{"id":72580,"date":"2024-09-18T08:43:49","date_gmt":"2024-09-18T00:43:49","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=72580"},"modified":"2025-01-07T08:27:18","modified_gmt":"2025-01-07T00:27:18","slug":"lived-experiences-of-mentors-in-an-asian-postgraduate-program-key-values-and-sociocultural-factors","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/lived-experiences-of-mentors-in-an-asian-postgraduate-program-key-values-and-sociocultural-factors\/","title":{"rendered":"Lived experiences of mentors in an Asian postgraduate program: Key values and sociocultural factors"},"content":{"rendered":"<p>Submitted: 21 February 2024<br \/>\r\nAccepted: 16 July 2024<br \/>\r\nPublished online: 1 October, TAPS 2024, 9(4), 26-32<br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2024-9-4\/OA3255\">https:\/\/doi.org\/10.29060\/TAPS.2024-9-4\/OA3255<\/a><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Aletheia Chia<sup>1<\/sup>, Menghao Duan<sup>1<\/sup> &amp; Sashikumar Ganapathy<sup>2,3<\/sup><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Paediatric Medicine, KK Women\u2019s and Children\u2019s Hospital, Singapore; <sup>2<\/sup>Department of Emergency Medicine, KK Women\u2019s and Children\u2019s Hospital, Singapore; <sup>3<\/sup>Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore<\/span><\/i><i><span lang=\"EN-GB\"><\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Introduction<\/span><\/b><span lang=\"EN-GB\">: Mentoring is an essential component of post-graduate medical training programs worldwide, with potential benefits for both mentors and mentees. While factors associated with mentorship success have been described, studies have focused on intrapersonal characteristics and are largely based in Western academic programs. Mentorship occurs in a broader environmental milieu, and in an Asian context, cultural factors such as respect for authority, hierarchy and collectivism are likely to affect mentoring relationships. We aim to explore the lived experience of mentors within an Asian postgraduate medical training program, and thus identify challenges and develop best practices for effective mentoring.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Methods<\/span><\/b><span lang=\"EN-GB\">: 14 faculty mentors from a post-graduate paediatric residency program were interviewed between October 2021 to September 2022. Data was collected through semi-structured one-on-one interviews, with participants chosen via purposeful sampling. Qualitative analysis was done via a systematic process for phenomenological inquiry, with interviews thematically coded separately by 2 independent reviewers and checked for consistency.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Results<\/span><\/b><span lang=\"EN-GB\">: 4 main thematic concepts were identified: \u201cprofessional, but also personal\u201d, \u201crespect and hierarchy\u201d, \u201charmony and avoidance of open conflict\u201d and the \u201cimportance of trust and establishing a familial relationship\u201d. Mentors also highlighted the value of structure in Asian mentoring relationships. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Conclusion<\/span><\/b><span lang=\"EN-GB\">: Cultural factors, which are deeply rooted in social norms and values, play an important role in shaping mentoring relationships in an Asian context. Mentoring programs should be tailored to leverage on the unique cultural norms and values of the region in order to promote career growth and personal development of trainees and mentors.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Medical Education, Graduate Medical Education, Professional Development<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Cultural factors are key in shaping Asian mentoring relationships. <\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">This includes being \u2018professional, but also personal\u2019, \u2018respect and hierarchy\u2019, \u2018harmony and avoidance of open conflict\u2019 and the \u201cimportance of trust and establishing a familial relationship\u2019.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Mentoring programs should be tailored to leverage on the unique local cultural norms and values.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Mentoring is an essential component of post-graduate medical training programs worldwide. Mentorship is a reciprocal, interdependent relationship between a mentor (often a faculty member who is senior and experienced) and a mentee (beginner or prot\u00e9g\u00e9 in the field) (Sambunjak et al., 2006). Benefits for mentees include aiding career preparation, development of clinical and communication skills, independence, and preventing burnout (Flint et al., 2009; Ramanan et al., 2006; Spickard et al., 2002). Mentors derive satisfaction from aiding the next generation, motivation for ongoing learning and institutional recognition (Burgess et al., 2018). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Variables associated with mentoring success have been described. Key components identified by mentors and mentees are communication and accessibility, caring personal relationship, mutual respect and trust, exchange of knowledge, independence and collaboration, and role modelling (Eller et al., 2014). Personality differences, lack of commitment, conflict of interests and mentor\u2019s lack of experience can contribute to unsuccessful mentoring relationships (Straus et al., 2013). