"We know what they're struggling with": student peer mentors' embodied perceptions of teaching in a health professional education mentorship program.

This paper reports on a study of student peer mentorship in the context of nursing education in a higher education program in Canada. The study used an embodied hermeneutic phenomenological methodology to investigate student peer mentors' perceptions of teaching during peer mentorship. The data were collected over one calendar year (2019) and involved analysis of 10 participants' interview data and their 'body maps,' produced in response to guided questions. Through the data analysis a core theme of 'commitment to mentee growth' was identified, along with seven interrelated themes: sharing responsibility for learning, moderating stress, mediating power relations, navigating unknown processes, valuing creative approaches, offering generous acceptance, and facilitating confidence. Student peer mentorship has the potential to contribute to health professions education in a number of unique ways including through embodied attunement, trusting intersubjective relations, and dialogic education. This study is innovative in its purposeful design and aim to investigate both cognitive and embodied perceptions of student peer mentors. The findings point to the promise of student peer mentorship for advancing health sciences education. Implications for peer mentorship program development in health professions education are discussed.

Introduction

Student-peer mentorship has potential for advancing the educational preparation of professional students (Andersen & Watkins, 2018). Student-peer mentors (SPMs) are students within the same program who help other students to develop professional capabilities over at least one academic term (McKenna & Williams, 2017; CNA, 2004). Researchers have raised concerns, however, that current approaches to peer mentorship are inconsistent, and that further research into lived experiences of peer mentors (Collings et al., 2015) and how best to support SPMs within post-secondary programs (Rohatinsky et al., 2017) are necessary. The embodied and relational perspectives of learning and teaching in higher education and practice also need more attention (Barnacle, 2009; DeLuca et al., 2015; Draper, 2014; Kinsella, 2015; Loftus, 2015; Marchetti et al., 2016; O’Loughlin, 2006; Perry & Medina, 2011; Wang & Zheng, 2018). Draper (2014) in particular has argued for further research into embodiment as it relates to the experiences of both clients and practitioners.

The outcomes of peer mentorship and “peer tutoring” in higher education and nursing have been described, including improved academic grades (Bryer, 2012; Joseph, 2009; Robinson & Niemer, 2010), greater sense of support and belonging (Cornelius et al., 2016; Glass & Walter, 2000; Lombardo et al., 2017), decreased anxiety (Demir et al., 2014; Kachaturoff et al., 2019), enhanced interpersonal communication abilities (Miles et al., 2014), and success in skills labs (Iwasiw & Goldenberg, 1993). Fewer studies have investigated the benefits to peer mentors, although recent studies have suggested benefits such as increased confidence (Gilmour, 2006), growth in leadership skills (Andersen & Watkins, 2018; Miles et al., 2014), enhanced interpersonal communications (Loke & Chow, 2007; Brannagan, 2013; Smith et al., 2015), improvements in critical thinking abilities (Andersen & Watkins, 2018; Loke & Chow, 2007), personal satisfaction (Blowers et al., 2003; Smith et al., 2015) and development of abilities as educators (Andersen & Watkins, 2018; Ramm et al., 2015; Rosenau et al., 2015). We found little literature on student peer mentors’ experience of teaching within peer mentorship programs, and none that addressed embodied perceptions of teaching by peer mentors in higher education.

Objectives

Our aim in this study was to contribute to knowledge about the cognitive and embodied experiences of peer mentorship by students in a health professions education context. Our research question was: What are student peer mentors’ cognitive/embodied perceptions of teaching during peer mentorship within a health professions education program?

Theoretical framework

We drew on phenomenologist Maurice Merleau-Ponty’s (2012) theories of embodiment, intersubjectivity and intercorporeality. Merleau-Ponty argued that all perceived knowledge comes about through the lived body; he wrote, “My body is the … very actuality of the phenomenon of expression…(it) is the common texture of all objects and is, at least with regard to the perceived world, the general instrument of my ‘understanding’” (2012, p. 244). He suggested that the social world is “a permanent …dimension of existence” (p. 379), and his focus on intersubjectivity highlighted the meaning-making that occurs between two people as they engage in dialogue. He proposed “In the experience of dialogue, a common ground is constituted between me and another; my thought and his form a single fabric … our perspectives slip into each other, we coexist through a single world” (Merleau-Ponty, 2012, p. 370). An aspect of intersubjectivity which may have particular relevance to health professional education is intercorporeality, or “the role of embodied interactions between the self and the other in the process of social understanding” (Tanaka, 2015, p. 455). We therefore also explored bodily perception (embodiment, intersubjectivity, intercorporeality), in advancing understanding (Harrison et al., 2019).

Methodology

We adopted an embodied hermeneutic phenomenological design, which integrates a body-hermeneutic perspective with phenomenological methodology to foreground bodily ways of knowing. Consistent with this perspective, we collected accounts of participants’ perceptions of peer mentorship. To minimise the delay between experience and recall, we encouraged the most immediate participant descriptions we could by actively encouraging embodied responses to experience (Kinsella, 2012).

