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Strengthening Mentoring in Low- and Middle-Income Countries to Advance Global Health Research: An Overview


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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.
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Am. J. Trop. Med. Hyg., 00(00), 2018, pp. 16
Copyright © 2018 by The American Society of Tropical Medicine and Hygiene
Strengthening Mentoring in Low- and Middle-Income Countries to Advance Global Health
Research: An Overview
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,
and Elizabeth A. Bukusi
Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano
Heredia, Lima, Peru;
University of California Global Health Institute, San Francisco, California;
St. Johns Research Institute, Bangalore, India;
Centre for Health Policy and Research Chair, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa;
Epidemiology, Sexually-Transmitted Infections and Human Immunodeciency Virus Unit, School of Public Health and Administration,
Universidad Peruana Cayetano Heredia, Lima, Peru;
Departments of Neurology, Global Health, Epidemiology and Medicine (Infectious Diseases),
University of Washington, Seattle, Washington;
Department of Global Health, Boston University School of Public Health, Boston, Massachusetts;
Vanderbilt Institute for Global Health, Nashville, Tennessee;
University of North Carolina, Chapel Hill, North Carolina;
Department of
Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut;
Instituto Gonçalo Moniz, Fundação Oswaldo Cruz,
Salvador, Brazil;
Research Care Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
Abstract. Mentoring is a proven path to scientic 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 ve Mentoring-the-Mentor workshops in Africa, South America, and Asia, which aimed at
strengthening the capacity for evidence-based, LMIC-specic 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 back-
ground, and presenting key ndings, conclusions, and recommendations.
Mentorship is the professional relationship by which the
mentor, an experienced and highly regarded, emphatic per-
son,guides a more junior colleague, the mentee, in developing
and reassessing his/her ideas, learning and development,
substantially furthershis/her personal and professional growth.
Mentorship is recognized as a deeply rooted tradition in ac-
and a proven path to the development of future
generations of scientists. Historically, investing in the suc-
cess 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 unofcially, with occa-
sional reports of conicts of interest and negative out-
Mentorship frameworks, tools, and programs have
only emerged in the last decades.
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.
The global health revolution has accelerated the spread of
mentoring cultures and practices in LMIC through the result-
ing exchange of academic models with high-income countries
and the increasing number of LMIC students receiving ad-
vanced degrees in high-income country institutions. This has
generated a growing interest from LMIC scientists to learn and
introduce mentoring practices into their careers, universities,
and research centers.
However, formal mentoring remains an
infrequent and largely unsupported practice in LMIC institutions
conducting global health research
and perhaps this has his-
torically inhibited the growth of their scientists and research
(Table 1). Many LMIC institutions do not yet have a strong tra-
dition of mentoring,
mentoring programs are very uncommon,
very few LMIC scientists have received mentorship training, and
institutions lack the resources and capacities needed to in-
stitutionalize mentoring programs and processes.
existing evidence, best practices, and norms for successful
mentoring are not t to LMICs but instead are highly biased
toward the environments and resources of high-income coun-
where opportunities abound and a diverse array of pro-
fessionals with different backgrounds are trained, prepared,
supported, and often rewarded to serve as mentors. This is a
challenge for the implementation in LMIC settings: in a study in
South Africa, many researchers reported mentoring increased
their workload and was nancially unrewarding.
to support themselves and their research are scarce and ex-
tremely competitive, and support to invest time in mentoring
is often nonexistent. Having time for mentoring in LMICs is
often viewed as a luxury, and therefore, the development of
mentoring capacities should be coupled by institutional
commitment to the implementation of mentoring programs
and recognition of the critical contribution of mentoring ac-
tivities. In summary, the adoption of mentoring practices in
troduction but instead a complex implementation science
issue requiring adaptation of existing approaches into dif-
ferent academic settings
(Table 1), until the needed
structural change takes place.
In LMICs, roles such as tutoring, supervisorshipand
thesis advisingare often operative,
and very frequently
are erroneously considered and referred to as mentoring.
* Address correspondence to Andres G. Lescano, Emerge, Emerging
Diseases and Climate Change Research Unit, School of Public Health
and Administration, Universidad Peruana Cayetano Heredia, Lima,
Peru. E-mails: or
These authors contributed equally to this work.
However, these practices lack the foundations of mentoring,
including maintaining effective communication, aligning
mutual expectations, addressing equity and inclusion,
fostering independence, and promoting professional de-
in addition to the lack of providing career
guidance and promoting networking.Asaresult,potential
mentors and mentees are not necessarily aware of the im-
plications and benets of a mentormentee relationship
(Table 1). A small fraction of the scientic community
in LMICs, particularly younger, internationally trained
doctoral-level scientists who have been exposed to a nur-
turing mentorship culture, tend to be more aware and are
progressively introducing mentoring practices, often with
little or no institutional support. Wider uptake, expansion
and impact is further limited by the limited institutional
awareness of and recognition for the role and value of
mentorship and a reward system for mentors, as well as lack
of trained mentors. Clearly, the gaps to provide adequate
tensive, multidimensional, and go beyond currently avail-
able institutional resources.
Low- and middle-income countries and their regions share
many commonalities but also present substantial cultural
differences resulting from their individual characteristics and
their specic past colonial inuences. The oppressive histo-
ries in many countries have contributed to research and ed-
ucation structures with authoritarian approaches,
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 re-
as well as strict formality in communication and di-
alog to the point that challenging the opinions of a senior
scientist or faculty can often be considered offensive or in-
The formal addressing of peers and superiors
by their titles and ranks instead of rst 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 rep-
resent a barrier to the development of a strong mentor
mentee relationship, preventing the trust that can enable
Differences between high-income and LMICs relevant to tailor mentoring efforts
Issue High income LMIC Mentoring adaptation
Availability of mentors Extensive, some trained in
Scarce, limited mentoring
Phased implementation, train
the mentor, joint-mentoring
with high-income country
Group mentoring, progressive
mentoring and peer
Mentors primarily in mid-career
Culture Horizontal, challenging
mentors ideas is
Tends to be hierarchical,
requiring acceptance of
seniors ideas and
discouraging critical thinking
or challenging mentor
Establishes rules to allow
respectful disagreement.
