INTRODUCTION
Mentorship is a vital tool in personal and professional growth; however, literature related to the successful characteristics of formal mentorship practice for postgraduate physical therapists is scarce. The aim of this study is to investigate the characteristics of formal mentorship programs and their alignment with best practices. This study will provide information to mentorship programs regarding the factors identified as improving outcomes related to mentorship within the physical therapy (PT) profession.
BACKGROUND
Mentorship is widely regarded as a useful tool in developing personnel across the span of their careers. It is defined as a developmental relationship between an experienced mentor and a less experienced mentee.[1] Mentorship is practiced either formally, as in structured programs within organizations, or informally, as in professional mentorship when mentors and mentees meet on their own volition.[2] Formal and informal mentorship practices are valued across a range of industries. Both formal and informal mentorship programs are among the most widely used development tools in over 350 global companies.[3]
Mentorship has been shown to be perceived as playing a large role in career development by improving both the professional and personal lives of the mentee and the mentor.[4,5,6] Mentorship is particularly important in the healthcare field as healthcare providers face a unique set of challenges. These providers can work in a wide range of settings, including academia, clinics, hospitals, or a mix of the aforementioned. Due to this variety of settings, providers require a broad set of skills, including clinical decision-making, patient care, research, and teaching.[7] Given that working in a healthcare profession requires such a dynamic skill set, mentorship is an invaluable tool.
While there is a wide base of research regarding mentorship in academic medicine, nursing, and other healthcare professions, little research has been done that specifically investigates mentorship in PT. One small-scale (n = 10) qualitative study found that mentorship helped improve patient outcomes and clinical decision-making.[8] Another small study (n = 19) explored potential supports and barriers experienced by PT students in their mentorship relationships with clinical instructors.[9] A larger study (n = 302) performed in Canada explored factors influencing mentors within the field of PT when engaging in a mentorship relationship with a mentee.[10] To date, there is a gap in the literature relating to factors influencing the intended outcomes of mentorship programs, specifically within the field of PT.
This study seeks to fill this gap by better understanding the characteristics and perceptions of formal mentorship programs for postgraduate physical therapists in the United States through the mentee’s place of employment by identifying components of a mentorship program that are strongly correlated with outcomes of increased clinician confidence and perception of improved clinical outcomes.
MATERIALS AND METHODS
A 38-question survey regarding mentorship programs at the place of employment was created based on the current literature. Survey questions were designed to collect demographic information about the mentees, logistical components of the mentorship program, the mentees’ agreement with the quality of the mentorship experience, and the frequency of the behaviors demonstrated by the mentor. The questions related to the mentorship experience were collected using standardized five-point Likert-type scales for agreement (strongly agree, agree, neither agree nor disagree, disagree, strongly disagree) and frequency (always, very frequently, occasionally, rarely, very rarely). The five-point Likert-type scale with the option not to participate was selected to minimize the time required to complete the survey and provide participants with a greater locus of control.[11]
The Institutional Review Board reviewed this study and determined it to be exempt from further review (STU00213096). The content validity of the survey was established by a panel of experienced researchers, recent graduates, and current PT residents. These subject matter experts reviewed the survey for content and clarity and achieved consensus around the development of survey questions. Cronbach’s α for internal reliability was 0.916 for the 6-item scale related to the agreement and 0.917 for the 6-item scale related to frequency. Additionally, the results of Hotelling’s T-square test suggest that both agreement and frequency variables have different means.
The target population for this study consisted of United States physical therapists and physical therapist assistants who experienced formal mentorship at their place of employment within five years post-graduation from an entry-level PT or physical therapist assistant program. PTs who participated in residency or fellowship education were excluded from participation in the survey due to the intensive national standards surrounding formal mentorship within these programs.[12]
A link to the online survey was distributed via multiple email listservs, including sections, academies, and state organizations within the American Physical Therapy Association (APTA), PT-related social media groups, and other PT organizations such as alumni organizations. The survey was launched on July 11, 2021 and remained open for 100 days until October 19, 2021. Reminders for the survey were sent both 30 and 90 days after the initial launch date of July 11, 2021. Informed consent from participants was obtained prior to participation, and their rights, including data security, were protected throughout the study.
