The Dual-Identity Dilemma: A Comparative Study of Mentorship Structural Barriers in Military and Civilian Medical Education

Introduction: Mentorship is a stabilizing relational framework in high-demand medical education. This study represents an international collaborative evaluation between the Defence Services Medical Academy (DSMA) and Avalon University School of Medicine (AUSOM). We investigate the "Dual-Identity Dilemma"—the structural tension between professional medical identity and institutional military role expectations. While mentorship is critical for resilience, military hierarchical structures can create unique barriers to relational openness. Methods: An explanatory sequential mixed-methods design (QUAN→qual) was jointly led by investigators from both institutions. Quantitative survey data were collected from 251 DSMA cadets and 100 AUSOM students to provide a civilian international benchmark. Qualitative inquiry was conducted within DSMA using mentor interviews (n=8) and mentee focus groups (n=8) to explain identified "friction points". Results: Mentorship expectations were high across both cohorts. However, DSMA cadets reported significantly greater communication barriers (65.2%) compared to the AUSOM civilian benchmark. ANOVA revealed significant variation at DSMA peaking in Year 2 for communication barriers (p < .001, η2p = .092) and career guidance (p = .001, η2p= .084). Qualitative data identified hierarchical authority gradients as "psychological walls", yet mentors also functioned as "identity integrators" who demonstrated that clinical professionalism and military discipline can coexist. Conclusion: This international collaboration highlights that institutional structure fundamentally shapes mentorship accessibility. Findings suggest that dual-role environments require intentional mentorship designs—such as the Military Mentorship Adaptation Model proposed in this study—to mitigate hierarchical communication gaps and support resilient professional identity integration.