To evaluate the notion that teaching, tutoring, role modelling, coaching and supervision may be a part of an overarching concept of mentoring, this study was made up of three stages. Stage 1 consists of systematic reviews of teaching, tutoring, role modelling, coaching and supervision carried out to provide better understanding of these processes. In acknowledgement of mentoring’s, coaching’s and supervision’s context-dependent, approach-specific nature, studies were confined to educational accounts that involve one-to-one interactions between tutor and learner. The term tutor was used to encapsulate mentor, supervisor, teacher, role model and coach.
Stage 2 drew upon prevailing descriptions of novice mentoring, the dominant form of mentoring, given that mentoring’s context dependent nature prevents conflation of different forms of mentoring [2-16].
Stage 3 sought to determine similarities between teaching, tutoring, role modelling, coaching and supervision and mentoring.
To carry out the systematic reviews, Stage 1 adopted Braun and Clarke’s (2006) approach to thematic analysis to identify key themes within teaching, tutoring, role modelling, coaching and supervision in medical education [17].
Stage 2 drew upon recent accounts of novice mentoring. Focus was maintained on novice mentoring which is the dominant form of mentoring in medical education and to prevent it from being conflated with other distinct forms of mentoring such as peer, group and e-mentoring [2-16].
Stage 3 sought comparisons being made between novice mentoring and teaching, tutoring, role modelling, coaching and supervision to determine the overlap between each of these approaches.
Stage 1: Thematic analysis of teaching, tutoring, role modelling, coaching and supervision
Methodology
A systematic review was proposed to explore the size and scope of available literature on assessing the impact of medical ethics education in published peer-reviewed literature [18-22]. This allowed for systematic extraction and synthesis of actionable and applicable information [23] whilst summarizing available literature [24, 25] across a wide-range of pedagogies, assessment contents and practice settings [26-30].
Levac et al. (2010) [31]’s and Arksey and O’Malley (2005) [18]’s framework for systematic review was used to map “the key concepts underpinning a research area and the main sources and types of evidence available” [21] and “produce a profile of the existing literature in a topic area, creating a rich database of literature that can serve as a foundation” to inform practice and guide further research [19, 32, 33].
Guided by PRISMA-P 2015 checklist [24], Levac et al. (2010) [31]’s and Arksey and O’Malley (2005) [18]’s framework, a 6-stage systematic review protocol was developed for this study [18-22, 31].
Stage A: Identifying the research question
Guided by two librarians from the medical libraries at Yong Loo Lin School of Medicine at National University Singapore and the National Cancer Centre Singapore and educational experts and clinicians from the Singapore General Hospital, the Division of Cancer Education at the National Cancer Centre Singapore and the Marie Curie Palliative Care Institute at the University of Liverpool (henceforth the advisory team), the 14-person research team (YR, JY, AH, KT, KP, NQ, RP, BT, AC, YP, RK, DT, SM, and LK) discussed prevailing concepts and practice surrounding issues, and practices surrounding teaching, tutoring, role modelling, coaching and supervision and identified the primary research question to be: ‘what is known of teaching, tutoring, role modelling, coaching and supervision in Internal Medicine?’. The secondary questions were “what are the key elements of teaching, tutoring, role modelling, coaching and supervision in Internal Medicine?’. These questions were designed on the population, concept and context elements of the inclusion and exclusion criteria [34, 35], using a PICOS format (Table 1).
Guided by the advisory team, the 14-person research team worked in teams of threes under the supervision of the senior researchers (LK, SM, DT, and RK) and supported by near peer mentors (YP and KT) to carry out independent searches of accounts of role modelling, teaching, tutoring, coaching and supervision published in the PubMed, Scopus, ERIC and Cochrane Database of Systematic Reviews. The searches were carried out between the 12th September 2017 and 18th October 2017. The respective search strategies are found in the PRISMA in Figure 1. In keeping with Pham et al. (2014) [33]’s approach of ensuring a viable and sustainable research process, articles published in English or had English translations published between 1st January 2000 to 31st December 2015 were included in the initial search.
