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Mentorship During Fellowship: A Real-World Experience

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Ashish K.Khanna, MD, FCCP, FCCM; Piyush Mathur, MD, FCCM,

Mentorship programs have a proven and well-established benefit for professional development. In 2018, the Society of Critical Care Medicine’s (SCCM) Postgraduate and Fellowship Education Committee surveyed 1,157 SCCM members who self-identified as program directors. The survey contained 25 multiple-choice questions using skip logic. The response rate was about 12% (134 responses). Almost all respondents were from universities or university-affiliated institutions. As shared at the Fellowship Program Directors Luncheon at SCCM’s 48th Annual Critical Care Congress, most of the surveyed critical care fellowship programs have an informal mentorship process but only 25% reported a formal structure. And importantly, at least half of all respondents reported that, despite the perceived and proven benefits, mentoring efforts were not recognized at their institutions.

A unique mentorship model is one that is based on understanding benefits and shortcomings of the process from both the mentor’s and mentee’s perspectives. An example is the process started at Cleveland Clinic, where a tradition of mentorship existed for some decades within the anesthesia critical care fellowship. In 2016, a formal mentorship program was initiated, with an effort to link mentorship goals to the Accreditation Council for Graduate Medical Education’s (ACGME) anesthesiology critical care milestones for the fellowship. Other value-added components, such as professional development or job search assistance, would remain with the ongoing formal or informal structure. Appropriate leads were appointed to run this mentorship program, which would cover ten anesthesiology critical care fellows every year. 

The initial process of selecting each mentor-mentee pair was based on a random pairing of fellows to faculty, with the option to change if needed. Education was provided to both fellows and faculty on expectations from the mentorship program and milestones set by ACGME. A minimum expectation was at least one monthly meeting between the faculty mentor and the fellow mentee.

Also, combined with the mentorship program was biannual feedback delivered by the program director to the fellows. In turn, fellows had the onus of recommending an action plan for areas deemed as needing improvement during their mentorship.

Most training programs have a process of formal or informal mentorship in place. This is not the challenge. The real challenge should focus on understanding whether the process is truly making a difference in outcomes. This starts from something as simple as mentor-mentee meetings. Do they meet? How often do they meet? Does the mentee feel intimidated by the mentor? Does the mentee have access to the mentor beyond assigned formal meetings? Is enough time allotted to each meeting? And most importantly, do mentors and mentees have specific goals of discussion for their meetings?

At Cleveland Clinic the success of the mentorship program was measured through a biannual survey, delivered at mid-year and at academic year end. This 10-question survey was linked to the impact of the mentorship program on defined ACGME milestones and had a response rate of 100%. Key results demonstrated that fellows valued a formal mentorship program more than faculty, though faculty perception improved as the academic year progressed. The highest impact of the mentorship program was demonstrated to be on milestones linked to professionalism and communication. This was consistent among both fellows and faculty. Here was a prime example of the impact of a structured mentorship program in supporting improvement of soft skills, which are not as much a focus in most educational programs compared to medical knowledge and procedural skills.

procedural skills. Having a formal mentorship program is important for continuous improvement in any educational program. This does not mean that the informal structure is not important; it should certainly remain an important supplementary support. Certainly, some of the best career development and support ideas are generated during mentorship on the fly—at meetings over coffee or breakfast, chance meetings in the hallway, talking to folks from other institutions who are perceived as role models, and last but not least, appropriate wisdom from mentors from other disciplines. In a similar vein, Cleveland Clinic had a unique tradition of interaction of senior and junior faculty over coffee every morning before clinical rounds. This tradition helped junior faculty ask questions, understand the culture, and develop skills essential to the process of running a successful service.

Measurement of data to change or supplement educational strategies is important. Clearly, the more formalized process of mentorship should not end when fellowship ends. Long-term impact and follow-up after graduation are important components that need to be built for most fellowship programs. It is hoped that the mentor and mentee stay connected one way or another even after the mentee leaves the institution. The professional growth and personal happiness of the mentee should gratify the mentor, and the availability of someone to whom he/she can ask a question should always be beneficial to a mentee. And most importantly, the relationship should be an enduring tribute to a more formal process that started during fellowship.