Academic Mentoring—How to Give It and How to Get It Allan S. Detsky; Mark Otto Baerlocher Online article and related content current as of May 12, 2009. JAMA. 2007;297(19):2134-2136 (doi:10.1001/jama.297.19.2134) http://jama.ama-assn.org/cgi/content/full/297/19/2134 Correction Contact me if this article is corrected. Citations This article has been cited 11 times. Contact me when this article is cited. Topic collections Medical Practice; Medical Education Contact me when new articles are published in these topic areas. Related Articles published in the same issue Catherine D. DeAngelis et al. JAMA. 2007;297(19):2139. JAMA's Contributing Writers Related Letters Access and Diversity in Academic Mentoring Ann J. Brown et al. JAMA. 2007;298(7):739. In Reply: Allan S. Detsky et al. JAMA. 2007;298(7):739. Subscribe http://jama.com/subscribe Permissions [email protected] http://pubs.ama-assn.org/misc/permissions.dtl Email Alerts http://jamaarchives.com/alerts Reprints/E-prints [email protected] Downloaded from www.jama.com at Univ Of Southern California on May 12, 2009 COMMENTARIES Academic Mentoring—How to Give It and How to Get It Allan S. Detsky, MD, PhD, FRCPC Mark Otto Baerlocher, MD S TUDENTS, TRAINEES, RESEARCH FELLOWS, AND JUNIOR faculty all benefit from the direction provided by academic mentors and research supervisors. The literature contains numerous reports on the importance of mentorship in helping facilitate the future success of trainees, documenting benefits such as more productive research careers, greater career satisfaction, better preparation in making career decisions, networking within a profession, and aiding in stress management.1-10 This Commentary describes several key points of advice both for individuals who mentor and those who receive mentoring (mentees). In some places, a mentor is an individual who is not the student’s direct clinical, academic, or research supervisor. This advice applies to those kinds of mentors as well as the more traditional direct supervisors. Determine How the Mentee Likes to Spend Time Several years ago a faculty member who had worked in his profession for 10 years visited the corresponding author (A.S.D.) to announce plans for a career change. Until that time, this particular faculty member was a basic science researcher in the division of endocrinology who also provided clinical care to patients with diabetes 1 day per week. He was moving to a full-time clinical position in a nonteaching hospital and he described experiencing moderate career success and enjoyment from research activities performed during the first 5 years, but thereafter realized a dislike for the work. His clue about his career became evident when he noticed feeling excited about how the day would unfold seeing follow-up patients with diabetes and determining their clinical progress on the 1 clinical day per week vs the other 4 days of the week when he awoke, pulled the sheets over his head in the morning, and dreaded going to work in his laboratory. This realization led to an understanding that he was in the wrong job. One of a mentor’s most important jobs is to help mentees determine what kind of career they wish to pursue.3,11 Those who train in medicine can pursue at least 4 types: clinical care, education, research, or administration. Good mentors should present all 4 options without communicating 2134 JAMA, May 16, 2007—Vol 297, No. 19 (Reprinted) value judgments. In particular, because the primary purpose of attending medical school is to learn how to provide direct patient care, it is inappropriate to cause mentees to feel this activity is less worthy than the others. The best way to help mentees choose a career path is to help them understand what day-to-day activities instill excitement. One suggested approach to determine this is for mentors to express the following: “Don’t tell me what you want to be (ie, an academic physician). Tell me how you want to spend your time. What gets you out of bed in the morning? What really interests you? What jobs are fun for you? Design your position around those activities.” Be Honest Mentors need to understand that mentees frequently are afraid to tell their supervisors what they want if they feel they will disappoint their mentors. It is important that mentors not promote their own agenda over that of mentees with aspirations of producing academic clones.11 The following has been stated (A.S.D.) to help the mentee become more honest: “I am a general internist, health economist, and I perform health care research. I am happy being me. I do not need you to be me to reaffirm that I made the right choice.” Once said, the body language of the mentee is often observed to become much more comfortable. It is important that mentees not simply tell mentors what they think mentors wish to hear, but rather what they really think, without wasting time by pursuing unwanted directions. At the same time, mentors need to understand that mentees may choose not to follow their advice. Mentors should not be disappointed when this happens. The nature of the relationship is that mentors and mentees should feel free to give honest expressions and advice without insistence from either side that mentees accept it.12 On a more formal note, some have suggested that mentoring relationships should undergo regular evaluations for process (clear objectives and regular, purposeful meetings), communication (feedback, mentees being able Author Affiliations: Departments of Health Policy, Management, and Evaluation and Medicine, University of Toronto, Departments of Medicine, Mount Sinai Hospital and University Health Network (Dr Detsky); Department of Medical Imaging, University of Toronto (Dr Baerlocher), Toronto, Ontario. Corresponding Author: Allan S. Detsky, MD, PhD, FRCPC, Mount Sinai Hospital, 600 University Ave, Room 427, Toronto, Ontario, Canada M5G 1X5 (allan.detsky @uhn.on.ca). ©2007 American Medical Association. All rights reserved. Downloaded from www.jama.com at Univ Of Southern California on May 12, 2009 COMMENTARIES to challenge mentors), and outcomes (sense of progress and development, improved networks).13 Such periodic evaluations are valuable tools to help ensure ongoing honesty. There are circumstances in which mentors should perhaps not be completely forthcoming. For instance, when the mentee tells of making a particular career choice (as opposed to asking for advice about the choice), the mentor should not show disapproval or state the choice is a mistake. In these circumstances, mentors must distinguish between the mentee’s requests for advice and announcements of firm decisions (often not easy to do). Once mentees have decided, expressing disappointment can be a very bad way to end the communication. Mentors can make it clear that the door is open to reverse the decision, but should not say “You are making a mistake,” because that phrase may be counterproductive and will not be forgotten. Follow Through It is important for mentors to be supportive. This can take the form of making the right introductions, dealing with individuals whose cooperation is required, or providing financial support.9,12,14 In other cases, providing