Mentoring is seen as an effective means of improving skills, attitudes and practices in caring for dying patients”, providing holistic and personalized support and advancing the academic and research interests amongst trainees that is lacking in Palliative Medicine (PM) training^[1-11]. However, the absence of a clear definition and the presence of diverse mentoring practices limits understanding and use of mentoring in PM^[8-11].

  PM’s use of a multidisciplinary team approach^[12] which is “a group of people of different health-care disciplines, which meets together at a given time (whether physically in one place, or by video or tele-conferencing) to discuss a given patient and who are each able to contribute independently to the diagnostic and treatment decisions about the patient” further complicates efforts to introduce mentoring in PM training^[12]. Wu., et al’s (2016), Wahab., et al’s (2016) and Loo., et al’s (2017) suggest that use of a MDT mentoring approach in PM which would see senior members from different clinical and healthcare backgrounds within the MDT mentoring PM trainees to ensure a holistic mentoring experience. The presence of various healthcare specialists from diverse clinical settings however makes provision of effective oversight, consistency in mentoring goals, role awareness and clarity in expectations and responsibilities, difficult and underscores the need for a consistent mentoring approach^[8-16].

  However design of such a holistic and consistent mentoring approach is further complicated by the failure of many reviews and studies to account for mentoring’s context-specific, goal-sensitive, mentee-, mentor- and organizationally-dependent nature which make comparisons between prevailing mentoring practices difficult^[8,9,10,11]. To address these concerns Wu., et al (2016), Wahab., et al., (2016), Yeam., et al (2016), Loo., et al (2017) and Toh., et al (2017) have argued that thematic analysis of prevailing mentoring practices could be used to identify common elements that could be applied in diverse settings as guiding principles that will better inform design of mentoring programs. Wu., et al (2016) and Wahab et al (2016) efforts to identify common themes in the mentoring approaches of key members of the MDT however were left frustrated by the lack of systematic, literature and narrative reviews in OT and PT.

The need for this study
  This review is aimed at filling the gap in mentoring knowledge in OT and PT. Concurrent evaluation of mentoring programs in OT and PT is justified given that both specialties will be used together in MDT mentoring programs.

  Acknowledging the intention to employ senior mentors from the core specialties within the MDT to mentor PM trainees in a consistent and transparent manner within a structured mentoring program, this review will confine itself to mentoring between a senior OT or PT and newly graduated and/or undergraduates from their respective specialties.

Methodology

  A thematic review of mentoring programs in OT and PT involving PubMed, ERIC, Cochrane Database of Systematic Reviews, Medline, Scopus, OVID, CINAHL and Education Source databases between from 1^st January 2000 to 1^st January 2015 was conducted to study mentoring programs and approaches used in the PT and OT training. The Joanna Briggs Institute Reviewers’ Manual Version 2016^[17] was used for appraisal of the articles selected refer to Appendix 2. The search terms employed for physiotherapy were: “mentor”, “mentoring”, “mentorship” AND “Physiotherapy*”, “Physiotherapist” or their combinations. The search terms employed for occupational therapy were: “mentor”, “mentoring”, “mentorship” AND “Occupational therapy*”, “Occupational therapist” or their combinations. Publications in English or those with English translations on mentoring programs run by OT or PT departments and/or programs that involved senior PT or OT faculty focused upon advancing the professional and/or personal development of trainees from their respective fields were included.

  We included all study designs and mentoring approaches including dyadic (one-to-one, senior-to-junior, face-to-face), group and e-mentoring approaches which entailed combining face-to-face meetings^[18] with online, text messaging and/or email^[19].

  We excluded leadership, patient, family, youth, peer and near-peer mentoring as they are considered distinct forms of mentoring. Practices such as supervision, counseling, advising, coaching, preceptorship, role modeling and sponsorship, which are often conflated with mentoring, were excluded. Supervision is defined as being focused upon professional development, preceptorship as helping students gain clinical competencies, coaching as facilitating learner development through use of “deliberate practice strategies”, role-modelling as creating a positive example of good practice, an advisor as helping with scheduling, logistics and applications and sponsorship as dependence upon the influence of another for promotion and advancement^{[ 9,10,20,21,22]}.

