Mentorship in Academic Medicine

Sharon E. Straus, David L. Sackett, Sharon Straus, David Sackett, Sharon E. Straus, David L. Sackett, Sharon Straus, David Sackett

• Publisher: BMJ Books
• Year: 2013
• Print ISBN: 9781118446027
• eBook ISBN: 9781118446041
• Edition: 1
• Topic: Medicina
• Subtopic: Formazione medica

Mentorship in Academic Medicine is an evidence-based guide for establishing and maintaining successful mentoring relationships for both mentors and mentees.

Drawing upon the existing evidence-base on academic mentoring in medicine and the health sciences, it applies a case-stimulus learning approach to the common challenges and opportunities in mentorship in academic medicine. Each chapter begins with cases that take the reader into the evidence around specific issues in mentorship and provides actionable messages and recommendations for both correcting and preventing the problems presented in the cases. 

Accompanying the text is an interactive, online learning resource on mentorship. This e-tool provides updated resources for mentors and mentees, including video clips and podcasts with effective mentors who share their mentorship tips and strategies for effective mentorship. It also provides updated departmental and institutional strategies for establishing, running, and evaluating effective mentoring programs.

Mentorship in Academic Medicine provides useful strategies and tactics for overcoming the common problems and flaws in mentoring programs and fostering productive and successful mentoring relationships and is a valuable guide for both mentors and mentees.

Chapter 1

What is the evidence for mentorship?

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Scenario

At the end of your first year as an academic clinician–investigator in a big, busy clinical department, with some 200 faculty members, you've just finished discussing your annual review with your department chair. She tells you that you're doing extremely well for a new faculty member, which is a great relief to you. Although you think you've done pretty well—in the past year, you received a peer-reviewed development grant, first-authored two papers and co-authored four others, have a systematic review in press, have an abstract accepted for a national meeting, are enjoying your time on the clinical service, and the medical students and residents submitted glowing assessments of your bedside teaching—you feel pressed for time, worry about your work–life balance, and wonder whether you're “on the right track” for a successful and enjoyable academic career. Although you've received encouragement from several senior members of the department, you've been conscious of how busy they are and don't want to impose on their jam-packed schedules to ask for advice. But now, stimulated by a recent session on mentoring which you attended at an academic meeting and emboldened by your chair's praise, you tell her that you and some of your colleagues are concerned about the lack of a formal mentorship program in the department. She says that to be able to “sell” this idea to the department, she wants to see the evidence that such a program does more than waste time, money, and energy, and she challenges you to lead a working group to track down, appraise, and summarize the evidence that a formal mentoring program benefits the career development and life-satisfaction of academic clinicians. With the promise of some staff support for your working group, you accept her challenge.

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Your first step in this task is to gather the evidence; specifically, what's the case for mentorship?

In this chapter, we'll set the stage for our mentorship discussion providing the definitions and terminology that we'll use throughout this book. In particular, we'll outline the scope for our discussion, including what mentorship is and isn't, and help you to provide the “case for mentorship” based on the relevant evidence. We invite you to join us in this dialogue via the website (www.mentorshipacademicmedicine.com) that accompanies this book; we'd love to hear about how you define mentorship and how you would meet the challenge we posed in the above scenario!¹

What is mentorship?

The concept of mentorship can be traced to Greek methodology. Odysseus placed his much older friend Mentor in charge of his palace and of his son Telemachus when he left for the Trojan War. Interestingly, Athena disguised herself as Mentor on several occasions to provide guidance to Telemachus. It was from this story that the term “mentor” was taken and began being used to mean a trusted, senior advisor who provides guidance to a more junior person.

Moving along to more recent times, there are many definitions of mentorship, including those from business [1] and psychology literature [2], but our focus in this book is on academic medicine, including clinicians who work in universities and academic health science centres. So, for our discussion, we'll use the definition commonly cited in academic medical literature:

A process whereby an experienced, highly regarded, empathetic person (the mentor) guides another (usually younger or more junior) individual (the mentee²) in the development and re-examination of their own ideas, learning, and personal and professional development. The mentor, who often (but not necessarily) works in the same organization or field as the mentee, achieves this by listening or talking in confidence to the mentee [3].

One element that we think is missing from this definition is that mentorship is about an exchange between the mentor and mentee and provides benefits to both parties; we'll explore these benefits later in this chapter.

Berk and colleagues have further elucidated the concept of mentorship to specify that it can range from an informal, short-term relationship to a formal, long-term relationship [4]. Informal mentoring is a relationship between individuals that develops without organizational interventions and is the natural “coming together” of a mentor and mentee. For example, a resident may identify a staff physician with whom they worked on a clinical rotation and developed a good rapport; this interaction may lead to a series of conversations that ultimately results in a mentoring relationship. Formal mentoring is initiated (in some places, mandated!) by an outside party or organization, as when a department chair not only requires that each new recruit has a mentor but makes sure that they get one.

A common source of confusion in the mentorship literature is that the term “mentor” is often used interchangeably with the term “role model” or “coach.” We maintain that these are very different concepts. “Role modeling” is a “passive, observational learning model in which an individual attempts to emulate observed, desirable behaviours and qualities” [5]. Indeed, there may be no personal relationship with the role model, and they are often oblivious of their role! Of course, a mentor can and often does serve as a role model, but that's just one, passive facet of their function. Similarly, mentoring goes far beyond “coaching” a junior colleague on the performance of specific tasks and skills [6]. This latter function is often the complete extent of an aspiring academic clinician's interactions with their research supervisor or department chair. We found an interesting analogy (for anyone who has seen Star Wars) that nicely highlights this difference: “Yoda is a coach, teaching Luke how to use the Force, and Obi-Wan Kenobi is a mentor, showing him what it means to be a Jedi knight” [7].

