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Sub-mentorship in neurosurgery: Pilot experience from a war-torn country
Correspondence to MUSTAFA ISMAIL; mustafalorance2233@gmail.com
[To cite: Ismail M, Al-zaidy M, Al-kafaji A, Ahmed F, Albairmani S, Al-ageely T, et al. Sub-mentorship in neurosurgery: Pilot experience from a war-torn country-Iraq. Natl Med J India 2026;39:188-90. DOI: 10.25259/NMJI_651_2023]
Abstract
Background
Mentorship is a high-quality educational process that provides exposure in clinical subjects to medical students. In the sub-mentorships system, mentees become mentors, directly connected to the senior mentor, and this stimulates early progress for all parties. We document the submentorship concept in neurosurgery and present our experience with this system in low and middle-income countries.
Methods
Over six years (2016–2022), we conducted 9 medical student mentorship programs covering 1116 mentees. Mentees underwent an integrated course based on 5 parameters: neurosurgery emergency rotation, neurosurgical intensive care unit, hands-on clinical laboratory training, operating room observership, and a research course. Students who showed an interest in neurosurgery were selected and prepared under the senior mentor’s supervision to be the program’s sub-mentors in future courses.
Results
A total of 27 medical students in different stages of training at various medical schools were trained to be sub-mentors. Of 149 research papers published, accepted, and submitted by our team, sub-mentor students participated in 73 projects. From around 500 neurosurgical procedures done over the past 4 years, students and sub-mentors attended 275.
Conclusion
Sub-mentorship can be a conduit for advancing the classical pattern of mentorship in neurosurgery. In addition, it may represent an avenue for capacity building in underserved areas or war-torn countries.
INTRODUCTION
Mentorship is integral to high-quality education, boosting individual development and progression, and increasing knowledge and experience while ensuring that skills and professional standards are ‘passed on’ to the next generation. Mentorship is vital to surgeons regardless of specialty.1 Since its beginning in the early 20th century, the field of neurosurgery has been a delicate, challenging, and intellectually demanding specialty in surgery. Mentorship has long been acknowledged as an essential part of neurosurgical education.2 However, there is a shortage of neurosurgeons and neurosurgery residents, especially in low and middle-income countries (LMICs). According to WHO, the median number of neurosurgeons per 100 000 individuals is 0.2 for low-income countries and 1.24 for high-income countries.3
Early exposure of medical students to neurosurgery can promote their interest in the field. Neurosurgery mentorship programs for medical students provide exposure to the life of a neurosurgeon, expand their awareness of the key elements of the branch, and pave the way for a neurosurgery match.4 Moreover, mentorship is an educational tool of high inspirational value. Unlike counselling or coaching, it is a free career-promotion strategy built on a personal relationship in a professional context. A senior mentor mainly focuses on promoting medical students’ professional skills and maximizing their potential to reach personal and professional goals. However, medical students’ mentorship seems less abundant or obtainable than it should be despite its inherent value.4
Like all forms of education, mentorships require a structure to be successful. A recent method is based on sub-mentorships that are directly linked to the senior mentor, with sub-mentors trained at tasks assigned to them, and promotes faster development in all aspects.5,6 To the best of our know-ledge, this is the first documentation of the sub-mentorship concept in neurosurgery. We present the experience of the neurosurgery sub-mentorship system in LMICs and Iraq as an example, based on 4 years of our team’s experience with this structure in the Hoz neurosurgery mentorship program.
METHODS
Hoz neurosurgery mentorship program
Over 6 years (2016–2022), 9 student mentorship programs were conducted with 1116 mentees from 18 countries, most of whom were from Iraq. The sub-mentorship system started with the fifth mentorship program in 2019. All mentees underwent an integrated course built on 5 parameters.
First, the neurosurgery emergency rotation included exposure to didactic presentations and emergency department clinical experience. Students were assigned to a resident during emergency department shifts.
Second was a neurosurgical intensive care unit (ICU) rotation to expose the student to critically ill patients and teach them the management principles.
Third was a hands-on clinical laboratory training that included neurosurgical instruments and skills such as suturing, bone work, and neurosurgical approach simulation through animal-based and synthetic training models.
