Mentoring in Hospital Settings: A Systematic Review of Guidance, Care, and Professional Development

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

Your review addresses a relevant topic by “synthesizing current evidence on senior mentoring of junior healthcare professionals”. The review covers a substantial body of literature across international contexts, and it demonstrates the potential benefits of mentoring.

Despite the relevance of the review, several methodological aspects would benefit from further clarification and refinement, as detailed in the comments above.

Introduction: The manuscript states an overall objective in the Introduction. The review question is only explicitly formulated in the Abstract and is not clearly articulated or operationalized in the main text. For a systematic review, the review question should be explicitly stated in the Introduction and/or Methods section, rather than being confined to the Abstract. There is some conceptual misalignment between the stated objective and the review question. To enhance conceptual clarity and methodological coherence, the authors are encouraged to ensure consistent alignment between the review objective, the review question, and the inclusion criteria. Given the evaluative nature of the review, it would also be beneficial to explicitly structure the review question using an appropriate framework (e.g., PICO/PICo),

The specific research gap addressed by the present review is not sufficiently explicit. In particular, the manuscript does not clearly discuss the existence of previous systematic reviews, nor does it specify how the current review differs from or extends existing syntheses? It is therefore unclear why this review is needed and what unique contribution it makes to the literature. The authors are encouraged to explicitly reference existing reviews, clarify whether a search for prior systematic reviews was conducted, and clearly articulate the specific gap that this review addresses.

In Section 2.1, the authors state that the study was designed as a “systematic literature review” and report adherence to the PRISMA 2020 guidelines. While PRISMA is an important reporting standard, it does not define the methodological type of systematic review. It is therefore unclear which methodological recommendations guided the conduct of the review. The authors could specify which established methodological framework (e.g., Joanna Briggs Institute, Cochrane Collaboration, or other) guided the conduct of the review.

In this section 2.1: does not specify whether a review protocol was developed and registered prior to conducting the review. According to PRISMA 2020 recommendations, authors should report protocol registration details or explicitly state if the review was not registered. Please clarify the status of the review protocol and provide registration information, if available.

Section 2.2:  The manuscript reports the use of a keyword-based search string combining Boolean operators across three databases. However, it is unclear whether controlled vocabulary terms were used in combination with free-text terms, and no information is provided on how the search strategy was developed, tested, or refined. Additionally, the search strategy appears to be presented only in a generic form, without database-specific adaptations. In line with PRISMA 2020 recommendations, the authors are encouraged to describe the process used to construct the search strategy and to provide the complete search strategy for at least one database, preferably as supplementary material.

Section 2.4: The manuscript states that records were exported to Microsoft Excel and that duplicates were removed; however, no details are provided regarding the tools or procedures used for duplicate identification. Please clarify whether any reference management or screening software was used, and describe how duplicates were identified and removed. Also, in line with PRISMA 2020, the authors are encouraged to specify the number of reviewers involved at each stage, clarify how discrepancies were handled across all phases.

Section 3.3 reports the results of a thematic analysis; however, the methodological approach underpinning this analysis is not described. It is unclear which analytical framework, or guidelines informed the thematic synthesis, and how themes were generated and validated.

Table 1 presents the extracted information of the included studies; however, the manuscript does not specify whether the data extraction form was developed based on established methodological recommendations or constructed ad hoc by the authors. In line with PRISMA 2020, the authors are encouraged to clarify how the data extraction items were defined, whether a standardized or piloted extraction form was used, and how consistency across reviewers was ensured.

The Discussion summarizes the findings but could be more explicit engagement with relevant theoretical literature on mentoring, professional development, and psychological well-being. 

I appreciate the authors’ efforts in conducting this review and acknowledge the relevance of the theme.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

1. The title is conceptually strong but lengthy; consider shortening while retaining “systematic review” to improve indexing and search visibility.
2. : The phrase “Between Guidance and Care” is evocative but abstract; clarify its operational meaning in healthcare mentoring contexts.
3. The definition of mentoring is appropriate, but it would benefit from a brief distinction between mentoring, supervision, and tutoring.
4. The abstract research question is clear; however, it could be framed more explicitly using a PICO or SPIDER structure.
5. Databases are listed, but search period is missing in the abstract and should be added for transparency.
6. Reporting “76 studies included” is clear, but no summary of study quality or evidence strength is provided.
7. Conclusions are balanced but slightly generic; consider stating one concrete implication for healthcare education policy.