Who are the targets for mentorship?

Much of the literature on mentorship focuses on targeting junior or new faculty members [8–10]. However, faculty at any stage in their career can benefit from it.³ A large qualitative study (moderate-quality evidence) of clinician researchers across two universities documented that senior (or established) faculty often feel that they are neglected and should have equitable access to mentors [11]. We also found a descriptive study of a mentorship program developed in a Department of Pediatrics at an academic medical centre that targeted mentorship activities not only to junior, but to mid-career and senior faculty [12]. Their survey of mid-career (associate professor level) department members found that respondents commonly wanted mentoring around the requirements and timelines for promotion, about how to redefine their careers, and how to network effectively (they were less interested in advice from mentors on how to transition to administrative positions) [12]. Senior faculty wanted mentoring around how to transition towards part-time opportunities and retirement, and on financial and succession planning. These results highlight that as a mentee's career progresses and evolves to take on different responsibilities or change career paths, different sorts of mentoring may be required. For example, a mentee's emerging interest in administration or education may require mentoring skills beyond those of their earlier clinician–scientist mentor.

In academic medicine, clinicians can have different career paths including those of a scientist, educator, or administrator, and having this career flexibility is one of the privileges and pleasures of academic medicine. Interestingly, surveys and qualitative literature (moderate-quality evidence) suggest that clinician investigators are both more likely to seek mentorship and more comfortable asking for it than are clinician educators [8–10]. This difference may be because clinician investigators have completed research training, are already used to having research supervisors, and are “primed” to seek the greater benefits of mentors. These studies also suggest that clinician educators are more likely to have difficulty with promotion than clinician scientists, raising the possibility of a causal relationship [8–10]. Throughout this book, we will identify differences in mentorship issues for each of these career paths whenever we find them in the literature.

What is the impact of mentorship?

Mentorship claims to develop and maintain faculty who are productive, satisfied, collegial, and socially responsible. However, not only are there no randomized trials of mentorship; we doubt we will ever see one, since it would be both methodologically and ethically challenging to randomize clinicians to either receive a mentor or be denied access to one.⁴ Accordingly, we based this section on the results from three systematic reviews of the literature [8–10], updated by more recent literature searches to the first week of March 2012. Studies of any design were eligible for inclusion, but the final selection was restricted to English-language reports targeting academic medical faculty.

Much of the evidence base is summarized in a quantitative systematic review that explored the impact of mentoring on career choices and academic advancement [8]. It included 42 articles describing 39 studies (34 of which were cross-sectional self-report surveys). A second systematic review of the qualitative literature on mentorship identified 9 relevant studies [9]. Since the publication of these reviews, we identified an additional 13 eligible studies:

• 7 surveys [13–19]
• 2 nested case control studies [20, 21]
• 1 uncontrolled before-and-after study [22]
• 1 case series [23]
• 2 qualitative studies [24, 25].

Most of the evidence base comes from cross-sectional surveys of academic clinicians who had or had not been previously mentored. The methodological shortcomings of such studies must be recognized. Specifically, if mentored academics are more successful in these observational studies, possible explanations for their success extend beyond mentoring, and include the possibility that they were destined to be stars from birth and therefore had a selection advantage in getting access to superior training programs that provided coincidental but unnecessary mentoring. And, the majority of the studies that we've found to date were done at a single site and didn't follow mentees' careers over a sufficiently long period of time.

Bearing these caveats in mind, there appear to be career- and life-benefits of mentorship to both mentors and mentees. We'll explore the benefits to mentees first:

1. Academic clinicians who got mentored reported greater career satisfaction [moderate quality evidence; 14–16, 22, 26]. Mentorship not only influences career choice [10, 24], it influences job satisfaction. For example, in a survey of faculty from 24 US medical schools, faculty members with mentors had significantly higher career-satisfaction scores (62.6 vs 59.5 on a 100-point scale, p < 0.003) than those without mentors [26]. Similarly, in a survey of gastroenterologists in the US, having a mentor was a predictor of job satisfaction (odds ratio of 2.32, p < 0.001) [15]. And, in a survey of mentors and mentees from t...

Table of contents

• Cover
• Title Page
• Copyright
• Acknowledgements
• Introduction
• Chapter 1: What is the evidence for mentorship?
• Chapter 2: What are the characteristics and behaviors of effective mentors and mentees?
• Chapter 3: How can you initiate mentorship?
• Chapter 4.1: Some effective mentoring strategies and tactics: Part 1: Mentorship meetings, priority setting, and time management
• Chapter 4.2: Some effective mentoring strategies and tactics: Part 2: Protecting mentees from “dys-opportunities”
• Chapter 4.3: Some effective mentoring strategies and tactics: Part 3: Mentoring for knowledge generation
• Chapter 4.4: Some effective mentoring strategies and tactics: Part 4: Mentoring for knowledge dissemination
• Chapter 4.5: Some effective mentoring strategies and tactics: Part 5: Mentoring for promotion, protection, and job prospects
• Chapter 5: How can you assess, diagnose, and treat mentorship that is in trouble?
• Chapter 6: How can you initiate and maintain a mentorship progam?
• Chapter 7: How can you evaluate the impact of a mentorship program?
• Chapter 8: How can you scale up and sustain a mentorship program?
• Index