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On teaching Professionalism

Professionalism is a multi-faceted concept that carries different meanings to different people; it ranges from a physician’s bedside manner and acknowledging mistakes, to how one interacts with their peers and if they show up on time. Not only that, but this all-encompassing term is cited as a core competency by the American Association of Medical Colleges. It is also a part of the American Medical Association’s code of ethics and explicitly mentioned in the syllabi of most medical schools and training programs across the U.S. Despite the broad acceptance of professionalism as a key character component of a well-rounded clinician, there is a significant difficulty experienced in trying to teach this to trainees. This may seem a little long-winded, but this is a subject that really resonated with me, and with JAMA instituting a professionalism section a few years ago, there have been more and more pieces published on the topic; I’m happy to see that this is gaining more traction. Everybody will tell you that administrative burdens and needing to deal with insurance providers for prior auths and the like definitely contribute to burnout, but having unprofessional colleagues can be just as burdensome and unsafe for patients!

I recently came across an excellent piece in the New England Journal of Medicine titled “Responding to Unprofessional Behavior by Trainees – A “Just Culture” Framework” wherein Dr. Wasserman, Redinger, and Gibb attempted to tackle the difficult yet important concept of professionalism in medical training. The article made a strong case for treating lapses in professionalism as if they were medical errors of varying severity, and they included an infographic, as well as gave several examples to go with this framework. In my opinion, professionalism is one of those behaviors that is nearly impossible to teach in a classroom and is often developed through a mix of modeling behaviors from more senior physicians, as well as a little bit of one’s own personality/temperament mixed in.

There was an example cited by the authors that centers around a medical student who has begun a collaboration with a mentor on some database analysis. The mentor states this is an IRB-exempt study and urges the student to begin analysis immediately, but the student’s research office instructs her not to download the data until getting an official exemption was issued by the IRB. The mentor pressures the student into downloading it anyways, and the student gets reprimanded for this. Wasserman et al suggest this is a lapse in professionalism at the lowest level – “no-fault suboptimality” resulting from the student’s faulty understanding that the supervisor (mentor) is right. They focus on teaching the student “strategies for diplomatically addressing her mentor” and acknowledge it is a difficult situation. What they don’t do, however, is acknowledge the context of this lapse of professionalism; they make no mention of addressing the mentor’s behavior or holding them accountable.

By all means, I agree that the student’s incorrect logic needs to be addressed. But, by not addressing the lapse in the professionalism of the mentor, I think the authors missed an opportunity to strengthen the analogy of professionalism and medical errors. In the “Just Culture” movement, physicians were just as accountable as nurses, who were as accountable as medical students for speaking up against unsafe practices. In this scenario, I would argue that the mentor is more liable, and should be held even more accountable than the medical student. As the authors have already made clear, trainees are still developing their understanding of professionalism, but this mentor is arguably an individual who has completed their training and should have a stronger grasp of professionalism than a mere medical student.

I concede that their article was aimed moreso at addressing lapses in professionalism of trainees, but this circles back to my personal view of how professionalism is developed. As others have stated, ensuring an individual trainee’s “competence in the area of professionalism requires the concerted efforts of many.” However, what about non-trainees? You could assume that a hospital board or professional society will self-govern to ensure professional behaviors, but with a term that is so loosely defined, and with financial incentives on the line, how much would someone be able to move the needle? I think most of us can remember at least one time (or many), when a senior physician tore into a helpless colleague, or became frustrated and lost their temper. How often do you think these individuals get a time-out or get part of their wages withheld as a punishment?

This brings me to my point: if the system is flawed, how does putting additional pressure on trainees fix that? The “do as I say, not as I do” approach has never been tested in a randomized trial, but conventional teaching theory (and common sense) will tell you that this is not effective. I myself am a trainee still (you’re reading the Fellows In Training blog, duh), so I certainly do not have all the answers.

From my time spent in developing medical school curricula, and sitting on academic disciplinary committees, I’ve come away with a few insights that I think might help. When the issue is a systems issue – such as “well everyone in my class skips grand rounds, I thought it was ok” the individual who got caught usually got caught due to chance, and reprimanding them would be unfair. Wasserman et al mentioned that the system needs to be changed, but didn’t talk about how. I’m gonna piggyback on that, because systems changes are difficult, and can be nuanced depending on the problem.

