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Get a Mentor, Be a Mentor

mentorship bubbleEarly in our careers, academics are encouraged to find good mentors. You need an advisor to get a doctorate, and this person is a mentor. You might be working in someone’s lab as a grad student or post-doc, and that person can be a mentor. You might be junior faculty and have a senior mentor to show you the ropes. There are formal mentorship relationships and informal mentoring relationships, and you’ve likely had both in your career. They’re a key part of professional development.

But what about being a mentor? The other day, a colleague came into my office and asked me to mentor her. My first response was to say “no, I can’t, I’m really new, we’re the same age, I don’t know anything you don’t know, you’re smarter than me. . .” But I paused. What made her ask for a mentor? What made her ask me? What can I offer this person to help her thrive professionally, so we don’t lose a much needed person in the field?

On reflection, I considered what mentorship means. Having a senior, accomplished mentor is a gift, especially if that person also works as a sponsor for you. Yet it’s also valuable to have a mentor who’s closer to where you are— someone whose life and struggle more closely resemble yours. A young(-ish) woman in academia can mentor another young woman in academia. Non-hierarchical and team models of mentorship also hold enormous promise. I attended a great session on this at #AHA18 in Chicago — I hadn’t thought of that before. Mentorship as a tool to encourage success is much broader than the classic senior-junior one-way relationship. My mentor-seeking colleague and I could certainly benefit from this kind of arrangement.

It’s also easy to forget that as early career scientists, clinicians, and educators, we are already accomplished. A grad student, an undergraduate student, a high schooler, or a middle schooler who’s interested in your field could benefit from your guidance and experience right now. Also at #AHA2018, AHA president Dr. Ivor Benjamin spoke about mentoring young black doctors. He then dug deeper, urging us to mentor young people earlier, before there’s a leak in the pipeline. This is such a crucial idea— the value of mentoring people from underrepresented groups in your profession is enormous. Science and medicine desperately need diversity, but this diversity cannot grow and flourish without the attention of dedicated mentors. Support is especially crucial for racial and ethnic minorities, LGBTQ people, and women, who remain underrepresented in many areas of STEM, including crucial leadership roles. In addition to perpetuating oppression by limiting access to career paths for individuals and groups, the downstream effects of this underrepresentation undermine equity in our science and clinical care. We can’t ignore the need for diversity and the crucial role for mentorship in building it.

 

So, early career scientists, educators, and clinicians, will you take up the challenge of mentorship?

 

Need a resource or want some further reading?

Check out this discussion of The Mentorship Guide.

 

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5 Things To Consider Before Choosing Your Dissertation Topic

As I am inching towards, what I hope would be my final year of PhD research, I have been thinking and analyzing a lot of my actions in retrospect. I thought of putting together a list of things I learned and things I wish I had considered in my first year.

 

1) Finding the “right” mentor.

We spend a lot of time in deciding the right lab or the best PhD supervisor. A lot has been said and done about finding the right fit. One thing I have learned is that apart from the usual parameters we set in finding the best supervisor for us personally, sometimes we forget to consider if the supervisor is right for the project. Sometimes the project may expand in an area beyond your and your mentor’s expertise. In such cases, it is important to consider whether your mentor will make the right resources available to you. Putting together a good research advisory committee, scientists who would have expertise in that specific topic, will come in handy. Research can be quite daunting and grad students deal with intense pressure and stress on a daily basis. Your time should be spent researching and not trying to find the right instrument in the cheapest core facility and definitely NOT YouTubing the workings of a new technique. Make sure to find someone to train you, attend workshops, shadow a technician and make sure your supervisor makes these available to you when needed. A mark of a good mentor is when they don’t hesitate to seek consultation or advise from an external or senior scientist who is an expert in the field.

 

2) Is this a good career investment?

Turns out most students forget about the crucial thing about spending years in grad school – landing the job! Most of us don’t think about job search or the next move until our final year, which I think is too late. While choosing a topic, you may want to consider things like job market, skill requirement, funding agencies and so on. For example, researching therapeutic drug targets for a disease that has no cure is far better than investing in a project discovering drug targets for a disease with multiple FDA approved drugs. Weigh the pros and cons carefully. Will your project help you acquire technical skills that are translatable to the industry? If you live in a city or country that is in dire need of science policy advisors or climate crisis advocates or good science communicators, will your PhD program give you enough skills to apply to these jobs?

