Acad Psychiatry 32:420-428, September-October 2008
doi: 10.1176/appi.ap.32.5.420
© 2008 Academic Psychiatry
Mentoring Increases Connectedness and Knowledge: A Cross-Sectional Evaluation of Two Programs in Child and Adolescent Psychiatry
Michelle S. Horner, D.O.,
Susan Milam Miller, M.D.,
David C. Rettew, M.D.,
Robert Althoff, M.D., Ph.D.,
Mary Ehmann, M.A.,
James J. Hudziak, M.D. and
Andrés Martin, M.D., M.P.H.
Received February 1, 2007; revised June 3, 2007; accepted June 15, 2007. Dr. Horner and Ms. Ehmann are affiliated with the University of Pittsburgh Medical Center, in Pittsburgh, Pa.; Dr. Miller is affiliated with the University of California, Davis, in Sacramento, Calif.; Drs. Rettew, Althoff, and Hudziak are affiliated with the University of Vermont College of Medicine in Burlington, Vt.; Dr. Martin is affiliated with Yale Child Study Center in New Haven, Conn. Address correspondence to Andrés Martin, M.D., M.P.H., Yale Child Study Center, 230 South Frontage Rd., P.O. Box 207900, New Haven, CT 06520-7900; Andres.Martin{at}Yale.edu (e-mail).
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ABSTRACT
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OBJECTIVE: The authors assess changes in knowledge and feeling connected to the field of child and adolescent psychiatry (CAP) after participation in a brief mentoring program held at two CAP conferences. METHODS: Similar mentorship programs were implemented at two CAP conferences, one national (N=119 participants), one international (N=53). The 4-day programs were part of larger travel awards, and included daily small group meetings consisting of a mode of two mentors and six participants. The authors created a survey with 40 quantitative questions designed to measure the change in participants’ perceptions related to the conference and mentoring program, and provided additional fields for narrative comments. RESULTS: Mean participant ratings were positive for all questions on the survey. Changes in connectedness were rated higher than those in knowledge. The highest mean ratings were related to feeling more connected to the host organization, to CAP, and to other program participants. Outcomes were similar between the two conferences, except for knowledge gained on research, which was higher among participants in the international meeting. Outcomes were similar across demographic variables, except for internationally trained participants rating higher on research knowledge, connectedness, and overall knowledge. Over 75% of participants felt they made a connection with their mentor, bonded as a group, and learned new things about CAP and the host organization. A qualitative review of comments revealed several themes, including heightened importance of networking, increased awareness of the field, improved connectedness, a desire for trainee-focused events, and mixed feelings about how much structure to provide within the mentorship experience. CONCLUSION: A brief group-style mentoring program is logistically feasible within large conferences, and can result in broad positive impact for trainees. Future studies are warranted to determine if these programs have lasting effects on connectedness, career choice, and career development.
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INTRODUCTION
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Mentors, defined as trusted counselors or guides, have long been considered "critical" for success in medical training (1). Enhancing access to mentorship can improve reported satisfaction with medical training, and address barriers to successful completion of academic endeavors such as scholarly projects (2, 3). Many residency programs offer some form of mentorship, ranging from formally organized to spontaneous initiatives. Few studies, however, have examined which aspects of mentoring are useful and meaningful to its participants. A recent review of mentoring in academic medicine revealed that only a few studies have evaluated the importance of mentoring from the trainees’ perspectives or the impact of structured mentoring programs on trainees (4). Some studies have looked specifically at mentoring in psychiatry, focusing on its importance within research training (5–7) and as part of a retrospective training survey of recently graduated child psychiatry fellows (8). Although more research is needed to expand our understanding of mentorship, most agree a successful mentoring experience can be highly influential and meaningful for trainees (4). Having a mentor has been related to career satisfaction for faculty as well as trainees (9, 10). In multiple studies, mentoring has been reported to enhance careers in general, and is felt to be highly influential on career choices (4). Mentoring programs have also been reported to increase self-confidence in participants (11), and result in less academic difficulty for select groups of students (12). From an institutional perspective, mentoring has been shown to improve retention of junior faculty, increase promotion rates, improve time spent in research, and lead to increased numbers of publications (11). Similar results were described in research-focused articles, where child and adolescent psychiatry faculty identified mentoring as critical to research success (6, 7).
