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Strategies for Building an Effective Mentoring Relationship

Hilary Sanfey, MB. BCh. MHPE. FACS – Southern Illinois University Springfield, IL
Celeste Hollands, MD, FACS, FAAP –
St. John’s Hospital, Springfield, IL
Nancy L. Gantt, MD, FACS –
Northeast Ohio Medical University, Youngstown, OH

Nancy L. Gantt, MD FACS
Professor of Surgery, Northeast Ohio Medical University
St. Elizabeth Health Center
1044 Belmont Ave.
Youngstown, OH 44501
Tel: 330-480-5910 Fax: 330-480-3640

This paper is submitted as part of the Career Development Resource prepared by the Association of Women Surgeons

Short Summary for Table of Contents and Abstract

Mentoring has been recognized as a critical aspect of the professional and/or personal development of the student, resident and faculty member. This career development resource discusses strategies for building effective mentoring relationships and outlines some of the challenges to contemporary mentoring.

The first account of a mentoring relationship can be traced back to The Odyssey of Homer, when the goddess Pallas Athena assumed the form of a family friend, Mentor, to support Odysseus’ son Telemachus.1 The term mentoring is used to describe an activity in which a more senior or experienced person who has earned respect and power within their field takes a more junior or less experienced person (known as a mentee or protege) under their wing to teach, encourage and ensure their success. This career development resource will discuss the types of mentoring relationships and the mentorship process. In addition, choosing a mentor, the responsibilities of the mentee and mentor and challenges to contemporary mentoring will be reviewed.

There is a wealth of literature in support of the benefit of mentorship to career advancement. An early mentor reference regarding surgical training indicates that Halsted’s residency system intended to “produce not only surgeons, but surgeons of the highest type, men who will stimulate the first youths of our country to study surgery and to devote their energies and their lives to raising the standard of surgical science.”2 Halsted could never have envisioned the challenges faced by surgeons today, including ever-advancing technology, on-line social networking, multidisciplinary team-based approaches, outcome assessments, and financial and regulatory challenges. Contemporary surgeons reflect the gender and ethnic diversity of the population,3 and need to be coached to excel in the more rigid and homogeneous surgical culture.

Although there are no randomized controlled trials, the literature shows that mentored individuals are promoted earlier4-6 and are more likely to publish.7 They also are more likely to follow initial career goals,8 and enjoy greater career satisfaction compared with individuals without a mentor.9,10 Conversely, lack of a mentor is frequently cited as the greatest deficiency in career development particularly among women.11

How to Choose a Mentor and Develop a Mentoring Relationship

A mentoring relationship may begin serendipitously from a common interest or goal. One partner will generally take the initiative to formalize the relationship. At the onset, the mentee needs to have clear goals; is the priority finding someone to help with basic science research, finding a job, achieve work-life balance or overcome political obstacles? It is equally important for the mentee to appreciate their own personal work style, strengths and weaknesses. Generally the mentor should be an individual who is at least a step (or two) ahead of where the mentee hopes to be professionally. They should be approachable, available and enthusiastic with good interpersonal skills. Other desirable attributes are dependent on the level of the mentee’s professional training.

One way to initiate a mentoring relationship is to begin by asking for specific advice and then assess whether or not the relationship is likely to be fruitful in the long term. A personal fit is important since differences in values can seriously undermine a mentoring relationship. Successful mentoring relationships have an altruistic mentor with both significant mentoring experience and an extensive professional network.12 Qualities of the successful relationship include honesty, active listening, flexibility, reciprocity, mutual respect, a personal connection and shared values.

In seeking a mentor, medical students should familiarize themselves with the faculty (and residents) in their institution by researching departmental Websites and talking to other students. It is helpful to evaluate the potential mentor’s interactions with peers and medical students during teaching conferences or on rounds. When selecting a career mentor, residents should also take into consideration the reputation of the faculty member at a national level, track records of former mentees, areas of expertise and research opportunities.

