Academic Mentoring - How to Give It

Academic Mentoring—How to Give It and How to Get It value judgments. In particular, because the primary purpose of attending medical school is to learn how to provide direct patient care, it is inappropriate to cause mentees to feel this activity is less worthy than the others. The best way TUDENTS, TRAINEES, RESEARCH FELLOWS, AND JUNIOR to help mentees choose a career path is to help them unfaculty all benefit from the direction provided by aca- derstand what day-to-day activities instill excitement. One demic mentors and research supervisors. The litera- suggested approach to determine this is for mentors to exture contains numerous reports on the importance press the following: “Don’t tell me what you want to be (ie, of mentorship in helping facilitate the future success of train- an academic physician). Tell me how you want to spend your ees, documenting benefits such as more productive re- time. What gets you out of bed in the morning? What really search careers, greater career satisfaction, better prepara- interests you? What jobs are fun for you? Design your potion in making career decisions, networking within a sition around those activities.” profession, and aiding in stress management.1-10 This Commentary describes several key points of advice both for in- Be Honest dividuals who mentor and those who receive mentoring Mentors need to understand that mentees frequently are (mentees). In some places, a mentor is an individual who afraid to tell their supervisors what they want if they feel is not the student’s direct clinical, academic, or research su- they will disappoint their mentors. It is important that pervisor. This advice applies to those kinds of mentors as mentors not promote their own agenda over that of mentees with aspirations of producing academic clones.11 well as the more traditional direct supervisors. The following has been stated (A.S.D.) to help the mentee Determine How the Mentee become more honest: “I am a general internist, health Likes to Spend Time economist, and I perform health care research. I am happy Several years ago a faculty member who had worked in his being me. I do not need you to be me to reaffirm that I profession for 10 years visited the corresponding author made the right choice.” Once said, the body language of the (A.S.D.) to announce plans for a career change. Until that mentee is often observed to become much more comforttime, this particular faculty member was a basic science re- able. It is important that mentees not simply tell mentors searcher in the division of endocrinology who also pro- what they think mentors wish to hear, but rather what they vided clinical care to patients with diabetes 1 day per week. really think, without wasting time by pursuing unwanted He was moving to a full-time clinical position in a non- directions. At the same time, mentors need to understand that mentees teaching hospital and he described experiencing moderate career success and enjoyment from research activities per- may choose not to follow their advice. Mentors should not formed during the first 5 years, but thereafter realized a dis- be disappointed when this happens. The nature of the relike for the work. His clue about his career became evident lationship is that mentors and mentees should feel free to when he noticed feeling excited about how the day would give honest expressions and advice without insistence from unfold seeing follow-up patients with diabetes and deter- either side that mentees accept it.12 On a more formal note, some have suggested that menmining their clinical progress on the 1 clinical day per week vs the other 4 days of the week when he awoke, pulled the toring relationships should undergo regular evaluations sheets over his head in the morning, and dreaded going to for process (clear objectives and regular, purposeful work in his laboratory. This realization led to an understanding that he was in the wrong job. One of a mentor’s most important jobs is to help mentees determine what kind of career they wish to pursue.3,11 Those who train in medicine can pursue at least 4 types: clinical care, education, research, or administration. Good mentors should present all 4 options without communicating S Be Explicit About Credit for Work At the beginning of the mentoring relationship, the roles are usually very clear: mentors often provide the initial ideas, infrastructure, financial support, and supervision for a project and mentees often perform the day-to-day work. Over time, roles change. For example, original ideas or questions will ultimately be generated by mentees and mentors may increasingly play a more peripheral role. This may lead to difficulties in determining who gets credit for the work. The principal objective way of assigning credit is the designation of an individual’s role on a grant application (principal investigator or coinvestigator) and the position of the names on the author list. Early in the corresponding author’s career (A.S.D.), an unfortunate interaction occurred between a mentor and mentee that best illustrates the problem. The mentee, who was then a junior faculty member, had an idea to use an existing medication to treat a genetic disorder and this Follow Through intervention had a very positive result in 1 patient. Because It is important for mentors to be supportive. This can take there had been no similar descriptions in the literature, the the form of making the right introductions, dealing with in- mentee prepared a manuscript describing this case report, dividuals whose cooperation is required, or providing fi- and the paper was subsequently accepted by a high-profile nancial support.9,12,14 In other cases, providing support sim- medical journal. The mentee did not include his mentor as ply involves responding to the mentee’s questions, reading a coauthor primarily because the mentee felt that the menmanuscripts, providing advice, and following through on tor, who was an internationally recognized