I think that lapses in professionalism should be addressed, but a better approach would be one that relies on positive feedback rather than only mentioning professionalism when it is missing. For example, in my medical school, and most training programs, at the middle and end points of a rotation, mentors would take the medical students for some formative “feedback”. Sometimes they were going off a form issued by the medical school, other times they would go off what they felt should be emphasized. If throughout a trainee’s career, different levels of professional behavior are emphasized by instructors, this could go a long way.

One example of this would be that mentors are instructed to focus on the aspect of timeliness and respectfulness with first-year students, making sure to comment on these in each student’s feedback; but when they give feedback to third years, they emphasize other aspects of professionalism, such as truthfulness, admitting to mistakes, knowledge gaps, etc.

Many theories have been put forth as to why professionalism can be such a difficult concept to teach and practice, but I think a critical shortcoming we have to acknowledge is the disconnect between the two worlds that trainees must straddle: the world in which we teach professionalism, and the world in which they practice.

 

References:

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Why Cardiology?

“Why Cardiology?” is one of the most common questions I have been asked by friends, family, interns, residents, and even the occasional stranger sitting next to me on a flight. Despite being a simple question, the answer is very complex. I initially started residency thinking I would pursue a career in pulmonary/critical care – I loved the acuity, broad differential diagnoses, and the bond created with families. However, after my first month in the unit, I quickly abandoned this career path for multiple reasons. Shortly thereafter, I did my first rotation on the cardiology wards service with Dr. Matthew McGuiness (who is still one of my closest mentors) and I saw the light.

The month on the cardiology wards service is best described as “finding the missing piece of the puzzle.” I loved the anatomy, physiology, patient population, subtle differences in presentations, and my interactions even as an intern with patients. I also loved the depth of cardiology – including both clinical and basic science research opportunities, advanced fellowships options, and the ability to create my niche in cardiology. I learned cardiologists were pursuing careers in preventative cardiology, cardio-oncology, cardiac critical care, and cardio-obstetrics. I was blown away at the possibilities of a career in cardiology and having the ability to create my perfect dream job.

As I mentioned earlier, I was very interested in critical care when I started residency but did not want to be in the medical ICUs. The cardiac intensive care units were much more interesting to me with advanced hemodynamics, malignant arrhythmias, various mechanical circulatory devices, and seeing how quickly the realm of the cardiac ICUs were changing. The CCUs are no longer filled with patients who have had a STEMI requiring a week-long admission, but rather those with decompensated heart failure/cardiogenic shock requiring mechanical circulatory support (MCS) with LVADs, Impella, or ECMO.

I am now combining all of my loves – cardiology, critical care, and obstetrics (yes, I at one point wanted to go into OBGYN) for my job as an attending. With the help of my mentors, I have been able to combine all my passions into one. I will be attending in the cardiac intensive care unit and have a predominantly general cardiology clinic with a focus on cardio-obstetric patients. And the best part, every cardiology fellow can create his/her dream job.

A few key questions to ask yourself are:

  • Do I see myself as someone who enjoys the in-patient or the out-patient setting? This will help focus career options and set the stage for your career.
  • Am I a proceduralist or not? For me, I hate wearing lead, so it was a simple decision to not go into interventional or EP.
  • What type of patients do I get the most joy of taking care of. In my case, it was the critically ill and women who are pregnant with cardiovascular disease.
  • Who is 5-10 years ahead of me career-wise and has my ideal job? This has helped me be more active with research, clinics, conferences, and improve my fund of knowledge. It also gave me a roadmap to follow – no need to reinvent the wheel.

Of course, these are starting points and it’s a vast topic that takes time to explore. My journey of “why cardiology” has been filled with highs and low, but with the help of various mentors I have a clear vision of what I envision for my future career.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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A New Year and A New Perspective on Mentorship!

At every stage of personal growth and development, mentors play a key role in providing advice and support to propel their mentees forward. The act of mentorship is a core element of social interactions and societal advancement. A line like “it takes a village to raise a child” is basically talking about mentorship. Same for the commonly used line in academic and medical circles – “See one. Do one. Teach one.” Graduate and postgraduate students and fellows are required to have assigned mentors to guide them through their final stages of education, and early stages of a professional career.

The level of success a person achieves can be accurately traced to the level of mentorship afforded to them. Mentorship, more so than just academic education, provides a broad spectrum of opportunities for learning and growth. Great mentors are able to provide advancement in what is classically referred to as “soft skills”. These are skills like: communication, leadership, time management, “tricks of the trade”, and other avenues of growth normally left out of school curriculums. This makes finding a highly qualified and experienced mentor an extremely valuable endeavor. Of course these skills are not limited to the medical and academic fields; mentorship is valuable in all aspects of personal and professional growth.