Hermeneutic phenomenologists explore first-hand experiences of phenomena in ways that are interpretive, dialogic and reflexive (Crotty, 1998; Dowling, 2007; Kinsella, 2006; Kinsella & Bidinosti, 2015) and involve studying meaning and relationships in context (Gadamer, 1975; Trede & Loftus, 2010). There are also personal and historical aspects to hermeneutic processes, and in this study, nursing and the education of nurses formed an important context. The primary researcher was socialized in traditions of nursing whereas the participants (age range 19–26, mean 21.1 years) were relative newcomers and from a different generation.

The constructs of embodiment, intersubjectivity and intercorporeality, as described above, informed our research questions, the design of the interview guide, how we interacted with participants, the use of body maps as a method, the design of our analyses, our researcher reflexivity, and the use of field notes throughout the study.

The research team engaged in critical reflexivity throughout the study, (Laverty, 2003, p 28) making as explicit as possible the ways in which our pre-understandings related to the research. The primary researcher recorded a “pre-understanding” self-interview and undertook a “self-body-mapping process” to explore her taken-for-granted assumptions. All research team members engaged in ongoing dialogic reflexivity through in-depth discussions about the research as it unfolded.

Methods

The research context was a baccalaureate nursing program in a university-college collaboration in Ontario, Canada which had 128 students per site per year. The peer-mentorship program involved second-year nursing students acting as peer mentors for first-year students in the skills laboratory of a health assessment course. Faculty members, second year SPMs, and first year nursing students attended a weekly 2-h laboratory session for 12 weeks in both the fall and winter terms. Peer mentors were assigned to one of four course sections of students in the skills lab and chose 5–6 sessions with their designated group of mentees per term. At the beginning of the academic year, faculty and previous peer mentors provided a 2-h orientation session for new peer mentors; mentors learned about expectations for the role such as providing feedback to mentees, enacting role-play scenarios portraying client assessments, and coaching mentees through practice assessments. Peer mentors applied for these volunteer positions and received co-curricular credit on their transcripts for ten or more hours per term as ‘STARS’–Student Teaching Assistants, Resources and Supports. All peer mentors had been mentees in the previous year.

Ethics approval for the study was obtained from both partners in the collaborative nursing program, the university Research Ethics Board and the college Research Ethics Board, prior to commencement. Purposive sampling was used to recruit 10 peer mentors, in one health professions educational setting, to participate in interviews and body mapping. Participants were recruited ‘at arm’s length’ by a different faculty member (not familiar to the students) who discussed the study at the end of a class, and through recruitment posters posted online and in the college.

Data were collected through semi-structured interviews and body mapping sessions (Gastaldo et al., 2012; Solomon, 2002). A semi-structured interview guide was designed to elicit cognitive and embodied responses, drawing on concepts of embodiment, intersubjectivity and intercorporeality. The guide was developed through an iterative process of attending to the research questions, considering theories of embodiment, dialogue amongst the research team, pilot testing and refinement. The interview guide is included in the Appendix (see Table 3).

Table 3

Initial semi-structured interview questions for peer mentors: teaching

Question	Probe examples
1. What stands out for you regarding your experience of the peer mentorship program?	Can you give an example? Story? Tell me about a time that was especially memorable for you
2. What stands out for you regarding your experience of teaching within the peer mentorship program?	Can you give me an example? Story? Tell me about a time when you saw a mentee growing in their learning What is your experience of being in the teaching role?
3. What stands out for you regarding your experience of being a mentor to other students within the peer mentorship program?	What is your experience of becoming prepared to be a mentor? What meanings do you associate with the idea of “mentorship?”
4. Can you think of any experiences related to the body that stand out in peer mentorship?	Your (or your mentee’s) embodied perceptions or responses (e.g., chill up the spine? sinking in the gut?) Awareness of your or your mentee’s bodies in space or in relation? Senses such as smell, sounds, sights or tactile feeling? Nonverbal forms of communication
5. If you were trying to help someone else to understand the experience of participating in the peer mentorship program, what would you say to them?	Are there any adjectives that come to mind?
6. Is there anything else you would like to add?	Anything else about peer mentorship that we didn’t discuss, and you’d like to add?

Body mapping has been used as a research method in many different contexts (McCorquodale & DeLuca, 2020; Orchard, 2017; Solomon, 2002), and it elicits embodied forms of knowledge (Harrison, in press; de Jager et al., 2016) through drawing guided visual representations of bodily responses that foreground the role of the body in creating meaning (Gastaldo et al., 2012, 2018). Participants were asked, to “On a large piece of paper, trace your body in a position that says something about your experience as peer mentor,” “Visualize the points on your body that give you power as a peer mentor and create personal symbols to represent them on the body map” and “Create a symbol to explain to others what being a peer mentor means to you.” Participants also wrote a story, or ‘testimonio,’ about their body-mapping process that included a description of their symbols and drawings.

Data analysis

The interview and body-map ‘testimonio’ data were analyzed using a hermeneutic phenomenological method (Wright-St. Clair, 2015). In the first phase of data analysis, primary researcher HH undertook in-depth reading(s) and iteratively developed a “mind map” of major emergent themes for each transcript and ‘testimonio.’ Analysis was anchored by the question “What meanings and embodied understandings are revealed about teaching within peer mentorship through interviews and body-mapping testimonios?” Participants interested in analysis were invited to participate in the same mind-mapping process for their own interview transcript, with four of the ten participants analyzing their data. Co-authors EAK, SD and SL also engaged in this process of mind-mapping interview transcripts to cross check for trustworthiness and consistency.