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">However, mentorship occurs in a broader environmental milieu. Sambunjak (2015) described an ecological model of mentoring in academic medicine, with a first societal level of cultural, economic and political factors; a second institutional level of system- and organisation-related factors, and a third level of intrapersonal and interpersonal characteristics. Studies on mentorship have mainly focused on the latter and are situated in Western academic programs. In an Asian context, cultural factors such as respect for authority, hierarchy and collectivism may affect mentoring relationships (Chin &amp; Kameoka, 2019). Trainees may show more deference to their mentors, and mentors may be more directive than collaborative. An Asian study surveying Doha\u2019s postgraduate paediatric program found 75% mentees unsatisfied in their mentoring relationship (Khair et al., 2015).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We aim to explore the lived experience of mentors within an Asian postgraduate medical training program, and thus identify the challenges faced by trainees and mentors and develop best practices for effective mentoring.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-GB\">A. Study Design <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This qualitative study is based on an interpretive phenomenological approach of participants\u2019 lived experiences in their mentoring relationships. Through close examination of individual experiences, phenomenological analysis seeks to capture the meaning and common features, or essences, of an experience (Starks &amp; Trinidad, 2007). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Semi-structured interviews were conducted. The interview guide was designed to follow a pre-determined structure whilst allowing for flexibility in probing. It was based on insights from literature on key socio-cultural determinants of successful mentoring relationships. Data was collected until saturation, with no new themes emerging. <\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">B. Setting<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We studied a paediatric residency program of a tertiary academic centre in Singapore, with 47 residents and 180 faculty members.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">A formal mentorship program (Figure 1) has been in place since 2010. Residents indicate preferred faculty mentors at the start of residency, and are advised to consider specialty of interest, characteristics, and gender. Matches are subject to availability, review by the residency program, and mentor acceptance. Residents have one formal mentor throughout the 6 years unless the mentorship is terminated by mutual agreement between mentor and mentee.<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/09\/OA3255-Figure-1-300x190.png\" alt=\"\" class=\" wp-image-72581 aligncenter\" width=\"636\" height=\"403\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/09\/OA3255-Figure-1-300x190.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/09\/OA3255-Figure-1-768x487.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/09\/OA3255-Figure-1.png 991w\" sizes=\"auto, (max-width: 636px) 100vw, 636px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-GB\">Figure 1. Mentorship program structure, with suggested meeting timings and requisite forms. Meetings are required minimally 6-monthly and are scheduled on an ad-hoc basis by the mentor and mentee.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">C. Participants<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Purposive sampling to identify mentors in the residency program who would provide comprehensive and relevant insights. Considerations included age, gender, race, and years of mentorship and faculty experience. Study members and their mentors were excluded. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Study information sheets were provided to participants with assurance of confidentiality, and written informed consent obtained from each participant. The study was approved by the SingHealth Institution Review Board.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">D. Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Qualitative analysis was done via a systematic process for phenomenological inquiry (Creswell &amp; Creswell, 2022), whereby statements were analysed and categorised into clusters of meaning that represent phenomenon of interest. Transcripts were interpreted independently by 2 reviewers (AC, MD) and reviewed by a 3rd study member (SG). Iterative data analysis and collection was performed, with coding done after each interview to identify new themes and inform further interviews. <\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">We interviewed 14 mentors from October 2021 to September 2022. 8 were male and 6 were female. 12 were Chinese, 1 Indian, and 1 of other ethnicity. This was representative of faculty demographics. Mentors had two to eleven years of mentorship experience within the program, and one to five existing and prior mentees. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Mentors described their lived experiences in their mentoring journey, providing insights into key values and their relationships\u2019 evolution. 4 main thematic concepts were identified: \u201cprofessional, but also personal\u201d, \u201crespect and hierarchy\u201d, \u201cavoidance of open conflict\u201d and the \u201cimportance of trust\u201d. Mentors also highlighted the value of structure in Asian mentoring relationships.