Mentoring of professionals classically encompasses areas not covered by clinical supervision or psychotherapy. In Homer's The Odyssey, Mentor was the guide and role model for Odysseus's son, Telemachus' journey into manhood. Mentor was actually Athena, the goddess of wisdom, in disguise. Medicine has recognized the importance of using guides and role models to enhance the professional development of medical students and faculty (1—6).
There have been a number of efforts to evaluate the effects of mentoring programs in medical settings. Physicians often enter academic medicine with little or no socialization to the attitudes, activities, and beliefs characterizing successful faculty (7,8). Mentoring helps physicians become socialized to their faculty responsibilities (7,9,10). Faculty members who report having had a mentor feel the arrangement assisted their career advancement, personal growth and development, and reduced personal stress (11). Characteristics of an effective mentor include being empathic, easy to talk to, trustworthy and knowledgeable, an active listener, emotionally supportive, and encouraging in both professional and personal matters, as well as suggesting specific strategies in managing departmental relationships and tenure (12—16). Three areas important to the socialization of academic faculty that can be predictive of success, are adopting academic values, managing an academic career, and establishing a productive network of colleagues (10).
As a result of a university department of psychiatry and a state department of health entering into a collaboration to improve the quality of care given to psychiatric patients throughout the state, the number of psychiatric faculty doubled over a 3-year period from 1991 to 1993. New faculty were recruited from Hawaii and the mainland to staff the state hospital and state outpatient clinics. All faculty were expected to teach, provide clinical services, and be involved in research to be considered for promotion. Because the department was spread over five sites, access to department administration and senior faculty was difficult. Problems included difficulty with assimilation, isolation, culture shock, and workload/job stress. One-quarter of the new faculty hired during the 3 years from 1991 to 1993 resigned.
To address the stated problems and enhance the quality of life for new faculty, the Faculty Development Task Force introduced a formal mentoring program. The personal experience of members of the task force as well as feedback from peers pointed to five areas needing attention: 1) socialization to academic psychiatry, 2) professional development, 3) collegial support, 4) departmental communication, and 5) attention to personal issues.
The Faculty Development Task Force established three goals for the mentoring program: 1) facilitate socialization/orientation to academic psychiatry, 2) facilitate and improve functioning of faculty, and 3) increase retention of new faculty members.
For this pilot study, all seven of the new faculty starting in July 1994 agreed to participate in the mentoring program. One faculty member was hired on a tenured track at the rank of professor; the remaining six were nontenured and assistant professors. One second-year faculty (assistant professor) was included, at her request, making the total mentee sample size eight.
Senior faculty members were recruited to be mentors through a general announcement in the monthly faculty meeting. All but one of the mentors who volunteered were at professor or associate professor levels. The majority were tenured with academic records. The mentors met with the Faculty Development Task Force before the start of the program. The orientation meeting reviewed the mentors' previous experience with mentoring, the history and rationale for our mentoring program, models of mentoring, and specific guidelines the mentors were to follow. A handout was distributed with a description of the focus areas for the program:
Specific guidelines were discussed for possible topics in the mentor-mentee meetings and included the following list: 1) orientation to the philosophy, expectations, and general workings of the department; 2) discussion of the mentee's experience at his/her primary duty site, including clinical and administrative issues; 3) guidance for research and academic interests; 4) support for teaching and supervision assignments; 5) personal and family well-being; and 6) requirements for promotion and tenure.
A one-to-one mentor—mentee model was chosen to facilitate bonding with the senior faculty and to give the mentee the opportunity to shape the experience to best suit his/her individual needs. Group mentoring sessions were not included for several reasons. We were concerned that mentees would be more likely to miss group sessions than individual ones; we hoped the individual mentoring model would maximize both attendance and productivity of the meetings. Some faculty perceived that there were too many meetings already and adding group sessions would be excessive. New faculty were based at different hospitals, making additional group meetings difficult to attend.
