Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned

Contextual challenges and impacts on the surgical ecosystem in Chiapas, Mexico: A qualitative study

Chiapas is a state in southern Mexico that faces significant challenges in healthcare delivery. Strengthening the surgical system requires a comprehensive understanding of all health system domains and the contextual factors that influence care delivery. This study used qualitative methods to identify factors related to both gaps and successes in surgical care in Chiapas, Mexico. Semi-structured interviews were conducted with 23 participants at 15 public and private hospitals. Participants consisted of nurses, physicians, surgeons, and hospital administrators. Interviews were transcribed, and a codebook was developed and applied to all interviews. Recurring themes were identified and described using thematic analysis. Four themes characterizing the challenging context through which care is delivered were identified: referral system challenges, workforce shortages, insufficiencies in perioperative and nonoperative care, and waste and mismanagement of resources. Three themes related to innovations and workarounds were identified: efforts to maximize resources and reduce waste, strategies to reduce language barriers, and planning to account for clinical needs in situations of limited access and emergencies. Gaps and challenges within the surgical system of Chiapas lead to challenges in care delivery across all domains of the health system. However, several solutions have emerged among local providers. Insight into these factors can be used in planning efforts to improve access to safe and effective surgical care.

Exploring the Mediating Role of Social Exchange Orientation in the Relationship Between Mentoring Experiences and Mentoring Intentions: A Cross-Sectional Study

The study utilized a cross-sectional design to determine the relationship between positive and negative mentoring experiences and intentions to engage in future formal mentoring and the mediating role of aspects of social exchange theory particularly Negotiated Exchange Orientation and Perceived Organization Support. The study was conducted among 303 nurses and midwives working in acute care hospitals in Uganda. The results showed that, in the negative mentoring model, Perceived Organization Support fully mediated the relationship between lack of mentor expertise and willingness to participate in formal mentoring programs (B = -0.201, 95% CI [-0.399, -0.056]). In the positive mentoring model, indirect effects were observed for the relationship between Individual Influence variable and willingness to participate in formal mentoring programs mediated by Perceived Organization Support (B = 0.131, 95% CI [0.011, 0.283]). Furthermore, indirect effects were observed between the Relational Quality variable and willingness to participate in formal mentoring programs mediated by Negotiated Exchange Orientation (B = 0.081, 95% CI [0.008, 0.183]). Therefore, the social exchange theory can explain the relationship between past mentoring experiences and future intentions to engage in mentoring activities.

Intersection of Race and Gender in the Cardiothoracic Workforce: Study of Representation and Salary

BACKGROUND

Cardiothoracic surgery lacks gender and racial/ethnic diversity. Recent studies have highlighted disparities based on gender and race/ethnicity among academic cardiothoracic surgeons. The impact of the intersection of these factors on representation and salary is unknown.

METHODS

A cross-sectional analysis of Accreditation Council for Graduate Medical Education and Association of American Medical Colleges data was performed on the number of trainees and clinical faculty stratified by race/ethnicity and gender using χ2 testing.

RESULTS

The number of women and underrepresented minorities was low in cardiothoracic surgery compared with other specialties, with lowest representation at the intersection of race/ethnicity and gender. Among trainees, 8% were Asian, 2% were Black/African American , and 1.5% were Hispanic/Latina women. Among cardiothoracic faculty, 3.4% were Asian, 0.8% were Black/African American, and 0.4% were Hispanic/Latina women. Women in academic medicine, surgery, and cardiothoracic surgery earned 80%-87% the salary of men of equal academic rank. White assistant professors earned more than their colleagues (all clinical faculty, surgeons, and cardiothoracic surgeons), this difference was further compounded by gender.

CONCLUSIONS

Salary disparities exist among cardiothoracic surgeons at the intersection of gender and race/ethnicity. Women experience salary disparity across all academic ranks and specialties. When considering the intersection of gender and race/ethnicity, gender is the predominant factor driving salary inequity.

The Role of Mentorship in Orthopedic Professional Development: From Training to Mastery

Introduction

Mentorship is essential to the professional and personal development of orthopedic surgeons. It promotes continuous learning, supports career development, and helps develop future leaders in the field. Our study explains key aspects of effective mentorship, differentiates mentorship from coaching, and highlights strategies to enhance mentor-mentee relationships.

Materials and Methods

A literature review was conducted to identify best practices in orthopedic mentorship using established models, expert opinions, and real-world training experiences.

Results

Strong mentorship positively impacts skill development, career progression, and overall job satisfaction. Key elements include structured guidance, open communication, and mutual commitment. Differences between mentorship and coaching were elucidated, emphasizing their distinct roles in professional development.

Discussion

Effective mentorship programs require formal structures, clear expectations, and institutional support. Successful mentor-mentee relationships thrive on trust, regular feedback, and goal alignment. Practical strategies to strengthen mentorship in orthopedic training include mentorship training for faculty, structured pairing programs, and promoting a supportive learning environment.

Conclusion

Mentorship is critical in orthopedic education and career development. Establishing strong mentorship programs can enhance learning, improve professional satisfaction, and develop future leaders in the specialty. Institutions should prioritize structured mentorship frameworks to ensure long-term success.

Challenges in early career for HPB surgeons: an international practice survey

BACKGROUND

Understanding the needs of early-career surgeons is essential for developing strategies for support. This study examined perceived needs of early-career HPB surgeons worldwide.