 

3) Is there scope for collaborations?

Collaborations are a unique way to expand into different research topics in your field, whether it’s a collaboration within your group or research with a different research group altogether. This lets you become more versatile, get a flavor of how other researchers approach their science and if nothing else, learn a new scientific topic up-close. A productive collaboration is one which will take your expertise and enhance another project, without taking too much time away from your project. Inter-lab collaborations are a great way to demonstrate your negotiating, team management and interpersonal skills. Oh, and did I mention it’s good for networking? So finding aims in your proposal early on, that are good for teaming up with other groups is a good idea, especially while conferencing.

 

4) Will it help you AND your science grow?

I will start with the science part first. Obviously, we all want to learn and become an expert in the respective field when we started off, so what do I mean by growth here? If your research topic is only going to be a repeat of your previous techniques and scientific concepts, chances are, halfway through the project, you’re going to lose interest. It is great to start off the project with something familiar, but if it isn’t exploring in areas that are uncomfortable and challenging to you, is it really worth a PhD? Test new ideas, push your boundaries and give yourself a deadline to fully delve into answering these questions. But be wary not to spend too much time and get distracted. It is good to spend the first two years (in a five-year program) to be adventurous, but if it gets too challenging it really should not be pursued at the expense of your time.

I stress on personal growth next. PhD project is a LOT of time commitment. Especially to one very specific thing, that more often than not, will consume most, if not all of your time. This means one must consider having room for co-curricular activities that will in turn be an asset for your own research project. For example, I love to read about popular science, wildlife, climate science, conservation, policies and history. My program had a structured graduate minor alongside my PhD major and I decided to study science communication for this minor. Now, I get to write, read or watch other popular forms of science, engage with community, organize local events and dissect science policies as part of my curriculum. I have also gotten opportunities where I talked about my own research to strangers and thus, honed in my craft of communicating science. All of this will ultimately reflect in your resume and you know that apart from spending long hours fine-tuning your experiments, you will leave with heaps of useful skills for future jobs. So, I would recommend finding things that compliment your science early on, this will go a long way!

 

5) Will you need a backup plan?

If you are diving into something extremely challenging, let’s say it will not only require you to learn new, field-specific techniques, but it will mean questioning the dogma – make sure you have another small project to safely rely back on. If your program has at least one first-author paper requirement for dissertation, it is imperative you sit with your supervisor and make sure you will get a paper out in time. No dogma is worth challenging at the cost of your degree!

 

These are some pointers that I thought of, from personal experience. I hope that you will find it useful and informative.

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A Profile in Mentorship: Dr. Thomas Pearson

Every scientist, even those who are particularly good at hiding away in their offices, will have an impact on others. Most of the time, this impact is a byproduct of our everyday work. We don’t give it much thought – it just happens. But what if that impact was not accidental, and instead was a deliberate, strategic path of choices that build up those around us – even those who disagree with us, compete with us, and threaten us? That is the path that has been trodden by Dr. Thomas Pearson who was awarded the 2019 AHA Council on Epidemiology and Prevention Mentoring Award.

Dr. Pearson has an impeccable academic pedigree and an enviable career. After an early start at the University of Wisconsin, he earned his Bachelor of Arts, MD, MPH, and PhD all from the Johns Hopkins University. He has achieved the goal of every early career scientist – over 35 years of continuous NIH support and is a Fellow of the American Heart Association, American College of Cardiology, the American College of Preventive Medicine, and the American College of Physicians. But the degrees, grants, and accolades are a byproduct of a man driven to service for the love of science.

Dr. Pearson’s own mentors reflected his insatiable curiosity. As a student, he drew from a broad mentoring team that left lifelong impressions of the qualities of good mentor. While excellent teaching was important, more so was the “utterly frank” assessment and advice they provided him. He states, “from them I learned that the primary role of a mentor is to provide an honest, encouraging perspective on the mentee’s ideas, plans and experiences. While some mentors may be tempted to acquiesce or tell mentees what they want to hear- that is abrogation of their responsibility of a mentor.” Such frankness can be tough in today’s academic environment, so to help cultivate this skill, Dr. Pearson’s University of Florida developed the Mentorship Academy. Equally important to learning how to deliver a frank assessment of the mentee is helping the mentee learn how to receive and act upon such advice without taking umbrage to it.

