Near-peer mentoring for medical students shows promise

IN 2013, the National Mental Health Survey of Doctors and Medical Students reported increased rates of psychological distress, mental illness and suicidal ideation for Australian medical students compared with the general community. A 2019 study investigated the global prevalence of anxiety among medical students, showing a rate of 33.8% worldwide. As a result, concerted efforts have been undertaken by medical program administrators to increase the wellbeing support available to medical students as they complete their studies.

However, in light of significant disruptions to medical curriculums around the world secondary to the coronavirus disease 2019 (COVID-19) pandemic, we believe it is increasingly important to offer innovative solutions to support medical student wellbeing. We have established a pilot program to deliver near-peer mentoring to students completing their psychiatry rotation through the St Vincent’s Clinical School at St Vincent’s Hospital Melbourne, which has been rapidly adapted to facilitate online delivery under the current circumstances.

While near-peer mentoring is an established form of wellbeing support for medical students, few registrar-led wellbeing programs have been formally integrated into the clinical teaching of medical curricula in Australia. Although our model is still being piloted, early feedback from students has been promising. We have chosen to share this model given the likely ongoing impact of COVID-19 on medical curriculums across the country and internationally, and the potential benefits that may be delivered for medical student wellbeing.

Developing a near-peer model for wellbeing support

Our pilot program launched in January 2020 and is ongoing at the time of writing. It is embedded within the 6-week psychiatry rotation at St Vincent’s Hospital Melbourne, completed by University of Melbourne medical students in their third year of the course. Anecdotally, many students find this rotation confronting, particularly those who may already be managing their own mental illness.

The model itself centres around the use of a registrar, who acts as the designated near-peer mentor and remains a consistent and available point of contact throughout the rotation. The registrar facilitates three formal wellbeing sessions, integrated into each 6-week rotation timetable and scheduled at a time convenient to the students that does not add to the burden of their already busy workload. The three wellbeing sessions include:

• one wellbeing session at the beginning of the rotation, used for introductions, to establish rapport, to develop an understanding of each student’s interests and goals, and to help frame expectations for the rotation as a whole;
• one wellbeing session during the middle of the rotation to provide opportunity to discuss clinical encounters and explore any transference and countertransference reactions that the students may have experienced, to check log-book progress, and to provide guidance around assessment or placement concerns; and
• one wellbeing session at the end of the rotation to provide opportunity to reflect on the rotation, and for students to provide more robust feedback (verbal and written) about the teaching program.

In addition to scheduled wellbeing sessions, opportunities for informal near-peer support are available to students through the designated near-peer mentor. These informal opportunities are responsive to student needs and may include meeting for coffee between or after classes, clarification of clinical concepts, remediation of clinical skills, and/or availability for phone or email contact for personal and professional support as required.

While the near-peer mentor is a registrar, a clear line of governance over the teaching program remains. Any wellbeing concerns of a serious nature that are raised by students or noted by the registrar are escalated to the coordinator of the teaching program in the first instance, with further escalation to the Clinical School and the Melbourne Medical School wellbeing officer where required or directed.

To evaluate our program, we have developed a number of success criteria based on previous feedback provided by medical students in response to the existing teaching program. These success criteria include:

• clear identification of a registrar point of contact throughout the psychiatry rotation;
• opportunity for reflection and debriefing of clinical scenarios and encounters;
• improved understanding of the role of transference and countertransference in professional practice;
• increased responsiveness of the teaching program to the student’s professional and personal needs;
• earlier identification of students who may need additional support to successfully complete the rotation; and
• earlier identification of students who may be at risk or have other wellbeing concerns.

At present, we have collected written feedback from 19 students across two rotation blocks – one rotation delivered in a face-to-face format to support usual clinical placements, and one rotation disrupted by COVID-19 with cessation of all clinical placements and rapid adaptation to online delivery. Written feedback across both rotations included a series of Likert scales as well as fields for qualitative commentary.