Here is where I introduce the main message I’d like to pass along in this piece. We (correctly) seek and value mentorship from experienced, highly qualified, and revered individuals, to assist us in advancing our knowledge and skills within our chosen fields. However by focusing on finding one type of mentor, we may be setting ourselves up for lost opportunities, learning and advancements of equally beneficial value, from individuals that don’t fit the classic idea of a mentor. By this I mean, when was the last time you looked for a mentor that was junior to you?

We all are kind of aware of how this type of mentorship can be, like how I’m happy to continuously coach my dad on how to advance his usage of smart phone technology, and how my younger relative is mentoring me on how to be a better skater and hockey player! This same kind of mentorship dynamic can also translate in a professional/academic setting. In our present fast-paced advancing world, many novel ideas and tools develop, and typically the earliest adopters are not individuals that have established some previously learned and used idea/tool (i.e. the ones with the lived-in world “experience”). Most of the time, early adopters are typically young, enthusiastic, quick learners!

This group has shown time and again, when it comes to the newest forms of knowledge and skills, they’re ahead of the archetypal mentor. Seeking and accepting younger mentors, in addition to classic mentors, allows the mentee to gain knowledge and skills in a wide range of topics and fields, as opposed to only seeking top-down knowledge. There is great value in learning from experienced individuals, but there is also value gained by seeking the expertise of younger enthusiastic early adopters of novelty, regardless of what field one is pursing mentorship in.

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(Image collage sourced from pixabay.com)

 

Considering this is the time in the calendar where everyone is reflecting on the accomplishments of the past, and making plans and resolutions for the coming year, I thought I would suggest an additional resolution to add to your list this time around. In an effort to maximize personal and professional growth, why not make a resolution centered on mentorship? I’ll even create a fun plot device J What if the resolution could be formulated as follows: This year I will seek (or continue to benefit from) one mentor that is “double” my age/experience AND one mentor that is “half” my age/experience (let’s call it the Double & a Half Mentorship rule!). *All values are approximate.

I’ll use myself for an example: as an early career scientist, a mentor “double” my age is already in place (that’s my boss, Chief Science Officer of the Institute I work in, and Senior Principal Investigator on the research group I’m part of; who truthfully has way more energy than I can achieve, proving that age is not a good measure for vitality!). A mentor “half” my age would be a summer/undergraduate student or temporary employee in our research group (again, the age part of the rule is approximate); someone that will teach me a skill in the lab or on a computer, that will promote my professional goal of learning and conducting high caliber research in cardiovascular disease areas.

This year I aim to continue finding ways to learn and gain skills from both an experienced mentor, and a young enthusiastic mentor, to advance my personal and professional development. I hope you maximize your mentorship opportunities as well. Happy New Year!

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Have You Picked Your Mentor’s Brain Lately?

It’s funny how people meet – some are coordinated efforts at work or meetings while others are random. I met one of my mentors – Dr. Jane Freedman – in the outpatient echo lab. We had never met prior to my fellowship but I recognized her name from the echo reports of my patients. After introducing myself to Jane, I fired all sorts of questions her way – mostly about restaurants in Boston we both enjoy, things we do in our free time, how to get involved in the AHA, and how best to read echocardiograms. This sparked not only a great friendship but an even better mentorship.

Jane has become my work-life-balance mentor, advising me on how to be an effective chief fellow, developing my own leadership style, types of jobs to pursue, and balancing personal life with the intense time commitment of medicine. I soon realized in order for me to be a good mentee, I had to support my mentor when I could. This included, attending her talk at the AHA not out of a feeling of obligation but out of a genuine desire to support my mentor. Over time, our mentor-mentee relationship has taken on more academic facets – largely, honing in the on the type of job I would want in the future. Jane has pushed me to clarify the type of job I want to pursue and more importantly, what are the reasons for wanting it.

mentorOver the course of my training, I realized that not all of my colleagues have mentors to turn to for these critical career conversations. It made wonder how mentors can help fellows in training, and more importantly, what are the key elements to a successful mentor-mentee relationship. To understand what made our mentor-mentee relationship successful, I asked Jane at a recent dinner at one of the many great restaurants we wanted to try.

In her experience, a successful mentor-mentee relationship comes down to be receptive as a mentor and mentee. You have to have the self-awareness of the relationship to provide support for those seeking it.  In addition, the relationship has to be symbiotic. The mentor has to give advice to the mentee based on the level he or she is at. For example, the chair of cardiology may not be a good mentor to a first-year fellow if he or she is not able to give the appropriate support needed for the fellow at that specific stage of training. Conversely, the mentee needs to work hard towards the goals and expectations he or she has set for this to be a successful relationship. This made me think: how do we go about even choosing the ‘right’ mentor??

