The Mentoring Process in Emergency Medicine – Part 2
- Apr 20th, 2017
- Brit Long
Authors: Brit Long, MD (@long_brit, EM Staff Physician at SAUSHEC) and Alex Koyfman, MD (@EMHighAK – emDOCs.net Editor-in-Chief; EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) // Edited by: Gus M. Garmel, MD, FACEP, FAAEM (Clinical Professor (Affiliate) of EM, Stanford University, Former Co-Program Director, Stanford/Kaiser EM Residency, Senior Emergency Physician, TPMG, Kaiser Santa Clara)
Case 1: The intern continues to do well. She and her mentor have been meeting monthly to discuss difficult scenarios encountered (clinical and non-clinical). The mentor has also found a potential research project for the intern. What are the next stages in the mentor/mentee relationship, and how do they continue this success?
Case 2: The junior faculty member has been in contact with a senior physician at his new institution. They have a meeting this week, and he sent him his CV. What should the mentee focus on or bring up at the meeting, and what should be discussed?
In part 1 of this series, we provided a foundation for mentoring including a definition, participants, goals, responsibilities, pearls and pitfalls. In part 2 we will explore four stages of mentoring, while reviewing several key aspects of mentoring.
Let’s get started…
Setting up the first meeting requires several considerations. First, schedule 30-60 minutes for the initial meeting. Both the mentor and mentee should discuss their own backgrounds, interests, and hobbies (time permitting), and exchange contact information including the preferred means of communication. Goals and objectives should be discussed to get a sense if the relationship seems promising and is to continue. The mentee should provide a copy of his/her CV before the meeting, which the mentor can review before the meeting (or evaluate at the time of the meeting if he/she is unable to do this in advance). During the first meeting, expectations and definitions of success should be clearly explained. The mentee should identify short- and long-term goals, with several areas of interest that might be conducive to collaboration or as a team. Following this, future meetings should be scheduled. This can be difficult given EM schedules, but recurring contact and meetings are key to continue relationship development.
Mentoring can be broken into four stages, with each reflecting the mentee’s learning and development needs. These stages can blend, and roles listed are not exclusive to each specific stage. These stages include: prescriptive, persuasive, collaborative, and confirmative.
- Prescriptive: The initial stage often occurs when the mentee has limited experience in either the field, organization, or institution. The mentee will depend heavily on the mentor for support and further instruction, and the mentor primarily coaches, teaches, and motivates the mentee, for whom building self-confidence is important. More time is required in this stage to ensure that a strong foundation is laid for a successful relationship. The mentee often soaks in new information provided, whether it be knowledge, mentor experiences, or cases.
- Persuasive: This stage entails the mentor persuading the mentee to investigate questions and seek challenges, as opposed to receiving them directly from the mentor. The mentee generally possesses more experience in their field than mentees in the prescriptive stage, but still requires direction from the mentor, including encouragement to seek opportunities for more learning and research. The mentor may suggest new strategies, questions, and challenges to the mentee. In this stage, the mentor functions as a counselor and guide. As the framework has been established in the prescriptive stage, the relationship now grows with sharing of experiences.
- Collaborative: The mentee now has experience and the ability to work with the mentor jointly to solve problems and communicate on a more equal basis. Career guidance is vital in this stage for the mentee, who is now more independent. The mentor may allow the mentee to function more independently or take the lead on joint projects, functioning as a career advisor and role model.
- Confirmative: This is an important stage for the relationship, as the mentee has developed and matured as a professional. The mentee often has a great deal of experience, mastering several aspects of the profession. The mentor plays a significant role as a sponsor, which entails offering advice and encouragement in career decisions.
Importantly, the relationship with a mentor may not start at the same place for different mentees, based on skill set, experiences, and needs. The relationship is not static can move back and forth between different stages, depending on what is needed. The mentor and mentee should consider several aspects: the mentee’s knowledge and abilities, the mentee’s level of experience, and the type and amount of guidance and support the mentee requires. Stages often overlap or mix in the mentoring relationship. The mentor and mentee need to continually evaluate the relationship during its evolution to ensure it continues to develop and meet both parties needs and objectives.
Case 1: The mentor and mentee seem to be in the prescriptive stage, perhaps moving into the persuasive stage, as the mentee is relying on the mentor for support and instruction. However, with the baseline relationship formed, the mentor can now challenge the mentee, as well as act as counselor and guide.