With all searches reviewed by the senior reviewers, the review process was extended, and additional searches were performed between 12th May 2019 and 24th April 2019 to review newly published literature from 1st January 2016 to 31st December 2018 for each of the learning approaches.
|
Role modelling
|
Teaching and tutoring
|
Coaching
|
Supervision
|
PICOS
|
Inclusion criteria
|
Exclusion criteria
|
Inclusion criteria
|
Exclusion criteria
|
Inclusion criteria
|
Exclusion criteria
|
Inclusion criteria
|
Exclusion criteria
|
Population
|
- Postgraduate or undergraduate
- Involve medical student/ junior clinician/ resident and/or senior clinician in a facility where medical services are provided, or in a facility of medical education
- Within clinical or academia or research setting
- Limited to Internal Medicine and General Medicine
|
- Clinical specialties not associated with Internal Medicine such as Surgery, Paediatrics, Emergency Medicine, Psychiatry, Obstetrics and Gynaecology, and Clinical and Translational Science
- Allied health roles, such as Nursing, Physiotherapy, Occupational Therapy, Pharmacy, Radiography, Psychology, Medical Social Work
- Wet bench research/lab work
- Veterinary work or Dentistry
- Ancillary staff such as housekeepers, administrators, finance professionals, accountancy
|
- Postgraduate or undergraduate
- Involve medical student/ junior clinician/ resident and/or senior clinician in a facility where medical services are provided, or in a facility of medical education
- Within clinical or academia or research setting
- Limited to Internal Medicine and General Medicine
|
- Clinical specialties not associated with Internal Medicine such as Surgery, Paediatrics, Emergency Medicine, Psychiatry, Obstetrics and Gynaecology, and Clinical and Translational Science
- Allied health roles, such as Nursing, Physiotherapy, Occupational Therapy, Pharmacy, Radiography, Psychology, Medical Social Work
- Wet bench research/lab work
- Veterinary work or Dentistry
- Ancillary staff such as housekeepers, administrators, finance professionals, accountancy
|
- Postgraduate or undergraduate
- Involve medical student/ junior clinician/ resident and/or senior clinician in a facility where medical services are provided, or in a facility of medical education
- Within clinical or academia or research setting
- Limited to Internal Medicine and General Medicine
|
- Clinical specialties not associated with Internal Medicine such as Surgery, Paediatrics, Emergency Medicine, Psychiatry, Obstetrics and Gynaecology, and Clinical and Translational Science
- Allied health roles, such as Nursing, Physiotherapy, Occupational Therapy, Pharmacy, Radiography, Psychology, Medical Social Work
- Wet bench research/lab work
- Veterinary work or Dentistry
- Ancillary staff such as housekeepers, administrators, finance professionals, accountancy
|
- Postgraduate or undergraduate
- Involve medical student/ junior clinician/ resident and/or senior clinician in a facility where medical services are provided, or in a facility of medical education
- Within clinical or academia or research setting
- Limited to Internal Medicine and General Medicine
|
- Clinical specialties not associated with Internal Medicine such as Surgery, Paediatrics, Emergency Medicine, Psychiatry, Obstetrics and Gynaecology, and Clinical and Translational Science
- Allied health roles, such as Nursing, Physiotherapy, Occupational Therapy, Pharmacy, Radiography, Psychology, Medical Social Work
- Wet bench research/lab work
- Veterinary work or Dentistry
- Ancillary staff such as housekeepers, administrators, finance professionals, accountancy
|
Intervention
|
- Accounts of, or involving, role modelling between medical student, junior clinician, and/ or resident, and senior clinician
- Dyadic/ One-to-one role modelling relationship
- Role modelling process
- Characteristics of the role model and student
- Role modelling relationship
- Barriers of role modelling
|
- Supervision, coaching, teaching, tutoring, advising and sponsorship
- Peer mentoring, mentoring for leadership, mentoring patients or mentoring by patients, interdisciplinary mentoring
- No mention of role modelling
|
- Accounts of, or involving, senior and junior clinicians, residents and/or medical students who underwent tutoring and/or teaching
- Dyadic/ One-to-one teaching/ tutoring relationship
- Teaching/ tutoring process
- Characteristics of the teacher/ tutor and student
- Teaching/ tutoring relationship
- Barriers of teaching/ tutoring
|
- Supervision, coaching, role modelling, advising and sponsorship
- Peer mentoring, mentoring for leadership, mentoring patients or mentoring by patients, interdisciplinary mentoring
