ASRA Pain Medicine Update

Mentorship is widely regarded as a necessity in medical training. Literature suggests that trainees with a mentor gain assistance on career choice, professional development, and productivity; however, current literature does not provide guidance on qualities of effective mentorship.^[1] A survey of Canadian anesthesiology residency programs revealed that 94% of residents feel that mentorship is important during training and 54% of residency training programs have formal mentorship programs. However, of the 74% of residents who identified having at least one mentor, 42% did not interact regularly with that mentor.^[2]

The most successful protégés are not content with one sponsor. Throughout their careers, they scan the horizon for leaders who either embody their values or value their strengths.

In formal mentorship programs, a new resident is assigned a faculty mentor; in less formal processes, residents seek out faculty with similar research or clinical interests. Although a formally assigned mentor can be helpful, especially when initiating training at a new hospital, many people feel that the most meaningful mentorship comes from working with a senior physician who has shared interests or background. This helps promote effective communication and increases the likelihood of spending significant and meaningful time together. The best mentors are energized and excited about their own work and accomplished in their own careers.

Also, residents may seek out different mentors for different aspects of training: research, career development, clinical practice, and personal wellness. Although some mentor-mentee relationships work best if strictly defined, others may evolve loosely and change over time based on the needs of the mentee or mentor.

Perspectives from Mentors

We interviewed three attending anesthesiologists about their experiences as mentors and mentees to learn from their perspectives.

Dr. Tim Lamer, American Academy of Pain Medicine president-elect and Mayo Clinic department of pain medicine consultant, stated, “When I was beginning my pain medicine career, it was a relatively new specialty. It was absolutely essential, and I was very fortunate to have excellent colleagues and mentors to really help get me started both academically and clinically. The value of those individuals to me emphasized the critical importance of role models and mentors and inspired me to give back by striving to be a good teacher, mentor, and role model as well. And, as it turns out, I have benefited more than my trainees and mentees over the years. Teaching, advising, and mentoring students and trainees has been one of the most rewarding components of my career. It is extremely gratifying to watch young physicians learn, grow, gain confidence, and ultimately become successful physicians and individuals. And it is both an honor and very humbling to, year after year, have the privilege of working with and learning from the bright, talented students and trainees that come through our program. I know I have learned more from them than I have been able to give back to them.”

When asked about the benefits of mentorship, Dr. Rebecca Johnson, consultant in the department of anesthesiology at Mayo Clinic, said, “Based on the literature, physicians with strong mentors are more productive, publish more articles, have more confidence in their abilities among their peers, and report greater perceived success and career satisfaction than those physicians without mentors. Strong mentoring relationships have been of benefit to me not only leading me to subspecialty selection in regional anesthesia but also providing me with various scholarly opportunities. I would cite lack of mentorship as a reason why career progression may be hindered for some. Good mentorship is difficult to find, and mentees can and likely need more than one mentor. Specific mentorship in different focus areas (eg, research, education, clinical practice) from multiple sources provides a mentee with more than one point of view and does not indicate failure on the part of the primary mentor.“

Finally, Dr. Susan Moeschler, consultant and fellowship director in the Mayo Clinic department of pain medicine, described mentorship as “important for guidance, feedback, and a perspective from experience to foresee opportunities and challenges ahead. As a mentor, it is crucial to help guide mentees to the right track that will work for them to pursue their areas of interest and not just your areas of interest. There should be a mutual agreement on meeting frequency or expectations for joint publications. The relationship can be a loose process, as well, depending on the needs of both parties and if for only a one-time, brief exchange.”

How to Maintain a Mentor-Mentee Relationship

Obtaining a mentor is just the beginning. The relationship must be consistently nurtured and periodically refreshed—tasks that largely fall to the junior player. Successful protégés understand that sustaining sponsorship looks a lot like earning it. And they find ways to support a mentor’s passion or help build his or her legacy outside of the organization. The most successful protégés are not content with one sponsor. Throughout their careers, they scan the horizon for leaders who either embody their values or value their strengths.^[3] There should also be mutual respect and clear expectations from both parties.