Mentoring may be especially important in underserved fields such as child and adolescent psychiatry (CAP) (13). Outreach to potentially interested trainees may be essential for educating them about the field. In a survey of recent CAP graduates, career guidance was described as the most helpful aspect of the mentoring relationship (8). An influential mentor or attending has also been attributed with greatly influencing specialty choice (14). While the American Academy of Child and Adolescent Psychiatry (AACAP) provides some assistance in finding mentors for interested trainees, little is known about the availability and success of CAP mentoring relationships for interested medical students and residents. In addition, such programs are typically limited to residents who specifically seek them out, and geographic and time constraints may restrict the development of these relationships. Given the pressing need for recruitment into the field of CAP and the perceived importance of mentoring in career guidance, innovative methods for exposing trainees to CAP mentoring opportunities are urgently needed. The mentorship initiatives described and evaluated in this article are one such method.
If mentoring is important to one’s career success, and lack of mentoring is potentially detrimental, why do not all trainees have a mentor? One study using resident focus groups identified a perceived lack of time and lack of mentors in general (15). These residents even suggested an all-day workshop to learn more about mentoring, and suggested providing incentives to faculty who volunteer themselves as mentors. One possible solution is to provide mentoring programs at conferences that bring together trainees, top faculty, and community practitioners. Many national medical conferences are well positioned to deliver highly visible networking and educational opportunities. Professional associations have been touted as the most important resource for developing collegial networks (1), and trainee participation is typically imperative to the organization’s future success. Therefore, special trainee events and discounted conference rates are typically offered to entice younger members. Several organizations also award travel grants to help defray the cost of participation for trainees. However, once the trainees arrive, they often feel overwhelmed by the number and breadth of participants, lectures, and events. Paradoxically, networking can be challenging in such an abundant environment. Moreover, attendees who are uncertain of their career choices often do not have ready access to seek guidance from senior members in the field.
We set out to create an innovative method of improving connectedness at large child psychiatry conferences while exposing trainees (i.e., medical students, residents, and fellows) to leaders in the field. To maximize exposure for as many trainees as possible, small mentoring groups were created. These small groups allowed for both peer and traditional senior mentoring in an open-exchange format. Successful peer mentoring groups have been described elsewhere (16), but to our knowledge, this is the first paper to report on group mentoring with several senior facilitators at a national meeting.
We hypothesized that combining the mentoring program with a travel award at a national meeting would lead to increased connectedness and knowledge for the participants, as well as increased awareness of the importance of mentoring relationships.
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Methods
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We worked with two professional organizations to institute a brief mentoring program that was added as a new component to previously established travel awards. The programs were designed to occur during the respective organizations’ annual conferences. The first was held at the 17th Congress of the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP), held in Melbourne, Australia, from September 10–14, 2006, and the second at the 53rd Annual Meeting of AACAP, held in San Diego, Calif., from October 25–28, 2006. Funds to support the travel award programs came from diverse sources, including the respective associations, the federal government, unrestricted pharmaceutical education awards, and philanthropic support. A minority of participants (n=8) received funding as part of a larger 12-week fellowship award. Funds were primarily used to defray travel and lodging costs for participants and, to a lesser degree, to support select events, such as a breakfast forum or social gathering. No funds were used to support the volunteer mentors. Both of the mentorship initiatives were modeled after a program first implemented at the 16th Congress of IACAPAP, held in Berlin, Germany, in 2004. That program, facilitated by Professors Helmut Remschmidt and Kari Schleimer, respectively the President and Secretary of IACAPAP at the time, was named after the late Donald J. Cohen (1940–2001), who had in turn been president of the association from 1992 to 1998, and had been a champion of mentorship initiatives in child and adolescent psychiatry around the world (17). The historical background of these initiatives is summarized elsewhere (18, 19), and some of the practical aspects of its implementation, as well as its exportability to other settings, in the article by Adler and colleagues (20).
Awardees were selected from a pool of English-speaking applicants based on a standard set of criteria. Additional participants were permitted to join the mentoring program on site if there was remaining space in the program. Mentors were chosen based on their experience, involvement with the organization, and availability during the meeting. Most were well-accomplished members of the field. Three senior CAP fellows who were involved with planning the program served as co-mentors. Awardees were placed into small mentoring groups with 6–8 trainees (mode=6) and 1–3 mentors (mode=2) for a total of 7–12 people per group (mode=8). Groups were arranged to be diverse, with a planned balance of gender, seniority, geography, and interest. Groups did not have specific themes or structured topics, and no attempt was made to match specific interests between mentors and mentees. To encourage a dynamic experience, mentors were given a brief list of suggestions on how to facilitate open discussion designed to evolve into a more focused format, guided by the trainees’ interests. Award recipients were provided with information about the mentoring program schedule, as well as all trainee-targeted events at the meeting. This information was distributed months in advance of the meeting, and was redistributed on numerous occasions. During the conferences, mentoring groups met in predetermined rooms for 90 minutes around lunch time. Several groups, however, chose to meet in other locations within each conference’s host venue.