Jane highlighted that everyone needs more than one mentor. For example, an academic mentor to help me pursue research opportunities, a clinical mentor who helps cultivate knowledge in my area of interest, and even a work-life mentor that I can turn to when this demanding job seems undoable. Every mentor offers something unique to the relationship and more importantly, not one mentor will be able to give you everything you need. Jane stressed that she never stopped at one mentor but sought those that will help her become successful in all aspects of her life and career.

Jane explained that while she was training she reflected on what would improve her work-life balance. There were only so many things she could accomplish in a day and had to recognize where she needed help. For example, with the various apps to help improve efficacy, I could order groceries to be delivered to our home. The time saved at the grocery story can be spent with my significant other or at the gym. Something Jane stressed – which I took to heart – was to never feel guilty for not being able to do it all. People who go into health care are incredibly driven but we all have our limits. It’s important to recognize these limits to prevent burnout, enjoy our work, and continue to work on achieving a balanced life.

A piece of advice Jane gave me is to make sure I pick a career path that will make me happy, not the one I think I should take. With the extensive amount of board certifications in cardiology, fellows feel pressured to take them even if they do not want to. Again, this comes back to a point Jane highlighted earlier – we need self-awareness to be successful.

As dinner started to wind down, I was able to reflect on how I was performing as a mentee and what steps I can take in the future to make our relationship more successful. Checking in with my mentors always brings about new found motivation and energy to continue to strive for success.

 

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Advice Given and Lessons Learned After My First Year as an Attending in the Cardiac ICU

One year ago, I started my journey as an attending pediatric cardiac intensivist.  People often say that you learn more in your first year as an attending than in your last year of fellowship, and I believe that is 100% true.  As I began this journey, I asked for advice from my previous mentors and compiled them into an article I published in the inaugural edition of the Pediatric Cardiac Intensive Care Society newsletter. Now, after surviving my first year and learning lots of lessons, I’m taking that article and adding some of my own observations/spin to the advice that I received. (My new editorial comments/additions/insights are in italics or bold italics).

“Wellness and self-care are critical. This is not an easy profession; it does not allow you to rest on your laurels when you’re actively caring for some of the sickest kids in the world and it’s not without its toll. Burning bright at 110% all the time will consume anyone, so practice self-compassion. ‘You are neither weak nor powerful. Bad things will happen. Try to blame yourself less.’ And take some time off for things that are really important to you. When you find yourself perseverating about a clinical situation or patient interaction that you wish could have gone differently, give yourself a time-out.  Don’t beat yourself up endlessly.  Take a minute to say ‘I cannot change the past; next time, I’ll react this way….’ and then sit down and force yourself to think about something else for a while: listen to music, sing a song, watch TV, read something for fun. 

In our field, we are both blessed and cursed to have lots of opinions about the work we do. Seek advice often, but when you’re making decisions, do what feels right for the patient. Definitely go with your gut; it’s almost never wrong.  By its nature, we are a team-based subspecialty, so always be respectful of your colleagues. We depend on each other and need to be kind and caring to one another.

‘Be flexible. Learn your new system before trying to make changes in it. Avoid saying “At my institution, we did it this way.” Although your past experiences are vital in helping you develop your style and way to do things, it is just as important to learn what works in your new system and then make changes that will be effective. Find several mentors. One person doesn’t have to fill all your mentoring needs. Ask questions frequently. I think I sat down with a senior colleague on an almost daily basis to rehash my decisions when I started.’ -Catherine Krawczeski, MD.  I definitely am still working on this. I ask for mentorship, but I really need to be more proactive in my mentor/mentee relationships.

Your presence on the unit as a trainee, no matter how experienced, is different when you become faculty. ‘Although you won’t always feel like it, you are the leader of the unit. As such, your reactions… are taken to heart more so than when you were a trainee… Share compliments liberally (but be genuine) and deliver critiques gently and with compassion. Teach as much as you can — everyone wants to learn and often those who are struggling crave it the most.’ Don’t take for granted the knowledge that you have.  Something that may seem second nature and completely basic to you might actually be a huge, mind-blowing revelation to someone else – we all learned what we know from someone else.

