Published in the May 2006 issue of Today’s Hospitalist
An essential part of medical training always has been the relationship between trainees and more senior physicians, but in recent years, the strains of increased clinical, research and administrative demands have made faculty less and less available to housestaff.
Without “mentors” “individuals who are separate and apart from supervisors “to help guide, advise, counsel, and sometimes just support them, residents often have no one to turn to during this stressful and difficult period of their training and development. That has some educators worried that with levels of burnout on the rise among residents, a lack of mentors may contribute to a generation of dissatisfied physicians.
On the other side of the equation, faculty who voluntarily throw themselves into the work of mentoring young physicians sometimes do so at peril to their own careers. The time they spend on this endeavor cuts into the limited amount available for the clinical, research or administrative efforts valued by tenure or promotion committees.
As the internists at Brigham and Women’s/Faulkner Hospital in Boston have shown, however, there is a solution. The hospital’s internal medicine department has developed a structured mentoring program that formalizes what is usually a casual relationship, one that gives attendings “credit” for mentoring the next generation of doctors.
A higher profile
The idea, explains Bruce D. Levy, MD, director of the medical residency program for academics and career development in the department of internal medicine, is simple. Raise the profile of mentoring so faculty consider it worth their while to devote some of their valuable time and energy “which they could otherwise be spending on direct clinical care, research or administration “to mentoring housestaff.
Dr. Levy notes that the time faculty spend building relationships with residents as mentors is largely uncompensated and often undervalued by institutions. And because many academic institutions base promotions on scholarship, not citizenship, activities like publishing and research often squeeze out mentoring.
To change all of that, the department of medicine at Brigham and Women’s has assigned a value to mentoring. Instead of going largely unnoticed by the department and remaining an “expected but unnoticed” job, mentoring can help raise a faculty member’s profile in the department. “We’ve tried to help people [who mentor residents] in their promotions as best we could,” Dr. Levy says.
As part of the program, which began in 2000, all faculty members report mentoring activities on annual self-evaluation form. They are encouraged to report their participation in the formal housestaff mentoring program on their curriculum vitae.
Mentors are acknowledged in a special grand rounds, and a faculty mentoring award is given each year in the department. (There is also a special award for senior residents who mentor medical students, interns and junior residents.)
The department also covers faculty expenses in the formal mentoring program, such as the costs of taking residents out for coffee, that faculty incur while meeting with their mentees.
The department has also put together a list of resources mentors can use to help guide residents through all kinds of situations, from mental health issues to housing needs. The goal is to help mentors cope with housestaff who unburden themselves to their mentors, sharing personal problems they might not want their program director to know about.
In studying the program at the end of the 2002-03 academic year, Dr. Levy and his colleagues found that 58 percent of the mentor-mentee pairs met at least twice a year, and 28 percent met more than four times a year.
Many communicate even more frequently by e-mail. When surveyed, housestaff say their assigned mentors were “helpful” 71 percent of the time and “available to help” 77 percent of the time. Currently, there are 180 residents and about 90 faculty participating in the program. All the faculty mentors are volunteers.
The types of problems and concerns that housestaff have tended to turn to their faculty mentors for help with range from clinical questions to career advice. For interns, Dr. Levy says, mentors seem to be most helpful with questions about priority setting, clinical acumen, and skills needed to survive training.
As training progresses, questions arise about difficult interactions with colleagues, nurses, patients and patients’ families. Senior residents tend to ask questions about leadership, teaching skills and their careers.
Good fit for hospitalists
Dr. Levy says that the hospital’s mentoring initiative can be particularly beneficial to hospitalists, who already tend to devote hours of time to this endeavor simply because they are present and available, but who tend not to receive academic credit for their efforts.
“A lot of the hospitalists here are really valued teachers, so there’s a natural attraction for residents and young physicians to want to work with them,” Dr. Levy says. “They’re wonderful as mentors. They’re very current because they’re on the wards so much. They understand the pressures that the housestaff are under. They know the pulse of a general medical service so they can know when it’s good to meet and what could be helpful.”
Given the natural combination of inclination and skill in mentoring, hospitalists have sometimes found themselves disadvantaged compared to some of their other faculty colleagues who tend not to interact with residents so much.
Dr. Levy says that the program is not intended to replace spontaneous mentoring relationships that may develop, but to augment them. “It got off the ground principally because all of the housestaff were not uniformly developing spontaneous mentoring pairings with faculty naturally,” he explains. “It just wasn’t happening.”
Since the formal mentoring program has been in operation, Dr. Levy adds, there seems to be more informal mentoring going on, too. “What we’re finding recently is a trend toward increasing the number of mentors that people accumulate,” he explains.
“By raising the profile of mentoring, the word gets around that it’s a fun activity,” he says. And although mentoring is not a formal requirement for advancement in the department, it can’t hurt.
While mentoring can be a rewarding activity in any workplace, Dr. Levy says, “in an academic center, it’s invaluable. Lifelong relationships emerge, and the experience helps to broaden faculty mentors’ view of the department of medicine and the training program and makes them more effective as an academic faculty member.”
Deborah Gesensway is a freelance writer who reports on U.S. health care from Toronto, Canada.