A Cross-sectional Descriptive Study of Mentoring Relationships Formed by Medical Students
Presented in part at the Society of General Internal Medicine Annual Meeting, May 2000, Boston, Mass; and the Clerkship Directors in Internal Medicine Annual Meeting, October 2000, Washington D.C.
Address correspondence and requests for reprints to Dr. Hauer: Division of General Internal Medicine, University of California, San Francisco, 400 Parnassus Ave., Box 0320, San Francisco, CA 94143-0320 (e-mail: firstname.lastname@example.org).
To describe medical students' mentoring relationships and determine characteristics associated with having mentors, 232/302 (77%) of third- and fourth-year medical students at the University of California at San Francisco (UCSF) were surveyed. Twenty-six percent of third-year and 45% of fourth-year students had mentors. Most met their mentors during inpatient clerkships (28%), research (19%), or sought them on the basis of similar interests (23%). On multivariate analysis, students who performed research prior to (odds ratio [OR], 4.8; 95% confidence interval [95% CI], 1.4 to 16.7; P = .01) or during medical school (OR, 2.4; 95% CI, 1.1 to 5.6; P = .03) and students satisfied with advising from all sources at UCSF (OR, 1.8; 95% CI, 1.4 to 2.4; P < .001) were more likely to have mentors.
Mentoring is a core component in the training of young professionals. Although there is no consistent definition of mentor, most emphasize teaching, professional and personal guidance, sponsorship, role modeling, and socialization into a profession.1–3
Much emphasis has been placed on creating and fostering mentoring relationships in medicine.4 Although the opportunity for mentorship begins during medical school, little is known about medical students' mentoring relationships or the students who form them. The purpose of this study is to describe the prevalence and characteristics of mentoring relationships among third- and fourth-year medical students at the University of California, San Francisco (UCSF). We sought to understand how these relationships form and whether certain students were more likely to develop successful mentoring relationships.
We performed a cross-sectional descriptive and analytic study of all third- and fourth-year medical students attending UCSF in Spring, 1999. We asked students to complete an anonymous questionnaire during courses in which attendance was required so that all students would be accessible for study entrance. Students not present at class and those who chose not to respond were excluded.
The survey included questions about demographics, perceived class rank, research experience, and career goals. Students were asked if they had developed a mentoring relationship, and if so, to describe it, including the functions performed by the mentor. Students without mentors were asked about perceived barriers to mentoring. We defined mentor in the questionnaire as:
A more senior person within the medical training environment, with whom you have a sustained, ongoing relationship. A mentor promotes your professional development by discussing your goals, needs, weaknesses and accomplishments. A mentor should be more than simply a role model or advisor.
The questionnaire was adapted from the study of role models by Wright et al.5 Wright drew on the Webster's dictionary definition of role model, “a person considered as a standard of excellence to be imitated.” An advisor is “a person who provides a recommendation regarding a decision or a course of conduct.” While a mentor may foster a student's career vision by serving as a role model and/or advisor, a mentor should not be a role model or advisor only. Our definition of mentor was drawn from business, educational, and medical literature.1–4,6–12 Functions that may be performed by a mentor, and that were elicited on the survey included: personal support (motivation, moral support, personal advice); career advising (assisting with career and residency choice decisions, aiding in career advancement); role modeling for career and family; and collaboration on research/projects. The definition and survey were reviewed by research faculty for thoroughness and piloted with residents and general internal medicine research fellows for clarity and completeness. The UCSF Committee on Human Research approved the study.
At the time of the survey, UCSF had no formal mentoring program. Two programs provided personal support and career advising. Students were assigned to the Medical Family Network, in which groups of approximately 10 to 15 students met with 2 faculty for quarterly group dinners. Students received personal support and general medical school advice from the faculty and senior students. Students also selected a career advisor in their specialty of choice at the end of the third year. These advisors provided information regarding residency application and career planning. Underrepresented minority students were also exposed to minority faculty for additional advising.
We analyzed the data using the statistical software package STATA 5.0 (STATA Corp., College Station, Tex). We performed descriptive statistics, χ2, Fisher's exact and Mann-Whitney rank sum tests. Using stepwise logistic regression, we assessed independent predictors of forming a mentoring relationship. The model included key demographic variables and all characteristics in bivariate analysis with a P value ≤ .05 (age, gender, marital status, children, ethnicity, medical school year, perceived class rank, interest in academic career, interest in research, surgical specialty preference, research prior to or during medical school, and overall satisfaction with advising from all sources at UCSF).
The authors have no conflict of interest, financial or other, related to any of the material in this manuscript.
Overall, 232/302 students completed questionnaires (77% response rate). Table 1 contains demographic characteristics of the respondents.
