Date Published: January 14, 2019
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Andres G. Lescano, Craig R. Cohen, Tony Raj, Laetitia Rispel, Patricia J. Garcia, Joseph R. Zunt, Davidson H. Hamer, Douglas C. Heimburger, Benjamin H. Chi, Albert I. Ko, Elizabeth A. Bukusi.
Mentoring is a proven path to scientific progress, but it is not a common practice in low- and middle-income countries (LMICs). Existing mentoring approaches and guidelines are geared toward high-income country settings, without considering in detail the differences in resources, culture, and structure of research systems of LMICs. To address this gap, we conducted five Mentoring-the-Mentor workshops in Africa, South America, and Asia, which aimed at strengthening the capacity for evidence-based, LMIC-specific institutional mentoring programs globally. The outcomes of the workshops and two follow-up working meetings are presented in this special edition of the American Journal of Tropical Medicine and Hygiene. Seven articles offer recommendations on how to tailor mentoring to the context and culture of LMICs, and provide guidance on how to implement mentoring programs. This introductory article provides both a prelude and executive summary to the seven articles, describing the motivation, cultural context and relevant background, and presenting key findings, conclusions, and recommendations.
Mentorship is the professional relationship by which the mentor, “an experienced and highly regarded, emphatic person,” guides a more junior colleague, the mentee, in developing and reassessing his/her ideas, learning and development,1 and substantially furthers his/her personal and professional growth. Mentorship is recognized as a deeply rooted tradition in academics2 and a proven path to the development of future generations of scientists. Historically, investing in the success of others has been an expected responsibility, although even accomplished scientists in high-income countries were typically not formally trained as mentors. Mentorship was performed somewhat intuitively and unofficially, with occasional reports of conflicts of interest and negative outcomes.3 Mentorship frameworks, tools, and programs have only emerged in the last decades.4,5 Regardless of potential imperfections in its implementation, mentorship can result in deep, continued friendships that evolve and mature over time. In fact, some scientists consider their relationships with mentees their most enduring contributions.
Low- and middle-income countries and their regions share many commonalities but also present substantial cultural differences resulting from their individual characteristics and their specific past colonial influences. The oppressive histories in many countries have contributed to research and education structures with authoritarian approaches,13,16 which in turn are additional obstacles for effective mentoring. Culture distills a deeply rooted respect for hierarchy and seniority (Table 1), which is echoed in medicine, academics, and research,17 as well as strict formality in communication and dialog to the point that challenging the opinions of a senior scientist or faculty can often be considered offensive or inappropriate.16 The formal addressing of peers and superiors by their titles and ranks instead of first names continues to be considered a sign of respect in LMICs, even in regions such as South America where warm, close interpersonal relationships and informal interactions are the social norm. This can represent a barrier to the development of a strong mentor–mentee relationship, preventing the trust that can enable questioning or disputing of the mentor’s position or views.18 In addition, the absence of such a close link may prevent the creation of a personal bond that frequently can make mentorship relationships last beyond specific training periods. Verticality and formality is present in varying degrees across continents and countries, which promotes paternalism and limits the ability of “mentoring up,” a process through which mentees are empowered to direct the mentoring relationship, and thus, places equal or greater emphasis on the mentee’s contribution to the mentoring relationship.15 The scarcity of resources and opportunities adds to this, as the success of the mentee can be erroneously perceived by mentors as increased competition and failure. Furthermore, remnants of colonial master–servant beliefs may prevent mentors from understanding that mentorship implies a greater shared power between the mentor and mentee instead of the mentor alone having all the power.
We propose the long-term goal of creating a local “identity” of mentorship within the cohesive social fabric of LMICs and developing models that build on local strengths, while dealing with factors such as hierarchy and social structure. The introduction and strengthening of mentorship in the specific cultural, economic, and structural settings of LMICs should have aims and approaches pragmatically compatible with available resources and institutional support (Table 1). A progressive and phased implementation science approach will require customization to the local institutional setting, pilot programs, and eventually scale-up efforts once LMIC-specific best practices and lessons learned are clear, and impact indicators are well defined. Just as in high-income settings, institutional mentoring efforts at LMICs will limited by available resources and will take time to initiate, scale-up and become self-sustaining. In the meantime, closely monitored and evaluated pilot introductions in individual research groups, departments, or academic programs at a smaller scale can serve as proof of concept. These initial efforts, some already underway, should produce diffusion of innovations and experiences on how to best advocate for the implementation of institutional-level mentoring programs in the future. Another key outcome of LMIC-mentoring programs should be principles, best practices, and evidence-based guidelines for others to replicate and expand successful efforts and models. Mid- or senior-career scientists with extensive exposure to international practices of mentoring should play key roles in leading initial mentoring programs (Table 2). Efforts to train and “mentor” the mentors will be needed and represent a key task of the global health academic community. Table 2 presents a few key recommendations for specific stakeholders in this endeavor. Together, these elements will eventually help to shape the identities of mentorship in LMICs.
Historically, LMICs have been the focus of substantial research capacity-building investments, ranging from the Rockefeller Foundation’s International Clinical Epidemiology Network22 to the U.S. National Institutes of Health Fogarty International Center’s (FIC) Global Infectious Diseases programs, Global Health Program for Fellows and Scholars,23 and Medical Education Partnership Initiative.24 Other recent efforts include the Wellcome Trust’s African Institutions Initiative25 and Brazil’s Science without Borders,26 in addition to activities supported by the U.S. Centers for Disease Control and Prevention, and the U.S. Agency for International Development. None of these investments, however, has specifically addressed the need for local mentoring models or approaches in LMICs. Cole describes a few examples of mentoring experiences and programs in high-income and LMICs, highlighting multiple research gaps and the need for greater evaluation and systematic assessment.27
This special issue addresses the challenge of implementing mentoring programs in LMICs and provides guidance on how to adapt mentoring practices used in high-income countries to the settings and cultural practices of research and academic institutions in resource-limited settings. These publications are directed at scientists, institutional leaders, administrators, and trainees in LMIC institutions in collaboration with partners in high-income countries interested in expanding mentorship at LMIC institutions to advance global health research. The articles can also serve as a reference guide for LMIC institutions to develop strategies, approaches, and programs to support mentorship across institutional units, including departments, schools, and colleges, and to select priority mentoring practices for implementation supported by a strong, LMIC-specific evidence base.
The advancement of global health research demands sustained career development opportunities for LMIC scientists that can only be attained via the implementation and dissemination of culturally compatible mentoring practices. Institutional resources and local academic and cultural factors should guide the phased implementation of tailored mentoring activities and programs for each setting, with planned, periodic evaluation of progress. Low- and middle-income country institutions also need to support existing mentors and train additional ones, while mentees can contribute to prevent overburdening the few trained mentors available, by playing an active role in the operational efforts of mentoring programs via progressing and peer mentoring. We hope this special issue will become part of the foundation of LMIC-specific mentoring approaches around the globe.