  These specifications allowed the adoption of the American Academy of Hospice and Palliative Medicine (AAHPM) College of Palliative Care’s (2006) definition of mentoring to facilitate consistent identification of mentoring accounts. The AAHPM definition^[6] see mentoring as a “dynamic, reciprocal relationship in a work environment between an advanced career incumbent (mentor) and a beginner (protege), aimed at promoting the development of both”.

  In the absence of an a priori framework for mentoring and a lack of understanding of mentoring processes, we carried out a thematic analysis of mentoring programs. Using Braun and Clarke’s (2006) approach^[23], codes were constructed from the ‘surface’ meaning of the data and semantic themes were identified from ‘detail rich’ codes.

Data Extraction and Analysis
  Two authors (YHW, JC) carried out independent searches and reviews of all full text reviews fulfilling the inclusion criteria. The final list of papers to be included was agreed upon by four authors. The four authors carried out independent thematic analysis of the papers and discussed and compared their results online. Any disagreement in the coding was discussed online and at face-to-face meetings where consensus agreements were achieved.

Results

Search results and Selection process

Figure 1: Search results and selection process for PT .

  1505 PT abstracts were retrieved, 46 full-text articles were analyzed and 6 papers^{[24,25,26,27,28,29]} were included in this review.

Figure 2:

  3407 abstracts on OT were retrieved, 44 full-text articles were analyzed and 5 papers^{[30,31,32,33,34]} were included in this review.
  Separate thematic analysis of PT and OT papers revealed 3 themes including (1) defining mentoring, (2) benefits of mentoring and (3) mentors and mentees’ perspective about the mentoring process.

(1) Defining mentoring

Table 1: Common elements in definitions of mentorship.

  Thematic analysis of the 4 definitions of mentoring in PT^{[24,25,26,27]} and the 4 definitions of mentoring in OT^{[30,31,32,33,34]} identified common elements. The findings suggest mentoring is a mutually beneficial relationship involving an experienced professional who oversees the professional and personal development of a novice through the sharing of knowledge and skills. All 8 accounts describe mentoring programs supported by organizational assistance and use matching of mentors and mentees^[35] to initiate mentoring relationships.

(2) Benefits of mentoring
a. Benefits to mentors

Table 2: Benefits of mentoring for mentors.

  The professional and personal benefits of mentoring for mentors feature in 3 articles in PT^[25,27,29] and 5 in OT^{[30,31,32,33,34,35]} (Table 2). The professional benefits include refreshing and updating skills and knowledge, remaining up-to-date, increasing research productivity and enhancing professional reputation^{[25,27,29,30,31,32,33,34]}. Common personal benefits include formal acknowledgement of the mentor’s work and being able to ‘pay it forward’^{[25,27,29,30,31,32,33,34]}.

b. Benefits to mentees
  5 articles in PT^{[24,25,26,27,29]} and 4 accounts in OT^{[30,31,32,33,34]} report on the benefits of mentoring for mentees (Table 3). Common professional benefits include gaining practical experience, benefiting from a safe platform for discussion and feedback, developing research, clinical and decision making skills and professional identity and faster promotions^{[25,27,29,30,31,32,33,34]}. Common personal benefits include improved self-confidence and personal development^{[25,27,29,30,31,32,33,34].}

c. Benefits to host organizations

Table 3: Benefits of mentoring for mentees.

Table 4: Benefits of mentoring for stake holders.

  Common benefits to the host organizations include better trained staff^[29,31] and accelerated professional progression amongst staff^[27,31,34].

(3) The mentoring process
a. Mentor’s perspective
   Mentors emphasized the need for appropriate mentoring styles and compatible interests with mentees^[25,29,34]. In addition mentors stressed the importance of ‘protected time’^{[25,29,32,33,34]} to ensure an effective mentoring experience and to nurture reflective and critical thinking^{[25,29,32,33,34]}.

Table 5: Mentor’s perspective of the mentoring process.

b. Mentee’s perspective

Table 6: Mentees’ perspective of the mentoring process.

  Mentoring was most effective when mentees and mentors were well matched sharing the same interests and goals and when mentees provided with career advice^{[24,27,29,30,32,33]}. Mentees also appreciated consistent mentoring experiences, effective role modeling and supportive environments that allowed frank discussions, effective feedback, clinical insights and facilitated reflective practice^{[24,27,29,30,32,33]}. Good mentoring interactions led to prolonged ties long after the mentoring project ceased^{[27,29,30,34]}.