expert in the promises. Prolonged delays on either side are harmful to the field, would have received credit for the idea. The mentee success of mentees. Students should, therefore, carefully in- claimed that the idea and work were entirely his and that vestigate the experiences of previous individuals who re- the mentor had no role in the paper; moreover, the mentor ceived mentoring from someone they are considering ap- certainly did not meet the current authorship criteria estabproaching. They should review a proposed mentor’s lished by the International Committee of Medical Journal curriculum vitae and determine how many students were Editors (this episode preceded the development of those overseen who now have successful careers. If the answer is criteria by several years).17 The mentor learned about the many, it bodes well for the future. If a faculty member has paper and objected strenuously to being excluded from the been in a mentorship role for more than 20 years but has author list. The disagreement ascended the chain of comalmost no successful disciples, the mentee might do well to mand at the university. Ultimately the paper was published avoid that person.12,14 in the high-profile journal without the mentor’s name as an author. This episode led to the mentee leaving the instituDo Not Become Friends tion because many of his colleagues reportedly ostracized In this relationship mentors have power. The individuals him for this behavior. can never be equal and therefore should not establish a reThe best way to avoid similar episodes is to be explicit lationship as friends during the mentorship period. Doing from the beginning of a project about who is going to reso may result in complications, hurt feelings, and can be de- ceive what credit, to acknowledge that the mentor/mentee structive. This is not to say that the mentoring relationship relationship will change over time, and to follow the Intercannot be cordial, personal, enjoyable, or fun. This simply national Committee of Medical Journal Editors’ estabmeans that the appropriate professional distance must be lished criteria for authorship, although this may require some maintained to protect both parties.15,16 subjective judgment. Mentors should not expect their mentees to include them as honorary authors. Do Not Be Afraid to Terminate Similarly, it may be common practice for some mentors a Mismatched Relationship to include their students as authors specifically to advance Personality conflicts in the mentor/mentee relationship may their careers even without proper contribution to warrant occur. If these conflicts are irreconcilable, to the point that authorship. This is equally inappropriate. If mentors wish a positive mentor/mentee relationship is unlikely, the rela- to include students as authors on manuscripts, an approtionship should be terminated. This advice applies for both priate set of tasks that constitute grounds for authorship mentors and mentees. should be assigned and conducted by students. to challenge mentors), and outcomes (sense of progress and development, improved networks).13 Such periodic evaluations are valuable tools to help ensure ongoing honesty. There are circumstances in which mentors should perhaps not be completely forthcoming. For instance, when the mentee tells of making a particular career choice (as opposed to asking for advice about the choice), the mentor should not show disapproval or state the choice is a mistake. In these circumstances, mentors must distinguish between the mentee’s requests for advice and announcements of firm decisions (often not easy to do). Once mentees have decided, expressing disappointment can be a very bad way to end the communication. Mentors can make it clear that the door is open to reverse the decision, but should not say “You are making a mistake,” because that phrase may be counterproductive and will not be forgotten. Separate at the End At some point, supervisors have to end the mentoring relationship with students. It does a junior faculty member no good to continue to put the supervisor’s name on grants or papers. Doing so stunts the growth and reputation of mentees and is problematic when they are considered for career awards or promotions. The responsibility for separation lies primarily with mentors and at some point mentors have to state directly, “We will no longer write together.” This does not mean that mentors stop providing advice. It just means that the names can no longer be attached on grants and articles.16 Although the exact publication record and length of time for mentor/mentee relationships is not well established, data from a preliminary survey suggest that the break point seems to be 6 to 10 papers and 3 to 5 years before separation typically occurs (unpublished data, A.S.D.). What Mentees Should Do If Mentors Do Not Wish to Separate In these situations, mentees should ascend the chain of command in the organization and solicit help of the division head, department chief, chair, or dean. These individuals will clearly understand the issue and broker the separation. After separation, mentors and mentees can become friends, assuming they actually (still) like each other, because at this point they will be equals. One of the wise mentors of A.S.D. taught the following: “I was always careful to be nice to the people I met on the way up. They were the same people I met on the way down.” The mentor/mentee relationship is an essential aspect of career development. These suggestions provide advice and helpful behaviors for this worthwhile and integral activity in academic medicine. Financial Disclosures: None reported. Disclaimer: The second author (M.O.B.) is a second-year radiology resident and the corresponding author (A.S.D.) is a senior faculty member who has mentored more than 500 students and junior faculty during the past 27 years. Acknowledgment: We thank Richard Sztramko, MD for his help with the literature review. He did not receive compensation for work relative to this article.