Comparisons were then made of the themes drawn out in the mind maps for each participant. Areas of convergence and divergence were noted and colour coded, and the transcripts were read a second time and highlighted in the 5–6 colours of the major emergent themes. Rich examples of each of the themes were identified by each person analyzing the data and were compared during iterative dialogue between team members. Interview data was also sorted and analyzed using the program “Quirkos©” [https://www.quirkos.com] by creating “Quirks” for each theme.

Once each transcript had been analyzed, dominant themes across transcripts and ‘testimonios’ were identified. This involved ongoing iterative research team dialogue, mind mapping of thematic representations of the data, and collation of ‘Quirks.’

Findings

Through the data analysis, a core theme of ‘commitment to mentee growth’ was identified, which we illustrated through seven interrelated themes: 1) sharing responsibility for learning, 2) moderating stress, 3) mediating power relations, 4) navigating unknown processes, 5) valuing creative approaches, 6) offering generous acceptance, and 7) facilitating confidence. (See Fig. 1). Figure 2 presents four examples of body maps arising from the study, and Table 1, presents symbols from these body maps and accompanying quotes from the ‘testimonios’ as exemplars; Table 2 shows relations among study concepts, study design and findings.

Fig. 1

Themes identified in the study

Fig. 2

Body map examples from the study

Table 1

Exemplars of body map symbols and testimonio excerpts by theme

Theme	Body map image	Description of image by participant
Sharing responsibility for learning		Carlos portrayed shared responsibility for learning through the image of a tree: I have a tree there and it’s being supplied by rain, the sun, fertilizer, raw soil base. And each component, any one of these can be a teacher or a peer mentor or a student, and together they’re making this tree grow. And that tree is our knowledge base, so the knowledge base in myself as a peer mentor and a teacher, or as a student, and altogether we’re helping to foster growth and knowledge
Moderating stress		Courtney drew a person meditating and a picture of the sun on her body map. In describing the symbols as representing her capacity to exude calm, as in meditation, in the midst of chaos she stated: I feel like I handle things very well. So, lots of things flying at you from every other angle and you still can remain calm and collected…I try and be just warm towards others and it’s something you're drawn towards
Mediating power relations		Courtney’s description of the ‘power pose’ she chose for her body-map highlights her connection to her position of power and strength as a mentor, and her desire to use this power ‘gently’ to help and teach and empower mentees. As a peer mentor, you feel powerful in a role where you're able to help and teach and…you give power to others through your help…[I] chose the purple outline because…it's a really strong looking colour without being harsh…for my hands, I chose a softer colour because I believe that even though we are strong, [we] have gentle hands in the way we work…we are still strong but gentle
Navigating unknown processes		On her body map, Alyssa created two separate symbols that she described this way: This is kind of the pathway that, as a peer mentor, you’re helping your mentees take. So…books and…you’re going to graduate, and then you’re (going) into healthcare…you’re going to continue on your path, which is kind of unknown in nursing because you can go in so many different directions The torch here …guides the way with its warmth. It represents the warmth of peer mentors and with its light it’s guiding the pathway through the darkness for mentees
Valuing creative approaches		Lin’s body map included her “image of self as a professional nurse in the future” with many people in the circle of collaboration. She explained: Compared to what I used to think about nursing (before the peer mentorship program), my view is more diverse, my picture shows…a lot of people…to show the collaboration… I really like the collaboration aspect of nursing, how I get to work with different professionals and people
Offering generous acceptance		Alyssa’s symbol of a heart as one of her “powerful points” on her body map was consistent with her descriptions of her efforts to provide a supportive, trustworthy presence for mentees. Surrounding that heart you see my power symbols [similar to a prism] because (my heart) represents power of mentors to me…Being a nursing-student-peer mentor requires…compassion, and positivity…[being] prepared to assist and teach your mentees…You must be…trustworthy, and supportive within your role
Facilitating confidence		Carlos: And I put the treasure chest [symbol] on my throat, because as a peer mentor I believe that my voice has a great potential to teach the Year 1 students to advocate on their behalf…I chose the [treasure] chest because typically as a nursing student or as a nurse, you won’t want to speak out as much or you might be shy, and the [treasure] chest represents someone’s untapped potential. That if you actually do open up, you do talk, you can really cause an impact
Facilitating confidence		Alyssa described her slogan: If you believe, then you will achieve.” So, that’s kind of believing in yourself, and really believing in your lab skills, really believing in yourself as a peer mentor as well so that the mentees believing that they can do it and the [mentors] believing that the mentees can do it, getting them…on the pathway to graduate