support simply involves responding to the mentee’s questions, reading manuscripts, providing advice, and following through on promises. Prolonged delays on either side are harmful to the success of mentees. Students should, therefore, carefully investigate the experiences of previous individuals who received mentoring from someone they are considering approaching. They should review a proposed mentor’s curriculum vitae and determine how many students were overseen who now have successful careers. If the answer is many, it bodes well for the future. If a faculty member has been in a mentorship role for more than 20 years but has almost no successful disciples, the mentee might do well to avoid that person.12,14 Do Not Become Friends In this relationship mentors have power. The individuals can never be equal and therefore should not establish a relationship as friends during the mentorship period. Doing so may result in complications, hurt feelings, and can be destructive. This is not to say that the mentoring relationship cannot be cordial, personal, enjoyable, or fun. This simply means that the appropriate professional distance must be maintained to protect both parties.15,16 Do Not Be Afraid to Terminate a Mismatched Relationship Personality conflicts in the mentor/mentee relationship may occur. If these conflicts are irreconcilable, to the point that a positive mentor/mentee relationship is unlikely, the relationship should be terminated. This advice applies for both mentors and mentees. ©2007 American Medical Association. All rights reserved. Be Explicit About Credit for Work At the beginning of the mentoring relationship, the roles are usually very clear: mentors often provide the initial ideas, infrastructure, financial support, and supervision for a project and mentees often perform the day-to-day work. Over time, roles change. For example, original ideas or questions will ultimately be generated by mentees and mentors may increasingly play a more peripheral role. This may lead to difficulties in determining who gets credit for the work. The principal objective way of assigning credit is the designation of an individual’s role on a grant application (principal investigator or coinvestigator) and the position of the names on the author list. Early in the corresponding author’s career (A.S.D.), an unfortunate interaction occurred between a mentor and mentee that best illustrates the problem. The mentee, who was then a junior faculty member, had an idea to use an existing medication to treat a genetic disorder and this intervention had a very positive result in 1 patient. Because there had been no similar descriptions in the literature, the mentee prepared a manuscript describing this case report, and the paper was subsequently accepted by a high-profile medical journal. The mentee did not include his mentor as a coauthor primarily because the mentee felt that the mentor, who was an internationally recognized expert in the field, would have received credit for the idea. The mentee claimed that the idea and work were entirely his and that the mentor had no role in the paper; moreover, the mentor certainly did not meet the current authorship criteria established by the International Committee of Medical Journal Editors (this episode preceded the development of those criteria by several years).17 The mentor learned about the paper and objected strenuously to being excluded from the author list. The disagreement ascended the chain of command at the university. Ultimately the paper was published in the high-profile journal without the mentor’s name as an author. This episode led to the mentee leaving the institution because many of his colleagues reportedly ostracized him for this behavior. The best way to avoid similar episodes is to be explicit from the beginning of a project about who is going to receive what credit, to acknowledge that the mentor/mentee relationship will change over time, and to follow the International Committee of Medical Journal Editors’ established criteria for authorship, although this may require some subjective judgment. Mentors should not expect their mentees to include them as honorary authors. Similarly, it may be common practice for some mentors to include their students as authors specifically to advance their careers even without proper contribution to warrant authorship. This is equally inappropriate. If mentors wish to include students as authors on manuscripts, an appropriate set of tasks that constitute grounds for authorship should be assigned and conducted by students. (Reprinted) JAMA, May 16, 2007—Vol 297, No. 19 Downloaded from www.jama.com at Univ Of Southern California on May 12, 2009 2135 COMMENTARIES Separate at the End At some point, supervisors have to end the mentoring relationship with students. It does a junior faculty member no good to continue to put the supervisor’s name on grants or papers. Doing so stunts the growth and reputation of mentees and is problematic when they are considered for career awards or promotions. The responsibility for separation lies primarily with mentors and at some point mentors have to state directly, “We will no longer write together.” This does not mean that mentors stop providing advice. It just means that the names can no longer be attached on grants and articles.16 Although the exact publication record and length of time for mentor/mentee relationships is not well established, data from a preliminary survey suggest that the break point seems to be 6 to 10 papers and 3 to 5 years before separation typically occurs (unpublished data, A.S.D.). What Mentees Should Do If Mentors Do Not Wish to Separate In these situations, mentees should ascend the chain of command in the organization and solicit help of the division head, department chief, chair, or dean. These individuals will clearly understand the issue and broker the separation. After separation, mentors and mentees can become friends, assuming they actually (still) like each other, because at this point they will be equals. One of the wise mentors of A.S.D. taught the following: “I was always careful to be nice to the people I met on the way up. They were the same people I met on the way down.” The mentor/mentee relationship is an essential aspect of career development. These suggestions provide advice and helpful behaviors for this worthwhile and integral activity in academic medicine. 2136 JAMA, May 16, 2007—Vol 297, No. 19 (Reprinted) Financial Disclosures: None reported. Disclaimer: The second author (M.O.B.) is a second-year radiology resident and the corresponding author (A.S.D.) is a senior faculty member who has mentored more than 500 students and junior faculty during the past 27 years. Acknowledgment: We thank Richard Sztramko, MD for his help with the literature review. He did not receive compensation for work relative to this article. REFERENCES 1. Roch GR. Much ado about mentors. Harv Bus Rev. 1979;57:14-20. 2. Palepu A, Friedman RH, Barnett RC, et al. Junior faculty members’ mentoring relationships and their professional development in US medical schools. Acad Med. 1998;73:318-323. 