Mentorship is a crucial component of professional development and is associated with increased academic and personal productivity, career advancement, and faculty retention.1–4 Additional benefits include the development of superior educational skills, increased confidence, better success with grant applications, and a greater tendency for mentees to pursue an academic career.3–5 Benefits for mentors include increased stimulation, personal satisfaction, research productivity, networking, and professional recognition.3,5 The Canadian Association of Interns and Residents (renamed Resident Doctors of Canada in 2015) highlighted the importance of academic mentorship by issuing a position paper urging all residency programs to establish formal mentorship programs.6

Despite the well-established benefits of academic mentorship, evidence suggests that this training model is often underutilized in anesthesia. A survey of 100 anesthesia trainees in the South Thames region, UK, found that, while 69% thought they would benefit from mentorship, only 28% of residents identified a relationship with a mentor.7 Another survey of 52 academic anesthesiologists, pre- and post-implementation of a mentorship program, revealed that, while 37 of 52 (71%) respondents thought mentorship was important, only 46% identified mentorship as part of their academic career development.8

In 2013, a survey of Canadian anesthesia residents and program directors (39% and 74% response rates, respectively) found that only 54% of anesthesia residency programs had formal mentorship programs.9 A 2016 qualitative study of anesthesia residents and faculty at the University of Ottawa found that differences in mentor-mentee expectations were associated with negative mentorship outcomes.10 These findings suggest that mentor-mentee relationships continue to be underutilized in anesthesiology and that, even when they exist, barriers for successful mentorship relationships remain.

Our study builds on these important findings by exploring the reasons for the gap between valuing mentorship and enacting these relationships. We examine current formal mentorship programs in Canadian anesthesia residency programs with respect to mentor selection and the benefits and challenges of mentorship from the resident perspective. This information will help guide further optimization of formal mentorship programs for Canadian anesthesia residents.

Methods

Questionnaire development

With the assistance of an epidemiologist, content experts, and reference to previous literature,3,4 we developed a 20-item, English-language questionnaire that examined resident perceptions of mentorship, current mentorship relationships, and perceived benefits and barriers to mentorship (Appendix 1). Response options for attitudinal questions used a seven-point Likert scale (1 = strongly agree; 2 = agree; 3 = somewhat agree; 4 = undecided; 5 = somewhat disagree; 6 = disagree; 7 = strongly disagree). We also included an option for respondents to provide written comments regarding any other thoughts they may have concerning mentorship in anesthesia. The final resident surveys were translated into French so that both English- and French-language versions were available for distribution. We pre-tested our final questionnaire with three anesthesia residents to obtain feedback on whether the questionnaire as a whole adequately measured attitudes towards mentorship and if the individual questions reflected the perceptions of benefits and barriers to mentorship relationships. The pre-test participants also commented on the clarity and comprehensiveness of the questionnaire.11 No changes to the survey were suggested.

We also developed a four-item English-language survey asking anesthesia program directors about their resident demographics, whether their department had a formal mentorship program, how mentors were assigned, and the duration of assigned mentorship relationships (Appendix 2). We pre-tested our questionnaire with three faculty members; only grammatical changes were requested.

The Hamilton Integrated Research Ethics Board approved our study in September 2014.Footnote 1 In March 2015, we sent e-mail invitations and our four-item survey to program directors of all 17 departments of anesthesia in Canada, identified through the Royal College of Physicians and Surgeons of Canada website (http://www.royalcollege.ca/portal/page/portal/rc/credentials/accreditation/arps). We solicited their participation in our study and requested that they distribute the resident survey on our behalf. The program directors’ survey was sent both by e-mail as an attachment and by hardcopy in the mail. Participating program directors sent their residents an e-mail with a disclosure letter and an online link for our survey, which was hosted by FluidSurveys® (http://fluidsurveys.com/). The survey was accessible for a four-month period from March 1 to June 30, 2015. Copies of our resident survey were also made available during the McMaster-Western Research Exchange Day and the 2015 Canadian Anesthesiologists’ Society annual meeting, with instructions for residents to complete the questionnaire only if they had not previously done so online. In our survey, a mentor was defined as “someone of experience who offers guidance”.12,13

Data analysis

We generated frequencies for all collected quantitative data. For presentation purposes and to facilitate analysis, we collapsed “agree” and “somewhat agree”, and “disagree” and “somewhat disagree” for all survey responses to produce a five-point scale. Missing data were excluded from both the numerator and denominator (complete case analysis). All analyses were performed using IBM SPSS® Statistics for Windows (version 22.0, IBM Corp., Armonk, NY, USA).

For our qualitative review of the written comments, two authors (S.E., A.W.) individually read and coded all of the comments in order to identify meaningful data segments.14 Related codes were amalgamated under common categories and organized in table form to identify broad common themes. The same authors compared their results to ensure the themes were clearly represented in the data, and they resolved discrepancies through discussion.