Additionally, Dr. Pearson offered this advice on how early stage professionals can intentionally become effective mentors, including:

  • Be a good communicator. Communication is the basis of mentoring. Good communication should include developing shared expectations of the goals, responsibilities, and processes of the mentor-mentee relationship. Many of the problems that occur in the mentoring relationship result from a misalignment of expectations and reality. An honest conversation, with both parties being active listeners, about the mentor and mentee’s strengths, weaknesses and goals early on in the relationship can set both parties up for success.
  • Broaden your network. Every day we hear about new grants, interesting conferences, and visiting professors. Yet because they are just starting their career, mentees may not hear about the same opportunities. Part of being a good mentor, Dr. Pearson suggests, “is to continually be looking out for opportunities for your mentee and actively encouraging them to pursue them”. This includes inviting a mentee to a lecture and offering to introduce her to the speaker. Opening this door can help a mentee broaden her professional network and embolden her to pursue new opportunities.
  1. Focus on the mentee. The mentor must recognize the mentee is not “hers.” Rather the mentor should focus on the mentee’s needs and goals and, if she finds another investigator can provide a better opportunity for the mentee, help to arrange it. Dr. Pearson states, “Mentoring and selfishness are like oil and water- they don’t mix.”
  2. Stay curious. In his acceptance speech, Dr. Pearson talked about how much he learned from each of his mentees. They taught and inspired him as much as he did them. But that can only happen by accepting that mentoring is a partnership in which each person has a lot to offer. Good mentors need to be curious about their mentees and excited about learning from them.

Dr. Pearson has mentored over 60 people during his career. Many have gone to have equally enviable careers where their impact reverberates into every corner of our profession. He told me, “You never really stop mentoring a mentee. People I mentored still call me and talk about their career, their family. At some point, they start being friends.”

Mentors – true mentors – view their work not as a requisite service but as a thread that weaves together the knowledge of the current and past generations to the next. Mentors are the foundation upon which scientific progress is made; and their impact is the greatest when their mentoring is done with humility, enthusiasm, compassion, curiosity, and an infallible sense of optimism. These are the traits Dr. Pearson embodies; and are the ones that all who seek to see further should strive to emulate.

 

 

 

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Fellow Focus: Peer Mentorship Program

During my first year of general cardiology fellowship, our program underwent an exciting transition – our incoming fellowship class increased from 6 fellows the previous year to 10 fellows in my class, nearly doubling the size of the fellowship. This growth was necessitated by the welcome addition of the West LA VA as a rotation site for house staff, which meant spreading our fellowship across 4 different clinical sites. While this gives our fellows the opportunity to train in a wide variety of clinical settings with different patient populations and pathologies, it also creates a very large fellowship program, with 30 fellows altogether. Although there are advantages to having a large program, a program this size poses the risk that fellows ultimately may not get to build the camaraderie that many acknowledge is a pivotal aspect of their medical training. Indeed, much of the education received during clinical training occurs through our peers.

At the beginning of my chief fellowship year, my co-chiefs and I chose to implement a new program within our fellowship to promote peer mentorship among our fellows. Inspired by an outstanding JACC article describing a peer mentorship program that was instituted in Columbia University’s Pediatric Cardiology fellowship,1 we created a similar program in which “Houses” were formed consisting of one fellow from each class. Each House would be led by its senior 3rd year fellow, who would also choose a faculty mentor for the group (Figure 1).

Figure 1: Schematic representation of the House system. Each pillar represents one “House” consistent of 3 fellows and 1 faculty mentor. Adapted from Reference 1.

Each House was advised to meet at least once each quarter, with each meeting organized by the senior fellow. Meetings were suggested to be informal, but discussion items, such as research opportunities, balancing family and fellowship, and exploring career paths, were recommended. Further, senior fellows were encouraged to take ownership of mentoring their respective 1st year fellows, particularly during the first half of the year.

After surveying fellows before and after the implementation of the House program, the results of the program were rather impressive. For instance, prior to the program, only 44% (4/9) first-year fellows said a senior fellow helped them during an early-year overnight call. Post-implementation, this number improved to 100% (10/10 first-year fellows from the next class). Further, first-year fellows were asked to assess their satisfaction with “Peer Mentorship” within the fellowship, and these ratings improved significantly after the House program implementation (Figure 2).