3. Pololi LH, Knight S, Dennis K, Frankel RM. Helping medical school faculty realize their dreams. Acad Med. 2002;77:377-384. 4. Allen TD, Eby LT, Poteet ML, Lentz E. Career benefits associated with mentoring for proteges: a meta-analysis. J Appl Psychol. 2004;89:127-136. 5. Cameron SW, Blackburn RT. Sponsorship and academic career success. J Higher Educ. 1981;52:369-377. doi:10.2307/1981284. 6. Schapira MM, Kalet A, Schwartz MD, Gerrity MS. Mentorship in general internal medicine: investment in our future. J Gen Intern Med. 1992;7:248-251. 7. Ramanan RA, Taylor WC, Davis RB, Phillips RS. Mentoring matters: mentoring and career preparation in internal medicine residency training. J Gen Intern Med. 2006;21:340-345. 8. Kirsling RA, Kochar MS. Mentors in graduate medical education at the Medical College of Wisconsin. Acad Med. 1990;65:272-274. 9. Jackson VA, Palepu A, Szalacha L, Caswell C, Carr PL, Inui T. ”Having the right chemistry“: a qualitative study of mentoring in academic medicine. Acad Med. 2003;78:328-334. 10. Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine. JAMA. 2006;296:1103-1115. 11. Rose GL, Rukstalis MR, Schuckit MA. Informal mentoring between faculty and medical students. Acad Med. 2005;80:344-348. 12. Lee JM, Anzai Y, Langlotz CP. Mentoring the mentors: aligning mentor and mentee expectations. Acad Radiol. 2006;13:556-561. 13. Grainger C. Mentoring—supporting doctors at work and play. BMJ Career Focus. 2002;324:S203. doi:10.1136/bmj.324.7353.S203. 14. Tobin MJ. Mentoring: seven roles and some specifics. Am J Respir Crit Care Med. 2004;170:114-117. 15. Ramani S, Gruppen L, Kachur EK. Twelve tips for developing effective mentors. Med Teach. 2006;28:404-408. 16. Hunt DM, Michael C. Mentorship: a career training and development tool. Acad Manage Rev. 1983;8:475-485. doi:10.2307/257836. 17. International Committee of Medical Journal Editors. Uniform requirements for manuscripts submitted to biomedical journals: writing and editing for biomedical publication, updated February 2006. http://www.icmje.org/. Accessed January 3, 2007. ©2007 American Medical Association. All rights reserved. Downloaded from www.jama.com at Univ Of Southern California on May 12, 2009 VOLUME 31 䡠 NUMBER 6 䡠 FEBRUARY 20 2013 JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y Tips for Success As an Academic Clinical Investigator Stephanie J. Lee From the Fred Hutchinson Cancer Research Center, Seattle, WA. Published online ahead of print at www.jco.org on January 7, 2013. Author’s disclosures of potential conflicts of interest are found at the end of this article. Corresponding author: Stephanie J. Lee, MD, MPH, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D5-290, Seattle, WA 98109; e-mail: [email protected]. © 2013 by American Society of Clinical Oncology 0732-183X/13/3106-811/$20.00 DOI: 10.1200/JCO.2012.46.8751 When confronted with a new and challenging task, the first thing I have always done is to see how others have succeeded before me. Hearing and reading others’ reflections on their tips, tricks, and pearls has often given me helpful strategies, whether the topic is parenting, traveling, or having a successful career. In hearing the reflections of those who went before, I can benefit from their experiences without any commitment to follow their paths. The advice is free, and I can take what I want and leave the rest behind. So it is in this spirit that I decided to share what I tell aspiring young investigators if they seek my advice about how to achieve success as an academic clinical investigator. After writing down my initial thoughts, I shared the list with my colleagues, who provided many helpful additions and edits. I then circulated it to junior investigators, and the list continued to evolve. Clearly the generalizability of the strategies varies, and the list reflects the lens of my experience. I have been told by some young investigators that the list looks scary, but I wanted to be concrete about how discipline and hard work can enhance your chances for success in academic medicine. My hope is that people reading the list might find some new tactics that resonate with them or, at least, that it will provide a nidus for more discussion about what success as an academic clinical investigator means and how best to achieve it. This article is not about what someone else can do for you—that is mentorship.1 This article is about what you can do for yourself—the behaviors and skills that you can cultivate to increase your likelihood of success in academic medicine. Although everyone has a unique path that reflects his or her interests, skills, talents, and environment, effective habits can help you achieve your goals and be more successful in whatever career you choose. For fellows and junior faculty who spend less time engaged in research, protected time may be more limited, making focus and efficiency consequently even more critical. A number of benchmarks have been used to quantify success in academic medicine, including number of publications, grants, lectures, research collaborations, and leadership positions.2,3 These closely mirror the physician-scientist criteria for promotion, the academic track with which I am most familiar. For the purposes of this article, academic success is defined as a personal sense of accomplishment and external recognition by others in the areas noted. It does not cover many other sources of job satisfaction, including the physicianpatient relationship. Clinician-scholars are also judged on their clinical productivity, clinical reputation, and teaching skills. I have not seen any tips for success published for this academic track but hope to see this gap in the literature filled by someone else. The following tips are organized according to the major challenges for academic clinical investigators: Choosing and Completing Projects 1. Choose important and feasible research projects. Consider all aspects of a project in addition to its intrinsic scientific quality. Will you gain new skills or work with someone established and successful? If you have a negative study, is it still interesting and publishable? Choosing good projects takes time, thought, and discussion with many people. It is a research project in itself. 2. Seek out a niche rather than a crowded area. The project should not be easily scooped or done better or quicker by someone else. 3. Make sure you are passionate about your research topic. It is hard to sustain the necessary enthusiasm unless you are vitally interested in your research question. 4. Stagger your projects. Try to have at least one short-, medium-, and long-term project going simultaneously so that the time crunches for each are spread out, and the payoffs are layered. 5. It is more efficient if your projects intersect. A simple test is whether you can adapt some of the previously written background material for use in your new project. 6. Take personal responsibility for your success. Attack problems and barriers with creativity and vigor. Do menial tasks yourself to move a project forward. The surest way to get something done is almost always to do it yourself. 