Academic Psychiatry 28:111-115, June 2004
© 2004 Academic Psychiatry
The Good-Enough Mentoring Relationship
Laurel L. Williams, D.O.,
John B. Levine, M.D., Ph.D.,
Seema Malhotra, M.D. and
Paul Holtzheimer, M.D.
Dr. Williams is Assistant Professor of Psychiatry at the Baylor College of Medicine, Houston, Texas. Dr. Levine is from Cambridge Hospital, Harvard Medical School, Boston, Massachusetts. Dr. Malhotra is from the Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Dr. Holtzheimer is from the University of Washington School of Medicine, Seattle Washington. Address correspondence to Dr. Williams, 6655 Travis Suite 700, Houston, TX 77030; senegal18{at}hotmail.com (E-mail).
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ABSTRACT
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Objective: This study aimed to describe the state of mentoring in today's academic environment. Methods: Resident focus groups from across the nation discussed their opinions about mentoring and experiences with mentoring, and individual faculty members were videotaped discussing the same. Results: Sixty-six residents and five faculty members participated in the project. There was consensus among residents and faculty regarding important qualities of a mentoring relationship, obstacles to forming a mentorship, and methods to improve the mentorship experience in psychiatric training. Conclusion: Mentoring is still believed to be a vital component of a successful residency experience. Specific components that warrant further research include boundaries within the relationship, ethnicity and gender factors, and potential need for resident and faculty curricula on the topic of mentoring.
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INTRODUCTION
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Mentoring is a time-honored tradition in medicine. The Norman Rockwell picture of the old country doctor and his apprentice reminds us that historically, learning the art of medicine has been achieved through mentorship. But how does this concept of mentoring fit into today's academic environment? Training psychiatrists now involves numerous clinicians, often of multiple disciplines, and no longer resembles the mentorship of years past. Previous studies have discovered that mentoring relationships can greatly influence learning. In order to examine the role of mentoring in today's academic environment, our group decided to elucidate current resident and faculty perspectives regarding mentorship. Specifically, how do residents and faculty across the country define mentoring? What do they define as the key qualities of a good mentor and mentee? What makes a mentoring relationship effective or ineffective? How do institutions effectively foster mentorship? Most important, is mentoring still considered a vital component for psychiatrists in training?
Despite the historically pivotal role mentoring has had in the education of physicians, there are a limited number of studies on mentoring in medicine. The current literature mainly describes personal retrospections about a particularly valuable mentoring experience from a favorite teacher (1) or overviews of theoretical approaches to mentoring based on personal experience (2, 5, 6). The Tiberius et al. chapter is an excellent source of information on the history and trends of teaching in medical education (8). This chapter emphasizes the relationship aspect of medical education primarily because previous research has indicated "that relational variables account for roughly half of the variance in teaching effectiveness" (8).
Quantitative data on mentoring have primarily utilized mail-out surveys to medical students and internal medicine residents. In such surveys, qualities of a good mentor that have been mentioned consistently include supportiveness, generosity with time, accessibility, an emphasis on building relationships, and promotion of professional growth (3). Impediments to good mentoring identified by these surveys include perceived lack of time, task-oriented mentors (applying for grants, locating funding), lack of prerequisite mentoring skills, and lack of perceived benefit from the relationship (3, 7).
There are some limitations to these studies, however. With the exception of the Tiberius et al. chapter, these studies do not define their terms, nor do they explore how programs could assist in facilitating mentorship. Finally, none of the studies include in-depth discussions with psychiatric residents and faculty regarding mentorship during training.
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METHODS
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This project involved focus group discussions with residents and videotaped faculty interviews from across the country. The design was purposely nonquantitative because the goal was to explore the complicated feelings and motivations residents and faculty have about mentoring that may provide preliminary data to assist in the design of future quantitative research.
Five residents volunteered to lead the focus group discussions at their respective institutions. Discussion topics and ways to manage the groups were decided by consensus through electronic correspondence. A standardized method for introducing topics was not employed. Flyers and general announcements were utilized to notify interested residents in the discussion groups. Participating residents knew the group leader as well as each other. Residents were informed that participation was voluntary and confidential. The data collected were note-based, and the leaders were instructed not to participate in the discussion.
A total of 66 residents from five institutions across the United States and Canada participated in the focus groups. Each group averaged 10 residents. Thirty seven residents were women, and 29 were men. Three were African American, and 21 were Asian. Twenty five residents were Caucasian, and one resident was Hispanic. Sixteen of the residents were international medical graduates (IMGs).
For the faculty interviews, residents volunteered to interview faculty at their institutions. The residents approached faculty members who they believed were good examples of mentors. As with the focus group participants, the videotaped interviews were voluntary. Each person knew the responses were being recorded and might be viewed at an American Psychiatric Association (APA) Spring 2002 workshop and discussed in this paper. One Caucasian female faculty member declined to participate due to the nonconfidential nature of the videotape. Five faculty members were interviewed from three institutions across the country. All five were Caucasian and two were women. Each interview lasted approximately 30 minutes.