Mentees were given their choice of mentors from the list of senior faculty who had volunteered to mentor. One mentor agreed to see two mentees who had requested him, and thus there were a total of seven mentors. The mentor and mentee pairs were asked to commit to an initial 4-month period; at the end of that time there was an evaluation to see if the collaboration would continue for the remainder of the year or whether different pairings or termination of the collaboration was indicated. Mentors and mentees were asked to meet on a regular basis, at least every 2 weeks at first. It was up to the mentor to call the first meeting; the mentor—mentee pairs were asked to develop a contract about the structure of their relationship (how often to meet, what to focus on, etc.).
An evaluation component was built into the program to measure how well the goals of the program were met. A 36-item mentoring program questionnaire focusing on the target areas was developed. The questionnaire was administered to the mentees before their first meeting and after the initial 4 months of the program to evaluate pre- and postachievement of targeted goals. Mentees were asked to turn in their pretest to their mentor as the mentors had requested to see the pretest to get an idea of where their mentee stood regarding the target areas. Mentees' posttests were collected by task force members, and only group data were shared with mentors at the end of the 4-month period.
A 5-point Likert scale was used for each of the 36 items on the mentoring program questionnaire, with 5 points assigned to ratings of "strongly agree," 4 for "agree," 3 for "neutral," 2 for "disagree," and 1 for "strongly disagree." In addition to deriving an overall mean score for all 36 items for each mentee, the items were intuitively grouped into subtests corresponding to the three major areas of study: 1) facilitation of socialization/orientation to academic psychiatry, 2) facilitation and improvement of the functioning of faculty, and 3) increased retention of new faculty members. Subtest 1 consisted of Items 1, 2, 8—12, and 24—32 (see T1A and T1B for specific item content). Subtest 2 was composed of Items 2, 4, 5, and 8—23. Subtest 3 included Items 4, 6, 7, 9—12, and 33—36. Means were derived for each of these three subtests for pre- vs. postadministrations.
Mentors did not fill out pre- and postmentoring program questionnaires. However, mentors and mentees completed a brief evaluation form that was developed and distributed after the initial 4 months to gather data on the experience of the participants. The items on the evaluation surveys were rated by the mentees and mentors using the same type of 5-point Likert scale as with the mentoring program questionnaire. Two open-ended questions were included, asking the participants to list the most helpful and least helpful aspects of the program. Responses to these evaluation forms were kept confidential.
All eight of the mentees completed the pre- and postmentoring program questionnaire. The mentee—mentor pair met an average of twice a month, with a range from 30 minutes to 1 hour per session. Most dyads had contact between meetings, usually by phone, personal contact, or exchange of materials.
To assess the internal consistency of the mentoring program questionnaire, Cronbach alpha was calculated separately on the pre- and postmeasures. Coefficients of 0.95 and 0.98 were obtained for the pre- and postadministrations, respectively.
The overall mean for the premeasure was 3.40, and the average for the postmeasure was 3.81, resulting in a positive statistical difference of +0.41 (t=3.13, df=7, P<0.05).
To gain more information concerning the three subtest domains, t-tests were conducted on the pre- vs. postmeans for each of the three subtests. For Subtest 1 (facilitate socialization/orientation to academic psychiatry), the premean was 3.15 and the postmean was 3.86, resulting in a statistically significant difference of +0.74 (t=3.83, df=7, P<0.01). It should be noted that this difference would be statistically significant even after protecting the analysis for the three t-test comparisons conducted (e.g., dividing the statistical alpha level of 0.05 by 3, resulting in a critical alpha level of 0.017). Although in the predicted direction, Subtest 2 (facilitate and improve functioning of faculty) and Subtest 3 (increase retention of new faculty members) did not result in statistically significant differences between pre- and postmeasures. The premean for Subtest 2 was 3.80 and the postmean was 3.87 (difference=+0.07, t=0.66, df=7, P>0.05). The premean for Subtest 3 was 3.65 and the postmean was 3.82 (difference=+0.17, t=0.93, df=7, P>0.05).
Given the pilot and exploratory nature of this study, t-tests were performed on all 36 items of the mentoring program questionnaire (see T1A and T1B). With the alpha level set at 0.05, 2 of the 36 comparisons would be expected to be statistically significant just by chance. However, the results of the t-tests revealed 9 of the 36 post—pre differences to be significant, with 8 of the 9 significant items being associated with the statement, "I am aware of departmental expectations for " (see T1A and T1B). The remaining significant item was Item 1, "I have a reasonable grasp of the roles and responsibilities inherent in being a faculty member."