7. Have productivity goals and timelines. A general benchmark of productivity for a young investigator is three projects in planning, two projects in process, and one manuscript under review or in © 2013 by American Society of Clinical Oncology Information downloaded from jco.ascopubs.org and provided by at Oregon Health Sciences Univ on August 21, 2013 from Copyright © 2013 American Society of Clinical Oncology. All rights reserved. 137.53.241.27 811 Stephanie J. Lee press at any one time. Approximately double this target is appropriate for a midcareer investigator. Set research goals for the month, and make sure you achieve them. Interacting With People 8. Surround yourself with people of high standards, skills, work habits, and compatibility. Ensure your efforts are enhanced rather than sabotaged. 9. Avoid chronophages who ask you to perform extraneous tasks that eat your time without reward.4 Ask yourself: “Where could this new responsibility be listed on my CV?” If you cannot find an appropriate heading to put it under, you should strongly consider saying no. 10. Fully commit to whatever you agree to do. If you are part of a committee, then strive to be part of the 30% of members who actually contribute to the functioning of the group.5 Prepare for meetings, and speak up. 11. If you cannot commit, be able to say no. If you have a hard time saying no to requests, then a strategy of “yes, no, yes” can be helpful. Starting with a positive statement such as “thank you so much for thinking of me” is an easy first sentence. Then deliver the no clearly: “But I’m sorry I won’t be able to write a chapter… join that committee… write a review… I am unable to meet your deadline.” Then end on a positive note: “Please think of me in the future” or just simply end with a thank you. You can offer to suggest someone else who will do a good job (if it is actually a good opportunity). 12. Understand and participate in others’ work, and include them in yours. Give insightful comments on others’ papers, protocols, and grants. Be a sought-after collaborator who can deliver what is promised. 13. Help your colleagues, and celebrate the success of others. Give credit where credit is due. Academic medicine is a small world. Giving Talks 14. Know your audience. Aim your content at them, and prepare meticulously. 15. Be clear in your slides, logic, and speech. Practice until you are completely comfortable with your talk. If you are a beginner, memorize your abstract presentations. 16. Make sure you stay within your allotted time, and allow adequate time for questions. Practice answering questions about your work. Know the work of others. Writing Papers 17. Write often and well. Understand that if nothing is published, then nothing is gained on your CV. During the promotion process, you will be asked to provide your three to five most important papers. 18. Take pride in what you write. Make sure grammar, spelling, and formatting are correct. People are getting an impression of you through your writing, even the drafts and e-mails. Read your writing out loud to see how it sounds and flows. Start early enough that you can put it aside for a while to get some perspective. 19. If you have writer’s block, break the paper apart on your to-do list. Methods, results, conclusion, and introduction are not as daunting as “write paper.” 20. If all else fails, just start typing some text. Worry about editing in the next phase. It is usually easier to edit than write. 812 © 2013 by American Society of Clinical Oncology Securing Funding 21. If research grants will be your primary source of support, then it is critical that you become adept at writing grants. These should convince others that your research question is important, and you and your team are capable of successfully answering the question. Read about how to write grants and look at other people’s successful grants. Ask more experienced grant writers for help, and give them enough time to help you. 22. Pace yourself with interim deadlines. Ensure you have adequate time to submit the best grant you can. 23. Do not waste your time writing a grant for a funding source that is not appropriate for you. Invest the time to talk to your colleagues and granting agency officials to find this out. Clinical Work 24. The earlier and more precisely you specialize, the easier it is to maintain your expertise with less clinical time. 25. Whenever possible, clinical work should synergize with research endeavors. Time Management 26. Set priorities. It is helpful to consider the profile of the various tasks in your day. Is a task important or trivial, difficult or easy? The basic idea is to do the hard and important tasks first, then fill in the remaining time with the easier and less important stuff (Fig 1). 27. Meet deadlines. Reliability is noticed, and reliable people are usually given more responsibilities, which can lead to great opportunities. Make it a priority to meet all external deadlines, such as paper reviews and return of comments to coinvestigators. Set your own deadlines for your research tasks, and make sure you achieve them. 28. Work many hours. The number of hours needed to work during the week is controversial and personal, but many academic physician-scientists I know log at least 60 hours, often gaining extra and precious hours of deep focus on the weekends, early mornings, late nights, or during travel. 29. Work efficiently. Make whatever hours are devoted to work count. Aim to work smarter, not harder. Know when you work most Important Grants Papers Protocols Prepare talks Enroll patients Plan new projects Review the literature Attend meetings Sign clinical notes Read journals Review papers E-mail Trivial Difficult Easy Entirely in my control Partially reliant on others Fig 1. An example of prioritizing research tasks based on balancing importance, ease of completion, and reliance on others. Set aside focused time for tasks in the upper right. Complete tasks in the lower left during downtime or at the end of the day. JOURNAL OF CLINICAL ONCOLOGY Information downloaded from jco.ascopubs.org and provided by at Oregon Health Sciences Univ on August 21, 2013 from Copyright © 2013 American Society of Clinical Oncology. All rights reserved. 137.53.241.27 Art of Oncology effectively during the day and week. Protect your research time from small distractions. 30. Do not confuse being busy with being productive. They are not the same thing. 31. Keep a realistic and prioritized to-do list. Find the format that works best for you. Self-Awareness 32. Think deeply and clearly. Force yourself to ask why and how, and be able to communicate this information to others. Aim to be authoritative. 33. Try to see yourself through others’ eyes. Critically evaluate yourself after completing something. Did I do a good job? Why or why not? Know your own strengths and weaknesses. 34. Study others you admire. Dissect which specific qualities you want to emulate. 35. Get feedback from different people. Self-reflect, reprioritize, and learn from these comments. 36. Understand why you want to be an academic clinical investigator. Keep sight of the noble goals of your work while you are down in the trenches. about your relationship or your children, it is impossible to focus on anything else. Make time for your partner and your children. 