- No mention of teaching or tutoring
|
- Accounts of, or involving, coaching between medical student, junior clinician, and/ or resident, and senior clinician
- Dyadic/ One-to-one coaching relationship
- Coaching process
- Characteristics of coach and student
- Coaching relationship
- Barriers of coaching
|
- Supervision, role modelling, teaching, tutoring, advising and sponsorship
- Peer mentoring, mentoring for leadership, mentoring patients or mentoring by patients, interdisciplinary mentoring
- No mention of coaching
|
- Accounts of, or involving, supervision between medical student, junior clinician, and/ or resident, and senior clinician
- Dyadic/ One-to-one supervising relationship
- Supervising process
- Characteristics of supervisor and student
- Supervising relationship
- Barriers of supervision
|
- Supervision of procedure
- Role modelling, coaching, teaching, tutoring, advising and sponsorship
- Peer mentoring, mentoring for leadership, mentoring patients or mentoring by patients, interdisciplinary mentoring
- No mention of supervision
|
Comparison
|
Comparisons of accounts on dyadic role modelling, including its approach to implement dyadic role modelling, processes, characteristics, challenges, evaluation methods and criteria
|
|
Comparisons of accounts on dyadic tutoring and teaching, including its approach to implement dyadic teaching/tutoring, processes, characteristics, challenges, evaluation methods and criteria
|
|
Comparisons of accounts on dyadic coaching, including its approach to implement dyadic coaching, processes, characteristics, challenges, evaluation methods and criteria
|
|
Comparisons of accounts on dyadic supervision, including its approach to implement dyadic supervision, processes, characteristics, challenges, evaluation methods and criteria
|
|
Outcome
|
- Personal outcomes
- Professional outcomes
- Career-related outcomes
- Research and academia outcomes
- Impact on role model and student
|
Studies where role modelling outcome was not the main component studied
|
- Personal outcomes
- Professional outcomes
- Career-related outcomes
- Research and academia outcomes
- Impact on teacher/ tutor and student
|
Studies where teaching/ tutoring outcome was not the main component studied
|
- Personal outcomes
- Professional outcomes
- Career-related outcomes
- Research and academia outcomes
- Impact on coach and student
|
Studies where coaching outcome was not the main component studied
|
- Personal outcomes
- Professional outcomes
- Career-related outcomes
- Research and academia outcomes
- Impact on supervisor and student
|
Studies where supervising outcome was not the main component studied
|
Study design
|
All study designs are included:
- Descriptive papers
- Qualitative, quantitative and mixed study methods
- Published between 1 Jan 2000 and 31 Dec 2018
- Written in English Language or translated into English Language
|
- Grey literature
- Perspectives, opinion, commentary pieces and editorials
|
All study designs are included:
- Descriptive papers
- Qualitative, quantitative and mixed study methods
- Published between 1 Jan 2000 and 31 Dec 2018
- Written in English Language or translated into English Language
|
- Grey literature
- Perspectives, opinion, commentary pieces and editorials
|
All study designs are included:
- Descriptive papers
- Qualitative, quantitative and mixed study methods
- Published between 1 Jan 2000 and 31 Dec 2018
- Written in English Language or translated into English Language
|
- Grey literature
- Perspectives, opinion, commentary pieces and editorials
|
All study designs are included:
- Descriptive papers
- Qualitative, quantitative and mixed study methods
- Published between 1 Jan 2000 and 31 Dec 2018
- Written in English Language or translated into English Language
|
- Grey literature
- Perspectives, opinion, commentary pieces and editorials
|
Table 1: PICOS, inclusion and exclusion criteria applied to literature search
Focus was on accounts of role modelling, tutoring, teaching, coaching and supervision that clearly described one-on-one interactions between a clinician and a learner in Internal Medicine. Accounts of teaching, tutoring and role modelling that did not clearly state one-on-one interactions were excluded as it did not facilitate comparisons with mentoring, supervision and coaching. Accounts of teaching, tutoring, role modelling, coaching and supervision in clinical specialities not traditionally associated with Internal Medicine as defined by the World Health Organization’s classification of healthcare workers, were also excluded to further focus this review [36].