A convenience sample of 85 participants consented and voluntarily participated in the survey via the REDCap survey tool. Data were downloaded from REDCap into SPSS for analysis. Each question allowed for optional participation resulting in a variety of participants per question. Fully completed and partially completed surveys were kept. All responses provided were analyzed as part of the data set. Data analysis included descriptive statistics of percentages for each response. The categories of “strongly agree/agree” or “always/frequently” were combined to indicate the “overall positive” response in reporting the summary of the frequency and quality of mentor behaviors. Chi-squared analysis with a significance value of P<0.001 and Cramer’s V effect size was chosen to identify the independent associations when making multiple comparisons between the mentorship best practice variables and each individual intended outcome of mentorship programs. This analysis was chosen based on the robustness of these statistics in relation to the distribution of the data as well as the lack of significant associations between participant and mentorship program characteristics with the frequency and quality of mentor behaviors within previous data analyses.[13] The Likelihood ratio is reported for these results as the assumption that 20% have an expected count of less than five has been violated. The strength of the Cramer’s V associations was determined based on the following values: weak (0.0–0.2), moderate (0.2–0.6), and strong (0.6–1.0).[14]
RESULTS
Participant characteristics
The participant characteristics of the sample are included in Table 1. These results show that most participants were female (84.9%, n = 45), licensed PTs (98.1%, n = 52), and current members of the APTA (75.7%, n = 40) with limited racial or ethnic diversity (92.5% White, n = 49). The mentorship occurred in a variety of settings and locations throughout the United States. It should also be noted that while mentorship occurred within five years postgraduation for all participants, participants were at various stages in their careers. This means that mentorship occurred during a variety of time periods.
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Table 1: Participant characteristics
Mentorship program characteristics
The most frequently reported mentorship program logistics included having one mentor (70.2%, n = 40), being the only mentee (63.2%, n = 36), and having the mentor appointed to the mentee (86.0%, n = 49). The mentee-mentor meetings typically occurred in person (96.4%, n = 53), sessions were held once a week (42.9%, n = 24), sessions typically lasted between 30 and 60 min (50.9%, n = 28), and the duration of the program spanned three to six months (25.5%, n = 14) [Table 2].
Table 2: Mentorship program characteristics
Frequency and quality of mentor behaviors
Mentees had overall positive responses regarding their mentor being on time (88.7%, n = 47), responding to their needs within a reasonable timeframe (88.7%, n = 47), and coming prepared for the mentoring sessions (84.9%, n = 45). There were also overall positive responses to the mentor using active listening (83.0%, n = 44), integrating evidence-based practice (71.7%, n = 38), and providing additional resources (64.1%, n = 34) within their mentoring sessions [Table 3].
Table 3: Mentee’s perception of the quality of their mentor’s best practice behaviors
The participants also responded with a positive agreement to the quality of mentorship experiences. This includes exhibiting expertise in the content area (92.5%, n = 49), fostering a safe learning environment (94.2%, n = 49), and demonstrating professional integrity (88.7%, n = 47). Additionally, mentees perceived that their mentors were interested in their growth (86.8%, n = 46), made adaptations to support the mentees’ learning needs (71.7%, n = 40), and regularly assessed their progress (60.4%, n = 32). Participants would recommend their mentorship program (77.4%, n = 41) as they reported that mentorship improved their clinical outcomes (75.5%, n = 40) and increased confidence with patients (81.2%, n = 43) [Table 4].