41. Consider getting involved in professional societies. Let organizations know you want to be involved. If invited to participate, make sure you do an outstanding job. 42. Keep your CV updated. Include dates of invited talks and committee participation. Know what format is required by your institution. Include a summary of your research program. 43. Have fun. Not always, not only. But academic medicine can be grueling, and you need to enjoy the many hours spent at your job. The personal sacrifices of achieving success in academic clinical investigation can be burdensome, in terms of the long work hours, job insecurity, lower salary, and delayed gratification. If after reading this, you find yourself saying, “I don’t want to do this, be like this, work like this,” then ask yourself whether this is the best career for you. There are many other definitions of a successful career. Academic clinical investigation is only one approach to improving the care of people with cancer. Recommended additional reading: Johns,6 Goldman,7 Sackett,8 and Lewis.9 AUTHOR’S DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. Keep Evolving 37. Be a continuous learner. Embrace challenges. Learn new skills, and take some chances to keep things fresh. 38. Practice leadership when you get a chance. Notice the skills and behaviors required to be a good leader. 39. It is helpful to interact with others from different disciplines and different institutions whenever you get a chance. This exposure helps encourage creativity and makes sure you are known outside your institution. Your local, national, and even international reputation will be evaluated in the promotion process. Final Bits of Advice 40. For those with significant others or children, do not underestimate the challenge of work-life balance. Choosing a supportive significant other and, if applicable, reliable child care about which you feel good is absolutely essential to a productive career. If you are worried REFERENCES 1. Sambunjak D, Straus SE, Marusic´ A: Mentoring in academic medicine: A systematic review. JAMA 296:1103-1115, 2006 2. Buddeberg-Fischer B, Stamm M, Buddeberg C, et al: Career-success scale: A new instrument to assess young physicians’ academic career steps. BMC Health Serv Res 8:120, 2008 3. Jagsi R, DeCastro R, Griffith KA, et al: Similarities and differences in the career trajectories of male and female career development award recipients. Acad Med 86:1415-1421, 2011 4. Nathan DG: The several Cs of translational clinical research. J Clin Invest 115:795-797, 2005 5. Simone JV: Understanding academic medical centers: Simone’s maxims. Clin Cancer Res 5:2281-2285, 1999 6. Johns RJ: Dinner address: How to swim with sharks—The advanced course. Trans Assoc Am Physicians 88:44-54, 1975 7. Goldman L: Blueprint for a research career in general internal medicine. J Gen Intern Med 6:341-344, 1991 8. Sackett DL: On the determinants of academic success as a clinicianscientist. Clin Invest Med 24:94-100, 2001 9. Lewis JD: The pathway to academic success starts during fellowship. Gastrointest Endosc 61:587-588, 2005 ■ ■ ■ www.jco.org © 2013 by American Society of Clinical Oncology Information downloaded from jco.ascopubs.org and provided by at Oregon Health Sciences Univ on August 21, 2013 from Copyright © 2013 American Society of Clinical Oncology. All rights reserved. 137.53.241.27 813 Faculty Mentoring Making the Most of Mentors: A Guide for Mentees Judy T. Zerzan, MD, MPH, Rachel Hess, MD, Ellen Schur, MD, Russell S. Phillips, MD, and Nancy Rigotti, MD Abstract Effective mentorship is likely one of the most important determinants of success in academic medicine and research. Many papers focus on mentoring from the mentor’s perspective, but few give guidance to mentees forging these critically important relationships. The authors apply “managing up,” a corporate concept, to academic medical Mentoring, a lifelong process particularly important for career development in academic medicine, is essential for a mentee to develop confidence in his or her work. It facilitates career selection, career advancement, publication productivity, and achievement of grant funding.1–3 Mentoring is a symbiotic relationship aimed at advancing careers and career satisfaction for both the mentor and the mentee.4,5 Ideally, it is a dynamic, collaborative, reciprocal relationship focused on a mentee’s personal and professional development.6 Mentoring can develop either spontaneously, based Dr. Zerzan is assistant professor, Division of General Internal Medicine, Department of Medicine, University of Colorado Denver School of Medicine, Denver, Colorado. Dr. Hess is assistant professor, Division of General Internal Medicine, Department of Medicine and Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Schur is acting instructor, Division of General Internal Medicine, University of Washington, Harborview Medical Center, Seattle, Washington. Dr. Phillips is chief, Division of General Medicine and Primary Care, and professor of medicine, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, Massachusetts. Dr. Rigotti is professor of medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Correspondence should be addressed to Dr. Zerzan, University of Colorado Denver, Division of General Internal Medicine, 12631 E 17th Ave., B180, PO Box 6511, Denver, CO 80045; telephone: (303) 724-2244; fax: (303) 724-2270; e-mail: ([email protected]). 140 settings both to promote effective, successful mentoring and to make a mentor’s job easier. Managing up requires the mentee to take responsibility for his or her part in the collaborative alliance and to be the leader of the relationship by guiding and facilitating the mentor’s efforts to create a satisfying and productive relationship for both on mutual interests, or be set up institutionally.7,8 Mentees benefit from multiple mentors to gain exposure to a variety of styles, opinions, and experiences. Previous research has focused primarily on the importance of mentoring and mentors’ activities.1,2,9 We focus on the active role a mentee (at any level: student, resident, fellow, or junior faculty) might take to promote success in a mentoring relationship. In addition, we discuss common pitfalls and how to avoid them. One classic definition of mentor is someone of advanced rank or experience who guides, teaches, and develops a novice.9 Mentors in academic medicine can help with day-to-day tasks, such as manuscript editing, or they can help guide more substantial decisions, such as career planning. Some mentors are on-site; others are at a distance.9 Mentors are peers, near their mentee’s level of training; sounding boards who listen to their mentees process a decision; or role models who provide inspiration. They provide emotional and career support, facilitate insight and change, and/or help mentees avoid burnout. Good mentors value mentoring as part of their professional role and avoid focusing on their own professional needs and agendas, instead helping mentees develop theirs.10 –12 Good mentors take an interest in the mentee, provide both professional and personal