Explicit support for diversity.
Promotes use of appropriate
and acceptable language
to express differences in
Relationship Friendship, long-lasting Paternalistic, dependence Promotes independence and
Institutional resources High Low Includes institutional resources
in funding proposals
Institutional support for
Limited Low or nonexistent Phased implementation via
postgraduate programs
and selected, promising
undergraduate scholars
Works with institutional
champions and interested
research groups.
Awareness and recognition of
mentoring activities
Extensive, often required for
academic promotion but
seldom rewarded nancially
or with dedicated time for
mentoring activities
Limited, not usually considered
for academic promotion
Institutional recognition and
reward of mentoring as a
key academic role, with
dedicated time for
mentorship activities.
Dissemination of concept and
process of mentoring among
faculty and students,
coupled with training
Consideration of personal
value and psychosocial
Advertise benets of mentoring
and success of mentors and
LMIC = low- and middle-income country.
* Progressive mentors are only slightly ahead of the mentee regarding experience or experience, while peermentors are in similar stages,although in both scenarios thementorship relationship is
mutually benecial.
questioning or disputing of the mentors position or views.
addition, the absence of such a close link may prevent the
creation of a personal bond that frequently can make men-
torship relationships last beyond specic 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 mentees
contribution to the mentoring relationship.
The scarcity of
resources and opportunities adds to this, as the success of the
mentee can be erroneously perceived by mentors as in-
creased competition and failure. Furthermore, remnants of
colonial masterservant 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.
Approaches to punctuality, the importance of rules and
regulations, and the meaning of deadlines and commitments
often differ between LMICs and high-income countries and
could limit mentoring success. In addition, evaluations in
LMIC settings are often very strict and focus primarily
on academicperformance without consideration of pro-
fessionalism, ethics/integrity, and work-life balance; topics
that are often addressed in formal mentoring programs. An-
other practice that varies across cultures is grade ination.
Low- and middle-income country mentees often do not ben-
et from the widespread practice of grade ination that takes
place in some high-income countries,
which can result in
less enthusiastic letters of support and recommendation from
both high-income and LMIC mentors, leading to lower chan-
ces of success and discouragement to advance in academics.
All these factors can also inuence how collaboration shapes
between scientists, reduce the depth and diversity of men-
toring, and in some cases exacerbate territoriality, reducing
the chances of scientic collaboration.
Several of the issues described in these mentoring articles
are rapidly evolving and should be assessed in the specic
LMIC contexts, where mentoring will be implemented. The
age, gender, culture, beliefs, place of training, and diversity of
LMIC students, research leaders, principal investigators, and
senior scientists should also be considered. For instance, the
mean age of mentors tends to be higher and female partici-
pation more limited than in high-income countries,
larly at the highest levels of decision making. Some countries
are making important headway in this area, and research and
training support tends to prioritize younger candidates.
However, reentry opportunities for women or older scientists
with family responsibilities tend to be scarce or nonexistent,
limiting their advancement while also amplifying disparities,
reducing the mentor pool, and increasing the burden of
existing mentors.
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 in-
troduction and strengthening of mentorship in the specic
cultural, economic, and structural settings of LMICs should
have aims and approaches pragmatically compatible with
available resources and institutional support (Table 1). A pro-
gressive and phased implementation science approach will
require customization to the local institutional setting, pilot
programs, and eventually scale-up efforts once LMIC-specic
best practices and lessons learned are clear, and impact in-
dicators are well dened. Just as in high-income settings, in-
stitutional 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 ex-
periences 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 princi-
ples, 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 in-
ternational practices of mentoring should play key roles in
leading initial mentoring programs (Table 2). Efforts to train
and mentorthe mentors will be needed and represent a key
Recommendations for the strengthening of mentoring in low- and middle-income countries
Institutions Mentors (faculty/scientists) Mentees (students)
Provide a policy framework Complete formal and informal training and
commit to improving mentoring skills
Complete research integrity training and
learn how to work effectively with
Formally recognize the value/role of
mentoring in academic and research
Introduce mentoring within research
groups and graduate/professional
degree programs
Learn about mentee roles,
menteementorship experiences and
choose committed mentors
Acknowledge importance of investing in
future scientists and in research-
enabling environments
Promote values and independence
among mentees and stimulate
scientic debate and disagreement
Be willing to listen to and engage with
Promote mentorship culture and altruism,
and research integrity
Support diversity of ideas and inclusivity,
and be willing to listen and engage with
trainees without judgment
Proactively contribute to dene
expectations and goals
Acknowledge and reward the best
Promote menteesgrowth into
independence, encourage work-life
Assess progress and help to improve
the experience when expectations are
not met
Invest resources in training mentors and
compensate them for time spent
Evaluate the outcomes and impact of
mentoring efforts.
task of the global health academic community. Table 2 pre-
sents a few key recommendations for specic stakeholders in
this endeavor. Together, these elements will eventually help to
shape the identities of mentorship in LMICs.
