Mentoring Junior Faculty: Fostering Tomorrow’s Leaders

Despite these challenges, research also highlights the benefits of a productive mentoring relationship, including increased career satisfaction, improved networking and faster advancement, shared advice on work-life balance, improved clinical and research knowledge, modeling of leadership skills and much more. So who is responsible for ensuring early- and mid-career physicians have the opportunity to benefit from the guidance and support of a mentor? And how should the field of pediatrics best approach mentorship of junior faculty?

To delve into this topic further, we queried clinicians and scientists in pediatric hospitals and academic institutions around the country for their thoughts on the importance of mentoring and ideas about what the pediatrics field could do to strengthen these relationships. Their comments follow.

We encourage you to add your voice to the conversation and let us know what you think could be done to improve mentoring opportunities in pediatrics.

On Improving the Mentoring Experience

Q. How can the field of pediatrics improve the mentoring experience for medical students, residents and junior faculty?

One of my interests is in the training of surgical residents to become pediatric surgical specialists. In this regard, I think surgical residents have little prior training in pediatrics (usually one eight-week rotation in their third year of medical school) and are thrown into a pediatric surgical specialty service and told to “take care of them.” Conversely, pediatric trainees receive little training in common surgical diseases; this is reflected both in inappropriate referrals to surgeons for evaluation of disorders that don’t require evaluation, as well as a failure to recognize serious surgical issues and refer them. I have recommended that two curricula be established: one for surgical trainees and focused on general pediatric issues that everyone who cares for children should know, and one for pediatric trainees and focused on common surgical issues that pediatricians will face in practice. Additionally, I think surgical residents feel estranged from the children’s hospital, where they (and perhaps anesthesia and radiology residents) are the only “outsiders,” coming in as itinerants for short periods of time (usually months) before returning back to the adult world. This propagates an “us versus them” attitude wherein the children’s hospital staff (primarily nurses) feel they need to “protect the children” from the surgical residents. This is often exacerbated by poor behavior among surgical residents who view their interactions with parents and pediatric care providers as less than appealing (as determined in my study). Again, perhaps educating surgical residents about how to deal with families and children, and educating pediatric nurses about why surgical residents are stretched so thin (usually because they are covering so many patients on so many floors, even in many cases both a pediatric and adult service when on call) and why they might not therefore respond as readily as the pediatric resident who has responsibility only for their ward. Finding ways for surgical and pediatric residents and nurses to interact on a social level outside of patient care activities, perhaps a sponsored luncheon periodically, might allow each group to see the other in a different light and generate more good will. This might attract more trainees into pediatrics.

Mark Dias, MD
Professor of Neurosurgery and Pediatrics
Vice Chair of Neurosurgery and Director of Pediatric Neurosurgery
Penn State Children’s Hospital, Penn State College of Medicine

I personally believe that the difficulties faced in academic medicine with regards to mentoring will only be solved by a solution that is “out of the box.” Traditional attempts to build mentoring programs in academic medicine have met with limited success. A mentee is lucky to find someone who will invest in his or her career, and a good mentor is truly a generous individual (as to do a great job it takes a great deal of time). The Holy Grail of mentoring would be a program that is highly utilized by all faculty and one that demonstrates success utilizing clearly defined metrics. I personally think that we will need to look to the private sector and their experiences. There are a number of new and innovative mentoring programs out there that we at Nationwide Children’s are currently exploring. People in all aspects of business face similar issues and we need to take advantage of that knowledge.

On Mentoring Physician-Scientists

Q. What makes for a successful mentoring relationship for early-career physician-scientists?

Of course there are many factors, but some of the important ones include:

• Input of some energy and effort on the part of both mentor and mentee.
• Generally some relevance between the long-term interest of the mentor and mentee.
• A supervisor-supervisee relationship may be less desirable for mentor-mentee pairs.
• Mentees need to understand that many mentors have significant time constraints so they need to make their schedule fit with the mentor.

J. Philip Saul, MD
Physician-in-Chief, Nationwide Children’s Hospital
Chair, Department of Pediatrics
Associate Dean for Pediatrics and Translational Medicine
The Ohio State University College of Medicine

The elements are autonomy, mastery and purpose as Daniel Pink states in Drive, but I would add passion as well as compassion. If one spends time with the younger generation, then one understands them more.