support, prompt a mentee to take risks, and help open doors to opportunities.5,10 Because all mentors have different strengths and may not perform all these roles and embody all parties. The authors review the initiation and cultivation of a mentoring relationship from the perspective of a mentee at any stage (student through junior faculty), and they propose specific strategies for mentee success. Acad Med. 2009; 84:140–144. these qualities, establishing a complement of multiple mentors capable of making diverse contributions is useful for mentees. Whereas mentees benefit through their personal and professional development, mentors benefit by gaining professional stimulation, personal enrichment, satisfaction, and a sense of giving back to their profession.8,13 The mentee is not an empty vessel receiving the mentor’s advice and wisdom but, rather, an active participant, shaping the relationship. The ideal mentee aspires to self-assessment, receptivity, initiative, responsibility, honesty, and appreciation for his or her mentor.4,14 One particularly effective way for mentees to get the most out of a mentoring relationship is “managing up.” Managing up is a common corporate concept for an employee/supervisor relationship that we believe to be highly applicable to mentoring relationships in academic medicine. The principal concept is that the mentee takes ownership of and directs the relationship, letting the mentor know what he or she needs and communicating the way his or her mentor prefers. Ideally, a motivated mentee manages the work of the relationship by planning and setting the meeting agenda, asking questions, listening, completing assigned tasks, and requesting feedback.4,5 Managing up makes it easier for a mentor to help a mentee, which makes the relationship more satisfying and more successful for both. We focus on initiating and cultivating a mentoring relationship, assigned or chosen, from the mentee’s perspective. We propose Academic Medicine, Vol. 84, No. 1 / January 2009 Faculty Mentoring using the strategy of managing up to guide the mentee’s actions during these stages (List 1).6 List 1 Initiation Getting ready Preparing self Before a mentee seeks a mentor, a few introspective steps are necessary.4,15 First, a mentee must clarify his or her own values: What motivates him? What values and attributes does she respect in relationships? Are there personal preferences such as gender or race congruence, personality, emotional needs, or work habits important to the mentee? Next, a mentee should consider his or her personal work style and how it fits with mentoring approaches. Remembering their work styles in past academic environments, mentees might ask the following questions: “How do I learn best— by reading or listening?”15 “Do I need structured, directive guidance, or do I prefer gentle supervision?” Finally, mentees must clarify their needs. What are their knowledge and skill gaps? Specifically, what domains do they want to gain or cultivate from the relationship: personal (creating work–life balance, building confidence), professional development (networking, establishing goals, choosing fellowships or jobs), skill development (communicating, managing time, increasing clinical skills), academic guidance (learning administrative skills, understanding department values, developing collegial relationships), or research (collaborating, developing methodology, drafting manuscripts, and writing grants)?5,7,16 Once a mentee has thought about his or her values, work style, and needs, the mentee should develop a clear vision of career goals using these values and needs. Creating specific, written goals for three months, one year, and five years is helpful.17 If a mentee does not know what he or she wants to be doing in a year, establishing a possible direction provides a starting point. Goals should relate to the knowledge and skill gaps identified, but otherwise they can be specific (e.g., publish a paper) or broad (e.g., improve clinical exam skills), medically related, work related, or personal.11 Setting goals helps a mentee present his or her needs to potential mentors. A mentee who clearly assesses skill and knowledge deficits and sets goals can effectively seek mentoring and become Academic Medicine, Vol. 84, No. 1 / January 2009 Checklist for Mentees to “Manage Up” to Create Successful Mentoring Relationships ▫ Clarify your values ▫ Identify your work style and habits ▫ Identify knowledge and skill gaps 䡩 Personal 䡩 Professional development 䡩 Skill development 䡩 Academic guidance 䡩 Research ▫ List specific opportunities sought — e.g. grant writing, presentation ▫ Write down goals: 3 months, 1 year, 5 year Finding a mentor . . . or two ▫ Meet with people you know ▫ Get recommendations ▫ Ask people you meet with who else they recommend ▫ Be persistent ▫ Find multiple mentors, both junior and senior people Things to look for in a mentor ▫ Is available and accessible ▫ Provides opportunities and encourages mentee to take risks ▫ Helps mentee develop own agenda ▫ Has prior mentoring experience The first meeting ▫ Tell your mentor how he or she has already helped you ▫ Share your background, values, and needs ▫ Send a thank-you note after the meeting Cultivating the mentor–mentee relationship ▫ Agree on structure and objectives of relationship ▫ Plan and set the meeting agendas ▫ Ask questions ▫ Actively listen ▫ Follow through on assigned tasks ▫ Ask for feedback ▫ Manage up 䡩 Set goals and expectations 䡩 Be responsive and flexible 䡩 Direct the flow of information 䡩 Follow a regular meeting schedule with agenda Separation ▫ Talk about when the relationship should end ▫ Talk with your mentor about next steps ▫ Talk about future mentors responsible for his or her own growth.9 It is important to refine and rewrite goals periodically.17 Finding a mentor . . . or two . . . Finding a mentor may be the most difficult step in establishing a mentoring relationship. Institutions may assign mentors, but often multiple mentors are helpful for specific needs, so a mentee may need to look for other mentors beyond those officially assigned. There are several ways to approach the process. Mentees may start by meeting with 141 Faculty Mentoring faculty they already know both inside and outside their department, school, and/or hospital in order to talk about what guidance and support they seek and to get recommendations of potential mentors who might be a “good fit.”10 In these meetings, a mentee should ask about potential mentors’ reputations and experiences mentoring successful mentees. Another strategy for identifying mentors suggests the mentee consider people who have positively impacted him or her. The official mentoring relationship can start positively if it is based on previously established admiration, trust, and compatible background and interests. Once the mentee has a list of recommendations, he or she should meet with the selected faculty and conduct informational interviews seeking compatible interests and work styles. Finally, during these meetings, mentees should ask who else the mentor might recommend to advise them, and in this way the initial list grows into a network of