Low- and middle-income countries can take advantage of
unique opportunities to implement mentoring programs,
such as the earlier engagement of undergraduate students
in research compared with high-income countries and the
large cohorts of LMIC researchers returning home as po-
tential mentors after degree training in international pro-
grams. An important foundation of ongoing international
research training opportunities is described in the next
section. Developments in Peru, Uganda, and Kenya are only
a few. In addition, new treatment and prevention opportu-
nities can support mentoring of young researchers, such as
the roll out of community-based HIV pre-exposure pro-
phylaxis and the emerging focus on the non-communicable
diseases epidemic, among others. These can be excellent
vehicles for building mentorship systems.
Historically, LMICs have been the focus of substantial re-
search capacity-building investments, ranging from the
Rockefeller Foundations International Clinical Epidemiology
to the U.S. National Institutes of Health Fogarty
International Centers (FIC) Global Infectious Diseases
programs, Global Health Program for Fellows and Schol-
and Medical Education Partnership Initiative.
recent efforts include the Wellcome Trusts African Institu-
tions Initiative
and Brazils Science without Borders,
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 specically 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
To help address these needs, the FIC Global Health Pro-
gram for Fellows and Scholar consortia members partnered to
offer ve regional Mentoring the Mentors in Global Health Re-
searchworkshops at LMIC institutions. Each 2-day workshop
was led by experienced faculty fromeachregionincollaboration
with senior U.S. faculty afliated with the FIC-supported con-
sortia and provided participants with the denitions, methods,
and tools to become effective mentors in LMIC settings. Work-
shops included between 19 and 37 mid- and senior-level sci-
entists primarily from universities and other global health
research institutions. The rst two workshops were conducted
back-to-back in May 2013 in Lima, Peru, for South American
training sites and in June 2013 in Mombasa, Kenya, for East
African sites. The third workshop was held in November 2014 in
Bangalore, India, for the South Asian sites and the fourth work-
shop took place in Johannesburg, South Africa, in March 2016
for southern African sites. A fth workshop was conducted for
West and Central Africa in Accra, Ghana, in May 2018. All ve
workshops received positive reviews addressing a much-
needed training gap.
Given the success of the rst four workshops, in 2017 we
held a senior-level technical advisory meeting on global health
mentoring at LMIC institutions. Leaders from the rst four
workshops, along with the principal investigators of the six FIC
Global Health Program for Fellows and Scholars consortia and
staff from FIC gathered to discuss and plan how to best
support the development, sustainability, and productivity of
strong mentorship programs in global health in LMIC institu-
tions. The goal for this American Journal of Tropical Medicine
and Hygiene (AJTMH) series of articles is to help herald in a
new era of increased mentoring in LMICs that leads to ad-
vancement of global health research and practice around the
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 institu-
tions to develop strategies, approaches, and programs to
support mentorship across institutional units, including de-
partments, schools, and colleges, and to select priority men-
toring practices for implementation supported by a strong,
LMIC-specic evidence base.
The recommendations presented in the articles follow four
principles highlighting the philosophy of this special issue.
First, LMIC scientists led content development as rst or se-
nior authors, for an intended audience of LMIC scientists and
their high-income country partners in mentoring efforts, as
well as LMIC institutions in resource-limited settings. Second,
all content was developed exclusively to guide the imple-
mentation of mentoring programs and activities in LMICs and
to address LMIC-specic gaps. Third, embracing diversity is
paramount, as culture, settings, resources, and opportunities
for mentoring differ substantially across LMICs. A one-size-
ts-all approach is neither viable nor desirable, and imple-
mentation will demand customization to each institution,
program, or group interested in advancing mentoring. Fourth,
a rigorous evidence- and best practicesbased approach to
mentoring in LMICs is critically needed, and these articles are
only the rst step in the process. Further renement of the
proposed recommendations is warranted.
This overview piece serves both as a prelude to the seven
detailed articles, describing the overall motivation and ques-
tions and issues each paper addresses, as well as an execu-
tive summary, presenting the key ndings, conclusions, and
recommendations for next steps. The seven other articles in
this special issue address specic aspects of the introduc-
tion and strengthening of mentorship practices in LMICs.
Shailendra Prasad and others
propose a conceptual
framework of mentoring tailored to LMIC settings and David
Hamer and Laetitia Rispel et al.
identify critical, technical,
and cultural competencies required for mentoring of LMIC
scientists. Monica Gandhi, Craig Cohen, and others compare
the barriers and facilitators of mentoring identied during the
LMIC mentorship workshops sponsored by the FIC Global
Health training programs that started this initiative. The
evolution of mentorship efforts after the workshops is pre-
sented via case studies by Emilia Noormahomed, Craig
Cohen et al.,
describing existing gap and mentoring needs in
various institutions in Africa, Asia, and South America. A
framework for the evaluation of mentoring programs, in-
cluding domains and metrics, is proposed by Benjamin Chi,
Tony Raj, and others,
whereas common issues related to
ethics and research integrity in LMICs are examined by
Elizabeth Bu kusi, Joseph Zunt, and ot hers
via four selected
case study scenarios. The collective knowledge of available
mentoring toolkits relevant for LMICs and related gaps is
discussed in a scoping review conducted by Bhakti Hansoti
and others.
All authors have attempted to link the contents
of each of these articles, recognizing that over time, men-
toring practice and implementation in LMICs will lead to more
cohesive and updated versions of these tools.
The advancement of global health research demands sus-
tained career development opportunities for LMIC scientists
that can only be attained via the implementation and dis-
semination of culturally compatible mentoring practices. In-
stitutional resources and local academic and cultural factors
should guide the phased implementation of tailored mentoring
activities and programs for each setting, with planned, peri-
odic 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 is-
sue will become part of the foundation of LMIC-specic
mentoring approaches around the globe.
Received July 9, 2018. Accepted for publication September 8, 2018.
