Implementing and evaluating Adaptive Mentorship Networks to strengthen primary care in Canada: protocol for a...

Canada's health workforce crisis is placing sustained pressure on primary care, particularly in the management of chronic pain, mental health conditions and substance use disorders. Mentoring is a compelling response to workforce, educational and well-being challenges in healthcare, and Adaptive Mentorship Networks (AMNs) have emerged in Canada as an interprofessional model to strengthen provider capacity, psychological safety and compassionate care. Despite widespread interest and demonstrable effectiveness, the determinants that influence successful implementation, spread, adaptation and sustainability of AMNs remain insufficiently understood.

This 3-year mixed-methods protocol will evaluate implementation of 11 AMNs that are established or in development across Canada. The study will focus on two complementary levels: (1) implementation of AMNs within healthcare ecosystems; and (2) capabilities, opportunities and motivations that contribute to adaptive mentorship between mentors and mentees. The overarching approach to understand the determinants of successful implementation and behavioural influences on adaptive mentorship uses implementation science and systems thinking methodologies to support a pan-Canadian Learning Health System. Work will proceed in three phases. Phase I will explore determinants of implementation (phase Ia) and behavioural influences on adaptive mentorship (phase Ib) through document review, interviews, systems mapping and readiness assessment. Phase II will use a Learning Alliance to identify, select and operationalise fit-for-purpose implementation strategies. Phase III will co-develop AMN-specific logic models and evaluate the feasibility, acceptability and initial utility of selected strategies. The study will be guided by the Active Implementation Framework, the Consolidated Framework for Implementation Research, the Consolidated Framework for Sustainability Constructs, the Capabilities, Opportunities and Motivation for Behaviour model, the Theoretical Domains Framework and the Health Equity Implementation Framework. Outputs from phase Ia will provide a compendium of determinants critical for the implementation of mentorship networks within healthcare arranged by stage of implementation, and the activities that current networks have taken to influence such determinants. Outputs from phase Ib will identify the capabilities, opportunities and motivations deemed critical for facilitating engagement in the act of clinical mentorship. Phase II will identify a contextualised understanding of strategies that are optimally suited to influence critical determinants of implementing AMNs and engaging in clinical mentorship. Our outputs from phases I and II will be pilot tested with each AMN and inform the development of site-specific logic models and a cross-site implementation blueprint that will be evaluated in phase III. This protocol advances a systems-informed approach to implementing AMNs across diverse Canadian health systems, with implications for mentorship-enabled workforce development.

Ethics approval has been obtained from the Bruyère Health Research Ethics Board (M16-25-001 and M16-25-002) and the Newfoundland and Labrador Health Research Ethics Board (Ref# 2025.047). Participants provide informed consent prior to participating in study interviews acknowledging potential risks and benefits to participation. Findings will be mobilised through integrated knowledge mobilisation with participating AMNs, members of the Learning Alliance, policy and practice partners, conference presentations, publications, AI-enabled knowledge sharing tools and plain-language resources.