12. Resident mentorship

Introduction

In Greek mythology, Mentor was the person to whom Odysseus entrusted his son Telemachus as he went off to fight in the Trojan War. His hope was that Mentor would guide and support Telemachus in his development and in facing the various challenges that came his way, as Odysseus could not be there to fulfill this role. The modern use of the term “mentor” became established through the business literature in the 1980s, and the concept and its application have been progressively imported into the academic world. Mentorship is now recognized as an invaluable adjunct in the development of health professionals, both while they are learners and as they progress to become faculty members. Your position as a program director (PD) places you in an important mentorship role with the residents in your program. To make the most of mentorship, it is important that you understand the benefits of mentorship for your residents and your program, the types of mentorship that exist and the various models by which mentorship can be provided.

Mentorship is not a “one-size-fits-all” concept. A mentorship relationship should ideally be based on a genuine interpersonal connection between mentor and mentee. Mentorship can be viewed as a journey of personal and professional development on which the mentor and mentee embark together; the relationship will evolve over time, depending on the needs of the resident as dictated by their current career or life stage. This chapter will describe the various types of support that can be provided through mentorship, the benefits of mentorship and the pros and cons of some of the models of mentorship. It will conclude with some tips on how you can make the most of mentorship in your program.

Review of the landscape

If you are a new PD, it will be important to learn about the mentorship opportunities that are currently in place in your program. For example, some programs have formal mentorship programs where residents are matched with a particular faculty member to have discussions about careers, some have research mentors and some have peer mentors. It is particularly important to find out what will be expected of you as the PD in terms of your role as a mentor.

Types of support

Mentorship has been recognized as being invaluable in the development of physicians. Even for established physicians, mentorship is increasingly being recognized as helping to enhance productivity, decrease burnout and create a sense of belonging and engagement that fosters vitality. Mentorship can take the form of instrumental, psychosocial or sponsorship support.

Instrumental support focuses on helping the mentee gain the skills and knowledge that are essential for successful work performance. In residency training, day-to-day teaching around clinical knowledge and skills is an obvious form of instrumental support, but a mentor who has a longitudinal relationship with their mentee can also help the mentee to develop their competency in the intrinsic CanMEDS Roles that are so essential to our professional practice. Having a trusted sounding board with whom to discuss issues related to the development of communication or collaboration skills can sometimes be more important for our trainees and the patients for whom they care than having a mentor who will simply focus on helping them to gain more medical expert knowledge. Mentorship around the development of the Scholar Role is also invaluable. It is standard practice for trainees who are interested in research to have a mentor who will help them to get their research career off the ground, but it is valuable for mentors to help all residents to enhance or develop a scholarly approach to their daily work. Finally, as highlighted in the case scenario, instrumental support also involves mentorship around the procedural knowledge that makes training and practice so much easier, which comes with experience: who to talk with to get things done, the quirks of the institutional culture or practices, the educational or clinical resources felt to be most useful, and so on. It is not always PDs who must provide this information, but it is essential that they know where to direct their residents to gain it; sometimes it is most useful to pair junior trainees with a near-peer resident.

Psychosocial support is personal support, encouragement and advice that may focus on relationships or work–life balance. This is often the type of support that comes to mind when people think of mentorship. Of the three types of mentorship support, psychosocial support is often the one that requires the most trust and openness between mentor and mentee, and it is richest when there is a genuine interpersonal “click” or fit. As a result, it is often the type of support that is hardest to achieve when formal mentorship programs pair people in an almost random fashion (see the discussion below about formal versus informal mentorship models). Residents may share personal and professional uncertainties, stresses and challenges, and they need to feel that they are doing so in a safe and nonjudgmental environment, with someone they trust truly has their best interests at heart (mentee-centred approach). In many circumstances, the PD may provide this type of support. Recognizing the very personal nature of psychosocial support is important, and understanding how this plays into situations where mentors might be in a supervisory or evaluative role is essential, especially for PDs. It is also important to recognize that sometimes the residents who most need this kind of support are the very ones whose personalities are such that they would not seek out a mentor themselves.  As PD your role may be to provide that mentorship or help them to find a mentor who would be a good fit, which would require some exploratory conversations with the resident. You may wish to  explore if the resident would like to receive support from a mentor with shared lived experience.   In the case scenario at the start of this chapter, the PD has clearly created an atmosphere in which the resident feels comfortable voicing his concerns.

The third type of support, sponsorship, involves active advocacy that champions the resident for opportunities within the institution and the profession and provides access to the mentor’s network of professional contacts. Mentors who provide sponsorship help residents to become full “members” of the profession by introducing them to people with whom they can collaborate or from whom they can actively learn a new skill. Sponsorship also helps residents to explore an area of medicine they might not have considered or understand a practice profile they might enjoy. This type of support helps residents to select the type of practice they think will be most satisfying, get the position they hope to have and advance their academic interests meaningfully. Sponsorship can be achieved through things like providing individual introductions, suggesting that the resident be invited to become a member of a particular committee, or advocating on their behalf with letters of support or verbal discussions. For example, in the case scenario, the PD could connect the resident with a colleague who is doing research in an area of interest to the resident. In programs that have a faculty member dedicated to overseeing the scholarly activities of the residents in the program, the PD’s primary role in terms of sponsorship would be to ensure that the resident is set up with a meeting with this person.

