Mentorship is a key factor in promoting and maintaining fulfillment in medical practice. Senior colleagues who share your clinical, research, administrative, or community service interests should be approached early in your formal training. An open and honest dialogue can be instrumental in setting your professional goals, defining its trajectory, and learning how to overcome barriers by adopting successful strategies.

— John A. Fromson, MD*

By Bonnie Darves

Most physicians who make their way into satisfying practice careers in a specialty they enjoy — and especially those who also end up in leadership roles — are usually quick to point out to their younger colleagues that they received some help, perhaps even a whole lot of assistance, along the way. Almost invariably, these physician success stories usually have a common thread: an important mentor, or possibly more than one key mentor, whose guidance proved invaluable.

In an era when it’s easy to network and seek guidance online in pretty much any area of one’s life, the notion of the traditional physician mentor-mentee relationship carried out over a series of regularly scheduled formal in-person meetings and the occasional phone conversation might seem almost quaint. It isn’t, and such relationships might be more important now than in the past because the in-touch-and-constantly-connected online environment doesn’t necessarily foster or sustain the deep, candid exchanges that characterize good mentor-mentee interactions.

Anne Pereira, MD, MPH, assistant dean for curriculum at the University of Minnesota Medical School, thinks that some physicians in training fail to recognize the value of establishing and cultivating relationships with mentors. “Absolutely, in-person mentorship remains fundamentally important in medicine, because a lot of mentorship is about developing a relationship that’s close enough that your mentor wants to support you,” Dr. Pereira said. “Unfortunately, I think that the value of having mentors is probably underestimated by many trainees.”

One reason, she points out, is that many young people today who end up in residency have never worked because they have been on a fast track. They’re essentially high-achieving, highly driven professional students who have been “on a fairly regimented pathway,” she explains, “and they haven’t reached a point where there are multiple pathways they could take.”

When physicians do get to that juncture, having an established mentor relationship might make the difference between a good, thoughtfully considered decision and a poor one later regretted, longtime physician mentors say. Ideally, that relationship — regardless of the logistics of how the parties meet and how frequently they connect — is a deep one predicated on two-way trust and defined objectives.

“In mentorship, I think anything that leads to a mutually beneficial relationship and the accomplishment of shared goals is fair game, but it’s definitely helpful to meet in person,” said Jennifer Best, MD, associate dean for graduate medical education at the University of Washington in Seattle. “Social media and the online universe can present a false sense of depth, and I think that we sometimes present different ‘selves’ in that environment.”

If there is one absolute prerequisite for a successful mentor-mentee relationship, it is a commitment to candor, according to Nathaniel Scott, MD, director of the combined emergency medicine/internal medicine residency program at Hennepin County Medical Center in Minneapolis. “There has to be some degree of personal connection, even in the most formal mentor-mentee relationship, and that both parties must be invested in it and honest if it is going to provide a benefit,” he said. “I think what the local relationship offers over a remote or online one is that your mentor will be more aware of the circumstances you’re in and the issues you are confronting on a more intimate level.”

To look at how young physicians can identify mentors and ultimately thrive in those relationships, NEJM CareerCenter recently spoke with physicians who have served as mentors or benefitted from the guidance that mentors have given them — or both — to obtain their perspectives on key issues.

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When should physicians start looking for a mentor, and what’s the best way to go about that?

“Ideally, people should start looking for a formal mentorship program when they’re looking for a residency program. Especially in a large program, having some help finding a mentor is important because it’s difficult to get your feet under you, and get to know the institution and individuals well enough to reach out on your own. I think that mentorship should be an important part of the culture in training programs.”

—Anne Pereira, MD, MPH, University of Minnesota Medical School

“The most important thing is to just start connecting with people in your institution, anyone — you can’t exist in a vacuum. You can do this without necessarily going out and looking for a mentor, by asking someone you admire for advice on a research project, for example, or guidance on how to publish a paper. Start with a specific request, and often, these exchanges will grow organically into a relationship. It’s also helpful to reach out to national physician organizations that provide mentor services on a group or individual level.”

—Chemen M. Neal, MD, assistant professor of clinical obstetrics and gynecology, Indiana University School of Medicine; mentor chair, American Medical Women’s Association

“All physicians should seek mentors as early as possible, and having a mentor when starting training is especially beneficial for international medical graduates [IMGs], because of the cultural challenges they might face. That initial mentor, ideally, should be a successful physician from the IMG physician’s country – whether the mentor is on the program faculty or not. It’s important for hospitals and health systems to help IMGs make those connections, but professional societies can also be helpful.

—Thomas Norris, MD, board member, Educational Commission for Foreign Medical Graduates and former chair of the American Board of Medical Specialties; former vice dean for academic affairs, University of Washington

“I think the majority of mentor relationships today are informal. By that I mean that you don’t go ask someone, ‘Will you be my mentor?’ I don’t think I’ve ever said that out loud. Instead, look for someone you admire who is ahead of you in the field, or in a position that you might envision for yourself, and establish a relationship by asking a specific question. Then later, ask if that person will grab some coffee with you sometime.”

—Fatima Fahs, MD, dermatology resident, Wayne State University; budding mentor

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What qualities or traits should physicians look for in a mentor?

“A good mentor is someone who says, ‘How can I help you succeed?’ and truly wants you to succeed. A lot of people still think that physician mentorship is hierarchical, but it isn’t — and shouldn’t be. When physician mentorship is done well, for the right reasons, the mentor-mentee relationship is a partnership.”