Acknowledgments: The authors received support from the FIC Global
Health Program for Fellows and Scholar consortia, including the
University of California GloCal Health Fellowship (FIC D43TW009343),
the Vanderbilt-Emory-Cornell-Duke Consortium for Global Health
Fellows (D43TW009337), the UNC-Johns Hopkins-Morehouse-
Tulane Fogarty Global Health Fellowship Program (D43TW009340),
the Northern Pacic Global Health Research Fellows Consortium
(D43TW009345), the Harvard-Boston University-Northwestern
University-University of New Mexico Fogarty Global Health Training
Program (D43TW010543), and Yale-Berkeley-FIU-Stanford Global
Health Equity Scholars Program (D43TW010540). A. G. L. is supported
by the grant D43 TW007393 Peru Infectious Diseases Epidemiology
Research Training Consortium,sponsored by the Fogarty In-
ternational Center of the U.S. National Institutes of Health (NIH/FIC).
Investigator support for B. H. C. is also provided by the National In-
stitute of Allergy and Infectious Diseases (K24 AI120796). We would
like to thank the assistance of Ludwing Zeta and Martha Bravo for
providing multiple references for this manuscript.
Authorsaddresses: Andr es G. Lescano, School of Public He alth and
Administration, Universidad Peruana Cayetano Heredia, Lima, Peru,
E-mail: Craig R. Cohen, Department
of Obstetrics, Gynecology and Reproductive Services, University of
California San Francisco, San Francisco, CA, and Department of
Global Health, University of California Global Health Institute, San
Francisco, CA, E-mail: Tony Raj, St. Johns
Research Institute, Bangalore, India, E-mail:
Laetitia Rispel, Centre for Health Policy and DST/NRF Research
Chair, School of Public Health, University of the Witwatersrand,
Johannesburg, South Africa, E-mail:
Patricia J. Garcia, School of Public Health, Universidad Peruana
Cayetano Heredia, Lima, Peru, E-mail:
Joseph R. Zunt, Department of Global Health, University of Wash-
ington, Seattle, WA, E-mail: Davidson H.
Hamer, Center for International Health and Development, De-
partment of International Health, Boston University School of Public
Health, Boston, MA, E-mail: Douglas C. Heimburger,
Institute for Global Health, Vanderbilt University, Nashville, TN, E-mail: Benjamin H. Chi, Department of
Obstetrics and Gynecology, University of North Carolina, Chapel Hill,
NC, E-mail: Albert I. Ko, Department of
Epidemiology of Microbial Diseases,Yale School of Public Health, New
Haven, CT, E-mail: Elizabeth A. Bukusi, Research
Care Training Program, Center for Microbiology Research, Kenya
MedicalResearch Institute,Nairobi, Kenya,
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... However, most of the available resources for research mentorship are tailored for high-income countries (HICs) [7]. Research institutions in HICs may have a longer tradition of supporting research mentorship and have greater institutional resources to sustain mentorship compared to LMICs [8]. ...
... Existing mentorship resources focus on the mentor-mentee relationship [8]. They often do not take into consideration the many forms of mentorship and the wider institutional factors (such as existing resources, cultural norms) that contribute to research mentorship [8]. ...
... Existing mentorship resources focus on the mentor-mentee relationship [8]. They often do not take into consideration the many forms of mentorship and the wider institutional factors (such as existing resources, cultural norms) that contribute to research mentorship [8]. There is a need for the development of an institutional research mentorship guide for LMIC researchers [9]. ...
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Background Institutional research mentorship is a form of mentorship whereby institutions foster mentor-mentee relationships. Research mentorship improves research effectiveness and supports relationships. However, resources are needed in order to institutionalize research mentorship tailored to low- and middle- income countries (LMICs). The aim of this study was to develop a consensus document on institutionalizing research mentorship through a modified Delphi process as part of the practical guide development process. Methods This study used a two-round modified Delphi process, which is an iterative, structured approach of consensus decision making. Each participant was asked about a series of items related to research mentorship using Likert scale questions. Agreement for each item was pre-defined as ≥80% of participants rating the item as “agree” or “strongly agree.” The items that reached agreement, were then discussed during round two at an in-person conference in Ethiopia. A separate group of individuals only participated virtually. For the final consensus survey, response rates and commenting rates (participants who wrote two or more comments) were compared among conference and non-conference participants. Results The Delphi process led to the inception of three main themes in terms of developing research mentorship: leveraging existing resources, measuring and evaluating institutional mentorship, and encouraging a research mentorship life cycle. During the virtual first round, 59% (36/61) participants who were emailed completed the survey. In the second round, conference participants had a response rate of 79% (11/14) compared to non-conference participants with a response rate of 45% (21/47). Conference participants had a 100% (11/11) commenting rate whereas non-conference participants had a 38% (8/21) commenting rate. This study achieved consensus in both survey rounds for all 35 items on the consensus document. Conclusions The data suggest that an in-person conference may increase participant engagement. The consensus developed through a modified Delphi method directly informed a practical guide on institutionalizing research mentorship in LMICs.
... This has, however, not been the case in low-and-middle income countries (LMICs) (Gupta & Garza, 2020;Hansoti et al., 2019). Informal mentoring has probably always existed in all academic and research settings, but only in the past two decades has the formalization of mentorship for early career faculty in South Africa and other LMICs received scholarly and institutional attention (Dhunpath et al., 2018;Geber, 2004;Lalloo et al., 2014;Lescano et al., 2019;Sawatsky et al., 2016). Moreover, the importance of formalizing mentoring for the purposes of developing research leadership in South African healthcare sciences academics came into sharp focus during the COVID-19 pandemic (Ward, 2020). ...
