Perspective Chapter: From Traditional to Digital Transformation – Literature Mapping of the Effect of Clinical Mentoring on Stress in Health Sciences Students

1.1 Research gap

A review of the existing literature on clinical mentoring and stress in health sciences education reveals a significant gap:

• Lack of Interdisciplinary Coverage: The vast majority of existing studies focus on nursing or medical education, but do not integrate other high-stress clinical branches such as dentistry, radiography, and pharmacy under the same analytical framework.

• Inability to Trace Conceptual Evolution: There is no comprehensive bibliometric study that quantitatively and visually proves the transition of mentoring from the traditional “master-apprentice” relationship to today’s “digital and well-being-oriented” structure using big data.

• Inability to Position Digital Transformation: It is not yet clear at what stage (niche or motor theme) technological trends such as “360-degree video” and “virtual mentoring” that emerged in the post-pandemic period are located in the literature.

This study aims to fill these gaps by analyzing a 51-year dataset using a multidimensional approach (VOSviewer, Biblioshiny, Python).

1.2 Research questions

This research seeks to uncover the global panorama of mentoring and stress relationships in health sciences education by addressing the following fundamental questions:

1. Q1: What is the annual growth performance and annual output volume of the clinical mentoring and stress literature from 1975 to 2026?

2. Q2: How is the interdisciplinary currency of the literature, and which branches have a high output capacity in this field?

3. Q3: Which countries and journals are most effective in the field of clinical mentoring and stress?

4. Q4: In which clusters (or clusters) are the key concepts in the literature concentrated, and how have these concepts evolved over time from a “technical focus” to a psychosocial focus?

5. AS5: What are the “motor themes” in the current literature and the “emerging/developing themes” that should be present in the future?

2.1 Clinical environment and stress dynamics in health sciences education

Clinical internships in health sciences education are critical processes where theoretical knowledge is transformed into professional identity; however, these processes simultaneously involve a high level of psychological stress [10]. Students’ first steps into the clinical environment are often described in the literature as a “reality shock”; the mismatch between the expectations of the academic world and the clinical field puts students in a vulnerable position [11]. When the sources of clinical stress are examined, the anxiety created by the first encounter with a patient, the fear of making mistakes, and assessment processes such as objective formal clinical examinations (OSCA) stand out [12]. The inability to manage this stress can not only reduce academic achievement but also lead to burnout and professional identity confusion [13].

2.2 The protective and developmental role of clinical mentoring

Clinical mentoring (preceptorship) and supervision function as the most fundamental protective shield for students in this stressful process. Mentoring is not only about transferring technical skills, but also a dynamic guidance process in which competencies such as emotional intelligence, empathy, and self-awareness are developed [14]. The support provided by an experienced professional increases students’ clinical self-efficacy while significantly reducing their anxiety levels [15]. Especially in environments with international students, “intercultural mentoring” prevents social isolation and reinforces the sense of belonging (Mikkonen et al., 2016). The restorative and formative functions of mentoring programs enable students to be more resilient in clinical decision-making processes [16].

2.3 Systemic barriers and evolving models

The success of mentoring depends not only on the relationship between mentor and student but also on systemic factors. Barriers such as excessive workload, staff shortages, and lack of institutional support can negatively affect the quality of the mentoring process, leading to burnout in both mentors and students [17, 18]. Furthermore, negative experiences such as “peer bullying” (undermining) stemming from the hierarchical structure in clinical settings damage the learning culture and increase stress levels [19]. Today, these traditional models are evolving into technology-supported guidance and digital mentoring systems. While digital transformation offers students readily accessible support at all times, cognitive load stemming from technical difficulties has begun to be discussed in the literature as a new stress factor [20].

2.4 The necessity of bibliometric analysis

Numerous systematic reviews and meta-analyses in the current literature generally focus on specific disciplines (e.g., only medicine or nursing) or specific interventions [10, 15]. However, studies that present the intellectual structure, conceptual change, and methodological development of the relationship between mentoring and stress in health sciences education on a global scale as a whole are limited. In this context, bibliometric analysis is a critical tool for visualizing massive datasets and revealing the temporal and spatial architecture of the literature at a “state-of-the-art” level [21, 22].