1. The introduction would benefit from anchoring mentoring within a specific educational or psychological theory (e.g., social learning, self-determination).
2. Lines discussing mentoring as “supportive” and “developmental” overlap conceptually and could be consolidated.
3. The clinical setting is emphasized well, but differences between undergraduate, postgraduate, and early-career professionals are not clearly distinguished.
4. The introduction leans heavily on nursing and medical education; allied health professions could be more explicitly acknowledged.
5. Terms such as mentoring, mentorship, tutoring, and support are used interchangeably—definitions should be standardized early.
6. The manuscript identifies heterogeneity but does not clearly articulate what specific gap this review uniquely addresses beyond prior reviews.
7. The novelty claim should be explicitly stated at the end of the introduction.

1. The choice of a systematic review over scoping or realist review is justified but could be strengthened with explicit rationale.
2. No PROSPERO or equivalent registration is reported; authors should clarify whether a protocol was registered or explain why not.
3. PRISMA 2020 is cited, but a completed checklist is not mentioned—consider adding it as supplementary material.
4. The Boolean string is detailed; however, MeSH terms (PubMed) are not explicitly described.
5. Excluding databases such as CINAHL or PsycINFO may have limited retrieval of nursing and psychology literature.
6. The inclusion of “students” and “junior professionals” is inconsistent—population boundaries need clarification.
7. Psychological well-being is central, but secondary outcomes (e.g., retention, performance) are not pre-specified.
8. The rationale for the ≥50% hospital-based participant threshold is not sufficiently justified.
9. English/Italian restriction introduces potential bias; this should be more critically discussed.
10. Independent dual screening is appropriate; however, inter-rater reliability statistics (e.g., Cohen’s kappa) are not reported.
11. Extracted variables are limited; mentoring model type and duration should be explicitly stated.
12. Use of QuADS is appropriate; however, justification for score cut-off (≤1) lacks methodological grounding.
13. Use of AI tools is transparently reported, which is commendable; however, journal policy alignment should be confirmed.

1. The flow is clear, but reasons for exclusion at full-text stage could be more granular.
2. Minor risk of confusion between “83 eligible” and “76 included” studies—consider a brief clarification sentence.
3. Over-representation of Anglophone countries may bias conclusions and should be flagged.
4. The narrative describes heterogeneity but lacks a summarizing table by study design.
5. Gender, age, and training stage are not synthesized across studies.
6. Psychological outcomes are reported descriptively; validated scales used across studies are not summarized.

1. Thematic categories are logical, but the analytic method (e.g., inductive vs. deductive) is not specified.
2. Emotional and professional support are merged; consider separating them analytically.
3. Distinction between technical and transversal skills is useful but lacks operational definitions.
4. Mentor benefits are mentioned but not systematically analyzed as an outcome.
5. Claims of reduced burnout are made without discussing effect size or strength of evidence.
6. This concept is important but under-theorized; consider linking to psychological safety literature.
7. Organizational outcomes are introduced but not systematically evaluated.

1. Comparison with existing systematic reviews is limited; explicit contrasts would strengthen contribution.
2. Differences between regions are interesting but speculative; empirical support should be clearer.
3. Mentioned briefly but not deeply integrated into the synthesis.
4. Discussion occasionally implies causal effects despite predominantly observational evidence.
5. Power dynamics are acknowledged but mitigation strategies are not sufficiently explored.

1. Well-articulated, but methodological rigor could be quantified (e.g., proportion of high-quality studies).
2. Self-report bias is noted, but publication bias is not discussed.
3. The inability to conduct meta-analysis is justified but could be further elaborated.
4. Recommendations remain high-level; concrete implementation guidelines would improve utility.
5. Gender and discrimination are addressed but intersectionality is not explored.

1. The conclusion is coherent but restates findings rather than synthesizing forward-looking insights.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This systematic review examines mentoring in healthcare settings. The topic is timely and relevant for healthcare education. Below are suggestions to strengthen the manuscript. However, the manuscript would benefit from tighter organization, deeper synthesis, and improved presentation of findings.

 

Introduction

1. The rationale for focusing specifically on hospital settings needs clearer justification. Why exclude outpatient or community contexts? This choice significantly narrows the scope and should be better defended.
2. Consider adding a brief theoretical framework (e.g., social learning theory, developmental networks) to anchor your analysis of mentoring relationships.
3. The research question "Can support from a senior colleague positively impact junior healthcare workers?" is quite broad. Consider refining it using the PICO format for clarity.