Table 2

Relations among embodied theoretical perspectives, research design and findings

Theoretical perspective	Research design	Relation to findings
Embodiment Primacy of the body in understanding of the perceived world	Research questions that centre both cognitive and embodied perception Individual interview and body-mapping methods that center embodied knowing Interview and body mapping questions directly referring to embodied perceptions	These themes included several examples of embodied experiences: Moderating stress Mediating power relations Facilitating confidence
Theoretical Perspective	Research Design	Relation to Findings
Intersubjectivity Creation of meaning through dialogue with others	Questions directly referring to relationships within SPM role Invitation to participants to join research team to analyze own data, join as authors	These themes included many examples of intersubjective experiences: Mediating power relations Sharing responsibility for learning Navigating unknown processes Valuing creative approaches
Theoretical Perspective	Research Design	Relation to Findings
Intercorporeality Social understanding mediated through the body	Inclusion of specific interview questions about bodies in relation and embodied responses relating to the phenomenon being investigated	These themes included examples of intercorporeal gestures (interpreting bodily gestures, use of body to comfort mentees): Navigating unknown processes Facilitating confidence Offering generous acceptance Moderating stress

Sharing responsibility for learning: “definitely a team effort”

‘Sharing responsibility for learning’ was a major theme. Lin (all names are pseudonyms) recalled the expectation of sharing responsibility for mentee learning: Peer mentors indicated they took seriously the review of ‘hands-on’ learning materials and skill demonstrations or case studies. Some described re-reading the materials to prepare.

When you’re actually going into it it’s pretty intimidating. You…have to answer questions about what you learned like four months ago so I’m like oh my gosh… But…you’ll get into it as you do it more and more. You’ll understand what…you have to pay attention to.

Several participants expressed surprise at the responsibility peer mentors were afforded to make decisions about how to facilitate mentee learning. Lin remarked, “It’s not as structured as I thought it would be. I remember the first time I was like whoa, I have so much leeway to what I’m supposed to do.” While some expressed a preference for more guidance, others seemed to appreciate sharing responsibility. “[I]t wouldn’t be so formal, we would pause, and say, okay, how about you auscultate this way?” (Blair) A sense of responsibility to gauge what might work well ‘in the moment’ was also described.

Participants discussed fear of providing incorrect information or looking “stupid”. As Blair stated—it was the “first time we were [discussing] this assessment in front of a…group of people, so we were sweating.” And Carlos recalled: “definitely you get those butterfly feelings when you have to go up there in front of people.… you want to be right for the students.” Some peer mentors expressed awareness of how their actions shaped the behaviour of mentees, and the consequent responsibility.

Several participants described a sense of responsibility to go beyond what was requested, offer extra help, and see students outside of lab hours. Alyssa recounted: “If there weren’t any peer mentors, I don’t think that student would have gotten that one-on-one support …having a peer mentor there and being able to work one-on-one for an hour… benefitted that student.”

Moderating stress: “It’s going to be okay”

Moderating stress was a theme highlighted by all participants. Peer mentors described observations of bodily cues of stress. Alyssa described “facial expressions and postures” and “outbursts of crying,” while Kelly noted stress exuding from mentees: “I can literally feel the tension radiating off these first-year students.” James described how stress spread: “It’s almost contagious… you see them uptight or pacing around or anxious, it seems to surge through the room. It carries an energy between them.”

Julia discussed trying to communicate with mentees when stress responses were heightened: “they can’t really hear what you’re saying.” Julia described putting herself in the mentees’ shoes by recalling her own past experiences: “my heart is in my stomach, shaking, and my thoughts are racing and spinning around, not being able to get control of my internal state.”

Kelly described building trust, and how the relationship moderated students’ stress: Participants described stress related to the lab, other aspects of the program, or from mentees’ personal lives. Many participants shared with mentees that they had similar experiences in first year. Courtney described “I…let them know it’s okay, you’ll get through it, I’m here right now and I was in the same spot …to kind of lift some of those internal weights…because I could see it on their faces… I was just like, it’s okay.”

[practicing on] me…helped them feel less anxious …someone who they could trust…You can see their anxiety lessen a little bit, physically…you can see tension in the body by how they’re standing, how their grip is, … As I start talking to them…I can see them…slow their pace down, and their bodies loosen.

All participants helped mentees manage stress by offering reassurance. Sophie described: “…take that extra minute with them in the hallway and try to say, you know, you got this, you can do it, take a breath, it’s going to be okay.” Emma suggested that helping manage stress may be a primary SPM role: “a lot of it was first-year students being very stressed out in lab, and just needing someone to talk to who has already survived the labs”.

A few peer mentors described moving to a smaller lab space with stressed students. Sophie related “where there's no stressors of having the professors watching exactly what you're doing; they could literally just take a minute, and relax, and just say, okay, I'm really nervous, can you please help me calm down?…I felt like our role, was to…help them relax.”

Mediating power relations: “We’re the middleman”

The topic of mediating power relations frequently arose in the interviews. All participants opined that professors were at the top of the power hierarchy, while first-year students had the least power. Many participants indicated peer mentors were between the range of equal to or ‘just above’ mentees, and midway-between professors and mentees. In Carlos’ words: “Being a peer mentor is kind of like the halfway point between teacher or prof, and that of a year-one student…you get a little taste of both of their worlds.” Blair described: “(Professors) are so up here (hand above level of head). They have Masters and PhDs …I don’t …think there's a power differential between the peer mentors [and mentees]… we just…have a little bit more knowledge.” James related efforts to purposefully equalize his own power with mentees: “I think they (mentees) feel that there is some power differential. They know you (peer mentor) come with more knowledge …I try to do my best to make them feel that we are…equal…so they feel comfortable asking me other questions”.

