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SCCM Pod-499: Is Mentorship Obsolete in Our Modern Healthcare Environment?

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Mentorship has been instrumental within critical care in the transfer of specialized knowledge and expertise. Critical care practitioners have leaned on mentorship to acquire not only technical skills but also clinical decision-making abilities that come with experience. But is mentorship a thing of the past or a necessity for the future of healthcare? Host Kyle B. Enfield, MD, FCCM, is joined by Lewis J. Kaplan, MD, FACS, FCCP, FCCM, and Kenneth E. Remy, MD, MHSc, MSCI, FCCM, to discuss whether mentorship is obsolete in our modern healthcare environment. The information discussed in this podcast was provided by the Society of Critical Care Medicine’s Leadership, Empowerment, and Development (LEAD) Committee.

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Dr. Enfield: Hello and welcome to the Society of Critical Care Medicine Podcast. I’m your host, Kyle Enfield. Today I’m joined by Dr. Lewis J. Kaplan, MD, FACS, FCCP, FCCM, and Dr. Kenneth E. Remy, MD, MHSc, MSCI, FCCM, to discuss the role of mentorship in our modern healthcare environment. My question to them: Is mentorship obsolete in our modern healthcare environment? We’ll be talking about both perspectives of the mentor-mentee relationship and how to succeed in filling those roles.

Dr. Kaplan is a general trauma and critical care surgeon in the Perelman School of Medicine at the University of Pennsylvania, who serves as the section chief of surgical critical care at the VA Medical Center in Philadelphia, Pennsylvania. He is also a professor of surgery in the Perelman School of Medicine at the University of Pennsylvania and served as the president of SCCM from 2020 to 2021. Dr. Remy is an associate professor of medicine, pediatrics, biochemistry, and pathology at Case Western Reserve University at the University Hospital of Cleveland in Cleveland, Ohio. He is also the Ellery Sedgwick, Jr. Chair and Distinguished Scientist in Cardiovascular Research. Welcome, Dr. Kaplan and Dr. Remy. Before we start, do you have any disclosures to report?

Dr. Kaplan: I do not.

Dr. Remy: I have no relevant disclosures.

Dr. Enfield: Ken, since this is maybe a new concept to some of the SCCM leaders and listeners, do you think that you could briefly describe what the LEAD project is?

Dr. Remy: Absolutely. LEAD in SCCM is a newer program over the last couple years. It stands for Leadership, Empowerment, and Development Program. It’s meant to try to increase confidence, to make leaders more well-rounded, to increase the efficiency of the ICU, improve performance, and achieve better patient outcomes. It’s multidisciplinary. It uses things at the annual Congress to improve upon skill sets and new tools in your toolbox, if you will, to be able to improve your leadership skill set. Really, it’s a great way, I think, to enhance how we’re improving outcomes for patients via this structure.

Dr. Kaplan: But more than that, Ken, it fills a gap. SCCM is an education society. We’re known for that. Yet when you look at our educational programming over the 50 years that we’ve been running, we didn’t do one thing. We didn’t do very focused professional development that helps people who are becoming fellowship directors or ICU directors or they’re going to lead a division or they now own a particular committee. We didn’t teach them how to do that. The very notion of professional development as another arm of the society spurred the LEAD Program development, and it really fills a gap that we’ve had for half a century.

Dr. Enfield: My question for both of you is the topic of this podcast, which is: Is mentorship obsolete in our modern healthcare environment? Maybe Ken can lead off there.

Dr. Remy: I think it’s a great question, and I would strongly say that not only is it not obsolete, it’s probably more needed now than in previous days. I say that because there are a lot of challenges facing those in the ICU, depending on what their discipline is. I think that there are unique opportunities with just the breadth of what it’s like to be a practitioner, to be a researcher in this field, to be a quality improver, to be in an area with persons who don’t work in data science. There are just so many different things pulling at you.

To be able to be successful, to maintain a strong focus in an area, to be able to move the field forward in, I think, a meaningful way, the only way to really do that is to work through people who have been tried and true in this profession, who understand where it’s been, and can help you understand where you want to take it. I think that if there’s ever been a time for having really strong mentor-mentee relationships, the certain present time is important.

Dr. Kaplan: I’ll certainly agree with that, but I will add something else to it. We use the term mentorship in a very encompassing fashion. Yet there are many different pieces that flow into that. The breadth of things that are called mentorship is something that we should discuss because you do need it, and I will add that mentorship in all of its different forms was how everyone learned professional development before LEAD so they are complementary and most certainly not obsolete.

Dr. Enfield: Ken, I think you had some questions for Lew today. Maybe we can start there.