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">A. Professional, but also Personal<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">All mentors agreed that the relationship was predominantly professional, with their key role being that of professional and career guidance. They described their roles as:<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">\u201cGuidance through difficult decisions or challenges\u201d (#1), \u201cleaning the real world of medicine\u201d (#2), \u201cdriving professional development\u201d (#12) and providing \u201ctimely and wise advice to support the journey\u201d (#13)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Relationships \u201c<i>predominantly focused on professional or educational aspects\u2026 as that\u2019s what it was meant to be\u201d (#10), and were \u201cmainly limited to career-related matters (#11)<\/i>\u201d.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">However, many also identified personal connection as key. While the focus was primarily professional, awareness of personal or emotional aspects aided in understanding their mentors to further professional development and psycho-emotional growth. This included sharing of family lives, and emotional difficulties faced at work.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">As the journey progresses it becomes a lot more about the psycho-emotional aspect, and about their mental health and personal well-being. (#1)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">A lot of time is spent discussing family issues. If we knew more about the personal life of our mentee it\u2019s so much easier to tailor the advice based on the individual\u2019s unique circumstances. (#3)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">A minority of mentors kept their relationship strictly professional and preferred not to talk about aspects outside of work, as it was <i>\u2018easier\u2019 (#10)<\/i> and shared concerns of <i>\u2018overstepping certain norms\u2019 (#11)<\/i>.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">B. Respect and Hierarchy<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Respect was a key factor brought up when exploring the socio-cultural aspects of mentoring in our Asian community. Mentors varied in their opinion as to the extent that this resulted in a hierarchical relationship, and if this had a negative or positive impact on the relationship.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">All agreed that respect is a key value in mentoring relationships:<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">Culturally there\u2019s a large part to play as we\u2019re taught to respect our elders. (#1)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">Respecting elders &#8211; definitely it&#8217;s more prominent in our Asian culture. (#2)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Many mentors highlighted that this resulted in a hierarchical relationship. This manifested in the way senior doctors were addressed strictly by title, polite communication, and consideration of what would be \u2018proper\u2019 to discuss or ask a mentor to do.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">The hierarchical kind of mindset is still very strong, and is something that is not necessarily healthy. (#4) <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">You would always see your mentor as someone higher than you. It\u2019s similar to the way in our Asian context we see our parents. a certain sense of distance (#11).<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">The way medicine is a <\/span><\/i><i><span lang=\"EN-US\">\u5e08\u5085\u5f92\u5f1f<\/span><\/i><i><span lang=\"EN-GB\"> kind of thing (\u2018master and disciple\u2019) (#13)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Many shared that this could be a barrier to open communication with juniors wanting to \u201c<i>respect and agree<\/i>\u201d with their mentors (#14), slowing the growth of some relationships.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">No matter how much honesty and trust there is. If they want to say something that their mentor is not happy to hear, or strikes them as being a bit rude or disrespectful &#8211; they won\u2019t say it. (#1)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">Our culture does say to respect your senior, don\u2019t argue and don\u2019t disagree with your senior. Sometimes they\u2019re not very vocal, \u2018ok sir ok sir\u2019. And then later you find out they have certain issues. (#9)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">One mentor felt that hierarchy did not play a large part in his mentoring relationships. This was possibly personality related, describing himself as naturally \u201c<i>quite informal<\/i>\u201d.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Mentors also highlighted factors that mitigated the hierarchical nature of their relationship. This included time, and setting clear boundaries and goals of the relationship.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">When we give\u2026 a clear boundary and aim with no go zones, then culture may not necessarily be that important anymore (#10)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">A minority of mentors felt that hierarchy and respect was not a limiting factor in their relationships:<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">If the primary aim is having someone to offer you guidance and a different point of view, even if the mentee sees you as someone who is not equal, you can still have that effectiveness. (#11)<\/span><\/i><\/p>\r\n<p><i><span lang=\"EN-GB\">C. Harmony, Avoiding Open Conflict and Confrontation<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Another socio-cultural concept highlighted was the avoidance of confrontation. While some of this was linked to avoiding disagreements given the hierarchical nature of the relationship, avoiding open conflict and striving for harmony was also a key factor.