Benefits

As you can imagine from the various types of support mentorship can offer, residents can benefit in various ways. The literature shows that mentees benefit in the following ways:

• individual recognition, encouragement and support;
• increased self-esteem and confidence in dealing with others;
• confidence to challenge themselves to achieve new goals and explore alternatives;
• realistic perspective on the workplace and learning setting;
• advice on how to balance work and other responsibilities;
• support in setting priorities;
• knowledge of workplace do’s and don’ts;
• networking;
• increased productivity;
• increased satisfaction (personal and professional);
• decreased burnout;
• guided self-reflection; and
• “experiential learning once-removed” (the ability to learn from others’ experience, particularly for high-stakes issues where a “mistake” could be costly in terms of time, career development or personal satisfaction).

What is less commonly recognized is that mentorship relationships also benefit the mentor and the institution. Benefits to mentors often include the following:

• satisfaction in helping a junior colleague reach their academic and professional goals,
• enhanced professional recognition,
• increased self-confidence and self-esteem,
• enhanced career satisfaction,
• rejuvenation of creative energy, and
• value in the annual performance review and promotion.

Institutions that support mentoring relationships can also benefit because mentorship:

• helps with recruitment and retention;
• strengthens individuals, which strengthens the department and institution as whole;
• provides a way to pass on common values and approaches; and
• creates a sense of community and bridges gaps.

Mentoring models

There are various models of mentoring relationships that you as a PD can consider when looking to foster mentorship for your residents. Knowing the strengths and weakness of each model can be helpful when you are implementing mentorship opportunities in your program.

• Hierarchical versus peer: Most people picture mentors in a residency training program as more senior, experienced physicians who will guide and support residents using the wisdom they have accrued through experience. This is the most traditional view of mentorship. However, although the benefit of experience in some circumstances cannot be overstated, and more senior often means more “power” to help, it should be recognized that hierarchical relationships often have an inherent power differential that may impede truly honest discussions and disclosures. This is particularly the case if the mentor will be in an evaluative position with respect to the resident mentee during their training. As a result, in certain circumstances, a peer or near-peer model of mentorship may be more appropriate; the assumption is that even residents who are at a similar stage of training have had different experiences and have learned different things and can therefore still help their peers or near-peers with some issues. They are also more able to understand the mentee’s current realities because they are living them or have just lived them and can therefore share practical tips and tools and commiserate.
• Dyad versus group: Although a pair of people is the most typical format of mentoring relationships, group mentoring can be useful when there are insufficient numbers of people to act as mentors. In this case a single mentor can act as group facilitator, encouraging peer-to-peer support, as well as mentor in the more traditional sense. This model can also attenuate the effect of the power differential as there is a certain safety in numbers. Theoretically these groups can be entirely peer led so that resident peers each have an opportunity to facilitate the group and learn different skills in doing so.
• Formal versus informal mentoring: One of the key ingredients to a successful mentoring relationship is the fit and trust between mentor and mentee. In more informal mentorship, often a resident’s admiration and respect for a faculty member’s competence and capacity to provide support and guidance will lead them to seek this person out as their mentor. A potential mentor may in turn recognize that a resident has potential, is coachable and is enjoyable to work with. This type of relationship develops informally and requires an element of serendipity and recognition of opportunities for mentorship. However, it often starts with positive expectations and intrinsically has that “fit” that is so key to success. Unfortunately, many times the very residents who need mentors the most may not have the personality to seek them out, or there is an expectation that the program provides mentorship, and for these reasons, many programs have developed formal mentorship programs. In formal mentorship programs, there are often growing pains before residents and mentors find commonality and develop an easy relationship, because they are assigned to each other rather than finding each other through an organic process. If personality fit is lacking, it can be a deal-breaker. Some programs have addressed this issue by assigning a mentor to each trainee in their first year of residency but allowing (and often expecting) mentors and mentees to form new pairings in subsequent years with no hard feelings, as relationships between various faculty members and residents build and as residents’ career aspirations crystalize.

The concept of multiple mentoring is also important. It is rare that a single mentor can provide mentorship on all aspects of a mentee’s personal and professional development at all phases of their life and career. As a result, residents often develop several mentoring relationships (sequentially, overlapping or simultaneously) to address different needs. This is appropriate and in fact should be encouraged. As a PD, you will very likely be one of these important mentors.

Conclusion

Mentorship is hugely beneficial for residents’ professional development and well-being. It is also beneficial for faculty members and has been shown to help bring groups together and foster more collegial environments. Although it may be easy for you as a PD to naturally take on that role, and to a certain extent the PD position does include mentoring, it may be beneficial to both your program’s residents and faculty members to explore additional mentorship opportunities. A better understanding of the benefits, models and potential pitfalls of mentorship will allow you to develop a process that better suits the needs of your residents, taking into account your existing training and institutional structures and the availability of potential mentors.

Further reading

1. Boillat M, Elizov M. Peer coaching and mentoring. Chap. 8. In Y Steinert, editor. Faculty development in the health professions: a focus on research and practice. New York (NY): Springer; 2014.
2. Kram KE. Phases of the mentor relationship. Acad Manage J. 1983;26(4):608–662.
3. Johnson WB. The intentional mentor: strategies and guidelines for the practice of mentoring. Prof Psychol. 2002;33(1):88–96.
4. Pololi L, Knight S. Mentoring faculty in academic medicine: A new paradigm? J Gen Intern Med. 2005;20:866–870.
5. Ramani S, Gruppen L, Krajic Kachur E. Twelve tips for developing effective mentors Med Teach. 2006;28(5):404–408.
6. Taherian K, Shekarchian M. Mentoring for doctors. Do its benefits outweigh its disadvantages? Med Teach. 2008;30:e95–e99.