Faculty may need to have more than one mentor as it is difficult to find a single individual in the mentee’s area of interest who is an outstanding teacher, clinician and researcher with the additional time to be a mentor. The mentee will likely need to develop multiple mentoring relationships over the course of their career in order to be successful. The workaholic mentor without any personal life may be a great research advisor but not be someone to emulate for life-balance. Mentors need not be at one’s home institution. For example, a mentor for overall career development may be a senior surgeon that is in a position of power or leadership at the mentee’s local institution while a mentor for advancement within the mentee’s specialty may be a more senior surgeon outside the institution. Choosing a mentor from outside the mentee’s department is acceptable and may be an advantage in establishing interdepartmental projects. Mentors can also be leaders in the community that have achieved success in an area aspired to, such as community service or fund-raising.

Gender is often a consideration when mentoring relationships are being developed, especially since there is a shortage of female surgical mentors.13 The literature has produced conflicting results with some research suggesting that men are overall less effective career sponsors for women than female mentors.14 Other evidence suggests that mentors of either gender are equally effective in counseling women about career advancement.7,15 Same-gender role models may be more effective at providing advice and encouragement in issues relating to work-life balance. While the literature does not provide clear evidence on specific gender advantages, it does show that in general women are more likely to perceive the lack of mentors as a barrier.7

With more people seeking out mentors at the beginning of their careers, some medical institutions are stepping up efforts to enhance faculty development opportunities by targeting professionals often marginalized from the traditional tenure-track environment. These are predominately junior (and often female) faculty with heavy clinical loads, moderate to heavy teaching responsibilities and little time for scholarly activities.16 Some institutions follow a business model of formal mentor assignment. Others adopt a more random informal approach or combine the two by identifying pools of potential mentors and mentees allowing each to select their own mentoring partners.

The formal or institutionally assigned roles customarily assume the relationship to be a strictly professional one: the senior person ensures that the junior person completes institutional requirements and is progressing appropriately in his or her field of study.17 Formal national programs include the Drexel Executive Leadership in Academic Medicine program,18 Junior Faculty Empowerment Program at Hershey19 and the American College of Surgeons and Association of Women Surgeons mentoring program for Early Career Women Faculty.20

Informal mentoring relationships are more likely to involve a personal element since informal mentors are often role models for integrating professional and personal responsibilities.21 It has been demonstrated that mentees with informal mentors demonstrated superior career development, higher incomes and more promotions than those with only formal mentors. 9,22

Other forms of mentoring, such as co-mentoring23, “mosaic mentoring”24, a “collaborative” framework of mentoring (also called peer-group mentoring)24 and long-distance mentoring can be successful when clear roles and goals are established for each mentor relationship. The differences between the initiation, structure, duration and process of the mentoring relationship can impact its outcome. If nurtured, however, all models can be successful.

The Mentorship Process

Mentors should set aside an hour for the first meeting with a mentee. Prior to the first meeting, the mentor should obtain a copy of the mentee’s curriculum vitae, grades and evaluations, where appropriate. Generally medical students who ask a surgeon to serve as their mentor are interested in pursuing a career in surgery. In order to give appropriate guidance the mentor must be familiar with the medical school class curriculum, know which courses are mandatory or optional and appreciate the policy on fourth year and “away” electives. The National Residency Match Program Website25 has a number of resources that are useful in advising medical students about their specialty choices.

Prior to meeting with a resident mentee for the first time, the mentor should familiarize themselves with the institutional or departmental policies on parental leave, moonlighting and grievances in addition to the Accreditation Council for Graduate Medical Education requirements for their specialty.26

If the mentee is a member of the faculty, the mentor should review the mentee’s official job description to ensure that the expectations of the mentor, mentee and chair are aligned. If possible, information should be gathered on clinical productivity to identify problem areas that might require intervention. Finally, the mentor should review the institution’s promotion and tenure guidelines.