contacts. connecting a mentee to other prominent scholars, providing research datasets, and giving long-term career planning advice. Multiple mentors are necessary to get needed guidance across the spectrum of work and personal goals.5,10 Also, identifying and cultivating multiple mentors is advantageous for the mentors because providing mentorship becomes less demanding and time consuming, and the mentor can keep focused on what he or she knows and does best. Strategies for making multiple mentors successful include clear roles and expectations for each mentor, a good relationship among mentors, and mentors with complementary experience.18 Potential problems arise when there are unclear expectations, disagreement, or competition among mentors. A risk of multiple mentors is erosion of a close mentoring relationship because the dyad spends less time together. Cultivating the relationship and managing up, discussed in the next section, will help address these problems. One common difficulty during the initiation stage is a perception by the mentee that people are too busy or unavailable to be mentors. Knowing that mentoring is time- and energy-intensive and that a potential mentor may say no, a mentee may be uncomfortable requesting mentorship and fear rejection. One remedy for these difficulties is persistence in approaching potential mentors. Additionally, a mentee should be clear in expressing needs, thus providing potential mentors a sense of the commitment sought. When people are too busy or overcommitted, they can gracefully decline and suggest others for the mentee to approach. Another impediment to approaching mentors, even after considering needs and listing potential mentors, is that a mentee may be indecisive regarding his or her career and, therefore, have difficulty knowing whom to approach.16 If a mentee does not yet have a clear career direction, he or she can seek out mentors who are good at guiding exploration of career options. Meeting for the first time Mentees should begin seeking mentoring early and in multiple places. A mentee benefits from cultivating mentors at both junior and senior levels. Junior-level mentors complement senior faculty mentors because they may have more time and are closer to the mentee’s career stage. Senior mentors are helpful in 142 When a mentee first meets with a prospective mentor, whether chosen or assigned, the mentee must have a plan.19 Mentees should consider how to market themselves; with busy and overcommitted mentors, it helps if a mentee can recruit a mentor. In fact, it may be best to schedule a brief meeting when considering a potential mentor, and only after the mentee has engaged the potential mentor and demonstrated organization and ability should he or she formally ask whether a person will mentor. The meeting may start with both individuals sharing their backgrounds, followed by the mentee clearly articulating his or her needs and values.20 A mentee demonstrates early success to prospective mentors by having predefined goals and needs. Other tips for the initial meeting include telling the mentor how he or she has already been helpful, asking for feedback about a research idea, or specifically discussing how the mentor may be helpful. A mentee should ask the mentor’s permission to contact him or her for future guidance and explicitly state the likely purpose. Finally, a mentee must be accountable to his or her prospective mentor and should follow up with a thankyou note or e-mail summarizing the discussion and the mentee’s plans to proceed, thereby keeping the mentor engaged. At the next meeting, the mentee can ask for more advice. Finding a suitable mentor requires effort and persistence, allowing brief interactions to grow into learning partnerships and long-term alliances.9,10 Cultivation Once a mentee has engaged a mentor, the relationship needs cultivation. At this stage, the mentoring dyad agrees on both objectives and a relationship structure such as meeting frequency (e.g., often an hour every two to four weeks), key responsibilities and needs of each party (such as the mentor’s availability outside of meetings, and networking opportunities for the mentee), mutual expectations and goals (e.g., the mentor will review writing; the mentee will ask for feedback), and concrete measures of progress and success (e.g., the mentee will eventually present an abstract at a meeting). It is important for each individual to make the relationship a priority, set aside time for the relationship, and agree on confidentiality.4 Managing up Managing up is one way of cultivating the mentoring relationship.15 Managing up means the mentee takes ownership of the relationship, letting the mentor know what he or she needs and organizing information in the form the mentor prefers. A mentee must express his or her needs in a direct manner and take responsibility for setting and sticking to a goal schedule. Managing up makes it easier for mentors to help a mentee, and it makes the relationship more satisfying and more successful for both parties because the mentor can target help and the mentee gets exactly what he or she needs most. A mentee must ask directly how the mentor will judge success and be responsive to the mentor’s suggestions and tasks. A mentee should be available and flexible if a mentor’s time or schedule changes. A mentee must communicate in a straightforward way by addressing issues of potential conflict (e.g., authorship on a paper) as they arise and asking when he or she does not understand something. A mentee’s understanding of him- or herself and the mentor is key to making the relationship successful. The mentee must know the work styles and personal styles, strengths and weaknesses, blind spots, and trigger points of both Academic Medicine, Vol. 84, No. 1 / January 2009 Faculty Mentoring participants.4,21 A mentee will observe these over time, but he or she may also ask about them, either directly or through other peers and supervisors. A mentee can use the information gleaned from his or her own self-assessment to develop and manage a healthy working relationship compatible with each person’s work style and expectations and, most importantly, in a way that meets his or her critical needs.21 Managing up requires the mentee to take responsibility for managing information flow.15 A mentee should ask directly about the mentor’s preferred communication style—Does the mentor like to know the detailed facts and figures, or is a broad overview with specific problems better? Does the mentor like to communicate by e-mail, phone, or both? Is the mentor a “listener” or a “reader”?21 If the mentor is a listener, the mentee should provide a verbal brief first and follow up with a short written summary of the details. If the mentor is a reader, than the mentee should provide written material in advance and follow up by talking about the issues in person at the arranged meeting. It is essential to communicate frequently and effectively according to the mentor’s preferred format and frequency of information exchange.4 A mentee needs to ask questions to get new insight, verify or clarify ideas, show interest, and listen actively. Although