Mechanisms of Change: Qualitative Analysis of a Group Peer Mentoring Intervention for Academic Medicine Research Faculty

INTRODUCTION: Despite the recognized need for effective mentoring for faculty in academic medicine, mechanisms driving successful mentoring interventions remain underexplored. Two consecutive cohorts of 20 academic medicine mid-career research faculty from 27 US medical schools participated in a randomized controlled trial of the yearlong C-Change Mentoring & Leadership Institute intervention. Participants convened quarterly for 2- and 3-day intensive sessions in 2020 to 2022. METHODS: We examined how this complex group peer-mentoring intervention produced positive changes in the perspectives, attitudes, and practices of individual faculty participants and the group. Qualitative data included ethnographic observations, participant writings, and semi-structured interviews. We used codebook thematic analysis to characterize changes in individuals and the group, paired with a realist evaluation framework to identify essential functions and activities within the C-Change Institute. RESULTS: The mechanisms that produced change consisted of four key functions, each involving multiple forms (or activities): (1) forming group culture through participatory activities, establishing psychological safety and mutual affirmation; (2) encouraging self-reflection through introspective exercises and structured storytelling; (3) forming empathic relationships, telling life stories, and discussing experiences of difference and power; and (4) envisioning a successful future through aligning personal values and professional goals, using structured stepwise short and long-term career planning. The authors illustrate the interactions of these functions and activities. DISCUSSION: This successful mentoring experiment of learning and career development in a changed culture provides a blueprint for broader culture change in academic medicine that must honor values, encourage reflective practice, team building, and relational leadership in career development.