3.1 Research design

This study was structured using a bibliometric mapping design to analyze the intellectual structure and developmental course of the relationship between clinical mentoring and student stress in health sciences education. Bibliometric analysis is a powerful methodology that visualizes the conceptual, intellectual, and social structure of a particular scientific field through quantitative data, presenting the evolutionary dynamics of the field from a “state-of-the-art” perspective [9, 21].

3.2 Data source and search strategy

The research dataset was obtained from the Scopus database, known for its high citation coverage and quality metadata content in health sciences and education literature. The search was conducted in April 2026, without any starting year restrictions, in order to capture the historical depth of the literature. Enhanced Search Query: TITLE-ABS-KEY ((“clinical ment*” OR “preceptorship” OR “clinical supervision” OR “clinical coach*”) AND (“stress” OR “anxiety” OR “burnout” OR “psychological distress”) AND (“health science*” OR “medical student*” OR “nursing student*” OR “dentistry student*” OR “pharmacy student*”)).

3.3 Inclusion and exclusion criteria

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed in the process of refining the dataset. The following criteria were applied to obtain a homogeneous data structure:

Document Type: Only “original research articles” and “reviews” with high scientific validity and peer review were included in the analysis. Editor letters, conference proceedings, and book chapters were excluded to avoid bibliographic inconsistencies. Language Restriction: To standardize interaction in global literature networks and optimize the text mining algorithms of analysis tools (VOSviewer, Biblioshiny), only publications in English were included. Content Suitability: Publications that treat clinical mentoring only as the transfer of technical skills or that do not focus on stress/psychological outcomes were manually filtered out.

3.4 Data analysis and technical tools

A three-part software approach was adopted in the analysis and visualization of the bibliographic data obtained in the study:

R-Bibliometrix (Biblioshiny): Used to perform basic descriptive statistics (Lotka’s Law, Bradford’s Law), annual publication growth rate, and conceptual evolution (Thematic Evolution) analyses of the dataset. In particular, the transition from “traditional to digital” was traced through Sankey diagrams.

VOSviewer (v.1.6.20): Preferred to transform “knowledge clusters” in the literature into high-resolution visual maps through inter-author collaboration networks, journal citation networks, and keyword clustering (co-occurrence) analyses. Python (Pandas & Seaborn/Matplotlib): Used to clean raw data pulled from Scopus, remove duplicate records, and create customized visualizations of interdisciplinary comparative graphs (e.g., distribution of medical vs. nursing stress factors) that standard analysis tools do not offer.

4.1 Distribution of publications by discipline and thematic focus of the literature

Bibliographic data obtained from the Scopus database proves that the topic of clinical mentoring and stress in health sciences education has an interdisciplinary spread (Figure 1).

Figure 1 shows that when the distribution of publications included in the analysis is examined according to their subject areas, Nursing and Medicine are the driving forces of the literature.

4.2 Descriptive bibliometric indicators

The general bibliometric profile of studies on clinical mentoring and stress in health sciences is presented in Table 1. The dataset consists of 274 qualified documents covering a broad period of 51 years, from 1975 to 2026.

Table 1 shows that the analysis results indicate a steady annual growth rate of 5.45% in the field. The fact that a total of 995 authors are producing work in this field, with an average of 3.86 authors per document, demonstrates that the subject is managed with a multi-authored and collaborative research culture. Furthermore, the fact that 247 out of 274 documents are original research articles highlights the empirically evidence-based nature of the literature.

4.3 Annual scientific output and literature development trend

Chronological analysis of the dataset shows that academic interest in the relationship between clinical mentoring and stress has gone through three main phases over a period of half a century (Figure 2):

The first of the three phases in Figure 2 is the stagnant initial and formation phase (1975-2000): From 1975 to the early 2000s, the number of publications was quite limited (an average of <2 articles per year). Although mentoring and stress were addressed separately during this period, it can be said that they were not yet systematically integrated into the context of health sciences education. The second phase is the phase of gradual growth and awareness (2001-2014): From the early 2000s onwards, the volume of publications began to increase steadily and reached double digits (n = 11) in 2013. This period reflects a process in which the importance of mental health and clinical supervision quality in educational outcomes for health professionals was discussed by a wider audience.

The final phase is the rapid growth and peak phase (2015-2026): A significant explosion in the literature has occurred since 2015. The years 2017 (n = 19), 2021 (n = 17), and 2025 (n = 20) stand out as periods of peak production. Even though it is only the first quarter of 2026, reaching n = 15 publications provides a strong projection that academic output in this field will break historical records by the end of the year. This growth trend is quantitative evidence that mentoring models in health sciences are evolving from traditional approaches to more evidence-based, dynamic, and possibly digitized structures. The consistently high level after 2020 can be explained by the fact that the stress-increasing effect of the COVID-19 pandemic on clinical training has led researchers to focus more intensely on mentoring solutions.

