A total of 50 (out of 62 mentors contacted) participated in the study by completing at least one questionnaire (pre- or post-exposure), resulting in a response rate of 50/62 (81%). Thirty-six mentors completed the pre-exposure questionnaire (response rate of 36/50 or 72%), while 38 mentors completed the post-exposure questionnaire (response rate of 38/42 or 90%). Thirty mentors (from cohorts 2018-2019 and 2019-2020) were invited to participate in both the pre- and post-exposure questionnaires, resulting in a response rate of 24/30 (80%). Out of the 50 participants, 39 were female (78%). The mean age of participants was 23.64 (SD 1.21) and the mean age for mentees was 11.51 (SD 2.48). The mean duration of the matches was 9.07 months (SD 2.61).
Pre-exposure self-identified goals
The pre-exposure questionnaire asked mentors (n=36) to list up to four objectives they wish to achieve prior to starting the AMI program. Twelve themes emerged, as summarized in Table 2. The most common goal identified was to gain a better understanding of psychiatric and developmental disorders in youth. Other goals included: improve communication skills with youth and families, learn how to advocate, build relationships with youth, increased comfort working with youth, have a positive impact on mentee, become aware of community resources, contribute to the community, career development and exploration, as well as to gain a better understanding of social determinants of health, child development, and physical illness in youth.
Table 2: Medical student mentors’ goals for the AMI program.
Goals
|
Number
n=36
|
Representative Quotations
|
Gain a better understanding of psychiatric and developmental disorders in youth
|
18
|
“Better understanding of psychiatric and developmental disorders in youth”
|
Improve communication skills with youth and families
|
16
|
“Develop skills in speaking with the child and their family”
|
Build relationships with youth
|
12
|
“create a reliable and supportive relationship with my mentee”
|
Gain a better understanding of social determinants of health
|
11
|
“Ability to appreciate the effects that...social determinants of health may have on a child and their family.”
|
Career development and exploration
|
11
|
“career development and insight from residents/fellows/staff”; “Evaluate my interest in pediatrics and psychiatry”
|
Learn how to advocate
|
7
|
“Gain skills in advocating for the needs of at-risk youth and/or young patients with mental illness”
|
Gain a better understanding of child development
|
7
|
“Understand the needs for healthy psychological, emotional and social development for youth and how to facilitate that”
|
Gain a better understanding of physical illness in youth
|
5
|
“Learn about physical illnesses in children”
|
Increased comfort working with youth
|
5
|
“increased comfort interacting with children”
|
Have a positive impact on mentee
|
5
|
“I hope I would have made a positive impact, however small, on my junior.”
|
Become aware of community resources
|
3
|
“Learn more about services and opportunities available for people living in Toronto”
|
Contribute to the community
|
2
|
“Contribute and give back to the community”
|
Self-reported confidence levels
Confidence levels pertaining to 8 skills associated with the AMI program were compared and summarized in Table 3. A sign test demonstrated significant increases (p<0.05) in respondents’ (n=24) confidence regarding working with vulnerable populations and advocating for medical and non-medical needs. There was no significant effect on confidence regarding communicating with youth, their family members, or with staff who provide care to youth. There was no significant effect on confidence involving working with children who have mental illness or a chronic medical illness.
Table 3: Self-reported level of confidence on various tasks before and after the AMI program.