Braun and Clarke’s (2006) approach to thematic analysis [17] was used to circumnavigate the wide-range of research methodologies that made statistical pooling and analysis difficult [17] in the papers reviewed. The narrative produced was guided by the Best Evidence Medical Education (BEME) Collaboration guide [37] and the STORIES (Structured approach to the Reporting In healthcare education of Evidence Synthesis) statement [38].
Stage B: Identifying relevant studies
Guided by the advisory team, the research team developed individual search strategies for teaching, tutoring, role modelling, coaching and supervision and selected PubMed, Embase, PsycINFO, and ERIC databases for review. In keeping with Pham et al. (2014) [33]’s approach of ensuring a viable and sustainable research process, the research team confined the searches to articles published between 1 January 2000 and 31 December 2018 to account for prevailing manpower and time constraints faced by the team.
Stage C: Selecting studies to be included in the review
After the independent searches of the databases were combined employing the ‘negotiated consensual validation’ approach and a final list of article to be reviewed was determined, the 7-members of the research team (YR, JY, AH, KP, NQ, RP, BT) guided by the senior reviewers (SM, RK, DT and LK) and near peer mentors (KT and YP) independently screened the title and abstracts.
A consensus based approach employing the ‘negotiated consensual validation’ approach was reached on the final list of papers to be included for thematic analysis [39].
The PRISMA charts are attached below (Figure 1).
Stage D: Data characterization and analysis
In the absence of a priori framework and a clear definition of role modelling, teaching and tutoring, coaching and supervision, Braun and Clarke’s (2006) [17] approach to thematic analysis was adopted to identify consistencies across these approaches [2, 14, 15, 17, 40-44].
Braun and Clarke’s (2006) approach was used to create codes from the ‘surface’ meaning of the data. Semantic themes were identified from ‘detail rich’ codes focused upon the various aspects of the role modelling, teaching, tutoring, coaching and supervisory process [17]. Each of the 10 coded scripts from role modelling, teaching and tutoring, coaching and supervision were reviewed by the senior reviewers. The research team discussed and agreed upon a common coding framework and codebook using Sambunjak et al. (2010)’s “negotiated consensual validation” approach [45]. Working in teams of three, overseen by the senior reviewers (SM, RK, DT, and LK) and peer mentors (KT and YP), the reviewers carried out independent thematic analyses of all articles in each of the four topics using the codebook, with new codes discussed online and at face-to-face at reviewers’ meetings [17, 46-49].
Stage E: Collating, summarizing, and reporting the results
From the 18938 articles reviewed, 34 articles on role modelling, 9 articles on teaching and tutoring, 43 articles on coaching and 18 articles on supervision were identified. The four themes identified include characteristics, processes, nature of relationship, and problems of the four educational roles.
The narrative produced was guided by the Best Evidence Medical Education (BEME) Collaboration guide [37] and the STORIES (Structured approach to the Reporting In healthcare education of Evidence Synthesis) statement [50].