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">Rather than openly bringing up something, to avoid being confrontational we have evolved other means of trying to work our way through that conflict. There is a conscious and deliberate effort to avoid open and confrontational conflict. (#3)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">When I was in the UK, they really questioned their mentors quite a lot &#8211; almost like a quarrel. That kind of questioning style may not be that well received in our own culture. (#2)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">When mentees had differing opinions from their mentors \u201c<i>they would rather not talk about the topic again, or just ask someone else<\/i>\u201d in order to preserve the relationship (#1). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Within our program, this resulted in difficulties in exiting the relationship to avoid \u201c<i>offending<\/i>\u201d the mentor:<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">When the mentor-mentee relationship is breaking down, culturally it can be more difficult for mentees to request to swap. That\u2019s very detrimental to both the mentor and the mentee in the long run. (#1)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This also manifested in avoiding overly \u2018emotional\u2019 discussions, with discussion often being more <i>\u201csuperficial\u201d<\/i>,<i> \u201creserved\u201d (#7) <\/i>and<i> \u201cfactual\u201d (#5)<\/i> in nature.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Conversely, one mentee shared that younger mentees being of a \u201c<i>younger generation<\/i>\u201d were more open to speaking their mind, and that this would continue to evolve.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">D. Importance of Trust and Establishing a Familial Relationship<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In exploring key values for successful mentoring relationships, many highlighted the importance of trust and building up an established relationship.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Chemistry and compatibility when starting out was key. Mentors often felt more comfortable if there was a pre-existing relationship they had their mentors and had \u201c<i>shared commonalities and chemistry<\/i>\u201d. Honesty and trust were key in enabling the relationship to progress. This included respecting each other\u2019s confidentiality. Relationships without trust was difficult as mentors \u201c<i>had to keep guessing what they want<\/i>\u201d, and \u201c<i>whatever you plan may not be the real goals of what they actually want<\/i>\u201d <i>(#2)<\/i>. Over time, establishing the relationship made it easier to confide in each other, overcoming boundaries brought on by hierarchy.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">It\u2019s about forming relationships before you can start reflecting with the person. Over time we get to know each other, and seeing that what is shared is truly kept private and confidential. Once we have trust among each other it (reservations) doesn\u2019t become a barrier. (#7)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">There must be a certain comfort and trust level before one readily does share vulnerabilities. (#2)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This can be enabled by being approachable, and creating safe environments where mentors can share their difficulties without consequence. However, this could be compromised if mentors have to take up a supervisory role or be involved in remediation processes.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Mentors who developed close and trusting relationships with their mentees described it as familial in nature. This could be as a big brother or sister who would give advice to their younger siblings in non-threatening and neutral ways. It was also described by one mentor as parental in nature.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">One interviewer highlighted that whilst Asian cultural factors may limit mentoring, there were also potential benefits: <\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">We must find the best of both worlds. The independence that the Western systems have is good, but Asians tend to be better at teamwork and team spirit. (#13)<\/span><\/i><\/p>\r\n<p><i><span lang=\"EN-GB\">E. Value of Structure in an Asian Mentorship Relationship<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Many mentors highlighted the value of having a framework for their mentoring relationship. Formalisation of the relationship and having a structure provided a foundation for discussions and enabled them to set boundaries. This prevented it from becoming awkward or \u201c<i>random and situation-based<\/i>\u201d (#15), and also helped faculty who were \u201c<i>still learning the whole journey of mentoring<\/i>\u201d (#7).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">When we don\u2019t know what to talk about it becomes quite awkward and uncomfortable. But if in the Asian context the mentor brings to it some structure, and they respect that structure, that structure is helpful. (#10)<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">A minority of mentors felt having a framework was too rigid or unnecessary.