Figure 2: First-year fellow satisfaction for peer mentorship within the fellowship program.

Many more aspects were assessed in these surveys, as well as in surveys given to senior fellows and faculty members. These included measures of feedback frequency given by senior fellows and faculty on conference presentations and measures of academic productivity (abstract submissions to national meetings, peer-reviewed publications). While many other factors besides the House program may have contributed to the improved scores we observed on these surveys (perhaps even a placebo effect), the feedback we received on this program from fellows and faculty were overwhelmingly positive. As the program is far from perfect, we have found that it was easy to implement, sustainable, and effective at improving fellow satisfaction with our training program. As it continues into its second year, we hope that it will continue to improve, and more importantly, that it will further improve the fellowship experience within our program.

This past weekend, I shared our experience with this peer mentorship program with others as a moderated poster abstract at ACC.19 in New Orleans, Louisiana.2 For other large training programs looking for methods to improve peer mentorship, we believe our House system was effective and would be happy to share more details from our experience with those who are interested.

 

References:

  1. Flyer JN and Joong AN. Improving Peer Mentorship: A Novel Fellow “House” Program. J Am Coll Cardiol. 68:2907-10. 2016
  2. Hsu JJ, Flyer JN, Joong A, Small A, Vampola S, Yang EH, Watson KE. House of Cards: Implementation of a Formal Peer Mentorship System in an Adult Cardiology Fellowship Program. American College of Cardiology, Cardiovascular Training Section, New Orleans, LA. March 2019

 

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The Invaluable Importance of Mentorship Throughout Your Career as a Female Cardiologist

Featuring an Interview with Dr. Stacey Rosen recipient of the American Heart Association (AHA) 2018 “Women in Cardiology Mentoring Award”

 

Lack of Females in the Cardiology Field

Over 36% percent of Internal Medicine residents are females. Despite this fact, females account for less than 20% of the Adult Cardiologist workforce in the United States and account of less than 10% of Interventional Cardiologists in the United States1. Recruitment and retention of many talented female cardiologists remain a constant challenge and is due to a variety of reasons. Some of these reasons include the thought that cardiology is a grueling field that does not allow for work life balance and is often inhospitable for females desiring to start a family. There is also difficulty in retaining females in the field due to increased gender discrimination in the field1. In fact the Professional Life Survey conducted by the American College of Cardiology had reported that many female cardiologists in the field report a high level of career satisfaction which has not changed over the last 20 years1. However, there are many challenges that have remained the same for female cardiologists over the last 2 decades, such as gender discrimination, the need to arrange for paid or unpaid childcare, being single and not having any children1. In addition, there has been aging of the workforce and there are increasingly more female cardiologists practicing in an academic and/or hospital employed setting rather than in private practiceand therefore having less autonomy over their work schedule and environment.

 

Need for Effective Mentorship For Female Cardiologists and the American Heart Association Women in Cardiology Mentoring Award

 

There is an ever increasing need to not only recruit more females in the field of Cardiology, but to also retain many talented female cardiologists in the field. Finding a good mentor and fostering good mentorship is invaluable for many females throughout their career in Cardiology. The Women in Cardiology Committee of the American Heart Association (AHA) values the importance of good mentorship and as such bestows the Women in Cardiology Mentor Award that is sponsored by the AHA Council on Clinical Cardiology to Cardiologists who have been recognised as having an outstanding record of effectively mentoring and supporting female cardiologists. Dr. Stacey E. Rosen,  Endowed Chair and Vice President for the Katz Institute for Women’s Health at Northwell Health, Partners Council Professor of Women’s Health at Hofstra North Shore-LIJ School of Medicine at Hofstra University and Professor of Cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell is the recipient of the 2018 AHA Women in Cardiology Mentoring Award. She has mentored and supported numerous female cardiologists, and in the following interview, I had the honor of discussing the following questions with Dr. Rosen.

Courtney could we add a hyperlink to the AHA WIC mentor award nomination site?

 

What attracted you to the field of Cardiology?