We created a four-page survey designed to capture the participants’ change in perspective related to the conference and the mentoring program. The questions were structured to measure key objectives for the mentoring program, including improved awareness of and knowledge about CAP and the organization in general; improved connectedness to the organization, the field, and the other participants; improved networking and professional opportunities within the field; and improved understanding of the importance of mentoring.
The survey contained 40 structured questions about the mentorship program. Questions were designed to measure the level of change that occurred as a result of attending the meeting and mentoring sessions. All questions were anchored on a Likert scale that ranged from –2 to +2. Additional fields for narrative comments about the travel award and attendance to specific program events were included. There were also two areas for hand written comments about the perceived strengths and weaknesses of the mentoring and conference programs. The survey was distributed toward the end of the conference. If participants did not complete a survey during the meeting, one was e-mailed to them, and reminders were sent until the form was completed. Data were entered using the Cardiff TeleForm Version 8.0 scanning program, with manual cleaning of all data prior to analysis (Cardiff Inc., Alta Vista, Calif.).
The study was deemed exempt from informed consent by the University of Vermont’s Institutional Review Board due to the implicit consent of the participants completing the survey as part of their travel award. Individuals who did not receive a monetary travel award yet completed the survey did so voluntarily after participating in the program. Because the award was contingent on completion of the survey, the survey was explained to have confidentiality-without-anonymity.
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Results
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Characteristics of the program participants are summarized in Table 1. One hundred seventy-two out of 173 participants (99%) completed the survey (119 [69%] from AACAP and 53 [31%] from IACAPAP). One individual participated in the mentoring program but did not complete the survey. The two groups were similar in composition by training status, with the majority of participants being CAP fellows, and smaller fractions of residents and medical students. The IACAPAP group included a small number of junior faculty participants (n=7). The majority of participants in both groups received travel awards to attend (81%), and about one-third in each group had previously participated in the respective organization’s meetings. The groups differed by gender (68% females in AACAP versus 49% in IACAPAP;  2=5.64, p=0.02); North America as continent of origin (80% AACAP versus 6% IACAPAP; 2=92.65, df=5, p<0.001); United States as the country of graduate training (74% AACAP versus 6% IACAPAP; 2=68.63, p<0.001); and professional background. AACAP gave travel awards only to physicians (including six DOs), whereas IACAPAP included 19% nonphysician awardees (psychologists, nurses, and other allied professionals; Fisher’s exact test p<0.001).
Participants’ attendance and ratings for different components of the mentorship program (AACAP only) are summarized in Table 2. Attendance was uniformly good (range 59%–92%), with the exception of a research seminar (30%) and the closing event (26%), a fact that may have had less to do with lack of participant interest than with conference logistics and travel schedules. Conference components had a pooled mean±SD rating of 0.75±1.04 on a scale ranging from –2 (not useful at all), through 0 (moderately useful), to +2 (very useful). The highest-rated components were the program breakfast, in which three speakers discussed their personal and very different trajectories into CAP, with generalizable lessons relevant to trainees; poster sessions, in which participants presented their work and received feedback; and the small-group mentorship sessions. Unstructured activities such as an open-forum town hall meeting and a resource room received the lowest ratings.
Participants’ outcomes on the domains of connectedness and knowledge are summarized in Table 3. The internal consistency for the scale items tapping into connectedness yielded respectable Cronbach alpha coefficients of >0.75, in contrast to the less cohesive knowledge items (alpha range=0.37–0.49). Nevertheless, their individual item scores provided useful information on particular areas of knowledge acquisition. Overall, outcomes of improved connectedness were rated more highly than those of improved knowledge (1.34±0.43 versus 0.82±0.32, t=5.14, p<0.001).
Outcomes were similar between the two conferences, except for knowledge gained in research, which was higher among participants at the international meeting (0.94 ± 0.40 versus 0.68 ± 0.54, t=3.20, p<0.001). Outcomes were comparable across all demographic variables, except for country of professional training, with internationally trained participants rating higher on changes in knowledge of research (0.92±0.47 versus 0.73±0.43, t=4.02, p<0.001), connectedness (1.41±0.40 versus 1.27±0.45, t=2.23, p=0.03), and overall knowledge (0.87±0.34 versus 0.77±0.30, t=2.07, p=0.04). Although there was clear variability in outcomes across the 19 small groups (11 in AACAP, eight in IACAPAP), cells were too small to conduct reliable intergroup analyses.
