the socialisation process remain unclear. Similarly, how PAL mentoring facilitates the development of mentoring relationships and the environment also requires further thought. In addition, the impact of mentoring support on the mentoring dynamics or the quality and nature of the mentoring relationship should be the focus of further studies.

Limitations

This SSR combines data from medical students, residents and senior clinicians. These backgrounds differ significantly. The focus on largely North American and European practices, articles in English and defined date range collectively limit our findings’ generalisability. These factors underscore the need for context-specific interrogation of the terms used to define the different elements within the mentoring umbrella, in view of current practice variations. This may explain the lack of data on the effects of the mentoring umbrella on different elements of the Innate Ring. These gaps also reiterate the variable meaning of the terms and the manner that some of these elements are considered in different cultures and practices.

Conclusion

The findings from our SEBA-guided SSR reveal that the success of mentoring in honing PIF is rooted in its ability to blend role modelling, supervision, mentoring, coaching and teaching with self-care, guided reflection, apprenticeship and assessment to meet the individual needs and changing circumstances of the mentee. The findings further emphasise the importance of:

• assessing and supporting the mentoring umbrella [166–168, 202].

• mentor and mentee engagement [25, 203].

• building trusting, enduring and personalised relationships [8, 15, 17, 108].

• addressing gaps in mentee and mentor training and support over the course of the mentoring process.

• the nature and level of personalised support [33, 69] which can take the form of portfolios [25, 203, 204], mentoring diaries and group [47, 48] and individual reflections [2, 169, 205] to supplement assessments, guided debriefs and reflective cycles.

• the impact of active support of mentoring relationships that ought to be mapped.

• ensuring the structuring of mentor training [22].

• nurturing a supportive mentoring environment [21].

These insights reflect the need to support the complex personal mentoring relationships and PIF. Whilst individual reviews of each of these elements have been ongoing, the focus of our coming work will focus on the immediate impact of mentoring support on the stakeholders as we continue to engage in this critical aspect of medical education.

Abbreviations

PIF

Professional Identity Formation

PAL Mentoring Support

Personalised, Appropriate and Longitudinal Mentoring Umbrella-based Support

SSR

Systematic Scoping Review

SEBA

Systematic Evidence-Based Approach

KPM

Krishna-Pisupati Model of Professional Identity Formation

RToP

Ring Theory of Personhood

CoP

Community of Practice

PICOS

Population, Intervention, Comparison, Outcome, Study Design

BEME

Best Evidence Medical Education

STORIES

STructured apprOach to the Reporting In healthcare education of Evidence Synthesis

Authors’ contributions

All authors LKRK, HYFK, NR, DWJW, VR, XYT, JS, JKL, EYML, TYL, AWJC, CJNL, YKN, AAT, AYDL, LNT, SPL, SPR, JRL, ELYQ, VJEF, RG, NABAH, CL, DSWS, EKO, SM, NS and SYKO were involved in data curation, formal analysis, investigation, preparing the original draft of the manuscript as well as reviewing and editing the manuscript. All authors have read and approved the manuscript.

Data availability

The datasets supporting the conclusions of this article are included within the article and its additional files.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.