Face-to-face delivery

Feedback from students during the first rotation indicated that the wellbeing program was meeting a number of success criteria:

• 100% of students strongly agreed that they were able to contact the near-peer mentor for additional support with clinical assessments;
• 100% of students strongly agreed that they were able to contact the near-peer mentor for social and emotional support relating to their participation in the psychiatry rotation;
• 100% of students strongly agreed that the wellbeing sessions offered an opportunity for reflection and debriefing of clinical scenarios;
• 100% of students strongly agreed that the wellbeing sessions offered an opportunity for reflection and debriefing of non-clinical scenarios;
• 100% of students strongly agreed that the wellbeing sessions contributed to their understanding of transference and countertransference in clinical practice; and
• 100% of students strongly agreed that the wellbeing program supported their clinical learning.

Students also provided qualitative commentary indicating that the wellbeing program was meeting both professional and personal needs, including the following examples:

• “Having a specific person to turn to for help is invaluable”;
• “All rotations should have a near-peer mentor”;
• “Excellent opportunity to debrief. Please have weekly;”
• “Helped us feel supported and less isolated when on rotation to different sites;”
• “I have never felt so well supported during a rotation before”.

Online delivery during COVID-19

The second rotation was significantly affected by COVID-19, with rapid cessation of all clinical placements. Feedback from students during this rotation indicated that the wellbeing program supported the delivery of the rotation during a time of significant uncertainty:

• 100% of students strongly agreed that they were able to contact the near-peer mentor for additional support with clinical assessments;
• 100% of students strongly agreed that they were able to contact the near-peer mentor for social and emotional support relating to their participation in the psychiatry rotation;
• 88% of students strongly agreed that the wellbeing sessions offered an opportunity for reflection and debriefing of clinical scenarios;
• 100% of students strongly agreed that the wellbeing sessions offered an opportunity for reflection and debriefing of non-clinical scenarios;
• 100% of students strongly agreed that the wellbeing program supported their clinical learning.

The qualitative commentary during this rotation was often highly personal, and we believe this reflects the unique supports that the near-peer mentor was able to provide in an otherwise challenging rotation. To respect the nature of this feedback, many quotes will not be shared. Other examples include:

• “Best approach to ensuring student wellbeing that I’ve seen during my medical course”;
• “This was really the only part of our rotation where we had ongoing contact with one doctor, so it formed a really pivotal role in our rotation, making us all feel slightly less disconnected while being physically separated”;
• “I found it incredibly helpful and reassuring to know that we had a designated point of contact”;
• “These sessions were great because they could be what we needed them to be”;
• “It was wonderful to have someone a bit more experienced but still close to my age group to talk to, especially given our placement was cancelled”;
• “Definitely recommend this program is implemented more broadly in future”;
• “I am so thankful to have had this program during COVID-19”.

Conclusions

While this pilot program is in its early stages, we believe that this model of near-peer wellbeing support has been successful in meeting its aims. It has been easily adapted to suit clinical circumstances both before and during COVID-19, with likely ongoing utility in a post-COVID-19 era of medical education. We would encourage other medical programs to consider the role of near-peer mentorship in enhancing the student experience at this challenging time.

We would like to acknowledge the following people for their ongoing support of the Wellbeing Program through the St Vincent’s Clinical School:

• Dr Sue Subasinghe;
• Professor David Castle; and
• Ms Giannetta Rizk.

Dr Skye Kinder is the 2019 Young Victorian of the Year and national finalist for Young Australian of the Year. Training with the Royal Australian and New Zealand College of Psychiatrists, Skye works as a psychiatry registrar at St Vincent’s Hospital Melbourne. Skye is currently an Honorary Clinical Tutor for the Department of Psychiatry at the University of Melbourne. She was named Victoria’s Junior Doctor of the Year in 2017.

Associate Professor Justin Tse is Clinical Dean, St Vincent’s Clinical School, University of Melbourne. He has been involved in medical education for 20 years and has interests in intern work readiness and e-learning. He is involved in cancer research and, particularly, in service delivery in primary care. He is a Research Fellow for the Cancer Council of Victoria.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.