Results

Characteristics of respondents

Our response rate was 16 of 17 (94%) for anesthesia program directors and 189 of 585 (32%) for Canadian anesthesia residents. Eleven of 16 (68%) programs surveyed reported a formal mentorship program. The majority of program directors surveyed (8 of 11, 73%) indicated that residents were assigned mentors by their academic program, and only 3 of 11 (27%) programs allowed residents to select their mentor(s).

One hundred and nine of 189 (58%) resident respondents were male and 80 of 189 (42%) were female. The majority were ages 26-30, and 172 of 188 (91.5%) had completed their undergraduate medical training in Canada. One hundred and nineteen of 188 (63%) reported access to a mentor (Table 1), and 100 of 112 (89%) of these reported that at least one of their mentors was an anesthesiologist. The number of mentors per resident ranged from 1-10, but most respondents reported access to one (44 of 114, 39%) or two (38 of 114, 33%) mentors. Almost all residents in formal mentorship programs (107 of 116, 92%) reported having been formally assigned a mentor, and 74 of 112 (66%) reported access to an “informal” or “non-assigned” mentor.

Table 1 Demographics of respondents
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Perceptions of mentorship

Of those anesthesia residents receiving mentorship, 100 of 117 (86%) reported benefit; two respondents did not reply to this question. Most respondents indicated that the role of their mentor was to assist them with academic goals (90 of 119, 76%) or with career opportunities (64 of 119, 54%) (Table 2). Residents, in general, agreed that mentorship relationships were beneficial for building confidence (169 of 179, 94%), development of clinical skills (136 of 178, 76%), development of teaching skills (147 of 177, 83%), and achievement of personal goals (140 of 179, 78%). Residents also thought that mentorship played an important role in promoting faculty retention of trainees within their department (118 of 170, 69%) (Table 3). Overall, 143 of 180 (79%) residents agreed that mentorship was important to overall success as an anesthesiologist (Table 3).

Table 2 Mentorship roles among residents engaged with a mentor (n = 119)
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Table 3 Perspectives regarding the role of mentorship
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Barriers to mentorship

Anesthesia residents reported that barriers to mentorship included a lack of connection between mentor and mentee (131 of 178, 74%), lack of time among mentors (126 of 180, 70%), and lack of mentors with similar personal and professional goals (110 of 179, 61%). Residents also identified lack of formalized meeting times (109 of 177, 62%) or formalized objectives in their mentorship program (103 of 178, 58%) as barriers. A minority of respondents raised concerns regarding lack of mentors of the same sex (23 of 175: 8 males and 15 females, 13%) or absence of mentors with the same cultural background (43 of 179, 24%) (Table 4).

Table 4 Perceived barriers to mentorship
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Written comments

Thirty-four respondents provided written comments which revealed two major themes: 1) Mentorship is important for professional development (33 comments), as exemplified by the following quote: “I believe mentorship is very beneficial for a trainee in any specialty, it definitely helps to increase confidence and helps the trainee to guide his objective through the residency according to his career plans”. 2) The quality of the mentor-mentee relationship is important (18 comments), as exemplified by the following quote: “Formally assigned mentors may be helpful if there was maybe some effort put into matching groups of people with similar interests, goals, or background, i.e., some source of connection, and also if mentors participated voluntarily”. An important subtheme was the importance for residents to choose their mentor (12 comments): “Real mentorship happens when established informally as the mentee connects with a mentor who isn’t necessarily the assigned mentor”.

Discussion

Anesthesia residents represent the next generation of anesthesiologists and are therefore crucial to the academic growth of departments. The academic literature is very clear on the benefits of mentorship in terms of increased academic and personal productivity, career advancement, faculty retention of trainees, superior educational skills, increased confidence, increased grant funding, and academic career pursuits.1–5 Much of the current academic mentorship literature is derived from other specialties; however, it is important to examine the role of mentorship in anesthesiology specifically due to the profession’s unique considerations. First, anesthesiology significantly lags behind other specialties in academic growth and research productivity.15 Improved mentorship models may foster better academic growth of the specialty, which is crucial to promoting evidence-based practices. Second, when compared with other specialties, anesthesiologists are at a much higher risk for burnout and other stress-related morbidity.16 Mentorship has the potential to improve resilience of the future generation of anesthesiologists.13,17,18 Third, anesthesiology as a career specialty may pose special challenges for mentorship. The practice is often solitary and residents are assigned to work with different faculty members on a daily, sometimes ad hoc, basis. This dilutes sustained faculty-resident relationships and may result in insufficient time and opportunities for mentoring.