The purpose of the first meeting is to get to know each other and set some ground rules including a commitment to confidentiality and to a regular meeting time. Expectations should be established about what each expects to gain and contribute to the relationship. Goals and priorities should be identified, with an appropriate timeline. Goals could be categorized as personal, clinical, education, research, and financial but will need to be flexible as priorities and opportunities will change with time.27 There are many ways in which a mentor can guide the mentee. The mentor should ensure that a mentee is on committees, a member of relevant professional organizations and acquires additional skills that will aid career development. In addition it may be beneficial if the mentor can facilitate invitations to social functions and assist in forming professional relationships in the institution and at a national level. A mentor can also provide guidance in identifying research opportunities to fund medical student or resident attendance at national meetings such as the American College of Surgeons Resident and Medical Student Programs28 and identify awards for outstanding residents or medical students that will advance their careers.28,29 Faculty should be encouraged to start a promotion portfolio and to ensure that they will meet the appropriate criteria for their academic track and rank.

Responsibilities of the Mentee

The mentoring relationship is one of collaboration that should ultimately benefit both parties. Therefore mentees should demonstrate eagerness to learn, flexibility and an understanding of the mentor’s demanding schedule.30 Mentees should be prompt for all appointments, and respect the time and effort the mentor is investing on their behalf. They should attend meetings prepared with lists of topics for discussion including timelines for projects. Open and honest communication is essential and the mentee should be open to feedback and critique. The mentee should become an active participant in their own future by developing a professional support network within and outside their institution.27 They should participate in the activities of professional organizations both locally and nationally. Furthermore, mentees should request visible leadership roles and learn how to promote themselves without alienating others. Finally mentees should ensure that they deliver, and deliver well, the tasks entrusted to them.30

A mentor is a unique individual who is a combination of friend, colleague and more. As such a mentee may witness private moments when the mentor lets her or his guard down and the mentee should show loyalty and maintain confidentiality. Although some mentor mentee relationships develop into long-lasting friendships, the relationship is, foremost, a professional one.

Responsibilities of the Mentor

Mentoring is like parenting in many ways: just as good parenting skills are essential for the upbringing of future generations of children so skills in mentoring are essential for developing future surgical leaders, educators and role models. Similar to parenting mentoring requires an investment of time, energy, and emotional resources. Mentors serve the dual function of guiding professional and personal development. They are essential in assisting individuals to make successful transitions such as from student to resident or resident to junior faculty.

Mentors support the professional development of mentees in multiple ways. They ensure that mentees achieve academic milestones. Mentors also contribute to the personal development of mentees by promoting their integration into the social environment of the workplace and assisting them in forming professional relationships that may lead to future collaboration. Mentors can also protect a mentee from excessive institutional demands, provide guidance in navigating institutional politics and give advice on which requests are “career-enhancing” or “career-killing.” A good mentor will encourage and demonstrate confidence in a mentee, ensure a supportive environment, and provide frequent feedback.

Effective mentors balance support with challenge by providing opportunities and setting positive expectations.31 A student may require active prompting and occasionally even pushing to encourage success while more senior mentees may need less direction to achieve their goals. Deciding which mentorship style is appropriate can be extrapolated from the Hersey Blanchard work on Situational Leadership whereby leadership styles are divided into categories depending on the ability and motivation of the mentee.32 The amount of direction necessary for the mentor to provide will depend on the development level of the mentee and the task at hand.

A mentor makes a long-term commitment to further the professional and personal development of the mentee. Over time the perceptions of both members of the relationship will change as the mentee’s performance evolves to new levels of competence under the mentor’s guidance and support. In all cases the mentor must respect the mentee and act responsibly as the wrong advice could destroy a mentee’s academic career. In this regard it is important to make sure that advice is current and appropriate. Mentors must also maintain cultural and gender sensitivity towards the mentee and respect confidentiality. Finally, mentors should be generous with credit and never see their mentee as a threat. It is worth emphasizing that imaginative, creative ideas often come from more junior colleagues. As with others we teach, we want to see our students reach beyond us and our mentee’s success is ultimately our success.19