Dr. Remy: Dr. Kaplan, I do have some questions. You’ve been in the field for a long time now; where do you think the importance of mentoring sits? Then, number two, could you explain a little bit from your experiences of the differences between what a mentor-mentee relationship is as compared to, say, an advocate or a sponsor or an advisor role, and how those fit as we currently move forward in the field?

Dr. Kaplan: The question is germane, despite the fact that you very nicely called me old, which I appreciate. We say mentorship, but we don’t always mean mentorship. We sometimes mean that you’ve had an advisor, someone who has helped you understand what you should do next and place it in context for you, but that may be the limit of that relationship. We’ve all had coaches, people who have taught us how to do something in a very technical fashion, whether it’s endoscopy or suture or even how to manipulate the electronic health record. That person is task focused and they do the same thing for lots of people; it’s not really unique to you.

Then there’s mentorship, and this is something that’s very different. Mentorship is something that evolves and it grows all on its own. The mentor and the mentee must each find something of merit and worth in the other. While it sounds like it’s a very hierarchical relationship, and it does start that way, its growth is anything but. It becomes very bidirectional. There are gross differences between mentors and coaches and advisors, and we’ll get to sponsors in a moment, but that mentor-mentee relationship is a durable one. It spans residency or fellowship, and it grows during your professional career, regardless of where you happen to go.

I have several different mentors in different spaces, different fields, and for different aspects of my career, but those are measured in decades of duration, not weeks or months of a particular rotation. Along the way, as you develop your mentor-mentee relationship, the mentor often acts as a sponsor. They help promote what you do and in many different spaces. You don’t have to ask for this sponsorship, it is simply provided for you. Sometimes you ask for it. You might need a letter of recommendation and that mentor that you’ve developed with knows you better than anyone else and therefore provides sponsorship.

These kinds of different relationships that we group under the heading of mentor really serve different functions throughout different aspects of your career. Certainly, Ken, you mentioned being a researcher as opposed to being an intensivist at the bedside. You may need a very different mentor for that kind of activity. Therefore, the development of a mentor-mentee relationship becomes singularly helpful because the mentor asks you to think about things through a series of questions quite commonly differently from how you previously thought about it. You get to explore different kinds of notions or different approaches. You get to reevaluate what your professional growth is like, but also, and this becomes key, and it goes right back to what you said, you’re pulled in so many directions, you’re also invited to explore the personal side of your development.

That mentor-mentee relationship is one that helps maintain balance because with all the things that we do, we’re often unbalanced. You can’t turn around without finding some other well-being or holistic approach to whatever it happens to be. Quite frankly, noon yoga with everyone else isn’t really a viable option for maintaining my well-being, but a 20-minute phone call on my drive home with one of my mentors can be very restorative. It’s absolutely essential. I think everyone needs at least one; some need more. You may develop them at different points in time in your career. I certainly did. Two of the mentors that I developed really helped launch me into leadership within SCCM. There are many different roles. They’re quite important and will span your entire career.

Dr. Remy: Dr. Kaplan, that’s fantastic. Have you had experiences in your career with attempting to navigate mentors outside of our profession? If so, why and how have you navigated such?

Dr. Kaplan: Oh, absolutely. When I was at Yale, I became a civilian police surgeon embedded in a special response team. How you function in that space, law enforcement, is in some ways similar, but in other ways, very fundamentally different from how you function within medicine. Therefore I needed a mentor to help deal with how you deal with police officers. Now, mind you, these are my police officers, even though I’m no longer in Connecticut. I view them in that way because of the bond and relationship that we developed, but I didn’t know how to do that initially. So I sat down with the chief of police and said, “Tell me about your people.” We set this up over coffee. There were no donuts. There were muffins. You had to have something with donuts with police.

It became a recurrent meeting. We did that every Sunday at 8:00 when I was not on service and on call, and that person, who started really as a bit of an advisor with a little bit of coaching, became a mentor. I keep in touch with him on a regular basis also to this day. It’s different. A lot of it happens outside of work hours and a lot of the medicine mentor-mentee dynamics occur within work hours. It teaches you how to do it differently, but it’s very rewarding.

Dr. Remy: That’s really interesting. Understanding the diversity of the different types of mentors you’ve had over the many years, I’m curious to understand: Do you think it’s incumbent to have a formalized procedure for mentors and mentees, and then certainly, obviously, an informal or less formal structure? Some folks, I think, may or may not understand when it’s best to have both.

