Mentoring and Emergency Medicine – Part 1

Authors: Brit Long, MD (@long_brit, EM Staff Physician at SAUSHEC) and Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) // Edited by: Gus M. Garmel, MD, FACEP, FAAEM (Clinical Professor (Affiliate) of EM, Former Co-Program Director, Stanford/Kaiser EM Residency, Stanford University) and Michael S. Runyon, MD, MPH (Professor of Emergency Medicine, Chief of Academic Affairs and Faculty Development, Department of Emergency Medicine, Carolinas HealthCare System)

Let’s start with two individuals: one is a new intern in her first month of Emergency Medicine residency. She’s been nervous about starting this new career, though this has been her dream. Her residency has a mentoring program, and she has already met with her mentor, established several long-term and short-term goals, and discussed aspects of the intern year, the hospital, the nurses, and patient population. She feels prepared, especially with the support from her mentor.

The second individual is a new graduate, fresh out of residency. He is starting a junior faculty position at an academic department. He and his wife just moved across the country, and he knows very few people at the new hospital. He had a brief meeting with the department head, credentials office, and EHR representative. His department head gave him a list of senior faculty members, but there is no formal faculty development plan. He had a great mentor during residency, but he just retired. Frankly, he feels alone in this new job and hospital.

This is the first in a two-part series on mentoring in emergency medicine. Part 1 will focus on what is mentoring, responsibilities of mentors and mentees, and pearls and pitfalls. Part 2 will focus on the process of mentoring. As we will see, mentoring is an important aspect of medical education and development.

What is mentoring?

Mentoring is a vital component of education, personal growth, and career development in every profession.  In emergency medicine, mentoring is beneficial, fostering career development, job satisfaction, and goal achievement.^1-10  Mentoring is defined by a trusted and experienced advisor (the mentor) who has a direct interest in the development and education of another individual (the mentee).^1-3 Importantly, mentoring is defined by intentional interaction, with the primary goal of mentee development.^1,3 The mentee seeks to receive guidance and wisdom, commonly in a confidential, protective, and supportive environment, from the mentor who actively sets aside time and energy and remains flexible.

This relationship can be short or long, structured or loose. It does not need to be continuous, and contact may be reestablished after breaks. It can occur with a variety of levels. Importantly, both the mentor and mentee gain from this relationship, though at first the mentee seems to benefit the most.^1-3

Who is involved?

As described, mentoring includes the mentee and mentor.  Classically, the mentor is the individual with greater experience and knowledge, as well as a more senior position. This can occur at any level including medical student and resident or staff, resident and resident, resident and staff, junior faculty and senior faculty.^1,2 Mentors may be from a separate career field or medical specialty, which provides the mentee with different perspectives and opportunities. The mentee is the learner, usually with less experience and less seniority. The mentor provides several major resources to the mentee including guidance, support, counseling, motivation, and education. The goal of this relationship is to improve the mentee’s development in several arenas (discussed further).  It is appropriate for mentees to seek and have multiple mentors, as this can assist them in gaining alternative views, opportunities, and guidance. Mentors may also have several mentees, though mentors must ensure they have adequate time and ability to provide a successful mentoring relationship for each mentee.

What are the goals of mentoring?

One major goal of the mentoring relationship is to help the mentee obtain skills and knowledge required for career and professional satisfaction.  The mentor’s main goal is to assist the mentee along the road for future success in life, obtaining his/her goals. However, success can be defined differently, depending on the individual, and the mentor and mentee may differ in their definitions of success. This should be one of the first items discussed, with the mentee’s goals and definition of success clearly defined, which will avoid confusion during the relationship.^1,3 Ideally, the mentee should progress not only as a physician, but as a person.

Why is mentoring important?

Mentoring has multiple benefits, including improved productivity, and most importantly, career satisfaction and development.^1-10 Physicians with mentors are more confident in their abilities; one study suggests physicians with a mentor receive a higher salary.⁵ Professional societies have established the importance of mentoring, many creating formal programs for mentoring with resources. Conferences and faculty workshops and committees have provided many new opportunities for networking and developing vital relationships.

Who benefits?

