title: Tensions in mentoring medical students toward self-directed and reflective learning in a longitudinal portfolio-based mentoring system - An activity theory analysis.
abstract: BACKGROUND
  In medical education, students need to acquire skills to self-direct(ed) learning (SDL), to enable their development into self-directing and reflective professionals. This study addressed the mentor perspective on how processes in the mentor-student interaction influenced development of SDL.
  
  
  METHODS
  n = 22 mentors of a graduate-entry medical school with a problem-based curriculum and longitudinal mentoring system were interviewed (n = 1 recording failed). Using activity theory (AT) as a theoretical framework, thematic analysis was applied to the interview data to identify important themes.
  
  
  RESULTS
  Four themes emerged: centered around the role of the portfolio, guiding of students' SDL in the context of assessment procedures, mentor-role boundaries and longitudinal development of skills by both the mentor and mentee. Application of AT showed that in the interactions between themes tensions or supportive factors could emerge for activities in the mentoring process.
  
  
  CONCLUSIONS
  The mentors' perspective on coaching and development of reflection and SDL of medical students yielded important insights into factors that can hinder or support students' SDL, during a longitudinal mentor-student interaction. Coaching skills of the mentor, the interaction with a portfolio and the context of a mentor community are important factors in a longitudinal mentor-student interaction that can translate to students' SDL skills.
authors.affiliation: a Department of Pathology, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands.|b School of Health Professions Education, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Heeneman
authors.affiliation: b School of Health Professions Education, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands.|c Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences , Maastricht University , Maastricht , The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: de Grave
mesh_terms: D003479:Curriculum; D006801:Humans; D007858:Learning; D008137:Longitudinal Studies; D000071252:Mentoring; D008611:Mentors; D018794:Problem-Based Learning; D013337:Students, Medical / Q000523:psychology*