—Susan Reynolds, MD, PhD, president and CEO, The Institute for Medical Leadership

“It’s important to look for mentors who can connect with you on a one-to-one basis and who will inspire you and also give you a pat on the shoulder. It shouldn’t be about idolization; you want someone who will celebrate you as an individual, not intimidate you, and someone who will also help you figure out how to overcome roadblocks.

I’ve always found the best mentors to be people who fill up my tank a bit to give me more energy to meet the next milestone.”

—Joseph Vercellone, MD, internal medicine resident in Royal Oak, Michigan, who previously worked in the film and information technology industries

“Start by looking for physicians you admire for their expertise or their skills, who are willing to give you good advice. Also look for people who you see as good people, as models for how you would like to lead your life.”

—Janis Orlowski, MD, chief health care officer, Association of American Medical Colleges

“Look for a person who has the time and desire to truly invest in your future. It matters less what their area of expertise is. You want someone who can act like a sponsor for you and connect you with the right people. And you should ensure that person doesn’t have selfish motives, like recruiting you.”

—Dr. Pereira

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How many mentor relationships should young physicians try to establish?

“Most of us benefit from having at least a few mentors — a clinical mentor, a research mentor, and an overall career mentor. They don’t all have to be in your field. I think it’s helpful to have a personal mentor, too, someone you bond with who’ll check in and ask you how you’re doing and whether you’re getting enough sleep.”

— Dominique Cosco, MD, associate internal medicine program director, Emory University, Atlanta

“Physicians absolutely need more than one mentor, maybe not in the beginning but definitely toward the end of residency as they start looking for their first job. There’s no perfect single mentor, so I think it’s helpful to create a quilt of mentors — a mentor who can help you procedurally, once who can help you with career planning, and another mentor for life planning.”

—Dr. Pereira

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How should young physicians approach about the issue of expectations in a mentor-mentee relationship, and do they even need to address that formally?

“It’s important to make the expectations somewhat explicit from the start. For example, after a first meeting, you might ask the potential mentor if it’s OK to meet for coffee every few months. And if the person says, ‘sure,’ the mentee should reach out to set up the next meeting. After the relationship is established, there should be expectations set about what the mentor and the mentee will do, and by when, and what both are seeking from the meetings.”

—Nathaniel Scott, MD, director, combined emergency medicine/internal medicine residency, Hennepin County Medical Center, Minneapolis

“The physician who identifies a potential mentor should be direct, and say, ‘I’d like you to be one of my career advisors.’ If that person agrees, the two should set expectations about the kind of communication that will occur and how often, and when the mentor will check in to see how things are going. It’s important to set out the expectations of the exchange, because if one party has higher expectations than the other, that could be strain the relationship.”

—Jennifer Best, MD, associate dean for graduate medical education, University of Washington

“I think that expectations can be fluid at the start, but as the relationship develops, the parties should set goals and establish what the mentee wants to work on and what he or she will bring to the meeting. It’s important that there be a timeline for goals or projects.”

—Dr. Cosco

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What should physicians be sure to do, or avoid doing, when they’re seeking a mentor or working with one?

“Frame your request by telling the person the concrete thing(s) you are interested in, and be specific. One of my pet peeves is when I receive an email that reads ‘Hello, Dr. Fahs. I am interested in dermatology. What advice do you have?’ The right way would be: ‘Hello, Dr. Fahs. I am interested in dermatology. Do you have any advice on how I can obtain a research project in medical school when I don’t have a lot of clinical experience?’”

—Dr. Fahs

“It’s very important to be honest with yourself and with your mentor about the kind of help you’re seeking or what you’re struggling with. Be willing, once the relationship is established, to ask for feedback on what you could do better, and then try not to be defensive, because that could damage the relationship. That honesty should be on both sides. Mentors should be open in sharing the things they didn’t do right in their careers.”

—Joshua Corsa, MD, trauma surgeon who trained at Orlando Regional Medical Center and is doing a critical care fellowship at Harborview Medical Center in Seattle

“Do your homework before you approach your mentor with a question, and don’t use your mid-career mentors or senior faculty member to obtain information that you can get online. Go to your mentor with those more nuanced questions where their expertise and experience will enable you to understand things in a way that you couldn’t by just reading about it.”

—Dr. Pereira

“Prepare well for every meeting with your mentor, and remember that every good mentor is looking for a mentee who is passionate, devoted to the field, and diligent. Because unless the relationship is also gratifying to the mentor, that mentor won’t want to stay in it. Keep in mind that your mentor is very busy, and he or she needs to have a reason to devote that time to you.”

—Nitin Agarwal, MD, neurosurgeon trainee-PGY 4, University of Pittsburgh; American Association of Neurological Surgeons resident advisor

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What should physicians do if they’re in a mentor relationship that isn’t working out?

“During training, you only have so much bandwidth. If the relationship isn’t a good fit, let the mentor know that you’re thinking about going in a different direction. Thank the person for the guidance so far, and say, ‘I hope you’re willing to stay in my life in an advisory capacity.’ It’s important to go out on a positive note.”

—Dr. Best

“Most of the time when mentor arrangements aren’t working, things tend to fall off naturally. If it’s a mismatch of expectations — one person wants to meet more frequently than the other — that should be addressed in a way that allows the two parties to just move on.”

—Dr. Scott

“If the chemistry [doesn’t] feel right when you start talking or meeting, find someone else. Working with a mentor is a little bit like dating; if you don’t connect early on, it’s probably a relationship that’s not going anywhere.”

—Dr. Norris

 

*Dr, Fromson serves as the editor for Career Resources and is Vice Chair for Community Psychiatry, Brigham and Women’s Hospital; Chief of Psychiatry, Brigham and Women’s Faulkner Hospital; Associate Professor of Psychiatry, Harvard Medical School.