Participants commented on grading as related to power differentials. Alyssa described: “that professor is determining their mark” while with “the peer mentor…there is a slight power differentiation but not as noticeable”. Lin proposed: “The mentors can’t mark them… if they do something…or say something embarrassing…they don’t feel there’s anything going to come back to them as opposed to talking to a teacher”.

Differences in power shaped the way students asked questions in the lab. Blair described a process to help mentees avoid fear of judgements:Blair described demonstrating that the professors were approachable.Several participants discussed not abusing the power of the peer mentor role. Kelly stated: “I know the power of my words when I’m in a mentorship position…people will listen to me.” Many participants described the power relation with professors as shifting as peer mentors. Sophie indicated “that power dynamic shortened quite a lot”. Alyssa described: “Before class starts, the peer mentors and professors always prep together, so I feel like there’s less of a power differentiation there”.

If there's ever a question or a pressing issue, they would come to us first and we would go to discuss it and we would come back and talk to them… like, oh, my teacher is not going to think I'm incompetent, I'm just going to ask the peer mentor, the peer mentor will ask the teacher, and the peer mentor will come back and explain it…. We’re the middleman.

If I knew someone was scared … I would purposefully mess up on something so that they would feel, oh, she's a human being. And then I would be like, oh, well, let’s ask the professor and see how the right way to do this is …and I think that them seeing the way we were with the professors as peer mentors, they're like, okay, the professors are approachable. We’re …the mediators.

Navigating unknown processes: “the little tips and tricks I learned”

All participants described assisting mentees to navigate unfamiliar processes. Alyssa highlighted “Students don’t necessarily come from a health-profession background …so everything is really new.” Participants mentioned the extensive readings and preparation required for labs and courses. Peer mentors described helping mentees to focus. Carlos relayed his approach: “You don’t have to worry about this part …this reading might not be as important, just keep that until you have extra time.”

Many aspects of clinical skills were unfamiliar to mentees. Several peer mentors recounted assisting mentees to navigate the process of interviewing. Lin recalls:Emma noticed that mentees need guidance “to not sound …intrusive or rude…[and] instead of going straight to, I’m going to do your vital signs, making them [patients] feel comfortable”.

When…interviewing, they were all really nervous...they’d ask a question and look at me and I’m like, keep going, and then I’d guide them …they were asking really specific questions and sometimes missing the most important questions… a lot of the first-years struggle with priority.

Peer mentors related that mentees frequently needed guidance and reassurance with assessments involving clients’ bodies. James stated, “finding the brachial pulse was always a struggle.” He responded by “stepping in and …just reassuring them about the process and giving them some tips.” Kelly described helping students with “little tips and tricks that I personally learned myself,” and understanding “what they’re struggling with because I was just there.”

Participants related efforts to assist mentees to understand the ‘whys’ of practice. Courtney stated: “One student was having a lot of trouble understanding a neurological record … he’s like, … but I don’t really know why we would ask that. …I was able to talk out some scenarios or reasons why you would ask the person a certain question.” Blair and Sophie discussed that knowledge may become ‘second nature’ to professors, such that demonstrations may not be clear. Blair described a strategy to assist mentees: “we would write out an assessment and how we would do it, so, step one, we do this, step two, we…everything that we could possibly answer was written down.” Julia wanted students to know “if you don’t do everything perfectly, that’s going to be okay. It is just a stepping-stone” to learning.

Valuing creative approaches: “Everyone has their own style”

Valuing creative approaches was another theme identified. Peer mentors described engaging in creative dialogue to augment what mentees learned from the textbook or lectures. Kelly voiced:Participants described encouraging mentees to find their styles. Sophie recalled, “We told them (mentees) there are different ways of doing things; I might do something that…the next person might do differently. In emphasizing the creative nature of interactions between peer mentors and mentees, Courtney stated: “It’s good to have opinions on how different people approach different assessments …because everyone has their own style…there’s not necessarily a right or wrong way, as long as you are checking off all those points of what needs to be asked.”

There are so many little tips and tricks…in any aspect of practice, that you don’t get to learn just from a textbook [or] …lecture. It’s these tips…that your peer mentors usually teach you because they’ve been in your shoes quite recently…I hear…I learned this from a peer mentor, and if it wasn’t for that person, I would not have known.

Carlos noticed advantages to peer mentors observing mentees’ because it “brings out all the knowledge that they would have used in front of an actual patient…in front of a…teacher, they only follow what’s on the list or what’s on the PowerPoint …use your own knowledge, just do what you think is best, and go in whatever order works for you.”

Some participants related that teachers portray ‘one correct way’. Courtney expressed that the teachers, “just…tell them all the same thing according to what they’re going to look for when they’re being marked.” In contrast, Carlos voiced his appreciation of creative dialogue: “Doing those demonstrations in front of peers is a great way for the professors to add in a couple other things as well, so that also adds to my knowledge…to the year-one students’ (knowledge) as well, so that’s good feedback.”

Several peer mentors mentioned how they benefitted from these interactions. Courtney described: “I was being the patient for the student… The way that she asked her questions, I felt was really great and I never thought about asking it that way…that was kind of like, aha! I’m going to use that now.” When asked how he might portray peer mentorship, Carlos described “sitting around the table…having conversations, having a good time, and just talking about…ideas…their opinions and your opinions. We all come together, and we all produce knowledge.”

