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African Journal of Primary Health Care & Family Medicine

On-line version ISSN 2071-2936
Print version ISSN 2071-2928

Afr. j. prim. health care fam. med. (Online) vol.12 n.1 Cape Town  2020

http://dx.doi.org/10.4102/phcfm.v12i1.2320 

CONFERENCE REPORT

 

Exploring gaps, strategies and solutions for primary care research mentorship in the African context: A workshop report

 

 

Chelsea M. McGuireI, II; Kenneth YakubuIII, IV, V; Nana K. Ayisi-BoatengVI; Keneilwe MotlhatlhediVII; Pius AmehVIII; Bola B. FatusinIX; Martha MakweroX; Louis S. JenkinsXI, XII

IFamily Medicine Speciality Training Program, Lesotho- Boston Health Alliance, Leribe, Lesotho
IIDepartment of Family Medicine, Boston University School of Medicine, Boston, United States
IIIFaculty of Medicine, University of New South Wales, Sydney, Australia
IVThe George Institute for Global Health, Sydney, Australia
VDepartment of Family Medicine, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
VISchool of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
VIIDepartment of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
VIIIDepartment of Family Medicine, Federal Medical Centre, Keffi, Nigeria
IXConsultant Family Physician and Academic Coordinator, Family Medicine Department, Federal Medical Centre, Gusau, Nigeria
XDepartment of Family Medicine, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi
XIDepartment of Family and Emergency Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
XIIDepartment of Family and Emergency Medicine, George Hospital, Western Cape Department of Health, George, South Africa

Correspondence

 

 


ABSTRACT

BACKGROUND: Primary care needs research to generate evidence relevant to community needs; however, there is a lack of research engagement among primary care physicians, especially in sub-Saharan Africa. Improved research mentorship for family physicians (FPs) can help address prevailing knowledge and practice gaps in primary care research.
WORKSHOP PROCESS: During the 6th annual Africa Regional Conference of the World Organization of Family Doctors (WONCA), we conducted three workshops on research mentorship for African FPs. Two workshops (one online and one onsite at the pre-conference) were geared towards the young doctors' movement of WONCA Africa. The third was onsite during the main conference. Following a brief presentation on the concept of research mentorship and known gaps, participants broke into small groups and discussed additional gaps, solutions and anticipated readiness for implementing these solutions. We used a content analysis to summarise key concepts and had participants to review the findings.
WORKSHOP FINDINGS: Identified gaps related to mentees' difficulty initiating and maintaining mentorship relationships and an overall shortage of capable and willing mentors. Organisational solutions focused on capacity building and creating a culture of mentorship. Interpersonal solutions focused on reducing the power distance and increasing reflectivity and feedback. Increasing the use of research networks and both peer and online mentorship were advocated. Barriers to readiness included resource constraints and competing priorities.
CONCLUSION: A multi-level approach is needed to address the gaps in research mentorship for African FPs. Identified solutions hold potential for supporting the research engagement needed to improve the population health across Africa.

Keywords: research; mentorship; primary care; general practice; family medicine; sub-Saharan Africa; workshop report.


 

 

Introduction

In June 2019, over 180 family medicine and general practice trainees, clinicians, educators and researchers convened in Kampala, Uganda, for the 6th annual Africa Regional Conference of the World Organization of Family Doctors (WONCA). It provided an opportunity to discuss the status of family medicine around the continent, share best practices to promote its development and tackle some of the most pressing challenges facing primary care in Africa. Among these challenges is a gap in primary care research, especially in sub-Saharan Africa.1 Mentorship is a crucial driver of research engagement.2,3 Thus, a series of workshops were held to advance the issue of research mentorship for family physicians (FPs) in the African context. This report summarises the workshop results, focusing on the innovative solutions that were generated with the hope of encouraging their implementation to build sustainable research mentorship for FPs in Africa.