Fourth was the operating room observership including open neurovascular surgeries, tumours, and endovascular procedures.
Fifth was a research course aimed at developing skills in the neurosurgery academic field.
The neurosurgical rotation was not limited to the period of the mentorship program and was scheduled depending on the students availability.
Sub-mentors’ selection and preparation
Based on the performance in the 5 courses, a fixed number of students who showed special interest, competence, knowledge, and skills in neurosurgery were selected to be become sub-mentors. The selection was done by the senior neurosurgeon subjectively.
Sub-mentors were offered opportunities to undergo further training in these 5 spheres under the direct supervision of the senior mentor and residents. They participated in research projects, writing scientific papers, and making presentations. They also supported and guided future mentees of the program. Mentees could enrol at any year of medical school, while sub-mentors were mostly, but not exclusively, at clinical years of education.
RESULTS
Twenty-seven medical students at varying stages of training at several medical schools were trained to be sub-mentors. They participated in 73 research projects, with some partici-pating in up to 31 projects, and one sub-mentor matched the neurosurgery residency program in Iraq. Of 149 research papers submitted, accepted or published by our team, 75 included the participation of 50 medical students.
Of approximately 500 neurosurgical procedures performed over the past 4 years, students attended 275 procedures. The sub-mentors helped the new students in all the procedures they attended, with a maximum of 110 operations attended by some students. Additionally, the students spent hundreds of hours in the emergency room, ICU, and neurosurgical skills laboratory.
DISCUSSION
The sub-mentors effectively contributed to making the mentor-ship more foolproof and straightforward by reducing the time and effort of the mentor neurosurgeon. They guided mentees on the processes and procedures in the operating room, sterility, and preparations for surgery. They supervised mentees about how to do research, write a paper and reviewed their work in small projects.
Sub-mentors featured prominently in the team’s research projects and contributed to increasing academic output. They helped to collect data, write a paper, do statistical analysis and reduced the burden on the team. They showed a lot of passion and a distinct motivation to exploit such opportunities.
One sub-mentor conducted an online research course of 8 hours over 4 days in a 1-week period. Its primary component was writing case reports and review articles on neurosurgery. After the course was completed, the feedback from the mentees was very positive. Such experience gives the sub-mentor and the mentee confidence to establish a peer education process in their career. The sub-mentorship program gives confidence to the students to prepare and present cases, research projects, and plans of the team.
Sub-mentors’ attainments
The sub-mentors benefit from this process as it helps advance their knowledge, skill and academic development. Furthermore, it helps them acquire leadership skills and helps reduce the occurrence of errors and increase their mentorship capacity. Some sub-mentors may resent the advice of their seniors. However, such incidents are rare.
Mentoring new students makes them strive to gain respect and confidence of the mentees in their abilities to impart knowledge. We noticed that students in leadership positions tended to study intensively and focus on details related to the assigned work. The program increased knowledge of both groups within a short time.6,7
Sub-mentorship helped to build a respectable research portfolio for students, especially in LMICs where university facilities, financial aid for research, and research centres are limited. It taught them how to conduct research and provided them with opportunities to write. Additionally, mentorship provides clinical, teaching, and leadership experience in the curriculum vitae of the sub-mentor.
However, matching the sub-mentors to neurosurgery residencies is not guaranteed. Mentorship can have several benefits for the student and the sub-mentor. It does not detract from the student’s learning of essential skills and knowledge that help them to excel in any medical specialty.
Sub-mentorship benefits for mentees
Sub-mentorship increased the number of mentees accommodated in one mentorship course. Sub-mentors regulated the flow of students and trained them in aspects that did not require the attention of a senior mentor. The age similarity between students and sub-mentors facilitated the interaction between them. It allowed them to ask questions which they may have been embarrassed to ask the senior mentor directly.
Building knowledge-based friendships allows students to share and receive different ideas and reach answers. Having someone approachable who can provide a satisfactory answer is what many medical students are looking for. Such an approach increases the chances of joint activity between them in the future, even if the mentees leave the mentorship program.
Conclusion
Sub-mentorship can be a conduit for the advancement of the classical pattern of mentorship in neurosurgery. Moreover, it may represent an avenue for capacity building in underserved areas or war-torn countries.
Conflicts of interest
None declared
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