Pay close attention to your patients and give them what they need. Some patients will do well if you let them heal without tinkering, and some will not, despite everything that you do to help. However, there is a small subset of patients who really need your utmost attention, thoughtful consideration, and active, intensive doctoring; your job is to identify this group and do everything in your power to give them the best outcome possible. Again, go with your gut.  When something seems like it might need a closer look, then it probably DEFINITELY needs a closer look.

‘Under the best circumstances, it takes at least two years for any new cardiac intensivist to begin to feel competent with clinical decision-making on most of the patients admitted to the CICU. Thus, it’s not realistic to expect you will be on top of a unit full of active cardiac patients soon after completing fellowship. And even after many years of experience in cardiac intensive care, it’s important to recognize that you are not truly in control of the clinical path of all of your patients. It’s simply not a place to feel comfortable and relax your vigilance.’ -Stephen Roth, MD, MPH. Preach!!!

Finally, time is short, do not waste a minute, always show up, be visible, get involved and take chances. From a young faculty administrative perspective, don’t be afraid to say ‘no’ when asked to do things that will extend you beyond your limits as far as time, energy, or passion,  but don’t be afraid to say ‘yes’ to things that you think will be difficult just because you’re afraid of failing – these are opportunities for growth.  Growth is hard, but worth it.

And when things are going south, take it one step at a time. Step 1: Keep calm and check the pulse and look at the ETCO2.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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Shift Your Perspective To Get The Most Out Of Mentoring

The AHA Epidemiology and Prevention and Lifestyle and Cardiometabolic Health Scientific Sessions is quite different from AHA Scientific Sessions. Smaller in size and more focused, with few concurrent sessions and ample coffee breaks, I enjoyed attending the numerous Early Career sessions. They varied in topic and format: “Connection Corners” were short round-table discussions twice a day with focused conversations on ‘beefing up your CV’, the grant writing process, developing a catchy elevator speech, and leveraging non-NIH funding. Both the EPI-Prevention and Lifestyle councils had lunchtime panels at the end of their annual business lunches, and had the audience asking questions about avoiding burnout in academia and global collaboration in cardiovascular research.

To end the week, the Early Career Council outdid themselves with the early morning ‘fire-side’ chat with Drs. Emelia Benjamin, MD ScM from Boston University School of Medicine, Norrina Allen, PhD from Northwestern Medicine, Jean-Pierre Després, PhD from Laval University in Quebec, Chiadi Ndumele, MD MHS from Johns Hopkins Medicine, and Lenny Lopez, MD MDiv MPH from UC San Francisco.

 Drs. Emelia Benjamin, Jean-Pierre Depres, Chiadi Ndumele, Lenny Lopez, and Norrina Allen (left to right) provide eye-opening mentoring advice to early career investigators at the EPI Lifestyles Scientific Sessions 2018 in New Orleans, LA
Drs. Emelia Benjamin, Jean-Pierre Depres, Chiadi Ndumele, Lenny Lopez, and Norrina Allen (left to right) provide eye-opening mentoring advice to early career investigators at the EPI Lifestyles Scientific Sessions 2018 in New Orleans, LA.

If you missed this morning session, no worries! I have you covered. The panel conversation, led by Dr. Emelia Benjamin, started with finding your niche as an early career investigator, and developed into a great discussion on building a mentoring team and planning your own path.

Using Sli.do to anonymously ask questions allowed for an unbiased view of what the audience was thinking. And overwhelmingly were questions along the lines of:

  • What do you do if your mentor selects a niche for you that doesn’t excite you?
  • How do you separate your niche from your mentor?
  • What can you do to fix a fall-out with your mentor?

I found these questions concerning! To me, they reflect a mentee perspective that 1) once you’re assigned a mentor, you’re stuck with them; 2) your mentor is the be-all-end-all guide in your career path; and 3) you must do everything your mentor tells you.

My first response to this perspective is: we’ve got to shift this mindset! If your relationship with your mentor is that of a duckling and mother goose, something has got to change. A mentor that “assigns” a research niche to you is either a Tormentor or is responding to your lack of initiative. If the former, you should find a new mentor. Your institution will have a number of resources including a faculty affairs office or an ombudsman and possibly a mentoring program that will help you find a mentor that best fits with your needs.

If the latter, you’ve got some work to do! But the career panel provided some great advice on how to get started. (So do Vineet Chopra, MD MSc, Vineet M. Arora, MD MAPP, and Sanjay Saint, MD MPH in an article titled “Will you be my mentor?” published in JAMA last year).