The relationship primarily benefits the mentee. As discussed, mentees demonstrate greater satisfaction, faster promotion, and more academic productivity in the literature.^1-3 Other benefits include professional safety, confidence, project opportunities, networking, greater understanding of medical roles, feedback, funding, and more relationships. Mentors also benefit, though these benefits may not occur as quickly. Mentors can assist in the development of a colleague, are less likely to experience burnout, are exposed to new ideas and excitement, and have an opportunity to share their own values. They demonstrate increased passion and excitement, greater satisfaction, academic advancement, productivity, and creativity.^1-3,10

Mentoring Models

Classically, mentoring consists of the mentee and mentor. This may be an assigned or spontaneous relationship. Group mentoring includes one mentor who meets simultaneously with several mentees.² This group often consists of mentees at different training levels, and junior learners can benefit from other mentees who may be more senior. Another form is telementoring, which is completed by email, video conference, phone, etc. This allows the members to stay connected over a distance.^1,2,10

Potential Topics for mentoring…

Mentoring encompasses a wide range of topics. Topics can be separated into three fields: training, personal and professional, and future career, which overlap. Training issues such as mentee progress in his/her residency or career, rotation selection, clinical efficiency, mentee preparation for lectures or presentations, medical knowledge, discussion of cases (interesting, successful, difficult, or challenging), and tests are the major components of this field.^1-3,5,10

Personal and professional issues include clinical and ethical conundrums, integrating work and personal life, time management skills, conflict resolution, professionalism, and financial matters. One major component of professional issues includes conflict resolution. Not everyone will “play nice in the sandbox”, as we’ve all had our problem with consultants or other healthcare employees. The mentor can provide valuable advice and support in this arena due to his/her experience and networks. Hospital politics, the residency program, new physicians and senior physicians, and administrators can create conflict.  In cases of difficulty with personal and professional issues, the mentor can act as an advocate, confidant, or safety net for the mentee.  EM is not an easy profession, and mentors can monitor the mentee for signs of professional or personal distress and intervene if needed.^1,2

Future issues such as career guidance for residents often focuses on networking, the decision to enter community vs. academic medicine, areas of future study, and niche development. As the resident starts to move towards graduation, fellowship and job opportunities can be discussed. However, this just scrapes the surface of what the relationship offers. This is also important for a junior faculty member (mentee) and senior faculty member (mentor). In this relationship, the senior faculty member can assist with similar topics including networking, projects, committees, and administrative or academic opportunities. Ultimately, these issues require goal setting, both short and long-term.^1,2

With these aspects, we now have a background on the participants in the relationship, the benefits, and topics that can be covered. However, what responsibilities do the mentor and mentee have to promote a successful relationship?

The mentee must:^1-3

Demonstrate honesty and integrity in the relationship

Be mindful of mentor time and limitations

Establish long-term and short-term goals

Initiate asking questions, finding projects, and developing skills and ideas

Express interest in the relationship

Take responsibility in his/her development

Work to actively apply mentor feedback and suggestions

Provide the mentor with feedback

Seek other mentors and remind each mentor of other mentors

Inform the mentor of deadlines, successes, and difficulties

Responsibilities of mentors include:^1-3

Provide oversight in the development of the mentee

Demonstrate sensitivity to cultural, gender, age, religious, and ethnic differences

Promote mentee interests

Promote mentee education and instruction

Ensure the mentee has clear goals established for development and career

Provide time and energy on a regular, consistent basis

Hold the mentee to high, but reasonable, standards

Push and encourage the mentee to reach his/her full potential

Answer questions and requests in a timely manner

Protect the mentee from possible threats

Pay close attention for new opportunities for the mentee

Advocate and champion for the mentee

Provide a confidential area for the mentee to express concerns and difficulties

Treat the mentee with respect, dignity, and courtesy

Demonstrate honesty in the relationship

Express interest in the relationship with the mentee

Impart knowledge for clinical skills and career development

Assist the mentee in networking and contacting others for help (research, statisticians, IRB)

Assist with applications for positions

Provide feedback, while also accepting feedback from the mentee

Identify areas of success and areas requiring development/limitations

Monitor the mentee for behavioral or physical signs of distress

Pearls in Mentoring

Mentoring requires a mentee willing to learn and develop, as well as a mentor who is capable and passionate. The mentor must be able to listen and commit to the needs of the mentee. Mentoring is an active process that takes time. The relationship is constantly evolving and is not static. The mentor must consider the mentee’s needs and balance that with the desire to succeed.  Both must respect the other. The mentee must consider the time commitment demanded of the mentor, while the mentor must be available and listen in a nonjudgmental, confidential manner. Meeting agendas can assist both in planning and staying focused, protecting the time for both mentor and mentee.

