October 2019 - Mentorship


October 2019
EAST Monthly Literature Review

"Keeping You Up-to-Date with Current Literature"
Brought to you by the EAST Manuscript and Literature Review Committee

This issue was prepared by EAST Mentoring Committee Member Stephanie Savage, MD, MS.

In This Issue: Mentorship

Scroll down to see summaries of these articles

Article 1 reviewed by Stephanie Savage, MD, MS
Teaching, Mentorship, and Coaching in Surgical Education. Lin J, Reddy RM. Thorac Surg Clin. 2019 Aug;29(3):311-320.

Article 2 reviewed by Stephanie Savage, MD, MS
Mentorship is Not Enough: Exploring Sponsorship and Its Role in Career Advancement in Academic Medicine. Ayyala MS, Skarupski K, Bodurtha JN, Gonzalez-Fernandez M, Ishii LE, Fivush B, Levine RB.  Acad Med. 2019 Jan;94(1):94-100.

Article 1
Teaching, Mentorship, and Coaching in Surgical Education. Lin J, Reddy RM. Thorac Surg Clin. 2019 Aug;29(3):311-320.

Traditional surgical training has been based upon the Halsted model, in which surgeons in training have multiple opportunities to care for patients with surgical diseases under the supervision of a more experienced surgeon. This is grounded by a scientific understanding of surgical diseases and graded responsibility over time. However, the traditional Halsted model is increasingly inadequate to encompass all of surgical training in the era of patient safety, quality initiatives and evidence-based medicine.  In this review article, the authors evaluate the role of teaching, mentorship and coaching across the spectrum of medical students, residents and junior faculty. They note these paradigms are especially important in the current era of work hour limitations, patient safety initiatives and quality improvement.
Teachers focus on specific lessons, which are cognitive in nature. Curriculums have become more innovative focusing on longitudinal patient-based experiences, electives and independent study. Online immediate-feedback systems allow students and residents to receive real-time evaluations after operative cases, resuscitations or clinic encounters. Boot Camps are becoming increasingly common in assisting students to transition to residency or residents to fellowship. Simulation training has also become an important adjunct in light of limited training hours, more complex and technology-driven cases and focuses on outcomes.
As the authors note, technical expertise does not translate to excellence as a teacher. Increased resources are dedicated to developing surgeons as effective educators.  This includes an increased focus on adult learning theory and the principles of: needing to be involved in the planning of the instruction, experience providing the basis for learning activities, increased interest in subjects immediately relevant to one’s job or personal life and problem-centered learning. The authors stress that new models need to be developed to recognize and reward teaching and to stimulate scholarly activity in education.
Mentoring is focused on personal development and long-term goals. Mentoring styles will differ but the authors describe different categories commonly seen including: challenger, cheerleader, educator, ideator and connector.  In the majority of surgical departments, mentorship remains informal and tends to be organic.  The long-term relationships arise from shared interests and may focus beyond academic and work-related issues to personal growth and beyond. Mentorship is a two-way relationship, with both parties maintaining an active participation. Formal mentoring programs are increasingly common in residency and among junior faculty and in many cases, mentoring may occur in a peer-to-peer fashion.  Establishment of successful mentoring programs are a key component of job satisfaction and faulty retention in surgical departments.
Coaching includes aspects of teaching and mentoring but focuses on improving and refining existing skills. Of coaching styles, the autonomy style focuses on the psychological needs of the individual to develop intrinsic motivation and improve performance. In medical school and residency, coaching often occurs as a debriefing immediately following an operative case or a notable event (such as a patient code event).  In these cases, facilitated reflection and feedback identify points of good performance, as well as deficiencies. As the authors note “Coaching incorporates the idea of deliberate practice by actively identifying areas for improvement by reflecting on performance, making adjustments and evaluating the impact of these changes.”
Though coaching is a natural part of residency training, coaching may not continue once surgeons enter practice. Continued learning and refining of existing skill sets are key aspects of surgical practice and are ripe for coaching.  Performance improvement and coaching go hand-in-hand and extend beyond clinical skills to academic performance, leadership and interpersonal skills. Coaches may be peers or expert coaches and they may both be useful at different points in a surgeon’s career or during skill acquisition. 
The authors note that setting aside time for these activities can be difficult in the modern surgical environment, where there is a heavy emphasis on clinical, administrative and research demands.  Video-based coaching and teleconferencing may be tools to increase access to high-quality teaching resources, mentors and coaching opportunities. There are also significant opportunities to determine the relationship between these activities and patient outcomes. Departments of surgery must place value on teaching, mentorship and coaching for surgical faculty.

Article 2
Mentorship is Not Enough: Exploring Sponsorship and Its Role in Career Advancement in Academic Medicine. Ayyala MS, Skarupski K, Bodurtha JN, Gonzalez-Fernandez M, Ishii LE, Fivush B, Levine RB.  Acad Med. 2019 Jan;94(1):94-100.

Academic medicine has traditionally focused on the role of mentorship in career advancement, in which a longitudinal and personal relationship provides advice, coaching and feedback. Mentorship has demonstrated many positive aspects for mentees including impact on personal development, academic productivity, job satisfaction and retention. However, mentorship alone may not be adequate to allow for career advancement. 
Sponsorship may be more important for career advancement and the ability to reach high-level leadership positions. Sponsorship is a more limited and less personal interaction, in which a highly-placed individual promotes a protégé (defined as a high-performer) for specific career-advancement opportunities. The purpose of this study was to explore how sponsorship relates to mentorship, to assess who gets sponsored and who performs the sponsoring and how this impacts career development.
The study was defined as a qualitative, semi-structured interview process, which included interviews of both sponsors and protégés. Transcripts of interviews were coded and used to identify major themes.  Overall 23 faculty participated with 12 sponsors and 11 protégés. All sponsors were male and chairs of academic departments. Protégés came from a variety of departments including surgery, behavioral medicine, internal medicine, neurology and anesthesia and critical care.
Five themes were identified by this study. Mentorship is different: Sponsorship is episodic and focused on specific opportunities. Mentorship focused on long-term development and was relationship oriented. Sponsorship focused on specific opportunities and the relationship was less important than recognition of potential. Effective sponsors are career established and well-connected talent scouts.  Sponsors are always on the lookout for talented protégés.  Importantly, sponsors are confident in their own position, are not threatened by talented protégés and provide unequivocal support. Effective protégés rise to the task and remain loyal.  Protégés must demonstrate potential and warrant the attention being paid. They must also remain loyal to sponsors ; they must be fully committed to successfully completing the task in addition to their own career advancement. Trust, respect, and weighing risks are key to successful sponsorship relationships. Trust ensures that the protégé feels the sponsor has their best interest at heart. Trust, respect and awareness of risk also ensure the protégé understands that the sponsor is putting their reputation on the line. Sponsorship is critical to career advancement. Sponsorship allows access to opportunities that would not be available based solely on individual talent. Sponsorship is also good for the organization, ensuring the best talent are working for the good of the organization.
In conclusion, the authors found that sponsorship fills a different role than mentorship. Sponsorship is critical for career success and promotes talent for the good of the organization. The authors also note that sponsorship is especially important for women and under-represented minorities.