... Hansoti et al. (2019) review of mentoring toolkits highlights common challenges of faculty mentorship programs for healthcare researchers and academics in LMICS where these do exist. These challenges pertain to institutional mentoring capacity, programs not being supported institutionally, and programs taking place in hierarchical and patriarchal cultural contexts that do not support mutually beneficial and reciprocal forms of mentoring (Hansoti et al., 2019;Lescano et al., 2019). ...
... Given the complexities of the current academic environment for healthcare researchers in LMICs (i.e. involving teaching, clinical supervision, postgraduate research supervision, independent research in under-resourced public health settings, and university/government leadership, and administration tasks) (Hansoti et al., 2019;Lescano et al., 2019), many of the participants praised the roles that several other people played in guiding them through their immediate and future career related tasks. In addition to the relationships that provided immediate and future career related guidance, Fellows 1 and 14 reflected on the value that the fellowship workshops (e.g. on career and mental health, grant writing skills, publication and writing skills) had on their careers and research leadership development. ...
... This imbalance in access significantly hampers their ability to benefit from the expertise and guidance of experienced mentors. 6 Language and cultural barriers Navigating language and cultural differences presents notable obstacles when it comes to establishing impactful mentorship connections. The presence of language barriers can impede the seamless exchange of knowledge and ideas between mentors and mentees, hindering effective communication. ...
... Beyond language, cultural differences can also shape mentoring preferences and outlooks, sometimes resulting in discordance in communication and mentorship approaches. 6 Resource constraints Researchers from the Global South encounter challenges in participating in mentorship programmes due to constrained resources such as funding and research infrastructure. Financial constraints may hinder their ability to travel for high-level conferences (eg, International AIDS Conference) or training programmes for networking opportunities to identify mentors. ...
... This imbalance in access significantly hampers their ability to benefit from the expertise and guidance of experienced mentors. 6 Language and cultural barriers Navigating language and cultural differences presents notable obstacles when it comes to establishing impactful mentorship connections. The presence of language barriers can impede the seamless exchange of knowledge and ideas between mentors and mentees, hindering effective communication. ...
... Beyond language, cultural differences can also shape mentoring preferences and outlooks, sometimes resulting in discordance in communication and mentorship approaches. 6 Resource constraints Researchers from the Global South encounter challenges in participating in mentorship programmes due to constrained resources such as funding and research infrastructure. Financial constraints may hinder their ability to travel for high-level conferences (eg, International AIDS Conference) or training programmes for networking opportunities to identify mentors. ...
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Mentorship in global health is a critical determinant of equitable, sustainable and inclusive improvements in health outcomes globally. Researchers from the Global South face unique global health mentorship challenges. Some of these challenges include: limited opportunities, access to mentorship opportunities, lack of a healthy mentorship culture, weak and insufficient institutional support, language barriers (non-English speakers) and colonial mentorship mindset. Healthy and respectful South–South and North–South collaborations and partnerships are needed. Indeed, ensuring ethical mentorship practices that respect and learn from cultural differences and integrate bidirectional North–South and South–North co-learning parallels are needed. A decolonised global health mentorship agenda is highly needed. Operationalising what ethical global health mentorship is, or should be, and how global health mentorship should be decolonised remain areas that deserve keen attention.
... Mentoring in High-Income Countries (HIC) is horizontal but strictly hierarchical in LMIC [31]. The absence of a mentorship guide in LMIC settings has the tendency to result in mentors taking advantage of mentees in response to culture or to social norms [32,33]. The mentorship guidance therefore provides a framework and document to initiate or improve the quality of mentorship in LMICs. ...
... Both mentees and mentors emphasized the need for a mentee to keep a record of all interactions throughout the mentoring process to ensure accountability and continuity [34]. This is relevant to assessing the positive outcomes for both the mentees and the mentors [32]. Previous studies on mentoring indicate that mentored individuals are more productive and have increased knowledge and skills. ...
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Background Implementation research (IR) is increasingly gaining popularity as the act of carrying an intention into effect. It is thus an important approach to addressing individual practices, policies, programmes and other technologies to solving public health problems. Low- and middle-income countries (LMICs) continue to experience public health problems which could be addressed using implementation research. These countries however fall behind prioritizing implementation research due to the disorganized approach used to providing knowledge about the value and scope of implementation research. This paper seeks to explain steps taken to resolve this by capacity strengthening activities through a comprehensive implementation research training and mentorship programme which was informed by needs assessment. Methods The roll-out of the comprehensive implementation research training and mentorship was done in phases, including engaging the implementation research community through TDR Global, competency building for programme officers and ethical review board/committee members, and practical guidance to develop an implementation research proposal. The Bloom taxonomy guided the training whilst the Kirkpatrick Model was used for the evaluation of the effectiveness of the capacity building. Results The findings identified critical areas of mentors and how mentorship should be structured and the most effective ways of delivering mentorship. These findings were used to develop a mentorship guide in IR. The mentorship guidance is to be used as a check-tool for mentoring participants during trainings as part of the package of resources in implementation research. It is also to be used in equipping review board members with knowledge on ethical issues in implementation research. Conclusion The approach for providing comprehensive implementation research training and mentorship for programme personnel has provided an opportunity for both potential mentors and mentees to make inputs into developing a mentorship guidance for LMICs. This guidance would help address mentorship initiation and implementation challenges in IR.
... Such mentorship involves guidance on trainees" research projects as well as support in acquiring academic positions, promotions, and recognition for professional achievements through nominations for awards and accolades (29,81,82). Although this kind of mentoring has been instituted throughout the US as a crucial aspect of research training, mentorship at academic institutions in LMICs can experience challenges, such as a limited number of qualified mentors, misunderstandings between mentors and mentees about roles and responsibilities, a lack of institutional support for mentoring, and little recognition for the value of mentorship for building research capacity (83)(84)(85). Furthermore, the effects of mentoring may not be apparent in academic outputs (81). ...