Anthony C. Chang, MD, MBA, MPH
Medical Director, Heart Institute
Medical Director, Medical Intelligence and Innovation Institute
Children’s Hospital of Orange County

In my experience, I’ve found that it is very important to truly embed early-career physician scientists within the appropriate basic science group wherein they have their research interests. Having your lab in close proximity to and being surrounded by those working in complementary or related areas as well as using methodologies, approaches and instrumentation needed by the physician-scientist for their own research project/program brings immeasurable value to the experience. Moreover, having the opportunity for the early career physician-scientist to regularly engage in informal discussion with colleagues and/or get instant feedback when troubleshooting is truly important to helping these individuals get launched successfully onto their own forward and independent career path.

Lauren O. Bakaletz, PhD
Vice President of Basic Sciences, The Research Institute
Director, Center for Microbial Pathogenesis
Nationwide Children’s Hospital

Q. What lessons could the medical field learn from the mentorship models in research?

The medical field has a huge advantage when it comes to research. The physician-scientist is in an optimal position to recognize problems at the bedside and to bring these problems to the research lab in order to find new therapies. However, in order for physician-scientists to be in a position to be able to do research, their mentors on the medical side of things need to support them. These mentors are often division directors and department heads that are running the clinical side of things. Time in the research lab means time away from the clinical side of things, which translates to decreased patient-generated revenue at the bedside which typically cannot be compensated for by the research funding that a young investigator might generate.

Gail E. Besner, MD
H. William Clatworthy Professor of Pediatric Surgery
Chief, Department of Pediatric Surgery
Principal Investigator, Center for Perinatal Research
Director, Pediatric Surgery Training Program
Nationwide Children’s Hospital

The first lesson is that at least at the more junior levels (medical student, intern/resident, new faculty or new practitioner), everyone should have a mentor formally designated for them. Ideally, the individual should seek out the person who is best for them, but if that’s not possible then the medical school or the department should assign someone in that role. Your mentor does not have to be the same person as your formally designated faculty advisor, and in some places those two people must be different. We generally do a good job of assigning a research mentor to subspecialty fellows, since they have to complete a research project as part of their training, but assigning a clinical mentor is also a good idea. In research, every graduate student has a faculty advisor and a chair of their thesis committee (not necessarily the same person), and every postdoctoral fellow has an established investigator who is responsible for giving the fellow every opportunity to progress. This mentoring model would work just as well in a private practice as in an academic center. In this era, most pediatricians are in group practice, and I suspect it already happens that the more senior members of the group regularly provide support, guidance and instruction to the younger members.

Another thing that’s done in research is to establish benchmarks of what accomplishments are expected of the trainee and by what time. The trainee meets regularly with the mentor to review progress and work out solutions for any problems that may arise along the way. This is something easily adapted to medical training.

A third thing to stress is teaching young physicians how to teach themselves. This is nothing new — when I was a first year medical student over 35 years ago, one of the first things I was told is that half of what I’d learn would be proven wrong within seven years, but the problem is that nobody knew which half! So we learned of the need to keep ourselves up to date. Unfortunately, I think at the time, those were just empty words because much of what we learned was told to us. Back then, the 100-hour workweeks we endured didn’t help — most of us were just too tired to take the time and energy to evaluate critically the literature on the conditions we saw, even if we were lucky enough to have the training to do that. We were happy when the faculty just told us what to do so we could move on to the next problem and get to bed a little earlier. In research, the faculty may ask the trainee a question, and perhaps might provide the trainee with a reference to get started, but the trainee is expected to find out the rest by themselves. Now that student, resident and fellows’ duty time is limited, the hope is that people beginning their medical career won’t be so chronically tired and will be more able to think critically about the things they do, if provided the opportunity to do that.

On that note, some curricula provide training on evidence-based medicine during the basic science time. I’m not sure that’s the best time for it, because at that point the students may not see the relevance. Assuming there are distinct basic science and clinical rotation blocks (and curricula are changing in this regard), training students in how to evaluate the literature, and how to educate themselves in the future, is probably best done during the clinical years, because that’s the time students will find it most relevant.

Mark A. Klebanoff, MD
Director, Ohio Perinatal Research Network
Principal Investigator, Center for Perinatal Research
Outstanding Mentor in Clinical Research, 2014 Award Recipient
Nationwide Children’s Hospital

On the Structure of Mentoring Programs

Q. How can health care institutions structure mentorship programs to best encourage relationships between junior and senior faculty?