Discussion Topics
- Definition of mentoring
- Qualities of a good mentor
- Qualities of a good mentee
- Factors affecting quality of mentorship
- Current experience with mentoring
- Fostering of mentorship by institutions
- Obstacles to developing mentoring relationships
- Methods to encourage mentorship
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RESULTS
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The demographic information and responses from the focus group discussions were collected. Given the informal format of both the focus group discussions and the faculty interviews, it was not possible to calculate exact percentages of the responses. However, if greater than 70% of residents agreed with a given statement, that was considered a consensus, except when noted below in the individual topic results. Additionally, given that faculty interviews were videotaped, their responses were utilized as direct quotations in order to highlight similarities to and differences from the residents' responses.
Topic One: Definition of Mentoring
The residents and faculty agreed that mentoring is about establishing a relationship based on both professional and personal interests. Most residents agreed that mentors are a "combination of a supervisor and a friend." Faculty commented on the importance of a "resonance between two people," relating mentoring relationships to both parenting and psychotherapy. One female faculty member reflected, "Just like it would be difficult for a child to grow up without a parent, it would be very difficult for a professional student to have a full and enriching development without a mentor." Another faculty member noted that mentoring had aspects similar to Kohut's theory of the parent as a self-object.
Topics Two and Three: Qualities of a Good Mentor and Mentee
The residents and faculty agreed on several qualities that mentors and mentees should possess that will facilitate good mentoring relationships. Specifically, mentors must be compatible on a personal level, active listeners, able to identify potential strengths in their mentees, and able to assist mentees in defining and reaching goals. Mentees must be proactive, willing to learn, and be selective in accepting advice from their mentors.
Topic Four: Factors Affecting the Quality of Mentorship
In considering factors that affect mentoring relationships, a similar pattern is seen in both faculty responses and residents' responses. Both female and minority residents and female and minority faculty were more likely to agree that gender and ethnicity were vital to the mentoring relationship. One female faculty member commented on how crucial it was for her to have a prominent female mentor who she described "as a tower of power." In juxtaposition, male faculty members and male residents commented that race and gender made little difference in the mentoring relationship. In fact, one of the male faculty members said that mentoring is about "the relationship between two people. The particular chemistry ... is the power that affects the degree to which we work with another person ... and is much more important than the external elements such as race or gender."
Topic Five: Current Experience With Mentoring
All five faculty members could identify several mentors who were crucial in their development. One noted that although he has had many mentors "it was never talked about explicitly ..." as a mentorship. In contrast, some residents stated they could not identify a person as a mentor or potential mentor. At a few institutions, all residents could identify that they had a mentor, whether or not it was a positive experience, whereas at other institutions, many residents believed that none of them had a mentor. There was not a majority consensus among the residents regarding current experiences with mentoring relationships.
Topic Six: Fostering of Mentorship by Institutions
Residents and faculty identified a few programs that are utilized across the country to facilitate mentoring. Most institutions have a "big sibling" program that attempts to match incoming interns with upper-level residents who have similar backgrounds and/or life experiences. Many find this helpful in assimilating to the new system but feel it has limited usefulness for long-range goals or in career development. Several insitututions have formal assignments of mentors. However, residents and faculty agreed that assigning mentors is largely ineffective because it does not involve the vital personal element of mentorship. One institution has a system of rotating lunches with different faculty members, while another has a female-only psychiatrist monthly group meeting. These programs are generally well liked because a critical personal element is involved.
Topic Seven: Obstacles to Developing Mentoring Relationships
Residents and faculty believe that there are several obstacles to developing mentoring relationships at their programs. The main obstacle that both faculty and residents encountered was lack of time. Additionally, most residents agreed that there was a perceived lack of available mentors in both the academic sector and the private sector. Some residents complained that mentors were too focused on research. Faculty added that mentoring relationships often went awry when the mentor expected the mentee to become a clone and perform only what the mentor is interested in, especially in research-oriented relationships. Several faculty members noted that a mentor could experience difficulty with a mentee if a mentee surpassed a mentor in their area of expertise or if a mentor demanded only certain outcomes from the mentee.
Topic Eight: Methods to Encourage Mentorship
The residents and faculty agreed that mentoring should be a vital component in today's residency training programs. In fact, one faculty member believed that the mentoring relationship begins as people are interviewed for residency. The residents and faculty also agreed that mentoring should be discussed early in training. A yearly seminar or 1-day workshop for interns to learn about mentorship was proposed by some resident focus groups. Additionally, the residents and faculty recognized the importance of educating faculty about mentorship. The residents and faculty concurred that giving faculty incentives such as formal evaluations, protected time, and awards would be beneficial. They also agreed that creating "a space" for interactions outside of the hospital was practical and manageable for most institutions. Examples included monthly or quarterly social mixers, either at homes or in restaurants, with interested faculty and residents, potluck dinners with smaller groups of residents and faculty, and movie/book clubs.