Methods

4. Please report inter-rater reliability statistics (e.g., Cohen's kappa) for the screening and selection process. Stating that disagreements were resolved through discussion is insufficient.
5. The thematic analysis approach needs more detail. Which method was used (e.g., Braun & Clarke)? How were themes derived—inductively or deductively?
6. Line 150-153 mentions using Perplexity Pro for English editing. Consider moving this to a separate "Use of AI" statement as per journal guidelines.
7. The search string (lines 95-100) is comprehensive but please clarify if any filters (e.g., language, date) were applied directly in database searches.

Results

8. The narrative synthesis is largely descriptive. Please provide more analytical depth—for example, which mentoring models showed strongest effects? Were outcomes different across healthcare disciplines?
9. Consider presenting a summary of findings organized by outcome type (e.g., well-being, skills, satisfaction) rather than listing themes with reference numbers.
10. The geographical distribution is interesting. Please discuss whether findings differed meaningfully between regions, not just that studies originated from different countries.

 

Table 1

The table spanning 16 pages is very difficult to navigate. I strongly recommend:

11. Moving it to supplementary materials

12. Creating a condensed summary table in the main text highlighting key study characteristics

Discussion

13. The comparison with Gardner (2007) and Baillie et al. (2013) is useful, but these are older sources. Please engage with more recent systematic reviews on healthcare mentoring to position your contribution.
14. The discussion of "risk factors" (line 280-286) is insightful but brief. This deserves expansion.
15. The limitations section is honest and appropriate. Consider also acknowledging the potential impact of including only English/Italian publications.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for the careful revisions made to the manuscript. I appreciate the effort invested in addressing my comments. I have no further remarks, and I believe the manuscript is now in suitable condition for publication. 

Best regards

Author Response

Dear Reviewer, thank you very much for your constructive feedback throughout the review process and for your positive evaluation of our revised manuscript. We greatly appreciate the time and expertise you dedicated to improving the quality of our work. Your insightful comments have substantially strengthened the manuscript, and we are grateful for your thorough assessment.

Reviewer 2 Report

Comments and Suggestions for Authors

1. The topic is timely and relevant; however, the novel contribution over existing systematic reviews should be stated more explicitly in the Introduction.

2. The authors claim a multidisciplinary scope across hospital settings, but the added value compared to prior reviews (e.g., Ellis et al., Juntunen et al.) needs clearer articulation.

3. The manuscript would benefit from a clear novelty statement at the end of the Introduction.

4. The distinction between mentoring, supervision, and tutoring is theoretically sound but inconsistently applied in the search strategy.

5. Inclusion of “tutoring/tutorship” in the search string risks conceptual contamination.

6. Please clarify how studies labelled as “tutoring” were evaluated to ensure alignment with mentoring theory.

7. The use of Kram’s Mentor Role Theory, JD-R, and SDT is appropriate, but these frameworks are applied retrospectively rather than guiding synthesis.

8. Consider explicitly mapping identified themes to each theoretical framework.

9. The research question is clearly stated; however, the population definition alternates between students, trainees, and junior professionals, which may dilute focus.

10. Clarify whether undergraduate students and early-career professionals were analyzed separately or jointly.

11. The exclusive focus on hospital settings is justified, but this restriction should be reflected more consistently throughout the paper.

12. The absence of PROSPERO registration reduces transparency.

13. Please clarify whether the internal protocol was finalized prior to study selection.

14. Consider providing the internal protocol as supplementary material.

15. Exclusion of CINAHL and PsycINFO may have resulted in missing relevant nursing and psychology studies.

16. The rationale for limiting languages to English and Italian should be more critically discussed as a source of bias.

17. The search string is lengthy but appears student-centric, potentially under-representing early-career professionals.

18. Please clarify whether MeSH terms were adapted per database or uniformly applied.

19. The study selection process is clearly described; however, inter-rater reliability statistics (e.g., Cohen’s kappa) are not reported.

20. While consensus discussion is acceptable, reporting agreement metrics would strengthen methodological rigor.

21. The rationale for excluding studies with QuADS ≤1 should be elaborated quantitatively.

22. The inductive meta-aggregation approach is appropriate, but examples of data transformation from quantitative to qualitative findings would improve transparency.

23. The thematic structure is logical, though some themes partially overlap (e.g., support vs psychological well-being).

24. Consider presenting a summary table linking themes to representative studies.

25. Results are comprehensive but largely descriptive; strength of evidence across themes is not differentiated.

26. No attempt is made to compare outcomes across mentoring models (peer, group, mosaic).

27. Geographical differences are described narratively but not analytically

Author Response

Please see the attachment.

Author Response File: Author Response.pdf