The Challenges of Mentoring: The Case of a Trauma Emergency Department in a South African State Hospital

Introduction

Mentoring is a common practice in many professional fields and is done either formally or informally. In the medical field, it is known as a medical internship, whereby medical students undergo intensive training as junior doctors upon completing their initial medical degree. The internship period entails ‘bridging’ from the acquired knowledge to gaining the required skills to effectively function as qualified doctors (Bola, Trollip, & Parkinson, 2005).

In South Africa, when one qualifies as a doctor, s/he is supposed to register with the Health Professions Council of South Africa (HPCSA); thereby beginning their two-year period of medical internship under the supervision of an experienced and senior medical doctor at an accredited state medical institution. During the mentorship period, the interns are exposed to different aspects of basic clinical procedures in various domains including general surgery, internal medicine, obstetrics and gynaecology, paediatrics, psychiatry, family medicine, anaesthesiology and orthopaedics. This experience provides the new doctors with the opportunity to gain the necessary skills, knowledge and competence, the ability to work in teams and develop the right attitude and values for the medical fraternity (Prinsloo, 2005). The environment in which the mentoring process occurs is quite challenging, characterised by significant pressure, long working hours, difficult patients and mentors, to mention a few. In addition, the mentoring relationship itself can be fraught with tension, miscommunications, cultural insensitivity, impatience and power struggles. This can inhibit junior doctors from being able to fully engage patients in a holistic manner, as outlined in the biopsychosocial model (Engel, 1977).

In the medical field, mentorship is a very important aspect of the journey to become a medical specialist, as it supports the medical students for their career and personal development as health professionals (Prinsloo, 2005). In most countries, medical graduates are anticipated to complete an internship, followed by residency programmes in various specialisations, before they become medical specialists. In this regard, medical students are often highly regarded in society, as they are the future health professionals to serve their communities. However, very little is known in terms of the challenges that they face before they become fully fledged medical personnel. Many studies (Gray & Armstrong, 2003; Labuschagne et al., 2014) have indicated that medical students often suffer from emotional exhaustion, low personal accomplishment and depersonalisation. These negatively impact on their performance, their health, professionalism, as well as their competency. The impact often leads some of them to fail to handle pressure, stress and anxiety. It has been indicated that due to these problems, about 8-25% of medical students become suicidal (Draper et al., 2012). Given the description presented above, the importance of mentoring cannot be underestimated. Mentoring is meant to provide the recently qualified doctors with the necessary knowledge, skills, behaviours and attitudes for them to become competent as medical professionals.

This chapter contributes to an understanding of the importance of junior doctors being mentored, in order to be able to approach a patient holistically, as aligned with the biopsychosocial model (Engel, 1977). Junior doctors need to be able to understand the interplay between factors relating to biological, psychological and socio-environmental factors (Engel, 1977; Borrell-Carrió, Suchman & Epstein 2004). Without mentoring by more senior and experienced medical professionals, junior doctors may be more focused on the medical or biological aspects of their patients. As aligned with the more recent model, a deeper understanding of social aspects may be gained through mentoring, thus ensuring that junior doctors are more patient-centered. This chapter thus expands on the challenges in mentoring in medical education and practice. This is shared so as to address factors which may ultimately be inhibiting the acceleration of the biopsychosocial model in public health.