Make the most of your time

Mentors have a number of responsibilities and how they have made their own career path and achieve work life balance is a great indicator if you will be a good fit. Do you aspire to a career like theirs? Do you admire their work-life balance? They might make a great life or career mentor for you.

Just as you expect your mentor to give you their full attention when discussing your goals, you must respect their time as well! That means giving thought to your research goals, planning the steps to get there, and using their expertise and experience to provide direction and improve your process.

Set up a meeting with your mentor and prepare an agenda beforehand. Know the topics you’d like to cover, whether their input on goals and milestones, plans for research projects, or ideas to brainstorm on. Preparing an agenda shows respect for both of your times and keeps you on track for a productive meeting. Jot down action items and follow-up after the meeting.

Judy T. Zerzan, MD MPH and coauthors discuss “managing up” and how to take responsibility for your half of the mentor-mentee relationship in “Making the Most of Mentors: A Guide for Mentees.”

Earlier this year, Dr. David Werho wrote about sponsorship versus mentoring in his 2-part article “When Mentoring Isn’t Enough”. Read Part 1 and Part 2 to learn about why dependability pays off, how to diversify and be the protégé you want, and why it’s worth it to do your homework.’

One is the Loneliest Number

Another solution to mentor woes is creating a mentor network. Over and over, the panel expounded on the advantages of having both a primary mentor and a mentoring group. This structure is explicit in career development grants, where the primary mentor supports your career development initiatives, and the content and methods experts support your training goals. Content and methods mentors in your network can also help you explore different areas in your field as you work to identify your research niche.

A mentor network means different researchers with different backgrounds and different perspectives. Bouncing your research ideas off them results in contrasting views, some that will jive more with you, and some that will make you think. Instead of being molded into a “mini”-me mentee, a mentor network helps you build the scaffolding upon which you’ll grow into your own independent researcher.

I’ll touch more on this idea later, but here’s a great read from Yan Shen, Richard D. Cotton, and Kathy Kram for the MIT Sloan Management Review. Even if you are post-tenure, you still benefit from a strong mentoring network! Read more from Kerry Ann Rockquemore in “Posttenure Mentoring Networks.”

Identifying a Niche

The pre-established theme of the Friday morning early career session was how to “Identify Your Niche”. While much of the discussion centered around mentoring and its supportive role in finding your niche, there was also focused advice on how to find your way.

The panel emphasized that as an early career investigator, it’s imperative to utilize this time to identify and achieve the additional training you see as important to your overall career goals. While this may be in the form of a post-doctoral position or a K-award, it can also be informal in the research projects you pursue and the skills you acquire.

Dr. Emelia Benjamin, who provides mentoring support to early career faculty at Boston University, gave us 2 homework assignments to help us plan our way.

First, reflect on where you’ve been and where you’re going. A 1-page personal statement makes a powerful addition to your CV, and the journey to this final product will help you learn to tell your story as a connected arc, rather than a zig-zag path jumping from topic to topic. The evolution of your research niche from project to project is hardly evident in your publication list, but through narration and self-reflection you can illustrate your approach to the scientific process and summarize where you might go next. Not only will you provide a picture of your research goals and personality to anyone reading your CV, but you will likely have a few “Aha!” moments discovering connections between projects you hadn’t seen before.

Second, diagram your mentoring network. It’s important to visualize this – are all of your mentors above you? Below you? Horizontal to you? Peers? Are they in the same division, institution, or all distance? A mixture is key, but the components of that mixture depends on your research and career goals. Dr. Chiadi Ndumele from Johns Hopkins Medicine shared his take on 5 valuable types of mentors to have:

  1. Methodological mentors are those you go to for questions and feedback about approach.
  2. Content or clinical mentors are those you go to about patient care of content expertise.
  3. Life mentors are those whose work-life balance is one you admire.
  4. Career mentors help you step back and see the big picture, particularly the asks you should say no to.
  5. A brainstorm mentor plays devils advocate and is a great sounding board to bounce ideas off of that also bounces back.

5 Valuable MentorsDr. Emelia Benjamin utilizes the theories from Kathy Kram, Monica Higgins, and David Thomas on “Creating Developmental Networks” and “Reconceptualizing Mentoring” with her early career faculty at BU. Take a cue from her, and use this worksheet, Define your Developmental Network, to identify the gaps in your mentoring network, and take the first step to filling them.

Bailey DeBarmore Headshot
Bailey DeBarmore is a cardiovascular epidemiology PhD student at the University of North Carolina at Chapel Hill. Her research focuses on diabetes, stroke, and heart failure. She tweets @BaileyDeBarmore and blogs at baileydebarmore.com. Find her on LinkedIn and Facebook.

