Table 3 Lessons learned for future implementation of surgical mentorship programs in LMICs

Key intervention characteristics

To improve access to safe, high-quality surgery in low resource settings, mentorship should take a holistic approach by building technical and non-technical skills in surgical providers and strengthening the surgical ecosystem.

A multidisciplinary team approach provides a comprehensive approach to mentorship (e.g. an anesthetist mentoring an anesthetist), and also facilitates teamwork and collective learning among mentees.

An environment of psychological safety where mentees can ask questions, raise concerns or admit mistakes without fear of consequences is important for learning. Mentees value relationships with mentors that are friendly, non-hierarchical, nonjudgmental and safe.

Clinical training prior to mentorship ensures standardization of evidence-based practices and provides a base of knowledge for successful implementation. Side-by-side surgical coaching at the mentee’s facility is a practical and efficient way of learning for mentees within their own context.

Innovations to increase dose such embedded mentorship, coupled facilities, and focal mentors within facilities should be explored. Blended models which combine in-person and virtual options such as tele-mentoring, WhatsApp and SMS can reinforce learning, strengthen relationships, and provide real-time support

The goals, scope, and performance targets of the mentorship intervention should be defined in conjunction with mentees, mentors, facility leaders, and regional authorities to facilitate buy-in and a common understanding.

Mentorship must be a managed process for success.

The design and implementation of the intervention should be guided by regular feedback from mentees and mentors. Feedback can be used to inform training and skills strengthening for mentors, to refine implementation, or to adapt the intervention, and can be obtained through mechanisms such as debriefing at the end of the mentorship visit, joint learning sessions, or surveys.

Data is necessary in understanding achievements and challenges. A monitoring and evaluation plan with key performance indicators related to inputs, provider behaviors, and patient outcomes should be identified, targets should be set, and reports should be shared.

A model of surgical mentorship can be developed at a small number of sites and then scaled up.

Supportive organizational Context

A situation analysis helps to understand inner context, priorities for strengthening surgical services, leadership support, and readiness for change. It can help to identify priorities and barriers to implementation and tailor the intervention for success.

Leaders who are engaged in the mentorship intervention can communicate objectives, align incentives, remove barriers, address resistance, and promote collective learning through data use, simulations, or debriefings.

Regional authorities should participate in trainings and experience sharing forums to understand the challenges faced by surgical teams and facilitate solutions.

Improving access to safe, high-quality surgical care requires adequate resources. Resources to must be available to ensure the success of the mentorship intervention.

Mentors require resources for capacity building, compensation, back up to allow time away from regular responsibilities, logistical support, guidelines, and recognition.

Sustainability of the mentorship program requires policy support, alignment with national strategy, integration within the health system, and development of a culture of mentorship.

Mentorship requires the collaboration, engagement, and support from key stakeholders such as government, professional societies, academic medical institutions, and senior surgical professionals. These key stakeholders can provide essential technical and professional support to the mentorship process, promote mentorship as an approach, and mobilize professionals and resources.