 

Workshop process

We conducted three workshops on 'Innovative Approaches to Research Mentorship in Primary Care: Exploring Gaps, Strategies and Solutions'. The first workshop was part of the pre-conference for AfriWon Renaissance (AfriWon), the young doctors' movement (YDM) of WONCA Africa. The second workshop took place during the main conference and was geared towards a wider audience, focusing more on the organisational level. Both workshops opened with a brief presentation which defined research mentorship as: (1) instrumental support regarding the 'how-to' of research; (2) connection to research resources such as software, experts in research methodology and funding; (3) research career development support; and (4) psychosocial support to facilitate emotional and personal development.4 The presentation also covered known gaps in research mentorship from the literature and the modified Delphi technique structure of the workshop. Participants then broke into small groups of 8-12 people and discussed (1) additional gaps or challenges to research mentorship; (2) context-specific, innovative solutions to these gaps; and (3) anticipated readiness and potential barriers to implementing these solutions in the participants' home context. Group leaders captured all generated ideas and presented the results in a large group discussion. A single list for each domain was compiled and participants then voted on the ideas. However, because of time limitations, the voting process was not completed for all domains. The third workshop took place virtually using a combination of WhatsApp messenger and Zoom video conferencing. Similar to the first workshop, it was geared towards the AfriWon demographic and intended to follow the same format. However, because of technical and network difficulties, only one breakout session occurred, and there was no final voting session.

RStudio (Version 1.2.1335) statistical software was used to analyse participant demographics. Given the departure from the typical modified Delphi technique voting process, we did not achieve consensus during these workshops. Rather, two team members used a content analysis approach to categorise key concepts from all three workshops under three domains: gaps, solutions and readiness.5 These categories were then verified by a third team member and summarised. Preliminary findings were shared with participants for verification and inputs were incorporated.

 

Workshop findings

Participants

The AfriWon pre-conference workshop had 30 attendees, and 26 attendees shared their demographic information. Participants were 46% female, ranged from 4 years pre-qualification to 6 years post-qualification, had a mean age of 36.8 (standard deviation [s.d.] 5.1) and came from 12 countries. The main WONCA workshop had 17 participants, and 16 participants provided demographic information. Participants were 13% female, ranged from first-year medical students to 30 years post-qualification, had a mean age of 38.9 (s.d. 6.2) and came from seven countries. Sign-up for the virtual workshop garnered 26 individuals. However, only eight were able to join the workshop, and no participants filled out the demographic survey. Of the 26 participants who provided a valid email address, nine provided feedback on preliminary workshop findings during the 1-week participant-checking period.

Gaps

The identified gaps fell into three categories relating to mentees, mentors and institutions. Concerning mentees, participants noted that they have difficulty initiating mentorship relationships, often because of a perceived power difference between themselves and potential mentors. After a relationship is initiated, mentees may not continue to reach out to the mentors because of poor understanding of the mentors' role. For mentors, attitudes such as paternalism, an unwillingness to 'truly mentor' and seeing themselves as supervisors instead of mentors were mentioned. A lack of confidence to mentor was also noted. Institutional gaps included an overall shortage of mentors and lack of a mentorship 'culture'. Little or no undergraduate exposure to mentorship and insufficient time for mentorship because of work demands were acknowledged. Inadequate funding and lack of institutional support for research inhibit overall research engagement and therefore research mentorship.

Solutions

The solutions offered also broadly fell into three categories: organisational, interpersonal and specific innovations for mentorship promotion and delivery (Box 1). At the organisational level, attendees emphasised capacity building in research mentorship. Participants suggested the need for explicit research mentorship training for mentors and mentees, starting at the undergraduate level. Participants recommended this training focus on interpersonal communication strategies needed for successful mentorship. Additional training on research-related skills such as time management, research methods, writing and grant applications was also mentioned. To increase the supply of mentors, policies that encourage FPs to pursue PhDs were advocated. Another solution was institution-based policies on research mentorship, including incentives and rewards for mentoring. Finally, participants expressed the need to shift the overall organisational culture, so research is part of everyday conversation and an integral part of family medicine practice. Research should not just be a graduation requirement, but part of daily work to find solutions useful for patients and health systems.