Dr. Kaplan: It depends upon your perspective. I think there should be a formal advising structure. Our fellows come to your institution, they have no idea who anybody is or how to do things, and they need to be linked with someone. That makes perfect sense. It also allows the advisor to keep track in a formal sort of way of what kinds of decisions their advisee is making.

But mentorship, I think, is much more organic and making it a formal thing sometimes forces it. These kinds of things happen on their own, I think, in the best way. It is useful to have a formal way to track the activities of mentors because there is some community service aspect or I don’t know how it will be identified in different institutions, but these are formal activities and they do take time. Being able to track that and give the mentor credit for that time, that becomes important. These are academic as well as personal activities. I don’t like really the informal side of mentor-mentee tracking. I like the formal credit piece of it. I like the formal advisee-advisor kind of structure. That’s my personal bias.

Dr. Remy: Yeah. There’s some universality, I think, to successful mentor-mentee relationships, and we can certainly get involved in some of those different traits and attributes that certainly lend itself toward more success. Would you be willing to share an experience with you as a mentor where perhaps it was unsuccessful? And what do you think led toward that unsuccessful mentor-mentee relationship?

Dr. Kaplan: Sure. Not all relationships work. That is most certain. We know that from our daily lives. But when you’re involved in a mentor-mentee relationship, you have this expectation that this is it, it is great, it’s always going to be good, and you have to stay in it. Well, that is simply not true, and it often happens as a result of changing priorities. One of my mentees simply was deeply embedded in pursuing a surgical career, got into surgical residency. We had a relationship that evolved and then his perspectives changed, his dynamic changed, what he wanted to do changed. I no longer became the right person to help guide him. I was the right person to help him explore why he was unhappy in surgery and that he should change his career. But once that happened, we’ve remained friendly, but I don’t have the same kind of relationship and I shouldn’t have the same kind of relationship because what he needed was not what I could provide.

There are other relationships that end in a somewhat acrimonious fashion. Often the mentor will suggest something that the mentee finds to be absolutely not useful for them. Therefore, once you have one of those bad experiences, everything else can get viewed through that same lens, and that’s okay, because the mentor changes, the mentee changes, and it needs to change in parallel so that there’s give and take for both. At some point, the mentee ends up advising the mentor and asking the same questions: Perhaps you should think about this. Have you considered that? If you can’t do that, that’s not a relationship in which you need to stay.

Dr. Enfield: Okay. I just want to jump in here and ask a question on my own. You’ve talked a lot about mentorships from the standpoint of the young faculty member, young person looking upward. But finding myself in the mid-career area of life, what are your recommendations to those people who are in the middle of their career to finding and establishing new mentorship?

Dr. Kaplan: Determine your need. With what are you struggling? Is there someone whom you’ve bonded with or with whom you resonate or perhaps you admire and whom you can talk to about the things with which you’re struggling? That often drives the identification of a new mentor. At the mid-career phase, you often can do that outside your own institution. We all travel for medical meetings and other kinds of venues and you find people there. A lot of what you need in mid-career can be achieved by Zoom or Teams or phone calls or just periodic meetings at medical professional meetings because you all go to the same kinds of ones. That’s fine.

It is so much easier earlier in your career to have someone right there, you can walk down the hall, or to the other side of the hospital or, if you’re at Duke, you take a bus across the campus to go find them. Then you can sit down face to face. Later in your career, you may not need that as much. Certainly, I’ve developed mid-career mentors for different kinds of things, and that’s great. You end up sometimes with a collection of mentors in and outside the same profession. I have some in surgery, some in anesthesia, one in emergency medicine, one who’s just in research, one in law enforcement. I’m not atypical, but people often don’t talk about the diversity of their mentors. But they all share one really important common characteristic. They can listen, and they can ask good questions as a result of what they’ve heard.

Dr. Remy: I think Dr. Kaplan’s points are poignant, and I think what’s really interesting to your question is, we’re certainly in a time where I mentioned earlier about being pulled in lots of different directions. Certainly in our field, we’ve heard the word burnout and folks having dissatisfaction in their career and I think that there’s a fundamental need for individuals to start thinking about, What makes my job as a physician, physician scientist, nurse, respiratory therapist, satisfying? And if it’s not satisfying, how can I get to where it is satisfying?

To be able to do that, you’ve got to be honest with yourself and start to think about, Do you want to increase your own self-worth? Do you want to find where you want to go? And that takes, What is that need, as he mentioned. I think that’s the hardest thing for people to realize, is that they do need something, and what they need is, first and foremost, to look introspectively, and then look outward at a myriad of different people, I think, who could be truly helpful in their career development, regardless of where they are and their stage.

