The "Perfect" Mentoring Program

By now, one can probably infer from my previous posts my particular interest in the area of mentorships during medical training. In my earlier blog, I discussed the premises for establishing a mentoring program and explained its effects on students. However, behind each success is an extensive effort by faculty and curriculum leaders pushing for its establishment. Not all medical schools have formal mentoring programs and even within the repertoire of existing models, evidence has not shown there to be a standardized approach to creating the “perfect mentoring program”. There is also a lack of defined outcomes for studying program effectiveness which limits the applicability of models and further program development.

Three main models of mentoring are currently used in medical schools:

1. Individual mentoring: this is the traditional paired approach where each mentee is matched to a mentor
2. Group mentoring: here, one mentor meets simultaneously with many mentees with different levels of training. Junior members often benefit considerably from the interaction with his/her advanced peers. This approach is used in the Internal Medicine residency program in Calgary; and despite students being assigned to mentor groups instead of choosing them, students have for the most part formed meaningful relationships with their upper year peers
3. Telementoring and distance mentorship: this is an evolving model of mentorship that usually takes place over email or personal messaging devices, usually developed after students partaking in traditional mentoring programs have relocated to other geographic locations

The traditional individual mentoring model is still used most frequently across Canada and provides most flexibility in goal-setting and frequency of meetings between mentor and mentee. Group mentoring has been gaining more momentum, especially in settings where the members share similar interests and career aspirations. For example, the Women in Emergency Medicine Mentoring Program developed by Indiana University School of Medicine employs a group structure using 3 processes: vertical mentoring (senior faculty to junior faculty and residents), peer mentoring, and role modeling. Scheduled sessions are held under voluntary direction of a female mentor, usually happening every other month in a relaxed environment and welcome to families. There are also organized workshops and annual meetings for greater networking opportunities. The program has been shown to have high satisfaction rates and retention of mentor involvement.

When creating a new mentoring program, it’s important to consider potential problems, including a lack of time and commitment from either party, overdependence of the mentee on the mentor, creating “clones” of the mentor and inconsistent experiences between students in the case of informal mentorships. To address these potential problems, we can consider adopting strategies from those who have collaborated to discuss them. “The Mentoring Toolbox” was an annual workshop conducted by the Pediatric Academic Societies with involvement from over 100 faculty attendees, each representing various types of mentoring programs. Together they developed a guide to help with mentoring program design; and also the results were published in The Journal of Pediatrics, the core principles can certainly be applied in other medical specialties as well.

First and foremost, four essential components should be addressed: formal vs informal structure, mandatory vs voluntary participation, assignment vs flexibility of mentor selection, and availability of rewards for participating mentors. The following conclusions were made at the conferences regarding the best possible strategy:

1. The program should be formally structured with explicit expectations and goals to produce a standardized experience and hold participants accountable. Formalization also shows institutional support which would facilitate formal mentor training.
2. The program should be voluntary for mentors but mandatory for mentees to promote professional development in all students.
3. Mentees should be allowed to explore multiple mentors and identify new mentors even if assigned a different mentor initially. This would allow a better chance of a meaningful relationship, promote autonomy, and increase commitment and satisfaction.
4. Tangible rewards should be available to mentors, perhaps in the form of awards and recognition in the formal promotional process. In addition, time used to participate in the mentoring should be compensated through a reduction in expectations of clinical productivity, and subsidized by the school and/or hospital.

Designing a mentoring program requires involved and motivated players at various levels of the medical education system. It is a rather large investment, in both the financial and physical effort departments. Until there are large-pool studies looking objectively at the vitality of mentoring programs after their establishment and producing results showing significant benefit to the school, I do not see it becoming a spontaneous addition to every medical school.

-JJ