Striking up a Conversation: Exploring Advising in Graduate Programs in Health Professions Education

ABSTRACT

Introduction

Advising is happening across the medical education continuum, within non-medical graduate education programs, and is central to the advancement of said learners. This suggests that advising should play a role in graduate health progressions education (HPE) programs.

Materials and Methods

To explore advising curricula among HPE programs, we conducted a website review of all published HPE programs on the Foundation for Advancement of International Medical Education and Research’s website.

Results

We recognized the lack of information published on advisory roles in graduate HPE programs. This prompted a literature review, which revealed a similar gap.

Conclusions

Advising serves to benefit a student, advisor, and program thus carrying importance and need for discussion. This article is intended to kick-start a scholarly discussion about advising within graduate HPE programs.

ISSUE

Thirty years ago, Ellis noted that “quality graduate programs have some sort of faculty mentor system in which students can obtain advice, counseling, and helpful direction in their training” (p 575).¹ Today, this advisee–advisor relationship continues to be crucial to a graduate student’s success.² Yet, there is an important gap in our discussion of advising in graduate health professions education (HPE) programs. In this article, an advisor is a faculty or staff member whose responsibility is to support a student progressing through a program. This role can go by a variety of terms including advisor, mentor, coach, supervisor, tutor, and more.

Graduate HPE programs result in health professionals seeking a graduate degree to become academic leaders and/or scholars (e.g., masters or PhDs in HPE). These programs are in the crosshairs of medical education and graduate education. When performing a preliminary search for information on advising in medical or graduate HPE, a number of results emerged.^3–6 However, there is a paucity of literature on advising in graduate HPE programs. Most HPE graduate programs advertise some form of advising on their website, but only a minority advertise a formalized and well-defined advising process. Given the importance of advising for learner’s success in HPE programs, we believe that a scholarly discussion on this absence of public information is merited.

ADVISING WITHIN THE MEDICAL EDUCATION CONTINUUM

Advising is critical to medical students’ career development. Canadian medical schools saw the potential for advising and developed a standardized, national approach to advising medical students, ‘The Future of Medical Education in Canada Postgraduate Implementation Project.’ The project lays out five essential advising elements that we believe transfer to graduate programs in HPE:

1. Structured approach to career advising

2. Information about available career options

3. Course selection

4. Program requirements

5. Social accountability.

Regarding elements 1 and 2, HPE graduate students often have additional career pathways opened as a result of their HPE degrees (e.g., assistant/associate program director, associate dean, and department chair). Consequently, they would arguably benefit from both career advising and information about career options. Elements 3 and 4 align with graduate HPE programs’ typical required and elective coursework and with any other program requirements (e.g., portfolio and/or practicum requirements). Element 5, social accountability, is “the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve” (p 1545).⁷ HPE graduate programs can serve as a proxy of social accountability as it is a form of faculty development which represents one way to meet the needs of the community their institution serves. Thus, core elements of advising medical students appear to transfer to graduate programs in HPE which makes sense given that physicians are a type of health professional.

ADVISING WITHIN NON-HEALTH PROFESSIONS GRADUATE EDUCATION

Like medical education, graduate education students, who are not pursuing HPE degrees, report benefiting from advising. For example, data from a longitudinal study demonstrated graduate students wished that they had more advising and recommended a series of methods for this to be achieved.⁸ Two specific additional recommendations were to provide more diverse teaching opportunities and exposure to more of the responsibilities they would have once faculty. One participant from this study reflected, “I have no idea what it’s like to be a faculty member. And I thought being a graduate student might give me some idea, and it doesn’t.” Students expect this personal/professional advancement and teaching experience to come from and to be encouraged by advisors.⁸

A study conducted from the perspective of experienced doctoral student advisors found they believe that they are responsible for assessing a student’s areas of weakness and strength, fostering professional growth, and helping students negotiate program requirements such as projects, doctoral committees, professional conferences, and publishing.⁹ Having an advocate, advisor, who is dedicated to your personal and professional growth, is relevant to HPE graduate students, who build their teaching skills, research abilities, and leadership responsibilities during the program.

These two studies support that advising is important to personal and professional advancement, from the perspective of both the student and the advisor. This is a notable connection as HPE students, nationally, can span the spectrum from medical students to tenured professors and deans and all may benefit from the expertise and perspectives of advisors.

HPE graduate programs typically include research as a graduation requirement. This requirement highlights research advisors’ role in the HPE field. Graduate education literature demonstrates that a research advisor aids in the development of critical thinking and research design.¹⁰ The research advisor is important to teach the student how to conduct research and to encourage them to complete their project. This research advisory role is necessary for the success of the advisee but also fulfills the social duty to further research and societal knowledge.

