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

Abstract

Introduction Mentorship functions as a stabilizing relational framework in high-demand medical education environments. This international collaborative study between the Defence Services Medical Academy (DSMA) and Avalon University School of Medicine (AUSOM) examines the “Dual-Identity Dilemma”—the structural tension between professional medical identity and institutional military role expectations. While mentorship is central to professional development, hierarchical military structures may shape its psychosocial accessibility. Methods An explanatory sequential mixed-methods design (QUAN→QUAL) was conducted. Quantitative survey data were collected from 251 DSMA cadets and 100 AUSOM students to provide a civilian international benchmark. Within DSMA, qualitative interviews (n = 8 mentors) and focus groups (n = 8 mentees) explored identified quantitative “friction points.” Descriptive statistics, ANOVA with Bonferroni correction, and effect size reporting (partial η 2 ) were applied. Results Mentorship expectations were high across both cohorts. However, DSMA cadets reported higher communication barriers (65.2%) compared with the civilian benchmark. Within DSMA, ANOVA revealed significant variation across academic years in communication barriers (p < .001, η 2 p = .092) and career guidance (p = .001, η 2 p = .084), with Year 2 showing the highest descriptive communication-barrier level. Qualitative findings identified perceived hierarchical authority gradients as barriers to psychosocial openness and suggested that mentors may function as ‘identity integrators’ by modelling ways in which clinical and military role expectations can coexist. Conclusion Institutional context may influence mentorship accessibility in dual-role educational environments. The Dual-Identity Dilemma provides a conceptual lens for interpreting how hierarchical authority relationships and competing role expectations may affect psychosocial mentoring in military medical education. Structurally responsive mentorship approaches warrant further evaluation.