|
Pre-Exposure
|
Post-Exposure
|
|
Task
|
Mean
|
Median
|
SD
|
Mean
|
Median
|
SD
|
p-value
|
Communicating with youth
|
3.25
|
3.00
|
0.676
|
3.29
|
3.00
|
0.550
|
1.000
|
Communicating with patient’s family member
|
2.83
|
3.00
|
0.637
|
3.00
|
3.00
|
0.780
|
0.454
|
Communicating with staff who are in a supervisory or care provider role of the youth
|
2.83
|
3.00
|
0.868
|
2.83
|
3.00
|
0.816
|
1.000
|
Working with vulnerable populations
|
2.54
|
3.00
|
0.833
|
2.88
|
3.00
|
0.680
|
0.039‡
|
Working with children who have mental illness
|
2.43
|
2.00
|
1.037
|
2.39
|
2.00
|
0.839
|
1.000
|
Working with children who have a chronic medical illness
|
2.13
|
2.00
|
0.947
|
2.13
|
2.00
|
0.741
|
0.754
|
Advocating for the medical needs of your patient
|
2.29
|
2.00
|
0.908
|
2.75
|
3.00
|
0.608
|
0.022‡
|
Advocating for the non-medical needs of your patient
|
2.29
|
2.00
|
0.955
|
2.67
|
3.00
|
0.761
|
0.013‡
|
‡p < 0.05
Self-reported knowledge levels
Level of knowledge pertaining to five domains were compared and summarized in Table 4. Sign tests demonstrated statistically significant increases in participants’ (n=24) self-rating of their level of knowledge across all five domains of knowledge (p<0.001). Specifically, there was a statistically significant median increase in social determinants of health (1.00), child development (1.50), attachment theory (2.00), chronic illness in youth (1.00) and autism and other developmental disabilities (1.50).
Table 4: Self-reported level of knowledge before and after the AMI program.
|
Pre-Exposure
|
Post-Exposure
|
|
Domain
|
Median
|
SD
|
Median
|
SD
|
p-value
|
Social determinants of health
|
3.00
|
0.859
|
4.00
|
0.537
|
<0.01
|
Child development
|
2.00
|
0.721
|
3.50
|
0.824
|
<0.01
|
Attachment theory
|
2.00
|
0.830
|
4.00
|
1.062
|
<0.01
|
Chronic illness in youth
|
2.00
|
0.584
|
3.00
|
1.083
|
<0.01
|
Autism and other developmental disabilities
|
2.00
|
1.007
|
3.50
|
0.881
|
<0.01
|
Self-reported skills gained
Thirty-one of 38 respondents (82%) answered “Yes, I have gained new skills.” Identified themes included skills in communication, relationship building with youth, advocacy, finding community resources, cultural competency, and understanding social determinants of health. Data are summarized in Table 5, including direct quotations taken from answers pertaining to each theme.
Table 5: Skills gained through the AMI program as described by medical student mentors.
Skills Gained
|
Number
n=29
|
Representative Quotations
|
Communication
|
21
|
“Learning how to adapt, effectively connect and communicate with a youth from vulnerable population and their supports.”
|
Relationship building with youth
|
10
|
“Building a relationship and gaining trust of an adolescent.”
|
Advocacy
|
5
|
“Advocating on behalf of youth and their families”
|
Finding community resources
|
3
|
“Ability to search for youth-friendly and cost-effective activities and resources available in a community.”
|
Cultural competency
|
2
|
“Understanding cultural practices”
|
Understanding social determinants of health
|
2
|
“We learn about [social determinants of health], but to go into the environment and hear first-hand the experiences of my youth really helped me to understand these determinants.”
|
Self-reported benefits of AMI
Respondents (n=32) identified benefits related to their engagement with AMI. From the textual answers provided, we identified 7 themes. The main benefit of the AMI program was identified as building a relationship with a mentee. Other themes that emerged included building a relationship with the resident mentors, positive impact on mentee, learning about child development concepts and child psychiatry, learning about real-life challenges first-hand, improving communication skills, and learning to advocate for youth. Table 6 provides representative quotations taken from responses related to the identified themes.
Table 6: Benefits of the AMI program as described by medical student mentors.