Perspectives from Mentees

Personally, each one of us has had a tremendous experience in our lives with mentorship as well. Dr. E. Morgan Pollard shared: “I have been lucky to develop some wonderful mentor-mentee relationships during my residency. The key for me has been to find attending physicians who have shared interests, both professionally and personally. Working with a wide variety of consultants has given me the opportunity to find mentors I click with. In my experience, sharing commonalities makes forming a mentor-mentee relationship more of a natural occurrence than setting up formal mentorship programs and assigning mentors and mentees. I have found it especially helpful to identify mentors who teach to my learning style. I have gravitated toward mentors in pain and regional who go over regional anatomy on three-dimensional models, textbooks, radiologic imaging, and even mobile apps prior to performing the block together. I also find the most helpful feedback to be given with the help of a similar visual aid. Conversely, when the feedback is entirely verbal, I often have a more difficult time understanding how to improve. In both regional anesthesia and pain medicine, hand-eye coordination is an important skill to acquire. I’ve found that both the teaching and previously mentioned feedback strategies have best helped me improve my hand-eye coordination, but all residents learn differently, and it is important to be taught by a wide variety of attending physicians to help identify personal learning strategies as well as mentors.”

Dr. Thomas Zouki says, “For me, mentorship has been at the foundation of my success and progression in the medical field. Medical school was a very intimidating environment. Everyone around me appeared so brilliant and polished, and I found myself plagued with self-doubt. Fortunately, I found a mentor, Dr. Iliou, who was my anatomy and pharmacology teacher. Dr. Iliou constantly encouraged me and reassured me. His positive reinforcement, along with excellent teaching and guidance, gave me a lot of confidence and motivation to maintain the hard work. Dr. Iliou was a retired anesthesiologist and pain physician. The countless anecdotes and incidents related to the field he discussed with me helped develop my interests for anesthesiology and pain medicine. Dr. Iliou was visibly passionate about the field of medicine: he taught the daily subject with enthusiasm and was very interested in students who were also passionate about the subjects, especially students who were engaged in class and inquisitive. He showed mentorship by closely following up with me, encouraging me by acknowledging my efforts, and challenging me to advance further. Good qualities of my other mentors have been those showing compassion, honesty, and willingness to give constructive feedback. As a mentee, I must also be willing to be open to constructive criticism for personal development.

“I believe that for mentorship to be successful, the mentor and the mentee must connect on a personal level. The mentor must see qualities as well as flaws in the mentee appropriate to his or her training level. A mentor needs to be personally connected, as well as emotionally engaged in the mentee’s success. I believe that failed mentorship comes from a forced mentor-mentee association in two individuals who do not share a common goal, which can ultimately lead to a lack of interest in mentorship from both parties.”

Poonam Pai, BH, MBBS, MS, added: “My chair has had a huge influence on me professionally as well as personally since the beginning of my residency. She helped me improve on my weaknesses while endorsing my strengths. She has been pivotal in matching my skill set with the opportunities available and promoting them. I am very grateful and humbled. Being an expert in the field of regional anesthesia, she made learning the basic anatomy and mastering the hand-eye coordination look so easy that I was instantly attracted to the subspecialty. I remember reading a picture on the cover page of a reputable journal as an intern which quoted ‘Is the needle mightier than the blade?’ I understood the real meaning behind those powerful words only after my regional anesthesia rotation, and I subsequently considered regional anesthesia as a subspecialty of my interest. My mentor would go over how to arrive at the ideal anatomic ultrasound image by sequential stepwise scanning methods either in the operating room or during resident workshops held during didactic teaching sessions. She reinforced the important points, for example, needle visualization before advancement, by constantly saying, “Show me the needle,” and her words are engraved in my mind even now when I’m performing the block in her absence. If approached with queries about techniques, she never hesitated to teach by scanning herself or showing me the video with the original description, not to mention instantly emailing me the journal article for further reading. Our discussions usually ended with updates from the literature which reiterated the importance of research and evidence-based medicine. I am now very excited about my career in regional anesthesia and the endless opportunities that come along with it.”

References:

1. Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296:1103–1115. https://doi.org/10.1001/jama.296.9.1103
2. Zakus P, Gelb AW, Flexman AM. A survey of mentorship among Canadian anesthesiology residents. Can J Anesth. 2015;62:972–978. https://doi.org/10.1007/s12630-015-0418-8
3. Hewlett SA, Marshall M, Sherbin L. The relationship you need to get right. Harvard Business Review. 2011. https://hbr.org/2011/10/the-relationship-you-need-to-get-right. Accessed December 17, 2018.