Young physician-scientists must be supported by their mentors. All too often, the department chair of a young investigator who receives a K award from the NIH, rather than being elated, is almost upset, since this translates to decreased overall revenue for the department. This attitude needs to completely change. Young scientists must be encouraged and supported in their early careers. They should be assigned research mentors that can guide and advise them and edit their abstracts, manuscripts and grant submissions prior to submission. They should be available to meet with their mentees regularly. Importantly, young investigators should be incentivized in such a way that recognizes and rewards the important contributions that they bring to the department in the areas of basic science, clinical, translational, outcomes and quality improvement research.

Gail E. Besner, MD

Perhaps weekend retreats similar to the 2014 Congenital Cardiology Group (CCG) Innovation Summit where everyone has time to mentor. The CCG was for cardiologists but could easily be [adapted] for all pediatric subspecialists.

Anthony C. Chang, MD, MBA, MPH

I think having a morning or noon talk on the value of mentorship, encouraging the use of a web-based matching program (like we are trying to develop through the American Academy of Pediatrics’ Section on Young Physicians and Sections on Medical Students, Residents and Fellowship Trainees), and checking in with participants to assure they are getting what they need, could be very helpful.

Ashley Miller, MD
Chair, American Academy of Pediatrics Section on Young Physicians
Physician, New London Pediatric Care Center

It’s important to have expectations around mentoring both for the mentors and mentees. The most important factor is that every new and junior faculty member establish a mentoring relationship for career development, institutional onboarding and personal development and issues. Then the institution needs to have a mechanism to track these relationships and their outcomes. At Nationwide Children’s, we are currently investigating software programs that facilitate these functions in addition to providing a matching system, not unlike online social matching systems. The matching system identifies a set of top choices based on a relatively small set of parameters input by the mentors and mentees. Then the system can be set up to require a set of steps each mentor-mentee pair should go through, and finally allows for tracking and reporting of groups and individuals.

J. Philip Saul, MD

On Preparing Faculty to Be Mentors

Q. How could pediatric teaching hospitals better prepare residents and attending physicians to be mentors throughout their careers?

I think that during residency and the early years of clinical practice there is far too little emphasis and education/training about how to mentor. Most residents simply pick it up by osmosis from their own mentors. This is unfortunately an incredibly inconsistent way to train the next generation of clinicians and scientists, especially in an era of increasing subspecialty training where mentors are few and mentoring abilities quite variable.

I also think that more time should be afforded faculty (or perhaps to a subset of faculty) who are willing to devote additional time to teaching, again particularly among subspecialists. Surgeons, and pediatric surgical specialists in particular, are driven both within and by their institutions and departments to produce (meaning patient care clinical activities such as operating and clinic). Teaching is an afterthought in many institutions and is largely didactic, done sporadically, and often not done very well. Although objective outcomes measures have been proposed during the last decade, most faculty don’t have time to formally assess residents’ competence in these measures — most often there is simply a faculty gestalt of a resident’s performance and it is difficult to find the time to assess trainees’ formal performance measures. Medical students often spend two weeks on subspecialty rotations where they may rotate with each faculty for a few hours at a time; interactions are brief, harried and leave little time for either teaching or knowledge assessment. I find myself at the end of a rotation asking the residents what they think about the student’s performance since I have little information from which to make an honest assessment. Having additional time to truly teach and mentor would be a bonus, but I suspect this will never happen as long as money drives the equation in medical care and clinicians’ time is increasingly spent running like a hamster in a wheel to collect Relative Value Units.

Mark Dias, MD

Mentoring is not an intuitive skill for the majority of individuals. As a matter of fact, I think that is why people tend to shy away from it. Mentoring is not easy. There does need to be formal training in this regard. The problem, however, is that we work in a very busy environment, and direct patient care issues are and should be a priority. Finding time for training and mentoring can be extremely problematic. I truly believe that academic medicine loses many extremely talented individuals each year as a result of poor mentoring. When people are not successful, they move on. We need to ensure that people are given the resources they need to be successful, and one of those resources is access to talented senior individuals who can show them the ropes.

Linda H. Cripe, MD

Demonstrating good mentoring relationships, as well as discussion about what mentoring is and its values, could be very helpful.

Ashley Miller, MD

Just as the best lessons in how to be a good parent are learned by having had good parents during our childhood, the best way to learn to be a good mentor is to have had good mentors early in our careers. Perhaps another way would be for academic pediatric hospitals to make mentoring part of the training of young physicians. Interns and residents could be expected to take on mentoring a medical student interested in a career in pediatrics (under faculty supervision, of course), specialty fellows could be expected to mentor interns and residents, etc. Let’s not forget that mentors aren’t just born, they are also made, and so we can have lecture series and short courses in how to be a good mentor, as well as how to be a good mentee.