Qualitative Review
Participants were asked to list the strengths/positives and weaknesses/negatives about the meeting and the mentoring program. Nearly all participants had positive comments regarding their mentoring groups and mentioned their increased knowledge. There were a few between-group differences for the two conferences. Participants of the IACAPAP meeting mentioned international collaboration and world health issues, whereas this theme was not a central focus for AACAP participants. Also, IACAPAP participants were required to present a poster based on their research, so comments about the poster session occurred more frequently in this group. Qualitative review of all the comments revealed several common themes, as summarized in Table 4.
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Discussion
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These results indicate that a brief mentoring program can have a meaningful impact on the trainees who will likely become the next generation of child and adolescent psychiatrists. Participants reported increased interest in child and adolescent psychiatry (CAP) as well as increased interest in mentoring. Furthermore, they indicated improved knowledge about mentoring and the fields of general psychiatry and CAP that can be partly attributed to the mentoring program. By facilitating connectedness to mentors, to the field, and to the organization, potentially career-enhancing relationships were started. Combined with increased connectedness, this enhanced knowledge may lead to increased interest in CAP, better experiences with mentoring, and enhanced understanding of the practice of CAP both nationally and internationally.
We hypothesized that exposure to mentoring would improve the participants’ view of mentoring relationships in their training. Eighty-five percent stated they agreed or strongly agreed that they had a better understanding of what a mentor can do for them, and 90% said they would be more likely to work with mentors in their field. Ninety percent stated they would be more likely to volunteer as a mentor themselves. Thus, even a brief program can greatly influence the perspective that mentorship matters.
The mentorship groups were intentionally mixed by training level, interest, and geography in order to provide a variety of resources to the participants. Our study revealed several advantages and disadvantages of using this "mixed group" approach. Participants seemed to enjoy the mixed groups, yet also wanted focused time in their main area of interest. This was especially true for medical students and trainees interested in independent practice. The majority of the group consisted of child fellows, and most of the mentors were in academic positions. This may indicate that objectives should be carefully considered when selecting and matching participants and mentors. Measures of connectedness were rated highly by participants, consistent with efforts to personalize the training experience through mentorship, as has also been attempted by others in order to "counteract feelings of bureaucratic anonymity and isolation" (21). Thus, our mixed group format may have been useful for improving connectedness, and further studies are needed to explore the influence of differently designed mentoring formats, or the contribution of different mentorship styles or mentor characteristics.
There were significant differences in the responses among internationally trained graduates, especially around the acquisition of research-specific knowledge. Such differences may have been due to a greater emphasis in the IACAPAP selection process on a concrete research project, which is subjected to the critique and feedback of peers and mentors, both in small groups and in dedicated poster sessions. Alternatively, it may have been due to lower "research literacy" among some international medical graduates, particularly those from developing nations, who generally reported less formal training in research methodology and statistics, and thus had "more room for growth" following the intensive mentorship experience.
The individual needs of the women in child and adolescent psychiatry (CAP) also warrant special consideration. For the AACAP award presented in this article, women outnumbered men more than two to one, reflecting a national trend of increasing numbers of female medical trainees and faculty in the United States (22). In light of the article by Ash and colleagues (23) revealing the inequity of women’s advancement in academic medicine, mentoring women and encouraging them to become mentors themselves will likely be of growing importance (24). To this end, our mixed group approach permitted similar representation of both genders. Further, mentor groups had mixed ages and ethnicities, allowing for additional diversity within groups. None of the participants noted a lack of diversity in the comments provided for our qualitative study, which may indicate another benefit of the mixed-group approach.
We also wished to provide career and development support to recruit younger trainees interested in CAP. However, the award recipients were mostly residents and fellows who were already committed to child and adolescent psychiatry. Relatively few students or "uncommitted" trainees applied for awards or participated in the mentorship program. As such, encouraging younger trainees to attend meetings and mentoring programs may be a strategic consideration for field outreach.
Despite the importance emphasized in this and other studies, the impact of mentorship may be different for each individual. One study reported that personality may play a role, indicating that "Individuals with good internal control, high self-monitoring skills, and emotional stability were more active in seeking mentoring relationships. These relationships resulted in greater success" (25). This finding, however, does not mean that mentoring is not useful to others if such a relationship can be found. Indeed, in a survey of recently graduated child and adolescent psychiatrists, only 2% reported that their mentor was not helpful (8). This finding is represented by our results, which showed a positive mean response to every question on the survey. Thus, efforts to ensure mentoring for trainees may be of vital importance on multiple levels, as many participants will have meaningful experiences.
