Clinical mentoring is a critical component of I-TECH's comprehensive approach to training, as it provides a bridge between didactic training and independent clinical practice. Clinical mentoring enables health care workers (HCW) to practice new skills in clinical settings with the support and guidance of a more specialized and experienced clinician. Intensive, practical training is especially important in HIV care and treatment given the diversity of illnesses associated with AIDS and the complexities of antiretroviral therapy (ART).
I-TECH defines clinical mentoring as "a sustained, collaborative relationship in which a highly experienced health care provider guides improvement in the quality of care delivered by other providers and the health care systems in which they work." Typically, the clinical mentor is an experienced clinician-trainer who provides onsite training and consultation on complex cases; supports and enhances high level problem solving, diagnostic, and decision-making skills; leads case discussions; and addresses issues of quality assurance and continuing education. These mentoring activities take place in the context of an ongoing, two-way relationship between the mentor and the clinicians working at the site. Within the resource-constrained settings in which I-TECH works, systems and resources issues inevitably intersect with clinical activities and have an impact on the clinicians' ability to provide high-quality care and treatment. As a result, most clinical mentors also work with health care facilities on systems strengthening activities to support high quality service delivery.
The I-TECH approach to mentoring includes five key components:
- Relationship building. The establishment of a trusting, receptive relationship between the mentor and mentee(s) that evolves and grows over the course of mentorship is the foundation of effective mentoring practice.
- Identifying areas for improvement. Observation and assessment of existing systems, practices, and policies leads to the identification of areas for improvement. I-TECH has developed a number of tools for use during the assessment phase. Information obtained during an assessment helps to inform the establishment of goals and objectives for the mentorship.
- Responsive coaching and modeling of best practices. Mentors must demonstrate proper techniques and model good clinical practice. Targeted activities with mentees may include demonstrating appropriate examination techniques, modeling proper infection control measures, and setting examples for establishing good rapport with patients. Setting a good example and intervening directly to improve mentee practice are equally important in mentorship.
- Advocating for environments conducive to quality patient care and provider development. This component relates to technical assistance in support of systems-level changes at a site. Mentors work with colleagues to enhance the development of clinical site infrastructure, systems, and approaches that can support the delivery of comprehensive HIV care. For example, mentors might provide technical assistance in support of improved patient flow at a facility, advocate for provision of privacy for patients during examination, or help to promote a multidisciplinary approach to HIV care at a site.
- Data collection and reporting. Mentors support the utilization and integration of patient data into clinical practice by encouraging staff to adopt documentation practices that promote effective chronic disease management. Mentors can help demonstrate the utility of data collection and reporting to mentees during mentorship. For example, data on patients who were lost-to-follow-up was collected and discussed with mentees in one I-TECH program. This led to an analysis of causes and solutions and, ultimately, a decrease in the cases lost-to-follow-up. A similar positive result occurred following an analysis of the time of initiation of ART among TB-HIV coinfected patients.
The ultimate goal of I-TECH's clinical mentoring programs is to build the skills of local clinicians to become clinical mentors themselves. Ideally, as the pool of expert HIV/ART clinicians in each country expands, a network of local HIV clinical mentors will emerge to support and train other HIV clinicians with less experience. Moreover, I-TECH clinical mentors have the advantage of drawing on the clinical expertise found in both of the universities in which it is situated as well as consultants within the network.