a mentee should put forth his or her own ideas, it is critical that he or she not get defensive or argumentative when the mentor disagrees or provides constructive feedback. The relationship’s ultimate goal is to help the mentee succeed, and the mentor has the mentee’s best interests in mind. If a mentee disagrees with a mentor, he or she should try to understand the mentor’s perspective but discuss both opinions because, although the mentor has more experience than the mentee, the mentee brings a new and potentially valuable view to a situation.4,12 If a mentee must disagree, he or she should do so respectfully and start by asking clarifying questions to find out more about the basis for the mentor’s suggestions. When mentees learn from disagreements, they grow. Mentees should take responsibility for managing the meetings. They should start by agreeing with their mentors on a regular schedule that is both feasible, Academic Medicine, Vol. 84, No. 1 / January 2009 considering time commitments, and adequate, allowing them to reach their intended goals. One suggested structure for each mentoring meeting begins with a social opening, followed by agenda negotiation, goal setting, discussion of two to three topics, and a closing, including a summary and plans for the next two to four weeks.22 A mentee should write an agenda for each meeting, even if it is simply for his or her own personal organization, to keep track of goals and progress. Some mentors may like to receive a written agenda and questions ahead of time; others just like to arrive and talk. At each meeting, a mentee should inform the mentor of his or her progress since the last meeting and ask what is expected in terms of tasks before the next meeting.4 A mentee should use a mentor’s time wisely by keeping meetings as short as possible or cancelling an appointment in advance if there is neither anything new to report nor new issues to discuss. Mentees should keep in mind, however, that nothing new to report can represent a road block they have encountered, and mentors may be able to help navigate this problem. Challenges Dissatisfaction and problems are common to every relationship, including mentorships. Finding a successful mentoring relationship is like dating: one cannot expect a perfect fit every time, and a good relationship takes work. Dissatisfaction may occur from a mismatch of goals, commitment, or expectations; from a reluctance of the mentee to own and pursue his or her own development; or from a mentee’s reluctance to ask for personal help.5,13 There can be power issues (over ownership of authorship or resources), generational tensions (over differences in work schedule expectations), or personality clashes (over differences in communication or work style). Occasionally, a mentor enters a mentorship in search of a clone, encouraging mentees to be dependent rather than to cultivate their own ideas.8 When problems occur, either the mentee or mentor can suggest a change, and the approach to the problem depends on the mentee’s and mentor’s styles. Often, another person outside the mentoring relationship can offer advice about disagreements or concerns. Common mentor complaints are that the mentee did not follow through, the mentee did not use the mentor’s time effectively, or there was a poor fit with work style and/or personality.19 If a mentee is aware of potential difficulties early, knows his or her values and needs, and manages up, then many of these problems can be avoided.12 Long-distance mentoring relationships, becoming more common as both mentees and mentors move institutions or as a mentee seeks specific expertise, inspire their own unique set of potential problems, including ineffectiveness because there is no direct observation or accountability, and misunderstandings due to phone and e-mail communications.18,23 Some ways to make long-distance mentoring more successful include establishing the relationship in a face-to-face meeting and then continuing it at a distance, having occasional face-time at conferences, and having clear expectations set up about roles and goals.18 Separation All relationships naturally change and evolve, and this is true of mentoring.9 Ideally, there will be a planned separation as mentees advance their careers, attain their goals, and become more collegial with their mentors. Mentorship needs evolve over time, and managing up helps smooth the transition of ending the mentoring relationship and moving toward more equal standing. Often, both the mentor and mentee recognize that their mentoring relationship has fulfilled its purpose, and both are ready for a change. Occasionally an insurmountable problem may occur such as differences in communication, respect, or resource use that leads to the sudden end of a mentoring relationship. Ideally, to promote productive future interactions, the mentor or mentee should directly address the transition, rather than letting the relationship dwindle away or avoiding talking about a problem. Part of the mentoring relationship is to communicate about any issues so that, as one mentoring relationship evolves, a mentee begins thinking about next steps and potential future mentors, if needed. In Sum Mentoring is an evolving relationship that requires time and attention to develop and includes successes and challenges. We outline the strategy, managing up, which may be helpful to improve mentoring relationships but that has not yet been empirically tested in 143 Faculty Mentoring academic medicine. Nevertheless, following these tips is likely to improve communication and the experience of both mentor and mentee. Next steps for research in this area include testing the success of this strategy in groups of mentees, so we are planning a phased, randomized study at a single institution. When a mentee knows him- or herself, knows his or her values and needs, manages up, makes the relationship a high priority, and shows appreciation, he or she will most likely become successful. By implementing these specific tasks, mentees can nurture and improve a relationship that may ultimately become a productive and enjoyable force in the careers of both the mentor and the mentee. Acknowledgments This work was presented in part as a workshop at the National Meeting of the Society for General Internal Medicine, Los Angeles, California, April 2006, and in Toronto, Canada, April 2007. This work was supported by the Office of Research and Development, Department of Veterans Affairs, and the Robert Wood Johnson Clinical Scholars Program at the University of Washington. Disclaimer The views expressed are those of the authors and do not necessarily reflect the views or opinions of the supporting programs. 144 References 1 Ramanan RA, Taylor WC, Davis RB, Phillips RS. Mentoring matters. Mentoring and career preparation in internal medicine residency training. J Gen Intern Med. 2006;21:340 –345. 2 Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: A systematic review. JAMA. 2006;296:1103– 1115. 3 Steiner JF, Lanphear BP, Curtis P, Vu KO. Indicators of early research productivity among primary care fellows. 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