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Background Gender-based violence (GBV) and violence against children (VAC) are two prevalent and highly interconnected global health challenges, yet data and research capacities to study these forms of violence and to generate evidence-based policies and programs remain limited. To address critical shortages in research capacity in Vietnam and to establish a model for other Low- and Middle-Income Countries (LMICs), we are establishing CONVERGE—the Consortium for Violence Prevention Research, Implementation, and Leadership Training for Excellence. Methods Based on a needs assessment with partners in Vietnam, CONVERGE will provide a comprehensive research training program supporting 15 long-term, postdoctoral trainees with multi-disciplinary research training in GBV and VAC. We also will offer in-country trainings and short-courses to 40 short-term mid-career academic trainees and 60 short-term practitioner/stakeholder trainees over 5 years to build productive GBV and VAC academic, scientific, and practitioner networks. The CONVERGE training program has four components: (1) 14 h of virtual/in-person annual mentorship training to prepare research mentors and to create a pipeline of future mentors in Vietnam; (2) a one-month intensive research training for long-term postdoctoral fellows at Emory University; (3) a structured 17-month, in-country mentored research project for long-term trainees that results in a peer-reviewed manuscript and a subsequent grant submission; and, (4) week-long in-country intensive translational trainings on implementation science, advanced topics in leadership, and advanced topics in science dissemination. Opportunities for on-going virtual training and professional networking will be provided for CONVERGE trainees and mentors in Vietnam with other trainees and mentors of D43s focused on injury/violence prevention, D43s housed at Emory, and D43s with other institutions in Southeast Asia. To assess the reach, implementation, fidelity, and effectiveness of these four components, we will implement a rigorous, mixed-methods, multi-level evaluation strategy using process and outcome measures. Findings from the evaluation will be used to refine program components for future trainee and mentor cohorts and to assess long-term program impact. Discussion Led by Emory University in the US and Hanoi Medical University in Vietnam, CONVERGE represents leading institutions and experts from around the world, with a goal of providing mentorship opportunities for early-career scientists with an interest in violence prevention.
... However, the effectiveness of clinical mentoring of undergraduate nursing students remains a concern (Royal College of Nursing 2015; Schwerdtle, Morphet, and Hall 2017). According to Lescano et al. (2019), when practised, it is often informal, infrequent, and largely unsupported. Furthermore, clinical mentoring approaches differ in resources, culture, and health structures (De Abreu and Interpeler 2015). ...
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Undergraduate nursing education involves the development of safe and effective practice through theoretical and clinical experience. This requires effective relationships between the higher education institution (HEI), clinical nursing mentors (CNM), and students. CNM hold various views of their role including knowledge of pedagogy and fluency of reflection, evaluation, and assessment skills. However, other evidence claims that CNM are inadequately prepared to work with students secondary to the unclarity of role expectations, role conflict, work overload, and lack of support. The CNM is crucial to ensure that students are fit for practice and thus need to be supported throughout. The purpose of this research was to explore the CNM perceptions of support received whilst mentoring undergraduate nursing students. Eight CNM participated in this qualitative research. Data was collected using semi-structured interviews and analysed thematically using an inductive approach. This research was approved by the Malta College of Arts, Science, and Technology Research Ethics Committee. Three main themes were identified: (1.) 'Multifaceted support' addresses the meaning of support and the multiple realities of how 'support' is experienced by CNM; (2.) 'Experience as a problem solver' explains how problem solving relied on pervious mentoring experience; and (3.) 'Challenges and barriers' explore the situations that leave an impact on mentoring practice and require support. The findings of this feasibility study will serve to inform and support the main research design for a project that will lead to the establishment of a program to support clinical nurse mentors. Further implications for practice include suggestions for areas to improve such as improved communication with academic staff, regular updates, and mentor role clarification.
... To foster this goal, the National Institutes of Health and the Fogarty International Center (NIH/FIC) have supported training and development of capacity of early career researchers in low-and middle-income countries (LMICs) with the vision that such trained researchers can advance biomedical research in their countries and contribute to finding solutions to locally relevant health problems [5,6]. One of this training opportunity for career development of researchers in LMICs is the "Emerging Global Leader" award otherwise known as the K43 career development award [7]. ...
Technical Report
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This practical guide provides tools, open-access resources, and advice for research institutions, tailored for LMIC settings.
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Objective: The objective of this scoping review was to explore and synthesize the available literature on health research mentorship in low- and middle-income countries (LMICs). Introduction: Research mentorship is broadly considered a useful strategy to improve research capacities and research outputs. Existing literature and guidance on research mentorship have focused on high-income countries and assumed resource-rich environments. Despite the successful endeavors to improve health research capacity in LMICs, the strategies that work best under different circumstances are poorly understood. There is a need to map and understand the evidence on health research mentorship in the context of LMICs. Inclusion criteria: Sources that reported existing practices, barriers, and mitigation strategies related to health research mentorship in LMICs were included. Methods: We searched for published and unpublished studies and reports written in English, Spanish, or Portuguese. The search strategy was not limited by search dates and the last search was conducted on January 28, 2022. The databases searched included MEDLINE (PubMed), Embase, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis. We also searched for gray literature in a selection of websites and digital repositories. The JBI scoping review methodology was used. Results: A total of 77 studies and reports were included in the review. The majority of the papers were from Africa (n=28). Others were from Americas (n=7), South East Asia (n=4), East Mediterranean (n=2), and Western Pacific (n=2). The remaining studies were from LMICs that included at least two regional offices. Most of the mentorship projects (n=55) were initiated and funded by institutions from high-income countries. The first authors of 41 papers were primarily affiliated from LMICs. The findings were categorized under a description of research mentorship practices, barriers related to research mentorship, and suggested mitigation strategies. Deliverable-driven training using intensive hands-on mentorship and ongoing peer mentorship programs were some of the non-regular, non-institutionalized approaches used to improve research capacity for junior researchers in LMICs. None of the included papers focused on institutional components of research mentorship in LMICs. The barriers to research mentorship activities in LMICs included lack of clarity on mentorship, cultural variations, unbalanced power dynamics, socio-political influences, language barriers, lack of experienced mentors, and limited local funding. Institutionalizing research mentorship, adapting mentoring methodologies relying on local resources, and addressing and respecting diversity in mentorship programs were among the main strategies identified to effectively implement research mentorship in LMICs. Conclusions: Research mentorship initiatives and practices are limited in LMICs. Few available practices are introduced by researchers and research institutions from high-income countries and yet not institutionalized. The identified existing practices, barriers, and facilitators on health research mentorship could help the design, implementation, and evaluation of programs to institutionalize health research mentorship in LMICs.