Benefits of AMI
|
Number
n=32
|
Representative Quotations
|
Building a relationship with the mentee
|
18
|
“The relationship I was able to form with my mentee and be reminded of the reasons I went into medical school.”
|
Building a relationship with the resident mentors
|
6
|
“the relationships I formed with the resident mentors and the guidance and support they offered.”
|
Positive impact on mentee
|
6
|
“The opportunity to make a real impact on a youth from a vulnerable background”
|
Learning about child development concepts and child psychiatry
|
6
|
“The combination of learning concepts and theory in child and adolescent psychology and then immediately witnessing and applying it towards the relationship with my mentee was highly effective in reinforcing these concepts.”
|
Learning about real-life challenges first-hand
|
4
|
“It is a completely different experience to learn about social determinants of health vs seeing for yourself how much those SDOHs [social determinants of health] really impact daily life of a family.”
|
Improving communication skills
|
3
|
“increased experience in communicating with…pediatric populations”
|
Learning to advocate for youth
|
2
|
“Understanding how to advocate for youth living in at-risk populations.”
|
Impact on future career
Twenty-three of 38 (61%) respondents indicated that participation in the AMI program influenced their future career. When asked to elaborate, textual responses provided codes generating five themes. The most common theme was that AMI strengthened mentors’ interest in working with youth. Other themes included awareness of social determinants of health, greater interest in psychiatry, greater interest in advocacy, and a better understanding of the advocacy role. Table 7 provides direct quotations taken from responses related to each of the themes.
Table 7: Impact of AMI on career trajectory as described by medical student mentors.
Impact on Career Trajectory
|
Number
n=23
|
Representative Quotations
|
More interest in working with youth
|
11
|
“This has reinforced my desire to work with youth as I see how important this period is developmentally and the opportunity to change the life trajectory of people in your care”
|
Awareness of social determinants of health
|
6
|
“I will now take into account social determinants of health when I recommend treatment plans for patients and their families.”
|
More interest in psychiatry
|
5
|
“Furthered my interest in psychiatry”
|
More interest in advocacy
|
3
|
“It just re-affirmed that I want to participate a lot in advocacy in whatever speciality I end up in.”
|
Better understanding of advocacy role
|
3
|
“Better understanding of how community programs and advocacy on the individual and organizational level play a role in child health and development”
|
Benefits of resident mentors
Thirty-five of 38 (92%) participants listed benefits from engaging with their resident mentors. From these responses, four themes were identified. The most common themes identified were that residents provided general advice and support as well as provided advice on handling difficult situations. Other themes included career mentorship and promoted discussion regarding mentorship experiences. These themes and sample responses are provided in Table 8.
Table 8: Benefits of having resident mentors as described by medical student mentors.
Benefits of Resident Mentors
|
Number
n=35
|
Representative Quotations
|
General advice and support
|
18
|
“They always took the time to check in with us and provide feedback on our situations with our mentees using their knowledge from paediatrics and psychiatry. This was helpful connecting my experience to the curriculum. They also took the time to understand our matches and talk about our emotions.”
|
Advice on handling difficult situations
|
18
|
“The advice they gave and the ability to talk about any problems we had and brainstorm ways to approach difficult or challenging situations with our mentees”
|
Career mentorship
|
7
|
“They went beyond what was required and helped support us both in the program and with our life circumstances and career aspirations.”
|
Promote discussion regarding mentorship experiences
|
4
|
“The supervising residents were able to mediate and promote highly constructive discussion amongst my classmates surrounding recurring themes.”
|
Interpretive Analysis of Communication Skills
Of 38 findings from 24 participants, there were 7 instances of agreement, 13 instances of dissonance, and 18 instances of silence.
Instances of Agreement
Five participants demonstrated an increase in confidence in their communication skills, as well as described that they gained communication skills. For one participant, they described gaining communication skills in all three categories (with youth, families, and staff who are in a supervisory or care provider role of the youth) and this was in agreement with increased confidence in these domains, resulting in a total of 7 instances of agreement.
Instances of Dissonance
There were 13 instances (by a total of 10 participants) in which gaining communication skills with youth and/or their families were described but were not associated with an increase in confidence in that domain. For two participants, they described gaining communication skills in general, but this was not associated with an increase in confidence in any communication domain (with youth, families, and staff who are in a supervisory or care provider role of the youth).
Instances of Silence
There were 18 instances (by a total of 11 participants) in which there was an increase in confidence in communication skills with youth, families, or with staff who are in a supervisory or care provider role of the youth, but without describing this increase in communication skills during open-ended responses.