Offering generous acceptance: “you have to develop the trust first”

Another theme was ‘offering generous acceptance’. Most participants recounted generous efforts to help mentees feel accepted. James expressed, “I’d never want them to feel overwhelmed around me or nervous …I want to be as approachable as possible… I would just try to make them feel comfortable… it’s okay, you’re not going to know everything.” Mentors described aspects of the social environment that may facilitate accepting attitudes. Lin noted a relaxed social environment: “I found everything to be a lot more casual and people were asking …silly questions, and I wouldn’t mind answering them.”

Emma suggested mentees felt comfortable asking questions because of the acceptance conveyed, “They’re able to confide in us…we’re just there to listen … [they] know that whatever they say to us is not going to be shared, especially with professors.” Emma stated, “I think that’s a big level of trust…you don’t care if you seem smart in front of the peer mentors.” Alyssa described a mentee: “I’ve developed that level of trust with a student…which was really memorable…I know that I’m able to make an impact on students through teaching while also gaining their trust and learning a little bit about them as a person.” Kelly noticed that peer mentors displayed patience, acceptance, and generosity: “I remembered how my [mentors] were in the year before. I was like, okay, how do I do that with my students, and how do I show that I’m patient, and that they can practice with me as much as they want, which I ended up doing”. Kelly related: “I remember…giving a student my arm, and I think she inflated the cuff seven times, and was super apologetic. But I was like, no, it’s fine, just keep going…you can do it. I think…she was very…thankful for that.”

Facilitating confidence: “lending a hand to help them do well”

The seventh theme was facilitating confidence. All ten participants suggested that confidence was important for students to develop. Julia described the need to recognize mentees’ vulnerability: “Students are in a vulnerable position, practicing skills for the first time and just learning to build their confidence.” She noted the importance of offering feedback that does not decrease confidence: “let them do… their assessment…and…give feedback afterwards…if I were to jump in and point something out right away, it might shake their confidence.”

Peer mentors described actively encouraging confidence, by sharing strategies for being organized through to providing constructive feedback. Alyssa advised mentees to practice assessments with family members or a stuffed animal, suggesting that “repetition is key” to building confidence. James described helping students to find “confidence in themselves to realize they can do all these things.” Kelly discussed facilitating confidence:Participants described allowing mentees to practice on their (mentors’) bodies to build confidence. Emma noted that mentees liked to practice on her “a million times” and stated that “they get to practice in a really safe space; if they mess up on you, then they mess up [shrugs].” Carlos said, “you see a lot more progress within the students when they practice on you,” and described the importance of “lending a hand to the students to help them to do…well.”

I can facilitate, or try my best to, but I think that comes with personal development that is very much dependent on the mentee. I remember the person who…during the mock practical [exam], was literally shaking…During the real practical [exam], I did notice…his confidence …improve.

Many mentors noticed improvements in mentees’ confidence after a few months of working together. Kelly noticed “exponential growth in confidence” and a change in mentees’ perspective from “anxious: oh my gosh, you’re a real person” to “cool, we get this opportunity to learn.” Blair described first-year students as “very hesitant at first” while practicing skills and noticed a gentle, shaky touch. James observed, “Some students…are already thinking ahead… Compared to when they first started, it was like, okay, oh, I need to introduce myself,’ ‘I need to do that’. Seeing them think from a more nursing perspective.”

Blair described mentors facilitating confidence by “just being able to share our insight…that really helps with your ability and confidence to approach a patient, or touch somebody.” She noted that higher level students (year-two) had benefitted: “There's still the few that are pretty nervous, fidgeting…but for the most part, you can tell they're…way more confident”.

Discussion

Our seven themes that reflect the core theme of peer mentors ‘commitment to professional and personal growth of mentees’ offer a comprehensive overview of dimensions that may be generative to peer mentor teaching. While some of these themes have been identified in other studies, this is the first study that we know of that elicits such a comprehensive picture of peer mentors’ perceptions of teaching.

Our findings are consistent with and extend previous research. For instance, our findings uncovered how peer mentors ‘shared responsibility for learning’ with students and professors (Rohatinsky et al., 2017; Smith et al., 2015; Vandal et al., 2018; Won & Choi, 2017) and expressed apprehension about misrepresenting knowledge and skills to mentees (Miles et al., 2014). Participants described ‘moderating stress’ of mentees (Brannagan et al., 2013; Bulut et al., 2010; Lombardo et al., 2017; Ramm et al., 2015; Rohatinsky et al., 2017; Vandal et al., 2018) by offering reassurance and reminding mentees that they were not alone, and that success was possible. They described ‘mediating power relations’ among mentees, mentors and faculty (Andersen & Watkins, 2018; Mills et al., 2008) by assisting students to ‘save face’ with their professors and helping mentees to build capabilities to approach professors. Peer mentors assisted mentees with ‘navigating unknown processes’ and frequently stated they understood mentees’ struggles or had recently ‘walked in their shoes’ (Lombardo et al., 2017; McKenna & Williams, 2017; Rohatinsky et al., 2017). Participants indicated that they ‘valued creative approaches’ to learning and constructing knowledge (Andersen & Watkins, 2018) by considering multiple perspectives and encouraging varying styles and approaches to client assessment. Participants related examples of ‘offering generous acceptance’ and trustworthy support to mentees (Andersen & Watkins, 2018; Bryer, 2012; Iwasiw & Goldenberg, 1993; McKenna & Williams, 2017; Miles et al., 2014; Won & Choi, 2017), and ‘facilitating confidence’ of mentees (Bryer, 2012; Hunt & Ellison, 2010; Loke & Chow, 2007).