Case 2: Even though the relationship has yet to formally start, the prospective mentee possesses a great deal of experience and ability to work collaboratively with the mentor. Due to the knowledge and skills of each participant, the relationship may begin at a more advanced stage (such as the collaborative stage). The mentee likely requires guidance related to aspects of the institution, such as politics, workload, and culture.
Building Skills and Optimizing the Relationship
Several aspects of the relationship can enhance the mentor and mentee’s growth. Location is important, with privacy, comfort, and time vital aspects. A meeting over coffee or food is a good excuse or opportunity to interact. Seek to utilize the most comfortable area, which should be convenient to both parties (especially the mentor), whether an office setting, cafeteria, or coffee shop. There may be a tradeoff between privacy and access to food, which should be factored in to the decision of where to meet. The meeting space is important because it can create an intimidating environment. For example, a large desk can act as a barrier. Also consider personal space: too close or too crowded can create a feeling of invasion. Aim for a welcoming, safe place for both mentor and mentee. If possible, the location should lack distractions of computers, mutual acquaintances, patients, and reading or work materials. The mentor should give the mentee his/her attention during the meeting, so an office setting may not be appropriate due to distractions. The mentor and mentee should avoid speaking or texting on cell phones during the meeting. As the relationship develops, meetings can occur on hikes, walks, or during exercise.
That brings us to listening, one of the most important aspects of the relationship. Two types are predominantly present, including one-way and two-way. One-way (passive) listening occurs with non-verbal feedback from the listener, which includes eye contact, gestures, nodding, and smiling. This can be great for a mentee just needing to vent, requiring a “sounding board”. Two-way (active) listening requires verbal feedback. Both types include questioning, where the mentor attempts to get the mentee to elaborate on information, and paraphrasing, where the mentor speaks back and rephrases to the mentee what was said. This allows both participants to ensure adequate understanding, clarification of ideas, and thought processing.
An agenda or set of goals for every meeting can improve the productivity and further development of the relationship. Planning where, when, and what will be covered is essential. Other keys include allotting an appropriate amount of time, each participant coming prepared, and avoiding surprises. If something needs to be addressed, the mentor or mentee should contact the other before the meeting to ensure the agenda is modified.
The next several components are related and exist along a spectrum. These include coaching, counseling, guiding, and advising, which are primarily mentor responsibilities.
The role of coach may be required for mentees who are less experienced in order to gain knowledge or overcome difficulties the mentee may be experiencing. In this role, the mentor should describe the behavior needed, demonstrate why the knowledge or skill is important, explain how to approach the task, act as a role model, observe the mentee, and provide feedback. As you can see, several points are difficult. Observing the mentee and acting as a role model might require working together while on shift.
Counseling requires trust and confidentiality, as well as a safe environment. Counseling may be needed for work, personal life, or finances. Respect is essential in this interaction. There are many types of counseling, though two will be discussed here. One is a non-directive approach, where the mentor allows the mentee to discover problems and solutions based on his/her own values. This requires active listening on the part of the mentor, who accepts the needs and values of the mentee. Another approach is more directive, where the mentor assists the mentee by recommending solutions.
Guiding incorporates assisting the mentee through inner working of a program, rotations, studying, and resources. “Unwritten rules” of the program, institution, and EM as a specialty can be important discussion points, especially critical responsibilities. For junior faculty, a new hospital can present significant challenges with documentation, culture, staff, diagnostic/treatment pathways, pharmacy, labs, and many other components. This is where a mentor or senior physician can assist in discussing these aspects. Inner workings are the “behind the scenes” dynamics or politics, which may not always visible yet can be difficult roadblocks or trouble areas. “Unwritten rules” include special procedures followed, guidelines that may not always be documented, interactions among departments, and policies.
Career advising is a major component of the mentor-mentee relationship. It is also one of the most rewarding aspects. To maximize career advising, several items should be considered:
- Determine the mentee’s interests – Ask what activities are interesting or satisfying. What do they enjoy the most, and what do they dislike?
- Identify the mentee’s knowledge, skills, and abilities within their interests. Most people are modest and may diminish their description of their own skill. The mentee should seek to evaluate his/her own strengths, weakness, responsibilities, and most significant accomplishments. This will provide insight into what the mentee values, while revealing important attributes. The mentee identifying his/her own skills forces the mentee to closely examine professional and personal interests and accomplishments.