Table 4: Mentee’s perception of the frequency of their mentor’s best practice behaviors
Associations with mentorship outcomes
Chi-square analysis identified associations between variables and intended mentorship outcomes of increasing mentee confidence and improving their perception of clinical outcomes. Table 5 shows the strong (0.6–1.0) associations for Cramer’s V between each of the mentorship best practices and the mentorship program outcomes of increasing mentees’ confidence, improving their perception of their clinical outcomes, and their likelihood to recommend the mentorship program. The three mentorship practices with the largest Cramer’s V associations with increasing mentee confidence are: creating a safe learning environment (χ2(36) = 182.025, P = <0.001, V = 0.803), having the mentor invested in their growth (χ2(36) = 174.791, P = <0.001, V = 0.779), and being prepared for the session (χ2(36) = 174.753, P = <0.001, V = 0.787). Though in a different order of importance, the same three factors have the highest association with mentee perception of improved clinical outcomes: the mentor being invested in the mentee’s growth (χ2(36) = 186.946, P = <0.001, V = 0.805), creating a safe learning environment (χ2(36) = 172.255, P = <0.001, V = 0.783), and being prepared for the session (χ2(36) = 174.699, P = <0.001, V = 0.788). The top three variables associated with the likelihood of recommending the mentorship program were being prepared (χ2(36) = 174.019, P = <0.001, V = 0.771), adapting the learning to the mentee’s needs (χ2(36) = 181.749, P = <0.001, V = 0.751), and creating a safe learning environment (χ2(36) = 170.896, P = <0.001, V = 0.744).
Table 5: Associations between mentorship best practice behaviors and mentorship program outcomes
DISCUSSION
A safe learning environment
This study found a strong relationship between the mentor fostering a safe learning environment and both mentee confidence (χ2(36) = 182.025, P = <0.001, V = 0.803) and perception of improved patient outcomes (χ2(36) = 172.255, P = <0.001, V = 0.783). Plack[9] noted congruent results as they discovered that a supportive learning environment decreased stress and enhanced communication between the mentor and mentee. They also noted that an unwelcoming environment impedes the learning process of the mentee.[9] This reiterates the importance of establishing a safe learning environment within mentorship programs and suggests that a supportive community in the clinic (i.e., students, clinicians, patients) is beneficial for the mentee’s confidence and, potentially, patient outcomes.
Mentor’s investment in mentee’s growth
This study also found strong relationships between the mentor’s investment in the mentee’s growth and both mentee confidence (χ2(36) = 174.791, P = <0.001, V = 0.779) and perception of improved patient outcomes (χ2(36) = 186.946, P = <0.001, V = 0.805). These results align with the Straus et al.[15] study of mentorship within academic medicine, which found that the relationship between mentor and mentee is critical to the outcomes associated with the mentorship program. To foster a successful relationship, the mentor had to ensure that the relationship provided benefit to the mentee.[15] For instance, Straus et al.[15] found that most mentees did not see their mentors as protectors and/or advocates and that a lack of invested time for mentorship between the mentee and mentor resulted in barriers to having productive mentorship sessions and relationships. It was also noted in their study that mentees believed it was the role of their mentors to provide advice on career progress and advancement, networking opportunities, and guidance for dealing with challenging workplace and clinical situations.[15] This correlates to the current study’s findings that a strong investment in the mentee’s growth and overall career success is essential in fueling mentee confidence and perception of improved patient outcomes. Interestingly, having a mentor that is an expert in a respective part of the field or that incorporates evidence-based practice did not correlate as strongly as the interpersonal relationship characteristics previously mentioned. Similarly, Henry-Noel et al.[16] also found in their literature review that professional status and reputability in the field of interest are desirable by the mentee yet are secondary to a mentor’s altruistic characteristics and investment in the mentee’s well-being and success. This demonstrates the importance of mentors possessing strong interpersonal skills to facilitate the best possible mentorship outcomes.
Mentor’s preparedness
The preparedness of the mentor for a mentoring session had a strong relationship with increased mentee confidence ((χ2(36) = 174.753, P = <0.001, V = 0.787) and with the perception of improved patient outcomes ((χ2(36) = 174.699, P = <0.001, V = 0.778). This supports the research done by Plack[9], which mentions that a mentor’s lack of preparation can be a barrier to learning. A study by Stefaniak and Dmoch-Gajzlerska[17] found that mentor preparedness was an essential factor in producing positive mentee outcomes. Both of these studies agree with the quantitative results found in this current study, highlighting the importance of mentor preparedness in mentee learning and professional development.