Interpersonal solutions focused on bridging the gap between mentors and mentees. Participants described the need to decrease the power differential within the hierarchy in academia, between faculty and non-faculty members, and medical disciplines in general. Some examples of how to break down these barriers were offered, including informal 'Meet-and-Greet' sessions where potential mentors are more approachable to potential mentees. Another solution aimed at encouraging mentors to reflect on their own past challenges as mentees. In addition, mentees were urged to give feedback to their mentors. Encouraging mentors to co-publish with trainees was identified as pertinent. Finally, mentees were advised to be innovative in their choice of research topics, strategically selecting topics that are exciting, achievable and interesting for both themselves and their identified mentor.

A broad range of innovative solutions for research mentorship were explored. One was virtual mentorship. This could be one-on-one or through online mentorship groups. Social media was identified as a useful tool for sharing positive examples of research mentorship for others to emulate. Other ideas included using mentorship teams, expanding local research networks and encouraging peer and 'near-peer' mentorship (e.g. between senior and junior registrars or doctorate and master's students).

Readiness

Following discussion of solutions, several key barriers to readiness were identified. Participants shared reservations about their institutions' overall capacity and support for research, which make buy-in and implementation of the potential solutions difficult. The ever-present issue of competing priorities and time constraints for busy FPs, lack of good systems for mentor-mentee matching and the threat of burnout among FPs were noted. A lack of resources relevant to both research engagement and mentorship, such as reliable internet connection, was identified. Finally, gender-related barriers, including gender-based violence, harassment and a shortage of female mentors, were also shared.

 

Discussion

The active participation in these workshops demonstrated a recognised need to increase access to quality research mentorship among FPs in Africa. There are challenges, the most significant of which may be time limitations and the hierarchical culture of medicine and research, especially within the African context. Proffered solutions include building capacity for research mentorship and improving interpersonal relations between mentees and mentors through specific training on interpersonal communication. Published research mentorship competencies in this domain include listening deeply, encouraging mentees to speak, communicating with compassion, providing constructive feedback and practising reflexivity.3 These strategies can help create the safety needed for research mentorship to thrive.2 An observed limitation of the workshop was the prevailing ambiguity between research supervision and mentorship. In the case of trainees, separating these may be needed to create a safe mentorship environment away from evaluation and grading. A YDM meeting report supports our workshop findings on the role of peer, near-peer and e-mentorship to promote research among young FPs.6 Successful mentorship programmes must be contextual and recognise diversity. Efforts should work to build simultaneously a culture of research and of mentorship.1,2

 

Conclusion

The workshop findings suggest that a multi-pronged approach is needed to address the gaps in research mentorship for African FPs, including efforts to (1) extend currently available mentorship through research networks, peer mentorship and e-mentorship; (2) build additional research mentorship capacity by increasing enrolment of African FPs into PhD programmes; (3) provide dedicated mentorship training to both mentors and mentees alike; and (4) support the development of a positive research culture within family medicine through advocacy, increased research funding, protected time and genuine commitment by institutions. These strategies hold potential for catalysing the primary care research engagement needed to improve the health of populations across Africa.

 

Acknowledgements

The authors would like to thank WONCA Africa and AfriWon Renaissance for hosting these workshops. They also thank Dr Rob Saper for his guidance and editing contributions; Professor Bob Mash for his provision of senior mentorship during the second workshop and for his guidance on the manuscript preparation; all participants who took part in the three workshops; and Dr Melvina C. Thompson, Dr T. Namane, Dr M. I. Makhele, Dr Enwongo Ettang, Dr Muhindo Lwanzo Chrispin, Dr Rianne van Vliet and Dr Oteju A.A. for their additional contributions during the participant-checking phase of their analysis.