I think that once you can identify what that need is, as mentioned, then you just have to say, “I’m going to be selfish because I’m going to go seek those people out who are going to be able to help me, at least guide me.” It may be very active and it may be at times less active but I think it all is incumbent upon the mentee to first and foremost be invested in themself and then realize that they’re going to go find someone who’s willing to invest their time as a volunteer to assist them and their career goals.

Dr. Kaplan: Dr. Remy, it sounds like you’ve started down the pathway of identifying key characteristics of being a good mentee, if I hear you correctly. If that’s the case, can you elaborate upon what else you need to bring, other than just being willing to be introspective and figure out what you really need?

Dr. Remy: Absolutely. I think this is a great question because certainly this is, as mentioned, a bidirectional relationship. I think the first thing, or first and foremost, is you have to be realistic with yourself. As you mentioned about the need, I think the need is important, but you’ve also got to understand that you’re willing to actually utilize someone else’s volunteer time to help assist you. As you understand that your mentor is a volunteer, you’ve got to take responsibility for what you need to learn. You’ve got to take responsibility to take the time to understand where you want to go and, as you do that, I think the mentor-mentee relationship starts to acquire trust.

I do think, like being in a good physician or clinician relationship, trust is at the forefront of a good mentor-mentee relationship. You have to have honesty, and that honesty includes being able to take the criticism or the constructive feedback from your mentor about where things currently sit and where you want them to be. And vice versa, being able to give constructive feedback to your mentor to say, “I really could use some assistance with this and I’m not getting it.” I think that level of trust certainly guides many things. You need to be realistic. Your mentor is not going to run your career. This is your “Choose Your Own Adventure” book. You’ve got to be able to utilize that time with your mentor in a fashion that affords you to be able to provide yourself with the opportunity to really pull and glean much from that mentor in a fashion that affords you to move forward.

The other thing is, if you’re going to have a formal structure with your mentor, come prepared. Come prepared with an agenda, come prepared with one or two things that you want to get across and understand really what that person might be suggesting for you to embark upon. Sometimes it feels great to have the mentor tell you you’re doing a great job, and there’s a place for that. But it’s also a good thing, actually, if you want to advance and have growth, to be able to hear from that mentor, Perhaps you need to improve upon these things or say no or be focused, or perhaps take that opportunity. Having those things, I think, is important.

The other thing, as was mentioned, recognize that you as a mentee have limitations, but so does your mentor. There’s not a single person who’s the all-encompassing mentor. You’ve got to recognize that, “Listen, I’m working in an area of sepsis immunology, and I understand adaptive immune dysfunction. However, my mentor is not great in this aspect.” So going and finding someone else who can help mentor you in this one aspect I think is important for you to have that dialogue with your mentor, but then furthermore, expand that mentorship across different people. It could be just for single areas that there is a limitation with your mentor. I think that that’s an important thing in the trust relationship with your mentee-mentor relationship. Those are just a couple of attributes, I think, that are certainly vitally important to success.

Dr. Kaplan: Did you bring your mentor into your family? Did they come home with you?

Dr. Remy: I will tell you that I have had probably four or five mentors who have been really instrumental in my career and three of them I speak to pretty regularly. They’ve been to my house and they’ve been involved in, and they know what’s going on in, my family. My other mentors really did not have that same relationship, but I would say that I probably, as a mentee, was less invested in that relationship as I probably should have been. As I started to value the importance of my mentor, I started to value how important they were not only to my professional life, but frankly I wanted to bring them into my personal life.

Dr. Kaplan: Great. Now you’ve also made the transition from mentee to mentor. What was the hardest thing about doing that?

Dr. Remy: Well, the first and foremost thing I would tell you, and I’ve got a number of mentees, is first saying, Am I ready to be a mentor? What are the things that I need to do? How do I do that? In fact, I leaned heavily on my mentors to say, “What did you do with me?” And they said, “You didn’t listen to me in the beginning.” And I said, “Okay, so tell me the things that I need to know.” And, honestly, it came down to honesty. Meeting and having a mentee, but also having a co-mentor for this mentee who was a bit more advanced in their experiences and mentor in the initial phases, I think was truly important for the development.

The worst thing you can do as a mentor is perhaps lead your mentee astray. The first thing in transitioning is realizing what my limitations were as a mentor because I certainly want my mentees to have tremendous success. In the resident and the fellow level, it’s a little bit easier because they’ve got finite times where they’ve got certain aspects of their scholarly development. As I transitioned to mentoring junior faculty, I think it became even more readily apparent to me that I needed to make sure that I was providing my mentee all of that expertise in return for their investment of their time.