Our study has several limitations, mainly based on the logistical challenges of implementing a pilot mentoring program at a national meeting. These limitations include a potential bias in the sample of mentors and participants (both groups were screened and selected), time conflicts between co-occurring conference and mentorship meetings, and lack of a matched group of conference attendees who did not participate in the mentoring program. Since the mentoring group meetings occurred within the context of a conference, it may be difficult to tease apart the impact of the mentoring experience from that of the conference. The travel award may also influence more positive outcomes. Eighty-one percent of the participants received a travel award. Of these, 55% stated they would not have attended without the travel award money, and 97% stated that having a travel award makes it more likely that they will attend future organization meetings.
The survey also had limitations. The tightly scheduled nature of the conference did not permit us to collect pre- and post-conference surveys, which would have provided a pre-conference baseline to better measure change. Since completion of the survey was required for distribution of the monetary award, the surveys were designed to have confidentiality-without-anonymity. While this aspect was not criticized in the comments, a lack of complete anonymity may have positively influenced the results. Furthermore, the scale was created just for these meetings. As such, there was limited ability to test the scale prior to implementation. The scale was only written in English, but some participants did not speak English as a first language. Thus, some of the questions or concepts may have been confusing. Finally, the survey was only created for mentees, and no data were formally collected about the mentors’ experiences, which could be an important area for future research.
Notwithstanding these limitations, the results provide insight into the general importance of mentoring. Participants had positive mean scores for every survey question. The majority of attendees felt they made a connection with their mentor, felt they bonded as a group, and would recommend their mentor to a peer (range=81%–90%). Many indicated a desire to have a formal method of keeping in contact with their mentor and peers within the group. Due to the mentoring program, 79% felt they learned things about CAP that they did not know before, and 75% felt they learned new things about the organization. The information gathered here points to the potential contribution of mentoring, even when provided during a brief conference.
Our study points to several potential areas of consideration for future studies on mentoring. Adding a peer-mentoring survey section and a nonmentored trainee comparison group may help elicit the change specifically attributable to the mentors and the mentoring program. Implementing a similar program for trainees who are still deciding their career path (e.g., general psychiatric residents, pediatric interest groups, medical students) may create a larger change in knowledge, connectedness, and may improve recruitment to the field. Furthermore, organizations could consider implementing similar programs at regional or state conferences, which may provide lasting local mentoring experiences. In addition, creating a method of tracking the mentors’ experiences may provide useful information for improving future programs. Examining the effects of this program via follow-up survey may provide insight into the features of mentoring that have lasting impact. Finally, comparing longer-term mentorship initiatives to shorter-term programs such as those described herein may help identify the optimal setting and timing to help trainees along their professional developmental trajectories.
While some papers emphasize characteristics and developmental stages of mentoring as vital (26), this article provides a glimpse into the potential of brief, intensive, small-group mentoring at the national level. Similar mentorship programs could be successfully developed and integrated within any department or professional organization, as exemplified by Adler and colleagues (20). Through electronic communication and collegiality, the mentoring that began formally can blossom into meaningful relationships whose impact continues far beyond the average conference experience, thereby providing connectedness that may last a lifetime. Longitudinally, little is known about the long-term impact of mentoring on recruitment and retention, as well as its influence on research interest. Nearly all the participants consented to future contact regarding the survey. Thus, we will be able to implement a follow-up questionnaire designed to capture the lasting effects of this brief mentoring program, given that "...mentorship can and often is a longer term process that lasts well beyond its beginnings, yielding different returns over time" (27). As exemplified by this study, even a brief mentorship experience can prove meaningful.
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ACKNOWLEDGMENTS
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On behalf of all program participants, the authors express their deepest gratitude to the leadership of the American Academy of Child and Adolescent Psychiatry and the International Association of Child and Adolescent Psychiatry and Allied Professions, and in particular to their respective presidents, Drs. Thomas Anders and Myron Belfer, for their vision, support, and commitment to the initiatives described herein. The authors also acknowledge the invaluable assistance of Ms. Stacia Hall and the helpful comments from Drs. James F. Leckman, Joseph Rey, and Steven Schlozman on an earlier draft manuscript. Supported in part by the Klingenstein Third Generation Foundation and by Public Health Service grant 5R25 MH077823 (J.F. Leckman, P.I.)
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ABSTRACT
INTRODUCTION