Competing interests

The authors have declared that no competing interests exist.

Authors' contributions

C.M.M. (Lesotho-Boston Health Alliance, Lesotho and Boston University, United States) co-authored the initial workshop design, facilitated both in-person workshops, summarised the content analysis, organised participant-checking and co-prepared the manuscript. K.Y. (University of Jos, Nigeria; University of New South Wales and The George Institute, Australia) co-authored the initial workshop design, led a small group discussion in each workshop, performed content analysis for one of the domains and co-prepared the manuscript. C.M.M. and K.Y. are co-first authors due to their equal contribution to this project. N.K.A.-B. (Kwame Nkrumah University of Science and Technology, Ghana) and K.M. (University of Botswana, Botswana) each lead a small group discussion in each workshop, performed content analysis for one of the domains, and contributed to and approved the final manuscript. B.B.F. (Federal Medical Centre, Gusau, Nigeria) and P.A. (Federal Medical Centre, Keffi, Nigeria) each co-facilitated the virtual workshop, performed content analysis for one of the domains, and contributed to and approved the final manuscript. M.M. (University of Malawi, Malawi) performed content analysis for one of the domains and contributed to and approved the final manuscript. L.S.J. (Stellenbosch University and Western Cape Department of Health, South Africa) provided senior mentorship during the second workshop, and contributed to and approved the final manuscript.

Ethical consideration

This report summarises findings from a conference workshop and, as such, is not research and did not require ethical clearance. The authors still followed all standard ethical procedures. Participation was voluntary and written consent was obtained in order to use participants' demographic information and to publish the names of participants who provided feedback on workshop findings.

Funding information

The production of this workshop report was supported by Dr McGuire's T32HP10028 Family Medicine-General Internal Medicine-General Pediatrics Academic Fellowship Program at Boston University.

Data availability statement

The data that support the findings of this workshop report are available from the corresponding author (C.M.M.) upon reasonable request.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.

 

References

1.Mash R, Essuman A, Ratansi R, et al. African Primary Care Research: Current situation, priorities and capacity building. Afr J Prim Health Care Fam Med [serial online]. 2014 [cited 2019 Oct 28];6(1):1-6. Available from: https://phcfm.org/index.php/phcfm/article/view/758        [ Links ]

2.Cole DC, Johnson N, Mejia R, et al. Mentoring health researchers globally: Diverse experiences, programmes, challenges and responses. Glob Public Health. 2016;11(9):1093-1108. https://doi.org/10.1080/17441692.2015.1057091        [ Links ]

3.Hamer DH, Hansoti B, Prabhakaran D, et al. Global health research mentoring competencies for individuals and institutions in low- and middle-income countries. Am J Trop Med Hyg [serial online]. 2018 [cited 2019 Nov 5]. Available from: http://www.ajtmh.org/content/journals/10.4269/ajtmh.18-0558        [ Links ]

4.Eby LT, Allen TD, Hoffman BJ, et al. An interdisciplinary meta-analysis of the potential antecedents, correlates, and consequences of protege perceptions of mentoring. Psychol Bull. 2013;139(2):441-476. https://doi.org/10.1037/a0029279        [ Links ]

5.Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013;15(3):398-405. https://doi.org/10.1111/nhs.12048        [ Links ]

6.Yakubu K, Colon-Gonzalez MC, Hoedebecke K, Gkarmiri V, Hegazy NN, Popoola OO. Meeting report: 'How do I incorporate research into my family practice?': Reflections on experiences of and solutions for young family doctors. Afr J Prim Health Care Fam Med. 2018;10(1):6. https://doi.org/10.4102/phcfm.v10i1.1640        [ Links ]

 

 

Correspondence:
Chelsea McGuire
chelsea.mcguire@gmail.com

Received: 12 Dec. 2019
Accepted: 12 Feb. 2020
Published: 25 May 2020

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