4.4 Analysis of the most productive references

The resource analysis, conducted to identify the journals where the literature is concentrated, reveals the “core” journals of clinical mentoring and stress (Figure 3).

Figure 3 shows the dominance of nursing education: According to the analysis results, Nurse Education Today (n = 30) ranks first as the most effective and productive source of literature. It is followed by Nurse Education in Practice (n = 12). The fact that these two journals contain a significant portion of the total publications shows that the subject has already become a standardized research area in the nursing education discipline.

Interdisciplinary Spread: Journals such as the American Journal of Pharmaceutical Education (n = 6) and Radiography (n = 5) included in the list prove that the relationship between mentoring and stress is not limited only to nursing and medicine; it also extends to technical health branches such as pharmacy and radiography.

Multidisciplinary Approach: The high ranking of public health-focused journals such as the International Journal of Environmental Research and Public Health (n = 7) indicates that clinical stress is addressed not only as an educational problem but also as an employee health and public health issue. This distribution shows that researchers, in their new studies on mentoring and stress, are primarily targeting high-impact journals focused on nursing education, but the field is increasingly diversifying towards more specific health branches.

4.5 Geographic distribution and scientific contribution of countries

The global distribution of studies on clinical mentoring and stress shows that the literature is concentrated in certain geographic regions and dominated by a Western-centric research ecosystem (Figure 4).

Figure 4 shows the leading countries and regional dominance: According to the analysis results, the USA (n = 234), the United Kingdom (n = 158), and Australia (n = 133) form the strongest three pillars in the literature. This can be explained by the fact that these countries have a long history and institutional support for structured mentoring and clinical supervision models (e.g., Preceptorship Frameworks) in their health education systems.

The rise of Asia and the Middle East: Despite traditional Western dominance, it is noteworthy that countries such as China (n = 55), South Korea (n = 26), and Saudi Arabia (n = 23) are among the top entries on the list. In particular, Saudi Arabia’s focus on health education reforms under “Vision 2030” can be considered the main motivation for the increase in publications in this field [23]. Developing regions: The presence of countries like South Africa (n = 26) and Brazil (light blue on the map) demonstrates that clinical stress and the need for mentoring are universal issues, and that this topic is beginning to emerge in the health systems of low – and middle-income countries. The density on the map (dark blue areas) indicates that clinical mentoring models are generally discussed with a focus on “quality improvement” in countries with advanced health infrastructure; the lighter areas show that this issue does not yet exhibit a completely homogeneous distribution on a global scale.

4.6 Conceptual structure and keyword clustering analysis

Keyword co-occurrence analysis performed via VOSviewer reveals that the literature is structured around 5 main thematic clusters. The size of the bubbles represents the frequency of word usage, and the relationships between them represent how often these concepts are discussed together in the literature (Figure 5).

In Figure 5, the pink cluster (mentorship and supervision): Located in the center of the map, this cluster includes the concepts of “preceptorship” and “clinical supervision.” The strong connections of this cluster to “transition” and “COVID-19” demonstrate how the pandemic triggered the need for mentorship in clinical training transition processes. The green cluster (educational stress): Focusing on the terms “nursing students,” “stress,” and “dental students,” this group points to the educational origins of stress and its prevalence across different disciplines. The connection to “professional identity” highlights the impact of stress on identity construction. The orange/blue cluster (professional outcomes): Includes the concepts of “burnout,” “resilience,” and “emotional intelligence.” This area represents the psychological mechanisms by which mentorship protects students from burnout. Turquoise/subset (educational technologies and learning): focuses on the pedagogical dimension of the mentoring process and peer support, using the concepts of “peer learning,” “preceptor,” and “professional issues.”