Finally (and this is a problem on both the clinical and research sides), we really ought to give mentoring the academic recognition it deserves. Being a good mentor takes both emotional investment and time — and time spent mentoring is time not available to write grants, write papers and see patients. So if someone is a very active mentor, a risk is that at their annual review their division or center director will say something like “You’ve spent all that time mentoring. How nice! Now let’s talk about writing grants, writing papers and/or generating clinical income.” Faculty are definitely not stupid — they see what really gets rewarded and learn that mentoring is just like any other “service” in that you do just enough mentoring to stay out of trouble but not so much that it takes up a lot of your time. So if we really value mentoring in both clinical medicine and research, we ought to put our money where our mouths are in terms of recognizing it.

Mark A. Klebanoff, MD

There could be “mentoring the mentors” type of sessions at meetings as well as in the hospital. One almost never sees that anymore in the busy day to day of pediatric subspecialists.

Anthony C. Chang, MD, MBA, MPH

Again, expectations are a part of the process, but developing a set of guidelines by which mentor-mentee pairs come up with a mentoring plan that has pre-set characteristics can be very helpful. For residents, it is critical that the training program has very well defined mentoring expectations for the relevant faculty, and doesn’t just leave things up to chance.

J. Philip Saul, MD

On Finding a Mentor

Q. Where does finding a mentor fit into the typical young physician’s educational and career plan?

Mentors were very important during my medical school and residency training. In medical school I thought I wanted to be a pediatrician, but I wasn’t sure. I had a wonderful woman who encouraged me to get involved in the Family Medicine Interest Group, and because of her I became involved in clinical research, spoke at a national conference and had a great family medicine clerkship rotation. It has been many years since I have worked closely with her, but about six months ago, she contacted me and asked me to be part of the Community Preceptors Education Board at our local medical school. I was thrilled, and again, have been involved in things my career wouldn’t necessarily have taken me towards naturally.

In residency I had several mentors, those that were involved in advocacy, those who helped me choose my first practice, and even those who just supported me through residency emotionally. These people all were very important in helping me become who I am today.

Early in my career, it was harder to determine who those mentors were going to be to fill my residency mentors’ roles. My research mentor is someone I know through the national level, as are those in my advocacy path. However, locally I have found some great folks who have been practicing for quite a while, one to walk me through the business side of things and another to help me figure out how to be the best doctor I can but still be an employee and keep life fun.

All of my mentors have been “unofficial.” We weren’t matched through a program, and no one said, “Hey, can I mentor you?” I was lucky enough to just fall into these relationships. I hope some of the students I have taught during the last few years could also consider me a mentor, and I’m excited to join a more established mentorship program, which the Section on Young Physicians (SOYP) and Sections on Medical Students, Residents and Fellowship Trainees (SOMSRFT) are working on.

Ashley Miller, MD

Q. Do hospital residency programs do enough to provide residents with mentors in the pediatrics field?

From the residents I have talked to, it does not appear that many residency programs have formal mentorship programs, and it is more left up to the resident to decide if they need a mentor and to search one out. Most programs have advisors, but these tend to be people who are just assigned to a resident with little thought or knowledge of shared interests.

Ashley Miller, MD

References:

1. Binkley PF, Brod HC. Mentorship in an academic medical center. The American Journal of Medicine. 2013 Nov;126(11):1022-5. Epub 2013 Sep 24.
2. Cornfield DN, Lane R, Abman SH. Creation and retention of the next generation of physician-scientists for child health research. Journal of the American Medical Association. 2013;309(17):1781-1782.
3. Dias MS, Sussman JS, Durham S, Iantosca MR. Perceived benefits and barriers to a career in pediatric neurosurgery: a survey of neurosurgical residents. Journal of Neurosurgy, Pediatrics. 2013 Nov;12(5):422-33. Epub 2013 Aug 30.
4. Kashiwagi DT, Varkey P, Cook DA. Mentoring programs for physicians in academic medicine: a systematic review. Academic Medicine. 2013 Jul;88(7):1029-37.
5. Ragsdale JR, Vaughn LM, Klein M. Characterizing the adequacy, effectiveness, and barriers related to research mentorship among junior pediatric hospitalists and general pediatricians at a large academic institution. Hospital Pediatrics. 2014 Mar;4(2):93-8.