Embodiment

Our purposeful integration of theories of embodiment into our study design, our focus on cognitive and embodied perceptions of peer mentorship, and on eliciting peer mentors’ reflexive observations of bodily comportment and gestures allowed us to show how peer mentorship activities involved intercorporeal gestures and social understanding. For example, while teaching, SPMs described assessing the gestures of the mentees in an embodied manner. Peer mentors described specific responses in their own bodies while teaching mentees (e.g., “butterflies” when they wanted “to be right for the mentees”), and they noticed responses in mentees’ bodies during times of stress (e.g., “tightness, crying”). Participants also recalled their own embodied responses to stressful experiences when they were first-year students and described drawing on those memories when assisting stressed mentees.

The use of theories of embodiment to inform the interview questions in this study helped to help bring tacit knowledge to the foreground. The depth of peer mentors’ embodied observations suggests they were well attuned to the mentees. Body maps drew attention to locations in their bodies where peer mentors felt “powerful” and to embodied emotions experienced while teaching. Many participants portrayed their voices and hearts as points of power and passion that shaped their peer mentorship activities. Specific attention to embodied attunement within student peer mentorship was not found in the literature; however, Vandal et al. (2018) identified a related theme from mentor interviews that suggested in-person, face-to-face contact was key to “foster an open dialogue and establish meaningful connections,” and was essential if later interactions were increasingly of an electronic nature (p 423).

Intersubjectivity

Merleau-Ponty’s concept of intersubjectivity was reflected in the ways that participants described developing creative approaches to client assessment through dialogue and interweaving faculty, peer mentor and mentee perspectives. Participants showed intersubjective engagement through frequent descriptions of “being in the mentees’ shoes” and expressions of personal identification with the mentee’s experience. When describing sharing “tips and tricks,” the mentors appear to relate intersubjectively to the professional, and personal contexts of peer mentees, and to tailor their tips for relevancy and meaningfulness. The intersubjectivity mentors experienced as mentees appeared to shape their interactions with their own mentees.

The cultivation of trusting intersubjective relations was a component of several of the themes, including ‘sharing responsibility for learning,’ ‘moderating stress,’ and ‘offering generous acceptance.’ Peer mentors described actively nurturing a sense of trust in several ways, for example, by helping mentees to feel comfortable and by showing that they were “one of them”. Interestingly, the cultivation of trust has not to date been a common topic of conversation in student peer mentor (SPM) relationships; searches for the word ‘trust’ in several integrative or scoping reviews of student-peer mentorship showed zero to three results each, with no significant discussion of the concept (Rohatinsky et al., 2017; Irvine et al., 2018; Secomb, 2008; Wong et al., 2016; Williams & Reddy, 2016). Studies of mentorship among new graduate health professionals, however, have supported the importance of developing trust within mentor–mentee relationships (Mills et al., 2008; Bryant et al., 2015; Wang et al., 2010). Trust was also highlighted by Lombardo et al (2017), who found that nursing student mentees considered SPMs to have “lived through similar experiences…more relatable and…a trustworthy source of information because mentors were more aware of current realities” (p. 228).

While professors are considered competent in the content areas, their positions of authority appear to engender less trust than what the peer mentors were able to achieve. Mentees may feel greater vulnerability with professors, given professors’ power to assign grades which determine students’ future progress in the program. The cultivation of trust may be related to perceptions of power differentials and hierarchical relations, with peer mentors closer in the hierarchical division of power than professors.

Our findings pointed to various ways in which peer mentors mitigated power relations; for instance, mentors anonymously brought questions to the professors to avoid perceived negative consequences for mentees from admitting to gaps in knowledge or capabilities. The mentees’ perceptions of being reliant on professors for passing grades, while being uncertain whether admitting knowledge gaps would unfavourably shape professors’ assessment, may lead to students feeling less inclined to open themselves up to the professor’s gaze by asking questions. In attempts to mediate power relations, peer mentors described purposefully assisting mentees to see that professors are approachable and that even mentors need to consult them for assistance on occasion.

Dialogic education

Freire wrote about the ‘banking method’ of education, in which students’ minds are filled with deposits of knowledge via the ‘expert’ teacher (2000, p. 72). Our participants’ descriptions pointed to an alternative approach, which seemed to align with what Freire referred to as ‘problem posing’ (Freire, 2000, p.79) where the problem-posing teacher is “no longer merely the-one-who-teaches, but one who is himself (sic) taught in dialogue with the students, who in turn while being taught also teaches. They become jointly responsible for a process in which all grow.” (2005, p. 80). This approach is consistent with our ‘sharing responsibility for learning’ and ‘creative approaches to learning’ themes.