Pitfalls in Mentoring

Several major pitfalls may occur in the relationship. These include inappropriate expectations, taking credit for work that is not one’s own, lack of time and commitment, inappropriate/insensitive interactions, doing work for the mentee inappropriately, not behaving in the mentee’s best interest, breaching confidentiality, failing to anticipate challenges or obstacles, giving up too soon on the relationship. Lack of respect for relationship boundaries and not knowing limitations (the mentor and mentee must acknowledge their own weaknesses and limits) are pitfalls that can destroy the relationship. The mentor must not depend on only his or her own skills, but allow the mentee to develop. One major pitfall is failure to set goals and expectations at the beginning of the relationship when possible, and each meeting should be scheduled in advance, with an agenda on what will be discussed.^1-3

Members of minority groups and women can find it difficult to identify possible mentors. This occurs for several reasons.^1-3,11,12 Fewer effective mentors for women and under-represented minority groups are present in academic medicine.^2,11,12 Differences in communication styles, interaction, and thought processes can be present between genders and minority groups. Fortunately, the numbers of female and minority faculty members are steadily rising. Also, mentors and mentees do not need to be of the same minority group or gender, though it remains imperative that future and current physicians receive mentoring that accommodates differences in culture, gender, and professional goals.¹

Back to our physicians…

The intern is doing well with her current mentoring relationship. She can discuss aspects of her development and personal life in a confidential, protected environment. Her goals have been established, and her mentor has already tried to involve her in several projects. Their next meeting will discuss these projects and research.

The new staff physician requested a list of senior faculty from his department head, followed by asking who would be willing to mentor new, junior faculty. He also called his prior mentor and asked if he could run things by him on a regular basis by email or phone, to which his prior mentor agreed. Things are starting to look up, but he still has his work cut out for him.

If you have any other thoughts, please comment below.  Part 2 will cover the process of mentoring including stages and roles, and we will continue following our two mentees. Stay tuned for more!

References/Further Reading:

1. Garmel GM. Chapter 4: Mentoring in emergency medicine in Practical Teaching in Emergency Medicine. Second Edition. Edited by Rogers RL, Mattu A, Winters ME, Martinez JP, Mulligan Terrence M. John Wiley & Sons, Ltd. Published 2013.
2. Yeung M, Nuth J, Stiell IG. Mentoring in emergency medicine: the art and the evidence. Cal J Emerg Med 2010;12(2):143-149.
3. Garmel GM. Mentoring medical students in academic emergency medicine. Acad Emerg Med 2004;11:1351-57.
4. Detsky AS. Baerlocher MO. Academic mentoring – how to give it and how to get it. J Am Med Assoc 2007;297(19):2134-36.
5. Jackson VA, Palepu A, Szalacha L, Caswell C, Carr PL, Inui T. Having the right chemistry: a Qualitative study of mentoring in academic medicine. Acad Med. 2003; 78:328–34.
6. Advisor, Teacher, Role Model, Friend: On Being a Mentor to Students in Science and Engineering. National Academy of Sciences, National Academy of Engineering, Institute of Medicine. Washington, DC: National Academy Press, 1997.
7. Clutterbuck D. Everyone Needs a Mentor: Fostering Talent at Work, ed 3. London: CIPD House, 2001.
8. Paice E, Heard S, Moss F. How important are role models in making good doctors? BMJ. 2002; 325:707–10.
9. Wright DW, Hedges JR. Mentoring faculty members to the next level. SAEM/AACEM Faculty Development Handbook, ed 1. Available at: http://www.saem.org/facdev/fac_dev_ handbook/4-2_mentoring_faculty_members_next_level1.htm. Accessed February 2017.
10. Ramanan RA, Phillips RS, Davis RB, Silen W, Reede JY. Mentoring in medicine: keys to satisfaction. Am J Med. 2002; 112:336–41.
11. Lewis RJ. Some thoughts regarding gender issues in the mentoring of future academicians. Acad Emerg Med. 2003;10:59-61.
12. Hamilton GC. SAEM under-represented minority research/mentorship task force: attitudes and opinions of under-represented minority medical students regarding emergency medicine as a potential future career choice. Acad Emerg Med. 2004;11:483-84.