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DISCUSSION
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Today, faculty and residents are called upon to perform multiple tasks, and the potential benefit of mentoring may be overlooked in a busy clinical schedule. Findings in this study support multiple aspects of previous data regarding mentorship. Specifically, residents and faculty concurred that mentoring could be important for both professional and personal growth, and qualities of a good mentor include being compatible on a personal level, an active listener, able to identify residents' potential, and able to assist residents in achieving their goals. Residents and faculty also agreed that qualities of a good mentee included someone who is proactive, willing to learn, and be selective in accepting advice. Furthermore, lack of time, inadequate mentorship training for faculty and residents, and lack of available mentors were viewed as major obstacles for developing mentoring relationships.
One goal of this study was to establish how current residents and faculty define mentoring, especially given the varied definitions found in the educational literature. This study explicitly defines mentoring as involving the personal aspect and/or the "chemistry" between two people. Inferred from faculty comments is the importance of adequate time and the appropriate space to foster a "good-enough mentoring relationship."
Unfortunately, the intangible underlying dynamics that are crucial in forging a mentorship may be partly to blame for the limited conscious awareness among residents and faculty. As one faculty member noted, he could remember being mentored, but neither he nor his mentor identified their relationship as such. There may be an unconscious reluctance to fully examine and quantify the relationship. This reluctance may be due to the issue of boundaries within the mentoring relationship. Given that residents in this study defined a mentor as a combination of a friend and supervisor, the boundaries could become unclear. This uncertainty might lead to tension and create anxiety for both parties regarding the extent of socializing, disclosure of personal problems, and even sexual feelings. The ambiguity and resultant tension in the boundaries may lead some residents and faculty to avoid the fostering of mentoring relationships altogether.
Another important finding in this study was the relative disparity among residents and faculty on the importance of ethnicity and gender. Females and minorities were more likely to state that these issues were of great importance to them in fostering mentoring relationships. However, race and gender are less likely to be an issue if mentors are not assigned, but rather forged through meetings between interested faculty and residents. Although the assignment of mentors can have many important uses (e.g., learning the institution's system, being exposed to more faculty, and becoming involved in research), training directors who utilize assigned mentors may want to consider matching female and minority residents and faculty together.
One particular area that residents believed hindered the mentoring relationship was a research-oriented faculty mentor. This may deserve special attention, especially given the recent calls for residents to become more involved in research. Residents often perceive these relationships as too task oriented and noncollaborative in nature. Residents who were observed in this study complained that such relationships involved doing work for the mentor's projects with an unfilled expectation that this would lead to guidance with the mentee's own career development, which is not an uncommon sentiment on the part of residents.
The residents and faculty discussed a number of methods that institutions could implement to foster mentorship. Programs could consider developing a curriculum to discuss the importance of mentoring for residents, especially junior-level residents. Programs might also consider developing faculty training for mentorship and creating incentives for those who make the time and space for this endeavor. The Tiberius et al. chapter may serve as required reading for instructing faculty members on more effective teaching skills. Finally, programs could help foster mentoring through creating more outside activities for residents and faculty.
The main limitation to this study is the methodology utilized in the resident focus groups. The participants were volunteers, and thus there was potential for self-selection bias. Furthermore, the data could not be broken down by postgraduate year. Additionally, this study was not specifically designed to examine the unique perspectives of minorities and women. Other potential drawbacks include the limited number of residency programs and faculty that were involved and the relatively large size of these particular programs, a partiality not in favor of smaller institutions.
In conclusion, this study explains current resident and faculty perspectives on mentoring in psychiatric training, which has not been conducted on such a large scale to date. There was consensus among the residents and faculty regarding the definition of mentorship, qualities needed to develop and sustain a mentorship, and, more important, the idea that mentoring has the potential to benefit psychiatry residents in training. Although the design for this study is not quantitative, future studies may gain from the use of standardized questionnaires in order to further clarify the importance of boundaries within the mentoring relationship, ethnicity and gender issues, and effective programs for fostering mentorship at different postgraduate levels. These three aspects of mentoring appeared particularly vital in our discussions with residents and faculty and may warrant further research into their significance in mentoring relationships.
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ACKNOWLEDGMENTS
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The authors thank Glen O. Gabbard, M.D., Professor of Psychiatry and Psychiatry Clinic Director at Baylor College of Medicine, for his assistance, and the APA GlaxoSmithKline Leadership Fellowship.
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REFERENCES
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ABSTRACT
INTRODUCTION