All eight mentees completed the program evaluation form. As indicated in T2, the means ranged from 4.13 to 4.75 for eight of the nine items. The mentees agreed or strongly agreed that the mentoring program was worthwhile, and the mentees recommended the program to other faculty. Overall, the mentees rated the mentors very positively on willingness to share knowledge, availability, competency, interest in the mentee's growth, provision of feedback, and helpfulness. A mean rating of 3.13 was obtained for the statement, "Because of this program, I am more likely to stay in academic psychiatry."
The results of the program evaluation completed by all seven mentors are presented in T3. These results are similar to those of the mentees with the range of means for seven of the eight items from 4.14 to 4.57. The mentor responses reflected feelings that the program was worthwhile, and the mentors would recommend the program to other faculty members. The mentees were rated as being actively participatory, available, competent, and willing to receive feedback. The only mean rating below 4.00 was for the statement, "My mentee was interested in academic psychiatry," which obtained an average response of 3.93.
Mentees and mentors were asked to list the most helpful and least helpful aspects of the program in two open-ended questions on the program evaluation. Individual mentee responses for the most helpful aspects were the following: acquisition of information about the department (including departmental politics), collegial contact, discussion of clinical issues, the mentor as a resource who "knows the territory," contact with senior faculty, comprehension of the overall process, discussion of resident supervision, and cultivation of an improved attitude toward academic psychiatry and the department. Individually, mentees listed the following as being least helpful: discussion of departmental politics, development of research, and the mentor not being able to meet or cutting the meeting short because of other duties. Mentors listed the following as most helpful: structured requirement to meet, communication and chemistry, quality of the mentee, opportunity for mentee to freely seek information about the state and department, opportunity to discuss issues in-depth, knowledge of the mentee, focus on professional development, and identification of the need for mentoring. The least helpful aspects for the mentors were the distance between sites, working out details on getting together, and lack of concrete knowledge of what was being produced.
The mentoring program was developed to address problems of assimilation, isolation, culture shock, and workload/job stress experienced by new faculty. An evaluation component was built into the program to assess effectiveness and to provide a basis for program improvements over time. The data presented here are in the context of a pilot study and must be interpreted as such. Overall, the results from the initial 4 months indicated the mentoring program was a positive experience for both mentors and mentees. Mentees showed statistically significant gains on the total of items tested. In general, the participants felt the experience was worthwhile and would recommend the program to other faculty members.
Our first goal, facilitating the socialization/orientation to academic psychiatry, was achieved based on the statistically significant finding in this area. Mentees indicated an increased grasp of the roles and responsibilities inherent in being a faculty member and an increased awareness of departmental expectations. There was a measured increase for all departmental expectation items surveyed (e.g., attendance at faculty-related meetings, etc.), with eight of nine showing statistically significant gains.
It is unclear if the second goal, to facilitate and improve the functioning of faculty, was achieved. Nineteen items were evaluated in this domain, with nine showing pre-to-post increases, four with no change, and six with decreases. None of the items were statistically significant. One may argue that a feeling of being prepared or more prepared to perform departmental responsibilities (Goal 1) improves the ability of new faculty to function in their academic roles. The increased excitement about being a faculty member can also point toward a feeling of improved functioning as a faculty member. The finding that the mentees felt slightly less prepared to be competent clinicians, conduct research, and teach medical students could indicate that new faculty started out with unrealistic ideas regarding the variety and depth of responsibilities inherent in a faculty position. Meeting regularly with a mentor may have helped the mentees develop a clearer picture of what academic psychiatry entails.
Our third goal, increasing retention, must be evaluated after a more sufficient period of time. Eleven items were evaluated in this domain with eight showing an increase, one being neutral, and two with decreases. Again, none were statistically significant. On the program evaluation form, mentees were neutral about being more likely to stay in academic psychiatry because of this program. There was no pre-to-post difference for mentees seeing themselves as faculty members after 5 years, although they were generally more excited about being a faculty member. Many of our new faculty were straight out of training and had little experience as an attending psychiatrist, teacher/supervisor, researcher, and/or administrator. The knowledge gained during their first months on the job, including the experience with the mentoring program, likely affected those who found they would rather pursue a different career path. The increased importance to mentees of discussing personal issues with departmental colleagues, and the feeling that their colleagues were interested in and available to help with their professional development, points to a cohesiveness within the faculty that will hopefully increase future retention.