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Getting Sponsored – When Mentorship Isn’t Enough (Part II)

Remember my disappointing story from Part I of this post? Well, I have an uplifting story from the same meeting.  A different colleague from a different training program came to the conference with a different group of mentors.  Every time I bumped into her at the meeting, she was being introduced to leaders in her field at a variety of institutions by her mentors/sponsors.  She left that meeting with many more contacts, opportunities, and potential future bosses than she had going in.  Now, she had not asked for her sponsors to recommend her to these people, nor had she even asked these mentors to be her “sponsors.”  She was a hard-worker who always delivered consistently on her projects, and those that mentored her felt proud to be recommending her to their colleagues, because they knew that she would be reliable and reflect positively on them.

Similarly, I’ve been very lucky to have been surrounded by mentors who were often very natural sponsors.  As I’ve grown in my career, they’ve stayed in touch and have been eager to recommend me for committees or projects that I would not have otherwise had the opportunity to become involved in.  But in thinking about many of my friends and colleagues who are not lucky enough to have these people in their lives, I wanted to put together a list of things that may improve one’s chances of getting sponsored:

  • EARN IT – Unlike mentors, who may be assigned to you or whom you can choose based on mutual interests and/or a similar research, sponsors are not assigned, and you cannot simply ask someone to be your sponsor – if you have a good mentor, and you show them loyalty and build your trust/credibility with them, they will likely want to be your sponsor.
  • DEPENDABILITY PAYS OFF – When you make yourself visible within your own organization by becoming involved in projects or workgroups and by reliably getting things done on time, people will start to notice and will want you to expand your involvement. This will naturally expand the pool of leaders that you can work with and impress.
  • DIVERSIFY – While you don’t want to spread yourself too thin, it’s important not to put all your eggs in one basket. If you spend all your energies impressing a single mentor or leader in your institution, and they are a terrible sponsor, or they leave, or something else happens, then you’re unlikely to have them as a sponsor despite all your efforts. Have at least a couple mentors that you work well with and work hard to build trust with them.
  • BE THE ONE THAT YOU WANT – Behave like the protégé that you will someday be proud to sponsor – chances are, someone will notice and will be proud to sponsor you
  • DO YOUR HOMEWORK – If you want to learn more, there’s tons of books and articles out there on this topic. Take the time to read up. This article from the Harvard Business Review by Sylvia Ann Hewlett is one example.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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Getting Sponsored – When Mentorship Isn’t Enough (Part I)

I recently witnessed something profoundly disappointing.  A close friend and former colleague who was finishing training at an excellent institution attended a large national meeting, accompanied by no less than 3 personal mentors, with the eager hopes of being connected with potential future employers.  As with most graduating trainees, he was expecting his mentors to help offer meaningful networking opportunities to get his “foot in the door” for some of the very few academic positions available in his chosen subspecialty.  I watched him struggle for several days before going home with no new contacts, no new prospects, and no job interviews.  His mentors, despite helping him excel in research and helping him develop a work-product to present at a huge meeting, ultimately failed him at the meeting in question.  In that moment, I realized that not all mentors are good sponsors. 

Sponsorship is very different from mentorship, though sometimes a great mentor will naturally be an excellent sponsor as well.  Sponsorship has been more recognized in the business world over the last decade after a study published in the Harvard Business Review, “The Sponsor Effect” highlighted the role that sponsorship has in advancing careers.  Specifically, they showed that more than 2/3 of participants who had a sponsor reported satisfaction in their career advancement, while greater than 2/3 of participants who did not have a sponsor resisted advocating for a raise for themselves.  The study also showed that sponsors can confer a 22-30% statistical career benefit.  However, sponsorship is only recently becoming more and more recognized as a key factor in advancing careers in academic medicine as well. 

What is a sponsor?  I think the following graphic from Stanford University does the best job of explaining the difference between a mentor and a sponsor

 

I think the bottom line is that sponsors are personally and professionally tied to the success of their protégé’s and make it a point to ensure that their protégé’s are connected to the people that will help them achieve their career goals and advance to bigger and better things.  Yes, traditionally, in the business world, this would be primarily within their own organization.  However, in the world of academic medicine, where so much of our career trajectories and growth opportunities (and promotions) are dependent on how we’re seen by people outside of our current institution, either at other programs, or within national societies/committees, I think a major part of sponsorship in academic medicine is active networking.