- Develop career goals – The mentee should first develop long-term goals and work backwards. Short-term goals should work to accomplish long-term goals. Goals need to be specific, measurable, achievable, relevant, and time-bound (SMART). They also should be time-framed, relevant, realistic, limited in number, and flexible. For more on SMART goal-setting, see https://www.mindtools.com/pages/article/smart-goals.htm.
- Target areas that need further development – In order to target development, the mentee and mentor should know the long-term goals and requirements to meet them.
- Create a plan – A plan for development includes specific actions needed to achieve desired goals. For this plan, the goals should be listed, followed by the plan with specifics. This plan serves a motivator.
- Determine indications of success – The mentee should define their success and list indicators of success.
- Evaluate progress – Recurrent meetings can help monitor progress and goals. The plan and even goals can be readjusted at follow-up meetings. Celebrating interim goals are important, as they build the relationship and motivate the mentee and mentor.
Feedback is needed in coaching, as well as other stages in the relationship. Positive feedback can reinforce correct behavior, while constructive feedback seeks to modify or improve behavior. Feedback should be frequent, concise and specific, and direct. Feedback should not be provided as a question, judgmental, or exaggerated. Before providing feedback, try to understand the actions of the mentee, and ensure the setting is optimal. Asking about the mentee’s thought process can provide valuable insight for the mentor.
Learning from Experience
Sharing prior experiences is important for the mentee and provides insights into how the mentor thinks. Errors and successes should be shared openly yet confidentially, which not only helps the mentee learn, but also strengthens the relationship of the mentor and mentee. To assist the mentee, several steps can be followed:
- Ask the mentee for a concrete, detailed description, and inquire about specifics.
- Ask about feelings the mentee experienced.
- Ask about lessons learned.
- Discuss strategies for future scenarios and successes.
A mentor acts as an example for the mentee, demonstrating professional practices, values, and ethics. This provides an important teaching tool, providing an opportunity to learn. Direct modeling can be difficult in EM because the mentee may not work shifts with the mentor in the ED. However, professionalism, compassion, empathy, and timeliness can be modeled through daily interactions.
This concerns creating and/or looking for new opportunities for the mentee. The mentor’s goal is to provide as much exposure to new opportunities as possible (while limiting risks). These opportunities should challenge and benefit the mentee. However, the mentor should ensure the mentee is set up for success, not failure. This also requires the mentor evaluating the mentee on a regular basis. Once the mentee has accomplished one goal or step on the plan, the next goal should be targeted.
At some point in the relationship (often after several years working together), the mentee may feel they are advancing through association with the mentor, rather than personal merit. The mentor should ensure the mentee’s competence and abilities are visible. The mentor can also connect the mentee to others or guide him/her toward a separate project.
Most mentees in EM will be highly motivated and want to succeed. Mentors may never need to fill the motivator role for their mentee. However, this role may be needed when the mentee feels overwhelmed, has an extremely difficult assignment, or is afraid of failure. Motivation can take the form of guidance and support in these circumstances. Encouragement involves providing positive feedback during an assignment to help move the mentee towards goals. This feedback can boost the mentee by providing a sense of accomplishment and self-esteem. Motivation also occurs through providing support. Mentor availability during stressful periods can really help the mentee, allowing the two to meet, discuss, and work through challenges or difficulties.
Case 1: At this current stage, the emergency medicine intern needs guidance and coaching from the staff mentor, while continually monitoring her goals and progress. Regular meetings are important. The mentor must continue to support the intern through her years as a resident, while being prepared for challenges associated with residency training.
Case 2: The junior faculty needs guidance and support on the intricacies of the new job and new institution. Career advice is also important to this individual, and a senior physician can provide valuable insight as well as pearls such as mistakes to avoid and what has helped him succeed. Connections are also helpful; the senior staff mentor can assist the junior faculty member in forming important relationships.
– Mentoring includes several stages: prescriptive, persuasive, collaborative, and confirmative, though these often overlap and are not always clear cut or linear.
– The mentor and mentee must devote time and energy to the relationship.
– Listening skills are essential for the mentor and mentee.
– Each meeting is best having an agenda. The meeting should be scheduled in advance with a plan, a location and time, and a set amount of time set aside.
– Coaching may be needed for mentees with less experience. Counseling and guidance are important through all stages.
– Advising is one of the predominant components of the mentoring relationship. The mentee should identify his/her interests, skills, knowledge, and goals. Targeting areas for development, plan creation, indicators of success, and continual reassessment of progress are vital.
– Mentors should seek to promote the interests of the mentee. Guidance and support may be needed if the mentee feels overwhelmed or experiences difficulty.
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