METHODS

A self-administered web-based survey of early career HPB surgeons (aged ≤45 years old or practicing for ≤5 years) was conducted. A questionnaire was developed through items generation and reduction, followed by pilot testing. Quantitative data were reported with descriptive statistics and qualitative responses analysed using open coding.

RESULTS

There were 282 respondents. Six main areas of challenges were identified: mentorship opportunities, continued skills acquisition and training, research and collaboration, leadership and career development, clinical knowledge exchange, and accessibility including financial barriers. Specifically, highest rated challenges were ebalancing work and personal life (mean 6.98, SD 2.92), research (mean 6.79, SD 2.50), career development/mentorship (mean 6.70, SD 2.30), networking/collaboration (mean 6.16, SD 2.71), leadership and (mean 6.09, SD 2.53). Rating of research as a challenge was higher in Africa and Central/South America (p = 0.01), and that of leadership was higher in Asia, Oceania, and the Middle East (p = 0.02).

CONCLUSIONS

This survey highlights the multiple challenges faced by early-career HPB surgeons worldwide. These results provide insights into how to better support early-career HPB surgeons to fully develop their specialty.

The role of teamwork and mentorship in pediatric and congenital heart surgery

Pediatric and congenital cardiac surgery, characterized by its complexity and high-stakes nature, demands superior technical expertise and multidisciplinary teamwork. With limited surgeons worldwide, the role of continuous skill refinement and collaborative practice is crucial for patient safety and successful outcomes. A literature search was performed using the PubMed, Cochrane, SCOPUS and Web of Science databases for studies published until September 2024. Articles were analysed to summarize findings on the impact of mentorship and teamwork within pediatric and congenital cardiac surgery. This article explores the dual importance of teamwork and mentorship in shaping the next generation of pediatric and congenital cardiac surgeons. The study examines the impact of mentorship on reducing learning curves and improving surgical outcomes whilst highlight the unique challenges faced by surgeons in low-income countries (LICs). Effective mentorship can serve as a bridge between knowledge and practice, ensuring that surgeons in resource-constrained environments can confidently adapt to challenges and improve patient outcomes despite the limited resources. By emphasizing a culture of innovation and collaborative teamwork, pediatric and congenital cardiac surgery continues to achieve increasingly better patient outcomes on a global scale. This study highlights how continuous mentorship and teamwork not only enhance technical proficiency but also drive advancements in surgical techniques and overall care, contributing to the ongoing global progress in pediatric and congenital cardiac surgery.

Surgical mentorship in low-resource environments: Opportunities and challenges, a perspective

Background and aims

In low- and middle-income countries (LMICs), a shortage of skilled surgical practitioners hampers healthcare delivery, impacting well-being and economic growth. Surgical mentorship programs offer a promising solution but face challenges in implementation. This review aims to comprehensively assess the impact of surgical mentorship programs in LMICs and identify challenges and opportunities for their development and implementation.

Methods

A thorough literature search was conducted from 2000 to 2023 using multiple databases, focusing on surgical mentorship programs in LMICs. Inclusion criteria encompassed full-text articles in English that demonstrated characteristics of mentorship. Rigorous exclusion criteria were applied to ensure high-quality evidence inclusion.

Results

Surgical mentorship programs in LMICs strengthen local surgical capacity, improve surgical skills and patient outcomes, optimize resources and technology utilization, and positively impact medical students aspiring to be surgeons. However, challenges such as resistance to change, resource limitations, financial constraints, logistical and technological challenges, and time constraints hinder their implementation.

Conclusion

Despite challenges, surgical mentorship programs hold promise for enhancing surgical capacity and healthcare quality in LMICs. Standardized metrics for accountability, innovative funding mechanisms, collaborative partnerships for scalability, interdisciplinary integration, and leveraging virtual mentorship programs are key strategies to overcome challenges and foster sustainable learning cultures, ultimately contributing to improved healthcare equity and quality in low-resource settings.

Training in the art and science of facilitation to scale research mentor training in low and middle income countries

Advancing biomedical research in low and middle income countries (LMICs) to expand the capacity for LMICs to integrate biomedical research into their health care systems and education has been the focus of many programs in global health over the past two decades. Central to the success of these programs is effective research mentoring, characterized by academic, career and psychosocial support through culturally appropriate practices. Research mentoring is a learned skill, developed through training, mutual discussions, practice and feedback. The majority of extant training programs are designed and delivered by US partners, so the next stage in building capacity is to train facilitators within the LMIC partner institutions to contextualize and advance mentoring specifically within their cultural and institutional norms by co-developing, delivering and evaluating semi-annual research mentoring training. To this end, we describe the development, delivery and outcome evaluation of a 5-week course in the art and skill of facilitation. Care was taken to explicitly distinguish between concepts of "teaching" and "facilitation," since "teaching" is closely connected to a transmission or banking model of education, which is characterized by "top-down," hierarchical relationship. The course discussed power and positionality, themes that resonate with partners in Nigeria and Tanzania. These themes provided unique entry into deeper conversations core to advancing mentoring practice away from the traditional dyadic power structure that remains from colonization. Evaluation findings indicate significant advances in awareness of differences between teaching and facilitating, increased confidence in facilitation skills, especially in the area of structured planning and organization, as well as improved communication and interpersonal skills. All respondents felt that students in Nigeria and Tanzania would respond well to the facilitation approach conveyed during the course and they found value in participating in the course as a cohort.