Formal mentoring is making a comeback in medicine.
Dr. Duncan Shrewsbury, an academic general practice (GP) resident in the United Kingdom, told Medical News Today that he gained a "fantastic" GP mentor after a placement at a general practice as a medical student.
"One life-changing example was when I was really struggling with what career to choose - pediatrics or general practice. I really loved my time in pediatrics but I'd become very unhappy working in the hospital."
Dr. Shrewsbury had recently bought a house with his husband and was mindful that pediatrics training could require him to rotate through different hospitals in the region, which he was unwilling to do; it would have been difficult for them as a couple.
"I got an email from [my mentor] saying, 'how are you, I haven't heard from you for a while.'" The timing couldn't have been better.
He explained to her that his experience with hospital colleagues had led him to believe that general practice was not a good option for someone with ambition and academic aspirations. "My consultant said he wouldn't give me a reference [for GP training] because it would be a waste."
Although "it would have been really tempting" for his GP mentor to tell him to go into general practice, he says that she was very impartial.
"She said, 'What would your ideal future look like?' She got me talking about whose perspective things were important from - thinking about what my husband might want and what hypothecated future might match that."
After their discussion, Dr. Shrewsbury decided to start GP training.
He had already begun a Ph.D. in medical education, which he found was "perfectly suited" to his GP work. He's almost completed his training now, is involved with the Royal College of General Practitioners in the U.K., and combines his academic post with general practice.
Mentoring in the 21st century
"Until the latter part of the 20th century, academic medicine was characterized by intense, almost formal mentoring relationships," Lara Goitein, M.D., a pulmonologist from New Mexico, told MNT.
Dr. Goitein recently published a Viewpoint article in JAMA Internal Medicine with her mother, Marcia Angell, M.D., in which they discussed the changes in medical education and practice that they have seen between the two different generations.
Dr. Goitein explained that in the past, "senior physician scientists would explicitly dedicate themselves to the cultivation of particular trainees, and the accomplishments of those trainees were taken as the success of the mentors. Physicians like Osler and Longscope in internal medicine, Halsted and De Witt Lewis in surgery, and Williams in obstetrics were famous mentors."
However, during her training in internal medicine, her experience was that "these close, long-term, explicit mentoring relationships were no longer the norm."
She attributes this to the high-pressure environment on the wards, the high turnover of patients, and the demands of balancing research and clinical duties for faculty.
Yet, she said that "mentoring still exists, even if not as commonly as in earlier generations in medicine, and even if more diffused and less formal."
A recent comment in The Lancet criticizes the lack of formal mentoring during most residency programs in the United States.
But the authors point to evidence supporting that "those with mentors make more informed career decisions, are more productive, experience less burnout, and have an improved sense of well-being."
Dr. Mott Blair - a family doctor in Wallace, NC, and member of the board of directors of the American Academy of Family Physicians (AAFP) - has mentored younger doctors and students both formally and informally through the North Carolina branch of the AAFP.
"Don't be shy" about asking, he said. The AAFP can help to find local mentors.
Dr. Shrewsbury recommended looking for someone whose opinion you value if you cannot find a mentor through your school or alumni network.
"If you just ask them - 'I could do with a bit of advice and help, can we have a cup of tea?' - they do generally jump at the opportunity."
There are some potential pitfalls for both mentors and mentees to be aware of. It is important to set ground rules at the start of the relationship, so that you know how best to contact your mentor and what support you can expect from them.
A study in Academic Medicine outlined what mentors want from their mentees:
- Actively listen and be open to feedback.
- Be respectful of your mentor's time.
- Come to meetings prepared with list of topics, action items, and timelines.
On the flip side, this is what mentees said that they want from their mentors:
- Provide career guidance.
- Create opportunities and open doors.
- Be honest about potential pitfalls.
- Provide emotional support.
- Help to reflect on work-life balance.
Ask yourself what you want to gain from your relationship with your mentor. "It's not all about career guidance," said Dr. Shrewsbury, who trains mentors himself. Personal circumstances can be just as important.
"The questions can be about where your life is going. I have developed mentoring for people going through issues around sexuality and identity," he explained.
By setting the ground rules, you can both know what to expect.
What makes a good mentor?
"It's not dissimilar to being a good GP," said Prof. Maureen Baker, former chair of the Royal College of General Practitioners in the U.K. Being a "good listener" is at the top of the list of skills.
Mentorship is about more than sticking to agreed meeting schedules and following a list of guidelines; it is about finding the right person for you to connect with who will support you through your individual journey.
"[He took] me on as a research assistant when he was president of the Association of American Medical Colleges," Dr. Goitein said of her mentor Robert Petersdorf, M.D, a prominent infectious disease specialist.
"Dr. Petersdorf had trained in the mid 20th century and carried that generation's focus on mentoring. He took the time to teach me a tremendous amount about health policy, writing, and, I would say, diplomacy. He also gave me guidance in my early career choices, and I have no doubt, helped to open many important opportunities for me."
Every mentor will have their own style. Dr. Shrewsbury is cautious about being too directive. "I try to resist giving specific advice," he explained.
He aims to "facilitate the process" of people finding their own answers. "It's easy to [say] 'you should do this and that's what I did when I was your age.' It won't be necessarily right for them. If they generate their own action plan, it's more suited to them."
When Dr. Shrewsbury was struggling with his own career decision, his mentor "gently challenged" some of his assumptions, such as that academia would be incompatible with general practice, or that it was not challenging enough.
"Rather than saying 'that's rubbish,' she'd ask me 'Do you really think that's right?' She picked up on my passion [for general practice] and created space for me to realise that's what I love, and who cares if somebody else thinks it's not a very good career?"
Benefits not only early career physicians
The focus of mentorship is often during the formative years of training, during medical school and residency. But mentoring isn't just about career choices.
Dr. Blair had a built-in mentor from childhood: his father, who was also a family doctor. "When you finish your medical training there's still a lot to be learned. He mentored us all his life - my other two siblings went into medicine, too. We learned a whole lot and it started at a very early age."
He's very aware that not all doctors have such an advantage, saying, "I think medicine is something we pass to the next generation. I would not be in the position I am if I'd not had good mentors. There's satisfaction in paying it forward." Even in his 50s, Dr. Blair says he "values the knowledge and wisdom that people older than [him] have the benefit of."
"It does change over time," he acknowledged. "Your needs are very different than when you are younger."
Prof. Baker agreed. "I think some things change. The ability to be able to talk something through with a trusted colleague is the same regardless of what point in your career [you are at]. Other things change with your level of experience [...] and options available."
"It's really good to speak to someone who does understand where you're coming from and provides a listening ear, but is also objective. They're not your best friend or your husband or partner in the [clinic]," she explained.
Finding your own mentor may not be plain sailing, and it might take time to find the right person. You may find yourself with a mentor who just doesn't do it for you. But remember the ground rules: be open, be respectful, and know what you want from this relationship.
"I've had many moments where I struggled to work out what to do, and might have decided to leave medicine altogether, had I not had fantastic support from key mentors along the way."
Dr. Duncan Shrewsbury