**10. Modern-day challenges to traditional mentorship in postgraduate medical education**

While mentorships and mentor-mentee relationships may have been less structured in the past, they have always been crucial to most training and education. There may be specific factors in today's clinical practice which impede one's ability to mentor effectively. We have already mentioned time constraints as one barrier, and in order to preserve and improve mentorship in post graduate medical education there is a need to identify in what ways time constraints, particularly in the modern day, may be more of a barrier than before. The dawn of the electronic health record has certainly made many aspects of clinical life easier and more efficient. Still physicians may spend more time in front of computers, in cubicles and offices than out on the wards where the traditional "paper charts" would be, and hence render themselves less accessible to potential mentees. Notes used to be briefer in the past when they were hand written and more time may have been spent with students and trainees to nurture potential mentorships. Electronic health records also bring with them more "tick boxes", asynchronous tasks and time spent on "filing" [117–119] which further could tighten existing time constraints. Additionally, the shift in employment of physicians by hospitals rather than being self-employed, along with the increasing administrative burden [120], highlights the need for "protected time" for teaching physicians to help promote and facilitate mentorship [121]. Non-physician managers may be less likely to understand the value of mentorship in medical training and may be more likely to be focused on optimization of clinical and financial efficiency. Another factor to consider could be the growing number of non-physician practitioners providing care and services in hospitals in the U.S. Where a medical or surgical team decades ago would most likely only have consisted of physicians at different levels of training, seniority and status, along with medical students, modern medical teams are much more diverse. Today a medical or surgical team is more likely to consist of a mix of physicians and non-physician practitioners. Given that the attending physician and the advanced practitioner are working together permanently over years and the trainee is only "rotating" through, he or she may feel more as an outsider, potential mentors may appear less available, and the landscape in which the mentee is navigating, may, in some ways appear more complex and intimidating. Physicians may actually be spending more time and resources mentoring non-physician practitioners and entrusting them with projects simply because of continuity. There is however little research into the effect that the growing number of non-physicians employed by hospitals have on training and mentorship, and more research into this topic may be beneficial. If the necessity of the mentor-mentee relationship in medical training could be elucidated, and robust data presented regarding positive outcomes with regard to diversity, retention of female physicians in the work place, and prevention of burnout, both for mentees and mentors, non-physician managers may see the benefits of more protected time to facilitate such relationships. Hence, it could be argued, that time set aside where faculty members are protected from clinical and administrative duties, in order to mentor physicians in training, may be an emerging and growing need in today's healthcare system.