Dr. Kaplan: In that setting, I found turning to one of the emeritus professors in the division really helpful because they had been there and done that and they’d helped lots of other people make that same transition so that I could profit from their experience. I’m glad that you shared those difficulties and that you thought about co-mentoring. Not everyone thinks about that and they believe they have to go it alone and yet you really do not, especially since critical care is a team sport, so too can this be a team sport. Well done.

Dr. Remy: The most dangerous words you can ask in an open-ended question is, “How can I do better as your mentor?” I’ve started to ask my mentees, “How is this going for you? I want to make sure that I’m providing you everything. Is there something I can do differently? How can I improve?” You leave that door open, but you leave it open to get that good constructive feedback so that you can continue to improve as a mentor. I actually believe that mentoring, I think, has allowed me to become a better mentee.

Dr. Kaplan: I will definitely agree with that, but I will add one other thing. You and I are both physicians. Yet you’re probably just like me, I have NP and PA mentees as well. It was easier for me to mentor physicians because I had to learn all kinds of things about advancement scales and national organizations so that I could effectively guide any of those APPs. That becomes really important, and it’s not intuitive. It takes some work and it takes some time, and there’s often a different time scale. If you’re at a place like where I am, there’s a particular metric of time for when you can get promoted. If you don’t get promoted, perhaps you end up working someplace else in certain academic tracks.

It’s very different in the NP and the PA space. You have to be sensitive to those things and learn them because we don’t come loaded with it. That’s part of why we created LEAD, so that you can learn all about those kinds of things in a structured way, as opposed to having to go find it out all on your own.

Dr. Remy: That’s a great way to come back. I think the other thing that comes up frequently when people ask me why I spend so much time and effort being a mentor, I don’t know about you, but there’s nothing more gratifying than certainly seeing your mentee go off to success. There’s nothing more gratifying than seeing your fellow or your junior faculty present at a meeting. There’s nothing more gratifying than moving yourself from senior author to middle author because your mentee now becomes senior author and starts to take mentees of their own. That’s why it’s so gratifying. But then on the other hand, it grows you to be a better physician, ICU practitioner. As things elapse and you’ve got a good mentor-mentee relationship, I think it just enhances your satisfaction within your own career.

Dr. Kaplan: I completely agree.

Dr. Enfield: Before we wrap up, one thing I wanted to come back to that came from Dr. Kaplan early on was this aspect of listening, which, amazingly, as clinicians where we’re trained to listen to our patients, is sometimes the hardest thing you can do when talking to other people. It came up not only in talking to other people but also listening to yourself. I wondered if you guys could both reflect on how you learn to listen better.

Dr. Remy: Can I be honest with you? My failures as a mentee are probably because I failed in the lines of the ability to keep an open line of communication with my mentor. I was so many times deathly afraid to approach my mentor with failure. I was so deathly afraid to approach, and that was on me, it wasn’t because we didn’t develop that trust early on, but I was so just uniquely afraid of it, that I actually didn’t keep an open line of communication. I think that it probably stunted me at some different parts of my career. I think that, like any other marriage or any other major relationship in your life, communication is probably, first and foremost, the most important attribute of any relationship for mentors and mentees, then followed with development of trust.

Dr. Kaplan: I took a slightly different path. I learned to do this through martial arts, where you had to pay attention to your body alignment, how you felt, how you breathed. There was always meditation that was involved with this; therefore, I will place this as a plug for mindfulness because it allows you to listen to everything around you, including what the person right in front of you is saying, and ask yourself, “What does that really mean?” rather than, “What have I heard?” Those are two different things. Pursuing what the meaning happens to be is what drives the next question that you’re going to ask your mentee. Different ways to get there, but they both end up in the same place. I’m glad you asked that question.

Dr. Enfield: Thank you all very much. I probably learned more because I’ve been taking notes through this entire interview for myself. I’m sure that our listeners are going to enjoy this conversation and look for more LEAD content to come out both on webcast and podcast. This concludes another episode of the Society of Critical Care Medicine Podcast. If you’re listening on your favorite podcast app and you liked what you heard, consider rating and leaving a review. For the Society of Critical Care Medicine Podcast, I’m Kyle Enfield.

The information discussed in this podcast was provided by the Society of Critical Care Medicine’s Leadership, Empowerment, and Development (LEAD) Committee. Find other professional development topics and more in the SCCM Resource Library.

Kyle B. Enfield, MD, FCCM, is an associate professor of medicine in the Division of Pulmonary and Critical Care at the University of Virginia. He received his undergraduate degree from the University of Oklahoma.

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Knowledge Area: Professional Development and Education