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-GB\">The structure must be there to guide the mentors, but the mentors chosen must also be of a certain maturity so they can find their own way. We must not be too prescriptive or rigid. (#13)<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">In this study, we explored the lived experiences of mentors within an Asian paediatric postgraduate training program. Existing studies have explored characteristics of effective and ineffective mentor relationships, but less is known about the impact of sociocultural factors. Key thematic concepts identified such as \u201crespect and hierarchy\u201d and \u201cavoidance of open conflict\u201d highlighted the importance of cultural factors in shaping mentoring relationships in an Asian context. These are deeply rooted in social norms and values of the region.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Hierarchy is a fundamental aspect of many Asian cultures, where individuals are expected to show respect and deference to their \u2018elders\u2019 or those in positions of authority. This was also observed in other Asian communities. A study in postgraduate medicine in Japan found that mentees had an inner desire to \u201crespect the mentor\u2019s ideas\u201d, with both mentees and mentors embracing \u201cpaternalistic mentoring\u201d (Obara et al., 2021). In our interviews, this was most apparent in the way mentees addressed their mentors: by title and respectfully. On a deeper level, this was a barrier to open communication. Open sharing was identified as crucial for a constructive mentoring relationship (Burgess et al., 2018), with the lack of it a cause of failed mentoring relationships (Straus et al., 2013).\u00a0 The willingness to share personal experiences by both mentors and mentees is key for effective mentoring and career growth. Additionally, this is not conducive to fostering creativity and innovation, which are increasingly important in the medical profession.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Communication was also affected by avoidance of open conflict and confrontation. Asian cultures have been described as collectivist, where the needs of the group take precedence over that of the individual, and intragroup harmony is paramount (Chin &amp; Kameoka, 2019). In mentoring relationships, this translates to prioritising a successful and harmonious relationship over personal goals. Indirect communication styles are also more common in many Asian cultures. This has been described as high-context communication, whereby \u201cmost of the information is either in the physical context or internalised in the person, while very little is in the coded, explicit, transmitted part of the message\u201d (Hall, 1976). Relying on indirect language nonverbal cues rather than explicitly stating one\u2019s thoughts and feelings can hinder open communication.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Hierarchy and a lack of open communication may result in mentors taking on the role of advisors or coaches rather than true mentors. While there is no universal definition of mentorship, key features are that of a long-term dyadic relationship that encompasses educational, training and professional aspects that is personal and reciprocal (Sambunjak &amp; Marusic, 2009). This is in contrast to tutors or coaches that primarily exhibit educational functions, or counsellors that exhibit personal functions. If the mentor-mentee relationship if influenced by hierarchical norms, mentors may be seen as figures of authority rather than partners in development. Cultural respect for authority figures and an emphasis on conformity may also discourage mentees from questioning or having open conversations with their mentors, limiting mutual learning. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Challenges with hierarchy and communication can be overcome with the aid of a structured program, and eventually establishment of trust and \u2018familial\u2019 relationships.\u00a0 A structured program can guide mentors and mentees in having open communication. In an Asian context, mentors may initially play a more authoritative role in guiding and directing their mentees with the aid of a structured guide, from which more two-way communication may open up as the relationship becomes more established. Whilst desirable mentors have characteristically been described as not \u201cbossy\u201d or authoritative (Sambunjak &amp; Marusic, 2009), a study of Japanese physician-scientist mentor-mentees viewed more paternalistic mentoring as favourable (Obara et al., 2021).\u00a0 However, this will need to be individualised, as a highly directive mentoring style may not be well-suited to those who prefer a more collaborative and participatory mentoring relationship. Communication and learning styles may also continue to evolve with as incoming trainee physicians belong increasingly to Generation Z (1997-2012) instead of Generation Y\/Millennials (1981-1996). A study of the mentorship experiences of Gen Z women medical students by Li et al (2024) described how current society had afforded them more opportunities for empowerment and expression, and emphasised the importance of tailored mentorship that considered the mentee\u2019s identify and intersectionality.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Having mutual respect and trust were also key. The mentee and mentor having a pre-existing relationship and familiarity helped, and was more common in our context given that mentees could indicate their mentor of interest. Mutual respect and having a personal connection were also identified as key components in effective mentoring relationships by Eller (2014) and Straus (2013). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Whilst we had initially hypothesised that Asian sociocultural concepts would limit mentorship relationships to be largely professional, mentors shared that mutual respect, trust, and time enabled the relationship to also extend to sharing of personal matters and psychosocial wellbeing. Successful relationships were even described as \u2018familial\u2019, with a sense of fulfilment from both parties. A family-like relationship and a sense of loyalty to the mentor and organisation was also described in Japanese mentoring relationships (Obara et al., 2021). Such relationships may be more common in more collectivist cultures. These can be furthered by fostering a sense of community amongst mentees and mentors, such as through group activities, peer support, and shared learning experiences.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">A. Limitations<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">This study was conducted in one of the two paediatric training centres in Singapore. Future studies should expand to other postgraduate programs to improve applicability of the results.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The investigators were participants in the program as mentees or mentors, with potential for bias in analysis. To minimise this, transcripts were analysed independently by two investigators followed by review by the third investigator. While our study focused on the lived experience of mentors, examining the perspective of mentees would be able to provide a more balanced and comprehensive understanding of mentoring relationships and highlight gaps where they can be better supported, and should be considered in future studies.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Our study did not delve into gender dynamics. Female medical trainees may face unique challenges, and male mentors may be stereotypically less nurturing and more process-oriented. Existing studies are varied: a survey of American cardiologists found sex concordance to be beneficial (Abudayyeh et al., 2020), whereas Jackson (2003) did not find same-gender matching to be important in an US academic program. In our initial interviews, gender did not come up as a significant factor and was hence not a focus subsequently. The role of gender in our program may have been minimised by a balanced gender ratio, with 59% of faculty female.<\/span><\/p>\r\n<p><i><span lang=\"EN-GB\">B. Future Research and Practical Implications<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Given the significant influence of sociocultural factors on mentoring relationships, mentoring programs should be tailored to reflect the unique cultural norms and values of the region. In Asian cultures, this would include methods to reduce hierarchy, ensuring accessibility to mentors, and having a structured program. Training on mentorship for mentors and mentees would be beneficial to promote characteristics of effective mentoring relationships, and should include a focus on culturally sensitive mentoring with a recognition of how culturally-shaped beliefs can affect mentorship. This is particularly important in multicultural societies where cross-cultural mentorship is more common.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Cultural factors play an important role in shaping mentoring relationships in an Asian context. Whilst such these may be limiting to a degree, these can be also be leveraged on to further effective mentoring programs. Mentoring programs should be tailored to reflect the unique cultural norms and values of the region to promote career growth and personal development of trainees and mentors.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">AC, MD and SG contributed to study conception and design. Participant interviews were conducted by AC. Analysis and thematic interpretation were done by AC, MD with review by SG. All authors were involved in drafting the manuscript and reviewing it critically, and all read and approved the final manuscript.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The study was approved by the SingHealth Institution Review Board (IRB number 2021\/2542).<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The data of this qualitative study are not publicly available due to confidentiality agreements with the participants.<\/span><span lang=\"EN-GB\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p><span lang=\"EN-GB\">No funding was received for conducting this study.\u00a0 <\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p><span lang=\"EN-GB\">The authors declare that they have no competing interests.\u00a0\u00a0 <\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p><span lang=\"EN\">Abudayyeh, I., Tandon, A., Wittekind, S. G., Rzeszut, A. K., Sivaram, C. A., Freeman, A. M., &amp; Madhur, M. S. (2020). Landscape of mentorship and its effects on success in cardiology. <\/span><i><span lang=\"EN-US\">JACC: Basic to Translational Science<\/span><\/i><span lang=\"EN\">,<i> 5<\/i>(12), 1181-1186. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1016\/j.jacbts.2020.09.014\">https:\/\/doi.org\/10.1016\/j.jacbts.2020.09.014<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Burgess, A., van Diggele, C., &amp; Mellis, C. (2018). Mentorship in the health professions: A review. <i>The Clinical Teacher<\/i>,<i> 15<\/i>(3), 197-202. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/tct.12756\">https:\/\/doi.org\/10.1111\/tct.12756<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Chin, D., &amp; Kameoka, V. A. (2019). Mentoring Asian American scholars: Stereotypes and cultural values. <i>American Journal of Orthopsychiatry<\/i>,<i> 89<\/i>(3), 337-342. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1037\/ort0000%20411\">https:\/\/doi.org\/10.1037\/ort0000 411<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Creswell, J. W., &amp; Creswell, J. D. (2022). <i>Research design: Qualitative, quantitative, and mixed methods approaches<\/i>. SAGE Publications. <\/span><\/p>\r\n<p><span lang=\"EN\">Eller, L. S., Lev, E. L., &amp; Feurer, A. (2014). Key components of an effective mentoring relationship: A qualitative study. <i>Nurse Education Today<\/i>,<i> 34<\/i>(5), 815-820. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1016\/j.nedt.%202013.07.020\">https:\/\/doi.org\/10.1016\/j.nedt. 2013.07.020<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Flint, J. H., Jahangir, A. A., Browner, B. D., &amp; Mehta, S. (2009). The value of mentorship in orthopaedic surgery resident education: The residents&#8217; perspective. <i>The Journal of Bone and Joint Surgery<\/i>,<i> 91<\/i>(4), 1017-1022. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.2106\/JBJS.H.00934\">https:\/\/doi.org\/10.2106\/JBJS.H.00934<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Hall, E. T. (1976). <i>Beyond culture<\/i>. Anchor Press\/Double Day. <\/span><\/p>\r\n<p><span lang=\"EN\">Jackson, V. A., Palepu, A., Szalacha, L., Caswell, C., Carr, P. L., &amp; Inui, T. (2003). &#8220;Having the right chemistry&#8221;: A qualitative study of mentoring in academic medicine. <i>Academic Medicine<\/i>,<i> 78<\/i>(3), 328-334. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1097\/00001888-200303000-00020\">https:\/\/doi.org\/10.1097\/00001888-200303000-00020<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Khair, A. M., Abdulrahman, H. M., &amp; Hammadi, A. A. (2015). Mentorship in pediatric Arab board postgraduate residency training program: Qatar experience. <i>Innovations in Global Health Professions Education<\/i>. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.20421\/ighpe2015.6\">https:\/\/doi.org\/10.20421\/ighpe2015.6<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Li, C., Veinot, P., Mylopoulos, M., Leung, F. H., &amp; Law, M. (2024). The new mentee: Exploring Gen Z women medical students&#8217; mentorship needs and experiences. <i>The Clinical Teacher<\/i>,<i> 21<\/i>(3), e13697. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/tct.13697\">https:\/\/doi.org\/10.1111\/tct.13697<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Obara, H., Saiki, T., Imafuku, R., Fujisaki, K., &amp; Suzuki, Y. (2021). Influence of national culture on mentoring relationship: A qualitative study of Japanese physician-scientists. <i>BMC Medical Education<\/i>,<i> 21<\/i>(1), 300. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-021-02744-2\">https:\/\/doi.org\/10.1186\/s12909-021-02744-2<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Ramanan, R. A., Taylor, W. C., Davis, R. B., &amp; Phillips, R. S. (2006). Mentoring matters: Mentoring and career preparation in internal medicine residency training. <i>Journal of General Intermal Medicine<\/i>,<i> 21<\/i>(4), 340-345. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1111\/j.1525-1497.20%2006.00346.x\">https:\/\/doi.org\/10.1111\/j.1525-1497.20 06.00346.x<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Sambunjak, D. (2015). Understanding wider environmental influences on mentoring: Towards an ecological model of mentoring in academic medicine. <i>Acta Medica Academica<\/i>,<i> 44<\/i>(1), 47-57. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.5644\/ama2006-124.126\">https:\/\/doi.org\/10.5644\/ama2006-124.126<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Sambunjak, D., &amp; Marusic, A. (2009). Mentoring: What&#8217;s in a name? <i>JAMA<\/i>,<i> 302<\/i>(23), 2591-2592. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1001\/jama.%202009.1858\">https:\/\/doi.org\/10.1001\/jama. 2009.1858<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Sambunjak, D., Straus, S. E., &amp; Marusic, A. (2006). Mentoring in academic medicine: A systematic review. <i>JAMA<\/i>,<i> 296<\/i>(9), 1103-1115. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1001\/jama.296.9.1103\">https:\/\/doi.org\/10.1001\/jama.296.9.1103<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Spickard, A., Gabbe, S. G., &amp; Christensen, J. F. (2002). Mid-career burnout in generalist and specialist physicians. <i>JAMA<\/i>, <i>288<\/i>(12), 1447-1450. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1001\/jama.288.12.1447\">https:\/\/doi.org\/10.1001\/jama.288.12.1447<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Starks, H., &amp; Trinidad, S. B. (2007). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. <i>Qualitative Health Research<\/i>,<i> 17<\/i>(10), 1372-1380. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1177\/1049732307307031\">https:\/\/doi.org\/10.1177\/1049732307307031<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p><span lang=\"EN\">Straus, S. E., Johnson, M. O., Marquez, C., &amp; Feldman, M. D. (2013). Characteristics of successful and failed mentoring relationships: A qualitative study across two academic health centers. <i>Academic Medicine<\/i>, <i>88<\/i>(1), 82-89. <\/span><span lang=\"EN\"><a href=\"https:\/\/doi.org\/10.1097\/ACM.0b013e31827647a0\">https:\/\/doi.org\/10.1097\/ACM.0b013e31827647a0<\/a><\/span><span lang=\"EN\"> <\/span><\/p>\r\n<p>*<span lang=\"EN-GB\">Dr Aletheia Chia<\/span><br \/>\r\n<span lang=\"EN-GB\">Department of Paediat<\/span>, <br \/>\r\n<span lang=\"EN-GB\">KK Women\u2019s and Children\u2019s Hospital<\/span><br \/>\r\n<span lang=\"EN-GB\">100 Bukit Timah Road<\/span><br \/>\r\n<span lang=\"EN-GB\">Singapore 229899<\/span><br \/>\r\n<span lang=\"EN-GB\">Email: aletheia.chia@mohh.com.sg<\/span><\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":4,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61889],"class_list":["post-72580","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-9-number-4-october-2024"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - 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