Dr. Rosen: “I am the first member of my family to become a doctor. I am the daughter of educators and while in high school , I volunteered at Memorial Sloan Kettering in the pediatric child-life center. I thought that the medical field would allow me to pursue various professional options including clinical care, education, advocacy and research. I felt one could never be bored in medicine! As a student in the 6-year medical program at Boston University, we dissected a bovine heart and I was so amazed by the “simplicity” of the structure. Nothing else seemed intriguing after that – my only important decision was between pediatric cardiology and adult cardiology.”

Who were the inspirational persons that influenced this decision?

Dr. Rosen: “The Division of Cardiology at Boston University School of Medicine in the 1980’s – and ever since – was extraordinary. The faculty at Boston City Hospital (BCH) demonstrated commitment and passion for those in the underserved neighborhoods near BCH and the faculty at University Hospital were national respected clinicians , investigators and educators.”

Who were your mentors in Cardiology and how did they contribute to the advancement of your career?

Dr. Rosen: I completed Internal Medicine residency and a chief resident year at Montefiore Medical Center in the Bronx, and was privileged to work with an impressive Division of Cardiology. Hildrud S. Mueller, MD and James Scheuer , MD taught me the importance of rigor and attention to detail in both clinical work and research. I presented my first oral presentation with John Fisher, MD – the recently retired division chief – and learned to perform a complete and thorough cardiac exam with Mark Menegus, MD.

As a fellow at Cornell – New York Hospital, Mary Roman, MD, Peter Okin, MD, Paul Kligfiled, MD, and Richard Devereux, MD fostered my fascination with imaging and non-invasive cardiology. Doppler physics was replacing hemodynamic assessment in the cardiac catheterization lab and I was hooked!

Finally, my first faculty position was at Mount Sinai Medical Center. Working in the echo lab with Martin Goldman, MD was an extraordinary opportunity. He inspired me to view echocardiography as a critical tool to enhance optimal patient care and helped me to develop the skills to become a lab director in my next position.

You have mentored many colleagues in the Cardiology field and have been valued by many as a great mentor, which led to your selection for the 2018 AHA Women in Cardiology Mentorship Award. What are the factors that mentees should consider when selecting a mentor?

Dr. Rosen:Mentees should consider several critical factors:

  • Compatibility – Choose someone with whom you are compatible but not someone who is a “mini me“ of yourself. You do want a mentor who will challenge you, be comfortable providing feedback, and teach you to internalize and utilize feedback to advance your goals.
  • Trust – You want a mentor whom you can trust – you will likely be sharing important and perhaps confidential conversations. It is also critical to know that you must earn a sense of trust from your mentor.
  • Expertise – Your mentor does not have to have the most senior titles or positions, but should have the requisite expertise to help you advance your career and help navigate challenges.
  • Willingness – A great mentor is one who is devoted to helping you develop a vision and is delighted to share knowledge and wisdom. It should be someone who is a good listener and has sufficient time to commit to the relationship.

 

Would you recommend having more than one mentor?

Dr. Rosen:  “Absolutely! But do remember that the mentee needs to commit sufficient time to each relationship in order to optimize the value of the partnership

 

How can mentees truly harness the power of strong mentorship?

Dr. Rosen:First – choose your mentor wisely and respect the relationship. Meet with individuals who you think may be good mentors and ask questions that will help you make a decision and get advice from friends and colleagues. Networking is often the key to identifying good choices.

Second – do the work and always respect the relationship! Discuss the goals and expectations of the partnership, as well as the process for communication, meetings and feedback. Be respectful of your mentor’s time and build trust immediately.

 

What are the differences between mentorship and sponsorship?

Dr. Rosen: Simply put – mentors advise you, while sponsors advance your career. A mentor is someone who can offer support, guidance and feedback, and allow you to develop your personal vision. A sponsor is earned – not chosen. A sponsor connects us to opportunities and advocates for our career advancement. It has been said that women are over-mentored and under-sponsored.

 

 

How has the experience of being a great mentor for so many colleagues contributed to your own career and personal growth?

Dr. Rosen: My late father was a middle school principal and my mother is a retired school teacher who taught in an underserved community in Brooklyn, NY. I learned from them the deep satisfaction one gets from teaching and advancing someone’s skills and abilities. I am also so grateful to MY mentors and get great satisfaction from “paying it forward.”  I am certain that I have learned as much from my mentors as they have learned from me!

What have been the 3 most rewarding experiences you have had throughout your career?