As I reflect on my own mentoring relationships, I see in hindsight the difference between my mentors and my sponsors.  While much of my personal and professional development is attributable to the advice and guidance of my mentors, I can now see that most of my current career, administrative, research, and educational opportunities have been directly because of my sponsors (even though I didn’t know it at the time).  I was extremely lucky to have these individuals take a vested interest in my personal success, without me ever asking.  But for those of us who are not lucky enough to have sponsors fortuitously arrive in our lives, there are a few ways to increase the chance of getting a good sponsor…  Stay tuned for Part II.

David Werho Headshot

David K. Werho, MD is an Assistant Clinical Professor at the University of California San Diego and a Pediatric Cardiac Intensivist at Rady Children’s Hospital – San Diego.  His research focuses on pediatric cardiac ICU outcomes as well as interventions and curriculum development in medical education.  He tweets @DWerho and contributes to the Pediatric Cardiac Intensive Care Society Newsletter as editor and contributor.

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When One Teaches, Two Learn: Core Values Of Mentor/Mentee Relationship

laptop, glasses, and paper working late into the night

Whether you are a junior graduate student or an established faculty, there is always something that you can learn. Whether you want to write your very first pre-doctoral fellowship grant or learn how to tweet about your center’s accomplishments, there is always someone that you can count on as your guide. That was the first point that stood up to me when I arrived at the 2017 Scientific Sessions. As the days went by, I started to appreciate the sacred bond that we AHA17 attendees all share: We are all mentees. Despite this mentality, young mentees point of views are often ignored. The ignorance is often derived by cultural differences, generation gaps and unbalanced expectation levels which may exist in the environment that the mentee is growing. To tackle this issue, having core values that helps flourishing the mentor/mentee relationship seems to be crucial. Therefore, as a young mentee and based on what I learned throughout the sessions in the meeting, I propose the following fundamental points to be considered as an infrastructure for establishing a successful mentor/mentee relationship:

  1. Find a synergy between your past experiences and the training opportunities in the new environment.
  2. Clarify your expectations from your mentor/mentee.
  3. Have short-term and long-term plans.
  4. Have self-assessments of your success in accomplishing your goals
  5. Either as the boss or the student, do not expect wins from the other party. Loosing is learning.
  6. Do not hide. Do not be an investigator who is just a name on papers and do not be a student who no one knows.

Having such major core values helps the establishment of relationships that will last for a long time and help both sides to move forward. As Phil Collins beautifully said years ago, “In learning you will teach and in teaching you will learn.” So, no matter which stage you are at, respecting the aforementioned points can help to be both a better learner and a better teacher at the same time. 

Shayan Mohammad Moradi Headshot

Shayan is a caffeine dependent PhD Candidate at the Saha Cardiovascular Research Center, University of Kentucky. His research area is focused on vascular biology and lipid metabolism. He tweets @MoradiShayan, blogs at shayanmoradi.com and he is the Winner of World’s Best Husband Award (Category: nagging).

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Mentorship Rests On Communication

Filing up on to the stage and taking their seat behind the microphones, the Early Career Day Panel on mentoring literally ‘set the stage’ for the young investigators at AHA Scientific Sessions 2017. 

Ranging from junior faculty to seasoned professionals, the speakers introduce themselves and share their top tips for mentoring.  

The Highlights

Emelia Benjamin from Boston describes mentoring as a “life course phenomenon” where there is “never a period in your career when you don’t need mentoring”.

Edda Spiekerkoetter from Stanford provides an inspiring example of networking in the digital age, and the role mentors provide in connecting us via email introductions.  

Stephen Chan provides a “two-the-point” list, describing two concept of self-awareness and mentor generosity as 2 keys for productive mentoring relationships.

AHA Early Career Mentoring

 The Take-Away 

Despite different backgrounds, different career paths, and different perspectives, an overarching theme emerges: Communication Communication Communication. Whether you’re searching for a mentor, looking to strengthen your mentor-mentee relationship, or facing challenges with poor mentor-mentee compatibility, communication is key.  

Dr. Benjamin closes with a quote from George Bernard Shaw:

“The problem with communication is the illusion that it happened”.  

Don’t let that illusion plague your mentor-mentee relationship. Be proactive, know yourself, and learn from every experience.

 Bailey DeBarmore Headshot
Bailey DeBarmore is a cardiovascular epidemiology PhD student at the University of North Carolina at Chapel Hill. Her research focuses on diabetes, stroke, and heart failure. She tweets @BaileyDeBarmore and blogs at baileydebarmore.com. Find her on LinkedIn and Facebook.