Table 1. Demographic Characteristics of 232 Third- and Fourth-year Medical Students and Bivariate Analysis of Medical Student Characteristics Associated With Having a Mentor, UCSF, 1999
|Men||103 (44)||41 (40)||.2|
|Women||129 (56)||42 (33)|| |
|Age, y*||28 ± 3*||27.5 ± 2.7 vs. 28.8 ± 9.0†||.5|
|Ethnicity|| || ||.12‡|
| Asian/Pacific Islander||67 (29)||17 (25)|| |
| African American||12 (5)||6 (50)|| |
| White||93 (40)||39 (42)|| |
| Latin American||22 (9)||11 (50)|| |
| Multiethnic||21 (9)||6 (29)|| |
| Other||16 (8)||4 (25)|| |
|Third-year student||117 (50)||31 (26)||.003|
|Fourth-year student||115 (50)||52 (45)|| |
|Self-identified class rank|| || ||.004‡|
| Top 1/3||95 (41)||44 (46)|| |
| Middle 1/3||109 (47)||32 (29)|| |
| Bottom 1/3||17 (7)||3 (18)|| |
| Undisclosed||11 (5)||4 (36)|| |
|Married||46 (20)||16 (34)||1.0|
|Unmarried||183 (80)||64 (35)|| |
|Children||17 (7)||5 (29)||.6|
|No children||213 (93)||76 (36)|| |
|Participant in MFN||135 (59)||49 (36)||.7|
|Not participant in MFN||95 (41)||32 (34)|| |
|Committee/organization work||185 (80)||68 (37)||.5|
|No committee/organization work||45 (20)||14 (31)|| |
|Continuity clinic experience||58 (25)||21 (36)||.9|
|No continuity clinic experience||173 (75)||61 (35)|| |
|Medical school research||158 (69)||70 (44)||<.001|
|No medical school research||72 (31)||11 (15)|| |
|Research before medical school||195 (85)||75 (38)||.02|
|No research before medical school||35 (15)||6 (17)|| |
|Strong interest in research§||70 (30)||35 (50)||.003|
|No strong interest in research||160 (70)||47 (29)|| |
|Strong interest in academic medicine§||136 (59)||59 (43)||.004|
|No strong interest in academic medicine||96 (41)||24 (25)|| |
|Primary care specialty preference‖||127 (55)||40 (31)||.2|
|Non–primary care specialty preference||104 (45)||42 (40)|| |
|Surgical specialty preference¶||23 (10)||13 (57)||.03|
|Non–surgical specialty preference¶||208 (90)||69 (33)|| |
|Satisfaction with medical school experience#||3.7 ± 1.1||3.8 ± 1.2||.11|
|Satisfaction with advising from all sources at UCSF#||2.5 ± 1.1||3.0 ± 1.3||<.001|
Only 36% (83/232) of all students reported having a current mentor, although 96% (222/232) rated mentors as important or very important. In contrast, 64% (147/232) of students had a role model (63% of third- and 64% fourth-year students) and 68% (158/232) had an advisor (64% of third- and 70% of fourth-year students).
Table 1 demonstrates the medical student characteristics associated with having a mentor on bivariate analysis. On multivariate analysis (Table 2), medical school year, research prior to or during medical school, and overall satisfaction with advising from all sources at UCSF were independently associated with having a mentor. Because the variable “overall satisfaction with advising from all sources at UCSF” may have been strongly influenced by having a mentor, a second model that was identical to the first, but excluding that variable was run. The results were similar except that ethnic minority students (African American and Latin American) were now more likely to have mentors (odds ratio [OR], 3.1; 95% confidence interval [95% CI], 1.3 to 7.6; P = .01).
Table 2. Multivariate Analysis of Medical Student Characteristics Predictive of Having a Mentor, UCSF, 1999*
|Fourth-year student||2.2||1.1 to 4.2||.02|
|Minority student†||2.1||0.8 to 5.4||.1|
|Medical school research||2.4||1.1 to 5.6||.03|
|Research before medical school||4.8||1.4 to 16.7||.01|
|Surgical specialty preference||2.7||0.9 to 7.9||.07|
|Satisfaction with advising from all sources at UCSF‡||1.8||1.4 to 2.4||<.001|
Fourth-year students most commonly met their mentors during the third (29%) and first (21%) years of medical school, followed by fourth year (19%), second year (17%), before medical school (8%), and other (6%). They met their mentors during inpatient clerkships (28%), through research activities (19%), or by seeking a mentor with similar interests (23%). Less commonly, students met their mentors during outpatient clerkships (9%), or through committee/organization participation (4%).
Students reported that 44% of their mentors were women. Sixty-three percent were between 35 and 50 years of age, with 11% less than 35, 23% greater than 50 years old, and 3% of unknown age. The majority of mentors were white (68%) or Asian (13%), with fewer being African American (5%), Latin American (5%) or other (9%). Twenty-four percent of minority students had minority mentors. Among African-American students, 33% of their mentors were also African American, while 18% of Latin-American students had Latin-American mentors. The majority of mentors were in the fields of internal medicine (12% subspecialty medicine and 20% primary care medicine) or surgery (15% subspecialty and 6% general), with a significant minority in pediatrics (12%), neurology (6%), family medicine (4%), psychiatry (4%), and obstetrics-gynecology (4%). Mentors in our study tended to be younger and were more likely to be female, but were otherwise similar to the general faculty population at the University of California as a whole.13 Specific data on the demographic characteristics of the faculty at UCSF are not available.