A survey conducted revealed that research advisors should be interested in the research topic, be available to provide feedback, help with time management, encourage independence, and identify areas of growth for the student to develop as an effective researcher.¹¹ Lee shares that how advisors fulfill these roles impacts the type of researcher their advisee becomes.¹² The importance of this research advising is illuminated in their piece, as they reflect on the increased research being conducted across all disciplines.¹² We believe that these same benefits translate to HPE graduate program advising given that these students are also asked to be researchers within many programs.

A NEEDED CONVERSATION

We know that advising is occurring in graduate HPE programs; however, there is a paucity of published literature on this topic. We believe that more research needs to be conducted in this area given that literature on advising across medical and other graduate education is abundant, also because the themes that emerge from the advising literature in these non-graduate programs in HPE fields reflect valued elements in HPE graduate programs (personal advancement, professional advancement, and research). We appreciate the value of advising in HPE graduate programs and seek to start this needed conversation for research and innovation.

EVIDENCE

We provide a foundation for this scholarly conversation with our website and literature review. Our website review was of the 158 HPE websites published on the Foundation for Advancement of International Medical Education and Research’s (FAIMER’s) website in 2022.¹³ Foundation for Advancement of International Medical Education and Research was chosen as the origin source of programs studied because of its use in another study evaluating HPE programs.¹⁴ Schools were excluded from the review for reasons such as inability to access the website using link/search engine, being a certificate only program, not having all information supplied in English, having no identifiable masters program focused on HPE, not being able to access information about Masters in HPE on the provided website or being a Veterinary college. Following the criteria in (Fig. 1) there were 110 schools at the final review. Of these 110 schools, 48 of them mentioned advising or similar terms (mentoring, coaching) in descriptions of either courses, advisory roles, mission statements, goals, and/or competencies. Programs had multiple names for advising including academic advisor, academic skills team, academic supervisor, advisor, coach, designated research mentor, faculty advisor, individual educational supervisors, mentor, online student support consultants, personal academic mentor, postgraduate research coordinator, program advisor, program supervisor, program tutor, project mentor, research supervisor, student advisor, student support team, and supervisor. To help ensure that we captured all of these roles in our search, each page of a program’s site was reviewed, in addition to a specific search for the following terms “coach, mentor, advisor, supervisor, support.” Moving forward with this article, we are using the term “advisor” to encompass the entirety of these roles, to be the individual responsible for any of the following: Assessing areas of weakness and strength, fostering professional growth, and helping students negotiate projects, doctoral committees, professional conferences, and/or publishing.

Foundation for Advancement of International Medical Education and Research’s list of all worldwide HPE programs revealed that 39 of the 110 programs mentioned having advisor roles in place. The roles of the advisor were advertised across 36 of these programs, yet few briefly explained how this advising was taking place. The data published across all 110 FAIMER’s websites reveals that research and personal and professional advancement based on advising were taking place. The programs that identified a clear role of the advisory position in research (n = 10, 9%) included responsibilities such as ensuring the student meets graduation requirements, enrolls in classes, files degree plans, picks electives, and receives mentored research/career advising/feedback/guidance/monitoring of their general progress.

Similarly, nine programs (8%) identified an advisory role-playing a part in the personal and professional advancement of the student. Only 2/9 eluded toward how this role is accomplished (Table I). We believe that the actual number of programs with ongoing advising is higher and not reflected in the data. We recognize that advising is important to the community that makes up HPE graduate programs—but we are not capable of identifying how the advising is actually taking place from the websites of these programs.

Because of this lack of information published on websites, a literature review was performed with the support of a medical librarian. Three phases of review were performed and resulted one article that met criteria for review. First, a two-tiered, review of published studies and review of other literature or gray literature was developed. This began with a search of the peer-reviewed literature across five databases (PubMed, Web of Science Core Collection, CINAHL, PsycINFO, and ERIC) using keywords that represent the topic (see Appendix A for the full detailed search).

Next, database searches became the first tier of the search, and additional tiers were identified to search the non-peer-reviewed literature (Fig. 2). Finally, the online search platforms Google Scholar and MedEdPublish were used to identify topic-relevant resources that may not be found in the peer-reviewed literature. The search terms used with these platforms were derived from the database searches.

The one paper that met criteria for full-text review was ‘Ranking of Doctoral Programs of Health Education: Methodological Revisions and Results’. This study examined variables across doctoral HPE programs to include “articles published; journal editorships; external funding of research; student activity; student/faculty ratio; mentoring and placement of doctoral students; and student support.” With the application of correlation analysis, authors were able to identify that programs with larger faculty populations were able to achieve higher rankings when these variables were considered. With which we would like to postulate, programs with larger faulty populations have more advisory support.

While the literature on successful advising practices in medical and non-HPE program graduate education programs abound, this literature and website review demonstrates a dearth of scholarly conversation around structured advising within graduate HPE programs. We believe that this conversation and improving scholarship on advising in graduate HPE programs could be beneficial to the advisee, to the advisor, and to the program leaders.