Frank (2004) states that the moral demand of dialogue is that each person grants “equal authority to the other’s voice” (p. 44), echoed by participant Carlos’ statement that “We all come together, and we all produce knowledge.” Maintaining a collaborative approach to development and exchange of knowledge can help to equalize power relations between health care professionals and clients, and between teachers and learners (Doane & Varcoe, 2021). Content-oriented health professional education may tend towards a ‘banking’ approach, whereas a collaborative, problem-posing, dialogic approach focuses on process and moves beyond ‘one right way.’

Our SPMs described feeling empowered to facilitate learning among mentees, but our mentees showed signs of stress and fear of being judged unfavourably, especially in practical exams. While students must demonstrate competence, fear of failure could perhaps be mitigated by teaching in ways conducive to dialogic learning; this could be a catalyst to developing ‘constructed knowledge’ that may be more supportive of beginning health-professions students than a predominant focus on ‘procedural knowledge’ (Belenky et al., 1986). Peer mentors were seen as providing a space for the active construction of knowledge by learners. Through their valuing of creative approaches to learning, they opened a space for mentees to engage in dialogue about what they wanted to do and why, potentially broadening mentees’ views of what counts as knowledge.

Implications for HPE practice

Peer mentors described ways in which they worked to cultivate mentee strengths and helped mentees mitigate challenges. Stressful situations were frequently described, with moderation of stress being perceived as a major contribution of SPMs. These findings suggest that educational programs may do well to consider the contributions to student mental health that peer mentorship programs may afford. Further, in preparation of SPMs, specific education about how to support students through strengths-based practices such as those described in the findings may be warranted.

While professors may prefer the ability to observe all learning activities themselves, SPMs noted benefits of interacting with mentees away from a space in which students worried they were ‘being watched.’ Peer mentor programs in higher education may do well to include such spaces in their design.

Peer mentors described benefits and challenges of being trusted to facilitate student learning. Although anxious initially, they later appreciated the ability to adjust learning activities ‘in the moment’ depending on the needs of their mentees. These findings parallel those of Vandal et al. (2018), whose participants initially described feeling “thrown to the wind” (p. 424), but who later valued the resourcefulness nurtured by the flexibility mentors were given to develop their role. It may be fruitful for SPMs to learn about the experiences of other peer mentors and to be involved in planning learning activities. We found that, when professors solicit input from peer mentors at the beginning of the academic year, these ideas have been beneficial, such as providing ‘mock practical exams’ and clarifying roles of peer mentors.

Our participants were aware of power relations created by differing roles in this program. Explicitly addressing these relations may open up dialogue among professors, SPMs and mentees, encouraging a more ‘problem-posing’ form of education (Freire, 2000). It may also be fruitful for professors to discuss the productive role of ‘failure’ in learning professional capabilities (Fong et al., 2018; DiPiro et al., 2013) as a means to encourage different perspectives on self-perceived shortcomings of students and to reframe failure as opportunity for learning.

The outcomes of this study have implications for stakeholders interested in increasing student engagement through peer mentorship, with broad relevance to higher education in health care professions. By shedding light on current processes and approaches to peer mentorship in one professional-education context in Ontario, Canada, this research contributes novel insights into enhancing the development of pedagogical practices that aim to foreground student-peer mentors’ contributions within professional education.

Limitations

While a sample size of ten participants being interviewed multiple times is considered robust in phenomenological research (Morse, 2000), a limitation may be that all peer mentors were involved in one peer mentorship program, at one site, during one academic year. While the findings were resonant with those of similar studies, interviewing peer mentors across academic years and across educational organizations may lead to richer data and more robust findings.

Areas for further research

This research investigated peer mentorship within one nursing program. Further studies of peer mentorship in other health care professional education programs over several academic years may lead to new fruitful insights. Given the findings related to student mental health, more in-depth investigation of peer mentorship contributions to student mental health may be warranted.

Research into potential affordances of interprofessional peer mentorship could provide insights into innovative interprofessional approaches to peer mentorship. Further study of experiences of intersubjectivity, embodiment and intercorporeality among students and professors, and among students and SPs, would provide a more fulsome picture of different forms of interaction among those facilitating learning among novice students. The study of power dynamics, structural issues, and conditions and behaviours that foster trust and positive relationships in peer mentorship relationships may be an important area of future study. In this environment of increasing use of technology due to educational advances, and the COVID-19 pandemic, comparisons of face-to-face and online peer mentorship, from an embodied perspective, may lead to generative insights.

Conclusion

The purpose of this study was to investigate student peer mentors’ cognitive and embodied perceptions of teaching during peer mentorship within a health professions education program. Seven themes arising from a core theme of ‘commitment to mentee growth’ were identified: 1) ‘sharing responsibility for learning,’ 2) ‘moderating stress,’ 3) ‘mediating power relations,’ 4) ‘navigating unknown processes,’ 5) ‘valuing creative approaches,’ 6) ‘offering generous acceptance,’ and 7) ‘facilitating confidence.’ The findings open discussions about embodiment, intersubjectivity, and dialogic education within student peer mentorship. Several recommendations are offered to enhance future peer mentorship programs to advance health sciences education.