4.7 Thematic map analysis

The thematic map analysis, conducted to understand the strategic structure of the clinical mentoring and stress literature, classifies the concepts into four groups according to their developmental level (Density) and relevance (Centrality) (Figure 6):

In Figure 6, motor themes (top right): This area represents both advanced and central topics in the literature. “Mental health nurses,” “360-degree video” (technological integration), and “clinical reflection” fall into this category. The inclusion of “360-degree video” here, in particular, demonstrates that digital transformation in mentoring has become a mature mainstream topic. Basic themes (bottom right): These are topics that form the overall framework of the field but are more generalizing in nature. “Nursing students,” “stress,” “burnout,” and “preceptorship” are clustered here. These concepts are indispensable to the literature, but are now more of a “fundamental building block” rather than just “motor” themes. Niche themes (top left): These are very specific and inwardly focused areas of development. “Medical student surgery clerkship” is included in this section. The relationship between mentorship and stress in surgical internships can be said to be a specialized field with its own unique dynamics, distinct from the general nursing literature. Emerging/declining themes (bottom left): The concepts of “radiography education” and “support” are located in this area. It can be interpreted that mentorship support in radiography education is a newly emerging concept in the literature, or that the general concept of “support” is now giving way to more specific terms (such as resilience).

4.8 Temporal evolution of the literature and emerging trends

A temporal analysis of the biblioshiny data strikingly reveals the conceptual transformation of the clinical mentoring and stress literature over the last 50 years. This shift symbolizes the literature’s move from a focus on “technical skills” to a focus on “holistic well-being” (Figure 7).

In Figure 7, the node sizes represent the total frequency of concept use (freq), and their positions on the horizontal axis represent the median year of publications (year_med). The conceptual shift between the Classical (1982-2010), Modern (2011-2020), and Digital/Psychosocial (2021-2026) periods is clearly visible.

Classical Period (1982-2010): During this period, the focus of the literature was more on general concepts such as “general practice,” “nursing staff,” and “teaching.” Mentoring was considered only as an “education method” (education program) during these years.

Modern Period (2011-2020): This is the period in which the concepts of “preceptorship” (year_med: 2017) and “clinical competence” became central. As of 2018, the relationship between “nursing student” and “mental stress” began to be examined in a more academic language (qualitative research). The Digital and Psychosocial Era (2021-2026): This period represents the “human” and “modern” face of the literature. Post-pandemic (2022) research has focused on concepts such as “wellbeing” (2025), “loneliness” (2025), and “paramedical personnel” (2026). The increased use of “thematic analysis” (2024) indicates that research is gaining depth.

5.1 Interdisciplinary inequality and “critical gaps”

The universality of clinical stress, as stated in the literature review [5], is reflected in our bibliometric data as an interdisciplinary inequality. The concentration of 41.8% of publications in the nursing field coincides with the early standardization in nursing education and intensive clinical practice hours highlighted by [13]. However, it is noteworthy that dentistry and pharmacy branches, identified as high-risk areas in the literature review (n = 8 and n = 11 according to RQ2 results), remain marginal in the bibliometric map. It was concluded that the fear of making technical errors experienced by students in these branches [3] is not sufficiently supported by mentoring mechanisms, and there is an urgent need for “structured guidance” in these areas.

5.2 Conceptual shift from technical competence to psychosocial resilience

The limited mentoring function of “reparative and emotional support” [16] mentioned in the introduction has been temporally proven in our Trend Topics analysis. The performance-oriented “clinic” of the 1990s has been replaced by the concepts of “well-being,” “loneliness,” and “resilience” in the 2024-2026 period. This situation proves that Moreira et al.’s [14] understanding of mentoring focused on emotional intelligence and self-awareness has become a “Motor Theme” in the literature. In particular, the rise of the expression “loneliness” shows that the need to prevent social isolation, emphasized by Mikkonen et al. (2016), has been incorporated into modern literature.

5.3 Digital transformation and paradigm shift

Digital transformation, which is also discussed as a stress factor in the literature review [20], is concretized in our Thematic Map findings with the emergence of concepts such as “360-degree video” and “virtual reality” as the driving theme. This finding reveals that traditional mentoring models have evolved with technology; however, this process should be designed to minimize the “cognitive load” indicated by [20]. Digital mentoring is no longer just an alternative, but has become a permanent pedagogical instrument of the post-pandemic era.

5.4 Bibliometric reflection of systemic barriers

In the literature, “excessive workload and lack of institutional support” [17], which hinder the success of mentoring, can be associated with the rising trend of developing countries (Saudi Arabia, Brazil, etc.) in our analyses. This new field of production, which goes beyond Western dominance (USA, UK), confirms that mentoring needs to be localized and institutional barriers need to be overcome with solutions specific to each culture (indigenization).