The mentees and mentors individually listed the most helpful and least helpful aspects of the mentoring program. It is difficult to generalize these findings into trends because what one individual lists cannot be applied to the group. For example, one mentee listed discussion of departmental politics as a most helpful aspect and another listed it as a least helpful aspect. However, both groups found meetings, the relationships that developed, and dissemination of information to be important for the dyad. Information on the least helpful aspects can be used to improve the program. In the orientation meetings with mentors, we can emphasize the aspects that seem to work the best as well as emphasize the need for mentors to make the meetings a priority. We will also work to assign mentee—mentor pairs at the same clinical site to help address the distance problem. Issues concerning developing research are being addressed by our Research Faculty Task Force. In the future, it will be helpful to ask specifically about problems/concerns during the periodic contacts with participants to address individual issues, such as not knowing what is being produced. It may also be helpful and more efficient to supplement the individual mentoring with group sessions. An initial session could cover basic departmental information for the mentees. Additional group sessions for mentees could process the faculty experience; facilitate faculty cohesion with social-recreational events; and/or pass on information pertaining to teaching-supervision skills, research, administration, and/or clinical issues.
There were a number of weaknesses to our study. The sample size was small. The questionnaire did not differentiate between measured change due to the mentoring program and measured change due to the experience gained by faculty during the first months on the job. There was no control group with which to compare the measured changes. However, one of the authors (EF) was a new faculty member the year before the start of the mentoring program and his experience was that of being unaware of certain departmental expectations after working for 6 months. We cannot draw a conclusion from one author's experience, but it may be that the mentoring program contributed to the positive results regarding departmental expectations. The assessment of which aspects of the program were more crucial for a successful program was not as comprehensive as desired. We did not measure enduring changes brought about by participation in the program.
One might expect that faculty entering the program at differing levels (full professor vs. first-year assistant professor vs. second-year assistant professor) might experience the program differently. Reanalysis of our data excluding the full professor found Item 1 to be no longer significant at 0.05 level, Item 25 significant at <0.05, and Item 32 significant at <0.01. The remaining comparisons resulted in identical findings (not significant, significant at <0.05, or significant at <0.01). All participants brought different career experiences with them, and in our study the findings were not significantly changed. This may be due to having only one full professor in the sample. It may reflect the flexibility of the one-to-one meetings, in which the information covered can be focused appropriately to the individual mentee.
Our program was based on an individual, one-on-one mentoring model, and there may be some concern that conflicts between supervisor and mentor might emerge. In our experience, there was no evidence of conflict between supervisor and mentor because these roles were viewed differently. In the future, an item asking specifically about such conflicts between these roles could be added to the program evaluation.
The economic realities facing academic medicine today, with diminishing resources for teaching and research and a greater demand for clinical service, are reshaping the role of faculty. Promotion and tenure will most likely continue to have standards calling for significant research and publication output. With less time available for newer faculty to learn about and conduct research and write for publication, a formalized mentoring program can be one of many ways departments will try to maximize faculty output. The financial incentives of private practice, coupled with the increasing workloads of the academic psychiatrist, may lead to decreased interest in academic psychiatry as a career. Those who are initially interested may find the reality of academics today less appealing, especially those who have little experience in research, publication, and/or teaching. Faculty who have had a mentor found the relationship assisted their career advancement, personal growth and development, and reduced personal stress (11). By formalizing the mentor—mentee relationship, we can provide a mechanism to ensure these advantages are available to new faculty. In addition, mentors reported satisfaction with the experience. The mentoring relationship may be beneficial for the senior faculty by enriching their faculty experience.
A formalized mentoring program can be a positive contribution to both new and senior faculty as well as to the department. We have found that a mentoring program can be an effective tool in assisting new faculty with the socialization/orientation to the roles and responsibilities of being a faculty member in a department of psychiatry.
The authors thank Richard Gibson, M.D., for his assistance with data collection.