Peer-led mentoring just part of the solution

PEER-led mentoring programs can help ease interns’ transition from medical school to the hospital environment but don’t address the underlying structural problems producing bullying, harassment, and mental health stigma.

Commenting on a study published in the MJA, Dr Tessa Kennedy, Chair of the Australian Medical Association Council of Doctors in Training, said peer mentoring had merit, but advice from senior registrars and consultants remained critical in instances of bullying or harassment.

“If you are having a hard time with bullying and harassment, [a mentor] at a similar level might not be able to defend you or help you to navigate complex [complaints] processes with the same confidence as a more senior clinician,” she said.

In the MJA study, researchers paired 26 first-year interns with residents (post-graduate Years 2 and 3) and compared their experiences with those of 27 interns who were not matched up with a peer mentor. Mentors and mentees were provided with suggested discussion topics, including administrative problems, work–life balance, career development, time management, and relationships with colleagues. The 12-month program was flexible, allowing peer-initiated meetings at mutually convenient times and locations, the researchers wrote. Qualitative outcome data were collected in semi-structured interviews and focus groups at 12 months to assess psychosocial wellbeing and job satisfaction.

The mentored interns felt that the program had had a positive impact on stress levels, morale, job satisfaction and psychosocial support compared with interns without mentors.

The researchers wrote that the program enhanced support structures for junior doctors, built a sense of community, and helped interns to navigate their new professional environment. They noted that the program was generalisable and self-sustaining, with satisfied interns keen to sign on as mentors in the following year.

In an exclusive MJA InSight podcast, lead researcher Dr Sonia Chanchlani said peer mentoring programs were also low cost.

“Our experience highlighted that the costs can essentially be negligible, as our interns believe the type of support they required from a peer mentor to facilitate navigation within the organisation and develop a sense of community did not require extra training. It was basic information that the mentor obtained through experience,” she said.

Dr Kennedy said that peer mentoring seemed to be a promising way to improve connectedness and ease some of the significant stresses associated with the transition to the hospital environment.

“That leap from being a medical student to an intern can be a really big one, so having somebody who is not too far above you there to support you can be helpful,” she said. “Having someone show you the way is more helpful if they aren’t too far in front.”

She said that while the peer mentoring program seemed beneficial in terms of practical guidance, it would be interesting to investigate its true impact on mental health and burnout using validated tools measuring psychological distress.

Alex Farrell, President of the Australian Medical Students’ Association, applauded efforts to improve the support for junior doctors, but said structural problems remained.

“More support is always welcome and there is something incredibly helpful about peers who understand what you are going through to help you find your way. However, it’s important to acknowledge that having someone to talk to and help to navigate problems doesn’t mitigate the structural reasons [why] those issues are there,” Ms Farrell told MJA InSight.

“This article noted issues surrounding bullying and harassment, and mental health stigma, and while having someone to talk to can be invaluable, it isn’t a cure for the larger factors at play behind some really pernicious parts of the medical health workforce.”

Dr Kennedy said there was a growing desire to improve the wellbeing of junior doctors, and that peer mentoring programs, along with pre-internship and orientation programs, were all a step in the right direction.

However, she said practical advice, such as how to manage shift work, was often missing from existing pre-internship and hospital orientation programs.

“You spend a lot of time doing mandatory training on waste management or how to operate a fire extinguisher but, for example, we don’t teach people how to manage shift work or support them in frequent transitions between jobs and geographyvery well. And yet these are such important contributors to stress and disruption in your life,” she said.

“The desire is there to improve the wellbeing of junior doctors, but we still need to work on providing the practical means by which to achieve it.”