Challenges to Effective Mentoring

Contemporary mentoring presents challenges not faced previously by academic medicine’s current leaders, most of whom were “groomed” by someone who looked, thought and acted just like them. The homogeneity of senior faculty contrasts sharply with the heterogeneity of young faculty, many of whom present priorities and values unfamiliar to their potential mentors. Given the rapidly changing complexities of medicine and career pathways, advice applicable even five years ago may no longer be helpful.24 Since child bearing is often a priority in early years after residency for women they may have a different career trajectory and a later professional peak.33 Similarly, men may desire paternity leave and a more flexible schedule when starting a family. Mentors may need to assist mentees in the development of novel career pathways. Challenges may also arise because of the intensity of mentoring relationships and the potential for misunderstandings; one example might be cross-race and/or cross-gender relationships where a mentor may have trouble identifying with the mentee or vice versa. Finally, generational differences can significantly alter the mentoring relationship. Effective mentoring for generation X (born from the early 1960’s to the early 1980’s) and millennials or Generation Y (born early 1980’s to early 2000’s) present additional challenges.34,35

A mentee may not successfully meet agreed-upon goals because of personal difficulties or external problems. The most common problems are time constraints, lack of research funds, or infrastructure. With assistance and guidance the mentee should learn to readjust priorities and say “no” to those distracting tasks that are not helpful towards advancement. A mentor can help a mentee explore the option of outside grants from professional specialty organizations and industry or make an introduction to a colleague to improve the strength of a proposal.36 It may be possible to “borrow” a colleague’s resources in exchange for the mentee’s expertise. Unhelpful or obstructive colleagues can be the most challenging problem. Occasionally it may be necessary for the mentor to facilitate negotiation on behalf of a mentee to resolve a conflict. There are instances when a mentee will need to follow different paths to seek advice and/or resolution depending on their institution and position. For example, medical students may seek advice from a representative of the Dean of Student Affairs, residents likely have an ombudsman through the GME office, and faculty would seek the counsel of their institution’s Human Resources department for advice on relevant institutional grievance policies.

Some mentee problems may overstep the boundaries of the usual mentor-mentee relationships. Mentees may develop clinical depression; have personality disorders, substance abuse or academic issues. Mentors should recognize when they are unable to resolve such problems and should refer challenged mentees to their primary care physician or suggest consultation with specialists such as study counselors or psychologists. Mentors are not expected to take on roles in which they do not have expert skills.

Mentoring relationships mature toward an end in a number of ways: mentees graduate, change jobs and/or need someone with different expertise. Both mentor and mentee should appreciate that as the relationship evolves, and the mentee progresses along his or her career path, his or her needs may change in a direction that leads them away from the mentor. This can be perceived as an awkward time for both but it should be regarded positively as evidence of the success of the mentoring relationship.

A more difficult situation is when a mentee encounters a bad mentor and needs to unilaterally terminate the relationship. The bad mentor may misinterpret the mentee’s potential, fail to define appropriate professional and personal limits, or even take credit for the mentee’s work. Competition between mentors and mentees can be a major contributor to a failed relationship.12 Other qualities of the bad mentor include inappropriate praise or criticism, disregard for the mentee’s opinions, and unethical and, rarely, immoral behavior. Major negative qualities include exploitation, secrecy, and dishonesty. The mentee will very carefully need to seek the advice of a more senior colleague, possibly at a different institution, and may need the advice of multiple colleagues to effectively manage ending an ineffective mentoring relationship. Care should be taken to gain the trust of the colleague the mentee seeks advice from while maintaining professionalism with regards to the issues of concern.

Mentoring is essential to the complex professional and personal development of the contemporary surgeon. While the process can be challenging, and expectations as outlined are significant on both sides, both mentor and mentee may derive great benefit from the relationship. A mentor has the opportunity to leave a part of themselves in everyone they mentor. Long after they have retired from the world of grants, publications, students and patients, their work will still be going on in those they have guided.1


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