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Following the Fogarty International Center-supported "Mentoring the Mentors" workshops in South America, Africa, and Asia, approaches and guidelines for mentorship at institutions within these low- and middle-income country (LMIC) contexts, appropriate for the respective regional resources and culture, were implemented. Through the presentation of case studies from these three geographic regions, this article illustrates the institutional mentorship infrastructure before the workshop and the identified gaps used to implement strategies to build mentorship capacity at the Universidad Peruana Cayetano Heredia (Peru), Kenya Medical Research Institute (Kenya), Saint John's Research Institute (India), and Eduardo Mondlane University (Mozambique). These case studies illustrate three findings: first, that mentorship programs in LMICs have made uneven progress, and institutions with existing programs have exhibited greater advancement to their mentoring capacity than institutions without formal programs before the workshops. Second, mentoring needs assessments help garner the support of institutional leadership and create local ownership. Third, developing a culture of mentorship that includes group mentoring activities at LMIC institutions can help overcome the shortage of trained mentors. Regardless of the stage of mentoring programs, LMIC institutions can work toward developing sustainable, culturally effective mentorship models that further the partnership of early career scientists and global health.
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Although mentoring is not a common practice in low- and middle-income countries (LMICs), there is a strong need for it. Conceptual frameworks provide the structure to design, study, and problem-solve complex phenomena. Following four workshops in South America, Asia, and Africa, and borrowing on theoretical models from higher education, this article proposes two conceptual frameworks of mentoring in LMICs. In the first model, we propose to focus the mentor-mentee relationship and interactions, and in the second, we look at mentoring activities from a mentees' perspective. Our models emphasize the importance of an ongoing dynamic between the mentor and mentee that is mutually beneficial. It also emphasizes the need for institutions to create enabling environments that encourage mentorship. We expect that these frameworks will help LMIC institutions to design new mentoring programs, clarify expectations, and analyze problems with existing mentoring programs. Our models, while being framed in the context of global health, have the potential for wider application geographically and across disciplines.
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Capacity building in low- and middle-income country (LMIC) institutions hinges on the delivery of effective mentorship. This study presents an overview of mentorship toolkits applicable to LMIC institutions identified through a scoping review. A scoping review approach was used to 1) map the extent, range, and nature of mentorship resources and tools available and 2) to identify knowledge gaps in the current literature. To identify toolkits, we collected and analyzed data provided online that met the following criteria: written in English and from organizations and individuals involved in global health mentoring. We searched electronic databases, including PubMed, Web of Science, and Google Scholar, and Google search engine. Once toolkits were identified, we extracted the available tools and mapped them to pre-identified global health competencies. Only three of the 18 identified toolkits were developed specifically for the LMIC context. Most toolkits focused on individual mentor-mentee relationships. Most focused on the domains of communication and professional development. Fewer toolkits focused on ethics, overcoming resource limitations, and fostering institutional change. No toolkits discussed strategies for group mentoring or how to adapt existing tools to a local context. There is a paucity of mentoring resources specifically designed for LMIC settings. We identified several toolkits that focus on aspects of individual mentor-mentee relationships that could be adapted to local contexts. Future work should focus on adaptation and the development of tools to support institutional change and capacity building for mentoring.
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A growing number of low- and middle-income country (LMIC) institutions have developed and implemented formal programs to support mentorship. Although the individual-level benefits of mentorship are well established, such activities can also sustainably build institutional capacity, bridge inequities in health care, and catalyze scientific advancement. To date, however, evaluation of these programs remains limited, representing an important gap in our understanding about the impact of mentoring. Without rigorous and ongoing evaluation, there may be missed opportunities for identifying best practices, iteratively improving program activities, and demonstrating the returns on investment in mentorship. In this report, we propose a framework for evaluating mentorship programs in LMIC settings where resources may be constrained. We identify six domains: 1) mentor-mentee relationship, 2) career guidance, 3) academic productivity, 4) networking, 5) wellness, and 6) organizational capacity. Within each, we describe specific metrics and how they may be considered as part of evaluation plans. We emphasize the role of measurement and evaluation at the institutional level, so that programs may enhance their mentoring capacity and optimize the management of their resources. Although we advocate for a comprehensive approach to evaluation, we recognize that-depending on stage and relative maturity-some domains may be prioritized to address short- and medium-term program goals.
