Introduction: Evidence of novice mentoring's successes in having senior clinicians support junior doctors and/or medical students in their clinical, academic, and research goals has spurred efforts to include mentoring in the core medical curriculum. However, lack of effective structuring threatens the viability of mentoring programs, precipitating ethical concerns about mentoring. This review aims to answer the question “what is known about mentoring structures in novice mentoring among medical students and junior doctors in medicine and surgery postings?,” which will guide the design of a consistent structure to novice mentoring. Methods: Levac (2010)'s framework was used to guide this systematic scoping review of mentoring programs in medicine and surgery published between 1 January 2000 and 31 December 2019 in PubMed, ScienceDirect, ERIC, Embase, Scopus, Mednar, and OpenGrey. A “split approach” involving concurrent independent use of a directed content analysis and thematic approach was used to analyze included articles. Results: Three thousand three hundred ninety-five abstracts were identified. There was concordance between the 3 themes and categories identified in analyzing the 71 included articles. These were the host organization, mentoring stages, and evaluations. Conclusion: The data reveal the need for balance between ensuring consistency and flexibility to meet the individual needs of stakeholders throughout the stages of the mentoring process. The Generic Mentoring Framework provides a structured approach to “balancing” flexibility and consistency in mentoring processes. The Generic Mentoring Framework is reliant upon appropriate, holistic, and longitudinal assessments of the mentoring process to guide adaptations to mentoring processes and ensure effective support and oversight of the program.

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Background: Mentoring is crucial to the growth and development of mentors, mentees, and host organisations. Yet, the process of mentoring in surgery is poorly understood and increasingly mired in ethical concerns that compromise the quality of mentorship and prevent mentors, mentees, and host organisations from maximising its full potential. A systematic scoping review was undertaken to map the ethical issues in surgical mentoring to enhance understanding, assessment, and guidance on ethical conduct. Methods: Arksey and O’Malley’s methodological framework was used to guide a systematic scoping review involving articles published between January 1, 2000 and December 31, 2018 in PubMed, Embase, Scopus, ERIC, ScienceDirect, Mednar, and OpenGrey databases. Braun and Clarke’s thematic analysis approach was adopted to compare ethical issues in surgical mentoring across different settings, mentee and mentor populations, and host organisations. Results: A total of 3849 abstracts were identified, 464 full-text articles were retrieved, and 50 articles were included. The 3 themes concerned ethical lapses at the levels of mentor or mentee, mentoring relationships, and host organisation. Conclusions: Mentoring abuse in surgery involves lapses in conduct, understanding of roles and responsibilities, poor alignment of expectations, and a lack of clear standards of practice. It is only with better structuring of mentoring processes and effective support of host organisation tasked with providing timely, longitudinal, and holistic assessment and oversight will surgical mentoring overcome prevailing ethical concerns surrounding it.

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A 41-year-old woman with dyspepsia unresponsive to proton pump inhibitors underwent an esophagogastroduodenoscopy which revealed a 5-cm necrotic ulcer surrounded by abnormal mucosa located 5 cm below the gastroesophageal junction (GEJ) (a). On entering the duodenum, a prominent papilla was seen. The gastroscope was switched to a duodenoscope, and the papilla appeared bulky, which was suspicious for tumor infiltration (b). Biopsies taken from the gastric ulcer and papilla showed similar moderately differentiated adenocarcinoma (c: left side for GEJ; right side for ampulla). Staging computed tomography scan showed a 1.3-cm nodular focus at the duodenal papilla with diffused mural thickening around the GEJ and multiple enlarged lymph node in the region. Six days later, she presented with tea-colored urine, and liver function tests showed cholestatic derangement. Endoscopic retrograde cholangiopancreatography revealed a stricture at the papilla in which a biliary stent was inserted. She was subsequently diagnosed with adenocarcinoma of the GEJ (Siewert II) with metastasis to the papilla. This is a rare case of obstructive jaundice caused by gastric metastasis to the duodenal papilla, highlighting the importance of looking out for metastatic lesions at the periampullary region when a gastric mass is noted on endoscopy. Previously reported primary sites include lung, kidney, breast, and skin cancers. (Informed consent was obtained from the patient to publish these images.

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