Discussion

  We will discuss the common theme in PT and OT mentoring programs in turn.

Relational-Dependent nature
  OT and PT mentoring relationships pivot on effective matching of mentees and mentors with similar goals and interests. Mismatches result in a reduction of interest amongst mentees and discourage their investment of time and effort in the mentoring process. As a result, pre-mentoring meetings hosted by host organizations where goals, time lines, responsibilities and code of conduct are established are important. Such meetings prevent misunderstandings and set the tone of the mentoring process. They also help nurture personal ties and lasting friendships.

Organizational-Dependent nature
  Host organizations play significant roles within mentoring relationships. Practically host organizations provide ‘protected time’ that allow mentors time set aside to provide effective, timely, appropriate, and individualized support. A critical role of the host organization involves nurturing mentoring environments that facilitate frank discussions and conversations about personal matters. Host organizations also provide mentor training and guidance for mentees. This is pivotal to establishing personal ties in mentoring relationships. In addition, host organizations provide formal recognition of mentoring efforts.

  Host organizations also play key relational roles facilitating the matching process, providing additional personal and professional support for mentees and mentors and providing oversight of the mentoring process.

Mentee-dependent nature
  A mentee’s character, motivations to participate, willingness to invest in a mentoring relationship and ability to realize mentoring objectives are critical. These mentee-dependent features are intimately entwined with the ability of the mentor to relate, inspire, work and support them.

Mentor-dependent nature
  The mentoring relationship is dependent upon the ability of the mentor to adopt the appropriate mentoring approach, nurture trusting relationships and provide effective, appropriate, timely, specific and individualized feedback.

Evolving nature of mentoring
  The various roles of the mentor at different stages of the mentoring relationships and the presence of short and medium term objectives within the mentoring process hint at mentoring’s evolving nature. The evolving nature of mentoring is emphasized by relationships that extend beyond the program and change into friendship over years^[36,37,38].

  Overall mentoring in PT and OT reveal evolving, mentee, mentor, organizational and relational dependent features akin to mentoring in medicine, surgery and nursing^[8,9,10,11]. These similarities suggest consistency in the mentoring approaches of the key specialties in the MDM and would suggest that senior OTs and PTs could be part of a consistent MDT mentoring process in PM.

Limitations & further research
  Whilst data does point to similarities between mentoring in OT and PT and the other specialties in the MDM, gaps remain. Lacking is data on context-specificity or goal-sensitivity that were pivotal to mentoring in medicine, nursing and surgery. Furthermore, what little evidence existing is largely American and may not be easily adaptable to other mentoring settings.

Conclusion

  Consistent, timely, holistic and individualized support that cuts across specialties provided by senior members of the MDT in a structured program that will provide transparency and accessibility to mentoring in PM is long overdue. This is particularly evident in the knowledge that PM can no longer afford to train its trainees along specialty lines. This review suggests that inclusion of OT and PT into a MDT mentoring program is possible but does raise questions as to how best to approach the design of a consistent mentoring approach.

  It may be that looking for commonalities in the mentoring approaches of core MDT specialties to design a mentoring approach that can be used by all MDT mentors is flawed. One alternative maybe that a consistent form of MDT mentoring based upon the common themes identified within nursing, OT, PT, MSW and medicine mentoring approaches could be applied amongst MDT specialties. Further research on both these option is required as is research of mentoring within the PM setting.

Acknowledge:
  The authors would like to dedicate this paper to the late Dr. S. Radha Krishna and Dr Deborah Watkinson whose advice and ideas were integral to the success of this study.

Conflict of interest:
  The authors declare that there is no conflict of interest.

Appendix 2

Appendix 2: JBI Critical Appraisal Checklist for Qualitative Research.

Appendix 2: Results of Critical Appraisal for Selected Qualitative Papers.

Appendix 2: JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies.

Appendix 2: Results of Critical Appraisal for Selected Analytical Cross Sectional Studies paper.

Appendix 2: Results of Critical Appraisal for Randomized Controlled Trials paper.

Appendix 2: JBI Critical Appraisal Checklist for Randomized Controlled Trials.

References