Mentors most commonly provided personal support, role modeling, and career advising. Personal-support functions included motivation (98%), moral support (91%), and personal advice (60%). Career-advising functions included assisting with specialty (98%) and residency choice (78%) decisions and providing opportunities that aided in career advancement (83%). Eighty-nine percent of mentors served as role models for career and 80% served as role models for achieving balance between personal and professional life. Less commonly, mentors provided research opportunities (60%), collaboration on research/projects (58%), resources such as funding, office space or administrative assistance (39%), or non-research project opportunities (33%). Students met with their mentors weekly or more often (24%), monthly (29%), or less than monthly (47%). Frequency of meetings did not correlate with overall satisfaction with advising.
Among students without mentors, 23% (34/145) had approached potential mentors and 12% (17/146) had been offered mentorship. Students cited several factors in their inability to find a mentor. These factors were considered to be important barriers if they were rated as 3 or higher on a 5-point Likert scale where 1 = not at all important and 5 = very important. These barriers included discomfort asking (67%), and failing to meet someone with similar career (59%) or personal (66%) interests. Forty students wrote in additional responses, including faculty seeming too busy (n = 13; 33%) and their own career indecision (n = 10; 25%).
About 1/3 of our respondents reported finding mentors during medical school. Performing research either before or during medical school was highly correlated on both bivariate and multivariate analysis with having a mentor. Several studies examining the impact of a research mentor on career choice and academic success have found that mentors are associated with decisions to pursue a research career.14 In our bivariate analysis, students with mentors tended to be interested in both research and academic careers. Students may also pursue research with the goal of developing a mentoring relationship.15 The fragmented medical school schedule, with frequent changes of courses and clerkships, does not promote sustained faculty–student relationships4 in the way that research collaborations do.
Contrary to prior literature, we did not find that female students were less likely to have mentors.16 Students reported that 44% of their mentors were female, whereas women comprised only 24% of the university faculty at the time. This finding may be reflective of the relatively large number of female faculty at UCSF in clinician-educator and administrative positions with significant exposure to medical students. Women faculty may also make a stronger effort to provide mentorship in the face of perceived barriers to success as a female physician. Alternatively, women students, who comprise half of our medical school class, may actively seek women mentors.
Unlike prior studies,16 minority students at UCSF were at least as likely to find mentors as nonminorities. Including or excluding the variable “overall satisfaction with advising from all sources at UCSF” in the multivariate model had a significant impact on the degree to which student ethnicity was found to be statistically significant. Perhaps minority medical students are more likely to have a mentor because of unmeasured factors (such as the minority advising program at UCSF), and then are also more likely to be satisfied with the advising received during medical school. Once we controlled for overall satisfaction with advising, minority status became nonsignificant.
Our study has several limitations. We collected data from a single institution during 1 academic year. The cross-sectional design prevents determination of causality. Results are dependent on student report alone. We designed a new survey instrument that has not been previously validated. However, we did build on questions used by Wright et al. in their study of role models,5 and we piloted the instrument thoroughly. Because of the absence of a universally accepted definition of mentor, our definition was derived from various definitions in the literature to indicate a relationship greater than that of an advisor or role model.1–3 Our 23% nonresponse rate introduces the possibility of bias, although our response rate is high compared to other survey studies involving medical students. We do not have information on whether the nonresponders were mentored or not, although the demographics of our respondents correspond closely with those of the class as a whole. Finally, we may have failed to measure some factors that are important to forming student–mentor relationships.
Ours is the first study we know of that profiles the medical students who form successful mentoring relationships and describes the characteristics of mentoring specifically for students. Our study emphasizes the importance that students place on mentors and the difficulties inherent in forming these relationships during medical school.
Our study suggests several ways to improve the quality of mentoring for medical students. On bivariate analysis, students with unformed career aspirations and those with interests outside of academic medicine were unlikely to find mentors. Early and frequent career advising may help students with unformed career aspirations make career decisions and solidify their goals, eliminating this barrier to finding a mentor. These advisors should then refer students on to potential mentors in the student's field of interest. Research or project time may also promote mentoring, although it is unclear if requiring such activities of students without interests in these areas would be successful. Exposure to faculty outside of academic medicine would assist students with nonacademic career goals.
Further studies are needed to clarify the effectiveness of early career advising programs, the components of successful programs (e.g., required research/project time, the assignment of students to faculty with similar career interests, including clinical practice as well as research), and the components of effective mentoring relationships (e.g., helping students to discover and define their interests versus influencing them in the direction of the mentors). In addition, more research is needed on the barriers that medical students face in finding mentors.
The authors thank David Irby, PhD, Maxine Papadakis, MD, and Eliseo Perez-Stable, MD for their insightful and constructive reviews of the manuscript.
This research was supported in part by Health Resources and Services Administration Faculty Development Grant D08 PE50109.