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Mentoring is beneficial to mentors, mentees, and their institutions, especially in low- and middle-income countries (LMICs), that are faced with complex disease burdens, skills shortages, and resource constraints. Mentoring in global health research can be enhanced by defining key competencies, to enable the skill set required for effective mentoring, determine training needs for local research mentors, and facilitate institutional capacity building to support mentors. The latter includes advocating for resources, institutional development of mentoring guidelines, and financial and administrative support for mentoring. Nine core global health research mentoring competencies were identified: maintaining effective communication; aligning expectations with reasonable goals and objectives; assessing and providing skills and knowledge for success; addressing diversity; fostering independence; promoting professional development; promoting professional integrity and ethical conduct; overcoming resource limitations; and fostering institutional change. The competencies described in this article will assist mentors to sharpen their cognitive skills, acquire or generate new knowledge, and enhance professional and personal growth and job satisfaction. Similarly, the proposed competencies will enhance the knowledge and skills of mentees, who can continue and extend the work of their mentors, and advance knowledge for the benefit of the health of populations in LMICs.
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Addressing ethical issues through mentorship is key to encouraging scientific integrity and increasing research capacity. Across the global health arena, mentorship requires helping mentees understand and negotiate the regulatory aspects of research-which can substantially differ even between countries with similar resources. Mentorship support spans across the research framework from obtaining ethical approval and ensuring scientific integrity, to determining authorship and disseminating study results-providing multiple opportunities to model ethical behavior for mentees. The power imbalances between the global north and south in accessing funding resources produce further challenges in setting the research agenda and for ensuring equity in the dissemination of research findings. Gender further complicates the aspiration for equity; the proportion of women in high administrative or research positions remains low. This study explores four specific mentoring case scenarios commonly encountered in the global health research field in low- and middle-income institutions.
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Background Most Low and Middle-Income Countries are facing a crisis in human resources for health which compromises their ability to meet health related targets outlined by the Sustainable Development Goals. The crisis is not limited to the availability of health personnel but also the quality of care and the training and development of the workforce. To address these challenges, evidence based education strategies are urgently required. Mentorship has been found to improve health personnel performance in High-Income Countries however, little is known about its role in Low and Middle-Income Countries. To address this gap in understanding, we conducted a scoping review of the current literature. Methods CINAHL, EMBASE and OVID Medline were systematically searched along with grey literature for peer-reviewed research papers specific to the research question. A six-step scoping review framework was utilised to identify the relevant literature and summarise the pertinent findings. Results The initial search identified 592 records, and five papers, reporting on four studies, were retained for data charting and extraction. All four studies described a positive effect of mentorship on the quality of care outcomes. The results are collated according to features of the intervention including mentor training, mentor-mentee ratios, mentorship model, intervention intensity and key findings in terms of outcome measures. Conclusions This review identifies a paucity of evidence of mentorship in this context however, current evidence supports the assertion that effective mentorship contributes to the improvement of certain quality of care outcomes. The features of successful mentorship interventions are outlined and the implications are discussed in the context of existing evidence.
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Background The aim of mentorship is to build the mentees capacity, enhance their skills and improve their ability to produce desired outcomes. However, the mentoring relationship is vulnerable to a number of challenges that may undermine its effectiveness and sustainability. We aimed to explore the experiences and perceptions of student and junior faculty mentees and senior faculty mentors at the Makerere University College of Health Sciences and identify the key factors defined by mentees and mentors as necessary for a successful mentorship program. Methods A qualitative design involving focus group discussions (FGDs) and key informant interviews (KII) was used. A total of eight KII and four FGDs were conducted, audio recorded and transcribed verbatim. Open coding of the transcripts was performed, and major themes were identified through multiple readings based on thematic analysis. Results Six key themes were shared by the mentees and mentors including: 1) defining the role of the mentor; 2) desired characteristics of a mentor and a mentoring relationship, with an emphasis on mutual trust and respect; 3) overlapping roles of mentors and supervisors; 4) issues with the process for identifying mentors, including the benefits and drawbacks of the mentee selecting mentor vs. being assigned a mentor; 5) current barriers to mentoring, including lack of knowledge about current program, lack of formal structure, uncertainly about who should initiate relationship, and unclear roles and expectations and 6) recommendations for the future development of mentoring programme, including the need for a formalized programme, and training adapted to the local context. Conclusions The mentees and mentors described the role of the mentor and desired characteristics of mentors and a mentoring relationship similarly. Most concerns about mentoring occurred when current mentoring programmes and practices were not well aligned with these desired characteristics. Recommendations for future development of mentoring included greater formalization of mentoring with mentoring programmes based on shared expectations and adapted to the local context.
Background: Nursing education institutions have issued recurring, global calls for mentorship; however, evidence-based program development guidance is scarce. To date, there are no comprehensive syntheses of current mentorship models, objectives, and program components to inform mentorship program development in nursing academia. The purpose of this review is to identify published articles that (1) described models for mentoring programs for academic nurses, and (2) described the objectives and core components of these programs. Method: A systematic search of five databases (Medline, CINAHL, Embase, ERIC, and PsycINFO) was conducted to identify articles describing mentorship programs for academic nurses. Program objectives and components were extracted and narratively synthesized to identify important patterns and themes across mentorship programs. Results: A total of 34 articles describing 30 mentorship programs were identified. Mentoring models included dyad, peer, group, online, distance, learning partnerships, highly relevant, and constellation mentorship models. Key mentoring program components included: (a) having a program coordinator; (b) orientation to the program; (c) selectively matching dyads; (d) developing clear purpose and goals; (e) frequent communication between mentors and mentees; (f) faculty development workshops; (g) mentee reflective journaling; (h) facilitation of socialization and networking opportunities; and (i) administrative support. Conclusions: In synthesizing the mentorship literature in academic nursing it is apparent that mentorship models and mentorship components look different in every setting with no empirical evidence that one mentorship model is more effective than another. Given the significant resources required to support mentorship innovations, understanding the benefits and shortcomings of various mentorship components can help ensure scarce resources are invested in the most effective mentorship strategies.