American Physical Therapy Association best practices in mentorship
These findings correspond closely with the APTA’s best practice recommendations, specifically the mentor’s role to “[create] a collegial atmosphere that provides responsiveness and respect for the mentee” and “[encourage] leadership development in the mentee’s chosen area.”[18] The APTA encourages the use of best practices when it comes to mentoring all individuals related to PT and physical therapist assistant professions, as mentorship helps set one up for a successful career.[18] While these best practice recommendations include a list of responsibilities for mentors and mentees in mentorship relationships within the profession,[18] they do not address the structure of mentorship programs or mentor competencies. Further guidance in these areas could have a significant impact on the outcomes of mentorship programs within the PT place of employment.
APTA recommendations, the findings from this study, and the existing literature agree that it is of utmost importance that the mentor be as actively involved as the mentee in all parts of mentorship. It is recommended that professional mentorship programs be structured and implemented early on in all PT settings to improve clinical reasoning and decision-making skills, determination of appropriate plans of care, and overall clinician confidence. Ultimately, this optimizes the perception of improved patient outcomes, job satisfaction,[12] and best practices throughout the PT profession.[18]
Strengths and limitations
This study is one of few studies related to PT mentorship within the United States that is reflective across a wide variety of years and locations across the nation. It provides a quantitative analysis of mentorship in the PT profession and offers suggestions on possible ways to improve the return on investment of mentorship programs at a place of employment. Additionally, it captures many different subspecialties within the PT profession to provide a holistic overview.
There are several limitations to this study. The convenience sampling resulted in a limited sample size of PTs and PT assistants in the United States, which limited the overall clinician diversity.[19] This could result in a possible gap in the representation viewpoints and experiences with mentorship in the profession. Since participation in each question was voluntary, the number of respondents per question varied. The varied response rate may have been due to survey fatigue, as some respondents terminated participation early. In addition, some ratings in this survey were retrospective. This limits the assessment of the current state of mentorship programs within the United States. There was also a limited number of respondents, and all of them were within the United States. Thus, these results only provide a snapshot of mentorship programs and may vary based on personal and workplace experience.
It is important to note that mentorship in residency and fellowship programs was excluded from this study. The mentorship opportunities within these programs are designed and evaluated by the American Board of Physical Therapy Specialties. These programs are governed by a set of national guidelines that may make them inherently different from mentorship programs implemented by a place of employment.[12]
Future research
This study provides quantitative data on formal PT mentorship programs in the place of employment. Future research should investigate how to structure mentorship programs and content to include for an effective curriculum. An evaluation of content in mentorship programs could provide additional guidance to improve patient outcomes and augment clinician confidence.
Further research could also investigate the connection between professional mentorship programs and a clinician’s ongoing commitment to organizational success. Investigations should include effects on job satisfaction, long-term growth within the PT profession, individual life-long commitment to learning, and overall retention at the organizational level. A broader understanding of the structure and content of mentorship programs will undoubtedly improve the future of the PT profession.
CONCLUSIONS
In this study, we provide novel evidence for the importance of early career mentorship in the PT profession and investigate the factors that contribute to the implementation of successful formal mentorship programs. The results of this study indicate that all mentorship factors analyzed in this study have strong correlations with the perception of improved clinical outcomes and increased confidence of the mentee. We found that the same three variables were most highly correlated with both perception of improved clinical outcomes and a mentee’s overall confidence in the ability to treat. The factors most strongly associated with these outcomes are the mentor providing a safe learning environment for the mentee, the mentor being actively invested in the mentee’s growth, and the mentor being prepared for mentoring sessions. These results support previous literature stating the primary importance of respect and support in the learning environment and the interpersonal relationship between mentee and mentor as related to intended outcomes for the mentorship program.
With our results and the previous literature in mind, it may be deemed essential for licensed PTs, regardless of setting type, to undergo professional mentorship early in their postgraduate endeavors to improve their confidence and perception of outcomes related to clinical practice. These findings accentuate the impact and importance of mentorship and note areas needed for the advancement of continued support from professional organizations, institutions, and PTs to improve mentorship experiences. Employers and mentors should incorporate these findings into their formal mentorship programs to improve formal mentorship programs and strengthen their intended outcomes of increasing mentees’ confidence and improving their perception of clinical outcomes.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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