BENEFITS TO THE HPE ADVISEE

In fields where it has been formally investigated, advising helps to support student success and learning.² The advisory role thus likely improves learning outcomes and conditions for the HPE student. Many students in HPE graduate programs have full-time jobs and families; this can lead them to have limited time and capacity to internalize program requirements and course logistics.¹⁵ Additionally, distance learning is on the rise across HPE graduate programs.¹⁶ Distance learning offers flexibility, which is beneficial to learners and programs; however, it can leave students feeling disengaged and without belonging.¹⁷ This is another opportunity for an advisor, as they can provide a level of personalized support. Advisors can serve as a point of contact and streamline logistics for learners. Additionally, the advisors can serve as a crucial conduit to helping learners feel connected to the program and to ensure learners are clear on program expectations.¹⁸

BENEFITS TO THE HPE ADVISOR

After a series of semi-structured interviews, in a study at the University of Gothenburg, Sweden, authors conclude that advising in graduate education is valuable, stating “providing leadership training for supervisors could be an important measure that may help improve conditions for the doctoral students they supervise,” with recognition of the weight the supervisor carries in research and education for the student (p 1).¹⁹ The lack of scholarship on HPE advising may indicate that HPE advisors are missing out on best practices in advising. These best practices could develop the advisor professionally. Health progressions education faculty members need support and development to advise effectively. Finding the time to adequately advise while balancing other responsibilities with little guidance from the literature does not set the advisor up for success.

BENEFITS TO THE HPE PROGRAM LEADER

Health progressions education program leaders may be interested in learning about structures and training that would benefit advisors. The Middle States Commission on Higher Education accreditation policies require in Standard IV—Support of the Student Experience that the institution must facilitate the success of students, through listed methods one of which is an advising program.²⁰ Thus—if the conversation of advising in graduate education further develops, institutions can share best advising practices as well as foster success with accreditation. Of additional interest to the programs, we also believe that when a student has a positive advising experience, they are more likely to stay involved in the program.

MILITARY-SPECIFIC HPE CONSIDERATIONS

The USU offers HPE graduate programs that we believe would benefit from this work as a result of the unique challenges imposed on the military HPE program learner and advisor. Within the military system, there is often geographical relocation of individuals, duty station change, and deployment. These geographical challenges coupled with carrying additional ancillary roles and responsibilities as a military officer impact the ability of successful advising with the additional challenges of distance, time management, and learner service retention. Acknowledging these aspects of our system that can challenge the success of advising demonstrates the need for cultivating advising best practices. We believe that this could be achieved through active participation in this conversation with non-military institutions.

CONCLUSION

We know, from our own experiences and from talking to colleagues at other institutions, that advising is happening in HPE graduate programs. Literature and HPE website review provides little information about how HPE advising is actually occurring. We need more scholarly information on the topic of advising, more programs need to explicitly address this, and we need more research into which strategies are successful.

LESSONS FOR PRACTICE

1. Advising is beneficial to medical education learners, to non-health professions graduate program learner, and to the cross-sections of these groups, i.e., graduate health professions learners.

2. Showcasing how advising is taking place in your HPE graduate program can help to identify best practices in HPE advising.

3. A paucity of literature exists on advising in graduate HPE programs—the conversation needs to start.

ACKNOWLEDGMENTS

None declared.

FUNDING

None declared.

CONFLICT OF INTEREST STATEMENT

None declared.

CLINICAL TRIAL REGISTRATION

Not applicable.

INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)

Not applicable.

INSTITUTIONAL CLEARANCE

Not applicable.

INDIVIDUAL AUTHOR CONTRIBUTION STATEMENT

S.A.W., J.S., and H.M. designed this study, collected and analyzed the data, and drafted the original manuscript. H.M. and S.D. reviewed and edited the manuscript. J.C. and C.N. assisted with literature review. All authors read and approved the final manuscript.

DATA AVAILABILITY

The data that support the findings of this study are available on request from the corresponding author Dr Shelby Wilcox.

Appendix A

Tier 1: Results from five literature database searches (PubMed, Web of Science Core Collection, CINAHL, PsycINFO, and ERIC) were loaded to Covidence for screening and review. Duplicates were removed (numbers logged in Covidence; visit Preferred Reporting Items for Systematic Reviews and Meta-Analysis view for full details). n = 34 unique results to screen; n = 7 (21%) for full-text consideration. n = 1 (3%) for full-text review pending. Tier 2: Non-peer-reviewed literature searches via MedEdPublish and Google Scholar. See notes on limitations and other factors impacting how the searches are conducted. MedEdPublish procured nine results. All were reviewed and did not meet inclusion criteria. For Google Scholar, n = 331 results were populated. n = 50 titles and abstracts were randomly selected and reviewed. n = 0 met the inclusion criteria. Therefore, we decided not to include the database.

REFERENCES

Author notes