Interest in mentorship in anesthesiology has recently grown.5,8–10,13,19 The 2013 survey of Canadian anesthesia residents found that, despite over 94% of respondents identifying mentorship during residency training as important, 42% did not interact regularly with their mentor.9 The authors concluded that incorporation of a formal mentorship program within all Canadian anesthesia programs may be helpful. Nevertheless, they did not explore reasons for the gap between valuing mentorship and actual enactment of these relationships.

Our study further builds on these findings by purposely exploring resident perspectives and identifying barriers towards mentorship that may explain this gap. Our study confirms that the majority of Canadian anesthesia residents (79%) agree that mentorship is important to overall success as an anesthesiologist. Despite this, only 11 of 16 Canadian anesthesia residency programs reported formal mentorship programs. Furthermore, a key finding in our study is that the majority of these formal mentorship programs (73%) use a predominantly “top-down” dyadic approach where the residents are assigned mentors by their academic program for the full duration of their residency.

A recent qualitative study of 11 anesthesia residents and 12 faculty showed that successful mentorship hinged on three key factors: 1) the anticipated goals of the mentorship relationship, 2) characteristics of participants, and 3) the structure of the program.10 The authors concluded that differences in the perception of the goals of the relationship and the structure of the program resulted in cases of disillusionment and negative mentorship outcomes.10 Our study revealed similar barriers related to the mentee-mentor relationship and quantified the extent of these issues, including a lack of connection or similar professional or personal goals and a lack of formalized meeting times and objectives in formal programs. The number of written comments provided (63 comments from 34 of 189 respondents) was limited; however, the major themes were consistent with our quantitative analysis in affirming the importance of mentorship and, in particular, the quality of the relationship and the need for choice in mentor selection.

There is an obvious disconnect between residents’ focus on a quality mentorship relationship that includes choice and the current “top-down” mentorship model in most Canadian anesthesia residency programs. This may explain the lack of connection or similar professional or personal goals expressed by the residents. In contrast, research on mentorship in the literature has shown a significant benefit for mentees in informal mentorship relationships (developed spontaneously by choice) compared with formal mentorship (assigned) in terms of satisfaction and professional and psychosocial growth.4,20,21

The paradigm shift from a mentor-driven to a mentee-driven model has been successfully adopted in business.21,22 Furthermore, a number of different mentorship models other than the traditional dyadic model have recently emerged, e.g., the functional, group, and distance mentoring models.21 These alternate models can address common barriers to effective mentorship and improve alignment of both mentor and mentee needs.10,21

These findings suggest that a top-down approach to mentorship in anesthesiology may not be the most effective. Rather, incorporating more choice and flexibility in mentorship models by granting residents input into the mentor selection process may result in more productive relationships and greater engagement by mentors and mentees.

A limitation of our study is that, while we achieved an excellent response rate (94%) for anesthesia program directors, only 32% of anesthesia residents completed our survey. This response is similar to that reported by Zakus et al.9 but considerably lower than the mean physician response rate of 54% reported by Asch et al. in their systematic review of postal surveys.23 Therefore, selection bias may limit the generalizability of our findings to Canadian anesthesia residents. On the other hand, we can be confident regarding our finding that the majority of anesthesia programs in Canada use a top-down approach to assigning mentors.

Another limitation of our study is that, due to insufficient numbers of residents responding, we were not fully able to explore the role of sex or ethnicity in anesthesia mentorship relationships. This may warrant examination in future studies as the lack of career advancement for females in anesthesiology is well documented.24 Females have been found to advance through academic ranks in medicine more slowly than males, and they are less likely to achieve tenured faculty positions in academia.25 In general, females in medicine are less likely to have a mentor.3 Nevertheless, females with mentors report more publications, more time spent on research activity, and higher career satisfaction than those without mentors.2 Likewise, the literature suggests that mentorship based on similar cultural or ethnic backgrounds may result in better acculturation through increased social support.26 Thus, the role of sex and ethnicity in mentorship should be further explored in future studies.

While the number of comments available for qualitative analysis was too limited to draw conclusions, the responses did offer additional insight that triangulated with our quantitative findings. Other strengths of our study include developing and conducting our survey in keeping with best practices,11 surveying all Canadian anesthesia residents and anesthesia program directors, and providing our resident survey in both of Canada’s official languages (French and English).

Conclusions

Our study confirms the high value that Canadian anesthesia residents place on mentorship and that mentorship programs continue to be underutilized. Barriers to mentorship relate mostly to the quality of the mentor-mentee relationship, such as a lack of interest, time, or connection—either personal or professional compatibility. Most Canadian anesthesia programs assign mentors to their residents. This approach contrasts with evidence from the literature which suggests that improved satisfaction and professional and psychosocial growth are more likely to occur in mentorship relationships that are not pre-assigned. Our findings suggest that a more meaningful environment for successful mentorship relationships may be facilitated by clear objectives and meeting times, improved matching of residents with mentors (i.e., with similar interests, goals, and motivations), and allowing elements of mentee-driven choice in the selection of mentors.