Dr. Rosen: As the director of the fellowship program at Northwell, I have had the privilege to work with dozens of trainees. I have helped impact their professional success and hopefully, the joy they find from practicing cardiology.

As chief of cardiology at Long Island Jewish Medical Center, I was able to rebuild a division that had weathered a hospital merger. Together with my colleagues, we completely revamped the division.

As a lifelong advocate for women’s heart health, I get enormous pride seeing the impact we have had on women’s health through improved clinical care, advances in gender-specific investigation and through advocacy and changes in policy. I know that our work is not done and that we still need to continue to advance women’s heart health agenda.

How has the field of Cardiology evolved over the duration of your career with regards to gender diversity and inclusivity of women in Cardiology?

Dr. Rosen: Unfortunately, our field has not advanced sufficiently when it comes to gender diversity and inclusion in Cardiology. Currently, fewer than 25% of cardiology fellows are female and fewer than 15% of board-certified cardiologists are women. Now that women are 50% of medical school graduates, the importance of developing a strategic approach to this lack of diversity is critical, or we will see a true talent drain in the near future. The good news is that both the American Heart Association and the American College of Cardiology have focused on lessening this disparity by better understanding the barriers facing female cardiologists and by making changes that will encourage young women to choose Cardiology.

What advice would you give to females considering a career in Cardiology?

Dr. Rosen: I can honestly think of no better choice! As clinicians, we can develop long-term longitudinal relationships and have an enormous impact on health and longevity. I believe that cardiology combines the best features of primary care and subspecialty medicine. As investigators, we can have a lasting impact on individuals and communities. Cardiology is also a field that is perfect for those who enjoy advocacy and advancing health policy improvements. I urge women NOT to eliminate Cardiology as a possibility because of concern about the challenges. Find the area of the field that you love, without fear or compromise, and then make decisions that will allow you to fulfill your vision of work – life integration.

References:

  1. Lewis SJ, Mehta LS, Douglas PS, et al. Changes in the Professional Lives of
    Cardiologists Over 2 Decades on behalf of the American College of Cardiology Women in Cardiology Leadership Council. J Am Coll Cardiol 2017

 

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Mentorship and Inspiration at Scientific Sessions

Life as a resident physician can be demanding at times. The long hours, the difficult task of cross covering multiple wards, and the emotional toll of caring for sick patients are all factors that can make residency a difficult road to travel.  It can be easy to lose sight of the bigger picture and in the process, your empathy. It is important to keep track of where you have been, and more importantly, who you want to become. This is why I believe that mentorship and inspiration play a critical role in medical training. A great mentor can guide you, can celebrate your victories with you, and also, pick you up when you are down. At the same time, inspiration helps you push through difficult times. As residents, we need to identify with and become inspired by those that have gone through the path we are on so that we may fight burnout.

With that in mind, I would like to make the plea to students, residents, and fellows at any level of training to attend the AHA Scientific Sessions next year. Here is why, given my experience this past year at AHA18:

First and foremost, walking into Sessions, you will feel connected to something larger than yourself. You will find thousands of people from different fields of study and walks of life in attendance who have traveled many miles in the name of their dedication to reducing the burden of cardiovascular disease and strokes. This part of the experience really changed how I viewed my own training as a resident, and I began to see my role in the bigger picture.

Second, Sessions provides an opportunity for professional development. Whether you are attending an activity in the Early Career Lounge, or watching a lecture in the main auditorium, you end up meeting influential clinicians and scientists at every turn. You learn more about the challenges they faced in their training, their work ethic, and their inspirations. I found that many had gone through the same uphill battles as me: balancing research and clinical duties, family and work, down to even grasping difficult concepts in cardiology. This resonated with me.

These face-to face interactions help you not only address your own challenges, but also plan out the next steps in your career. Whenever possible, I took the opportunity to discuss a research idea or career choices with the mentors I met at AHA. Whether they supported the idea or played devil’s advocate, they helped me view these ideas in a different way. At the same time, I was able to pitch in my experiences as a resident and a former medical student to help those going through training.

Setting aside time from clinical duties to attend conferences can at times be a difficult endeavor, but I believe that experiencing a national conference such as Scientific Sessions can aid your career. It will help you identify mentors, role models, and potential collaborators.

 

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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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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.