Dermatology Online Journal

Mentorship in dermatology residency training programs: Charting the right course
Jeff C Donovan MD PhD
Dermatology Online Journal 15 (5): 3

Division of Dermatology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. jeffrey.donovan@utoronto.ca

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Abstract

Considerable attention is given to mentoring issues for dermatology trainees. Many residents consider it important to have mentors. Mentorship Programs are flourishing in residency training programs and a majority of the national dermatologic societies have established funded mentoring opportunities for residents. With the level of support for mentorship that has been established within the dermatology community, there are now several issues that need further evaluation in order to ensure that all residents have access to and achieve benefit from high-quality mentoring opportunities.

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Introduction

In the last 10-15 years, the dermatology community has witnessed a remarkable increase in attention given to the topic of mentorship. Although the terms 'mentor,' 'mentee,' and 'mentorship' are commonly used in everyday language, mentoring has only recently become a widely discussed and studied tool for enhancing the professional development of physicians. Mentoring issues are increasingly recognized as important to resident physicians. In the following commentary, the potential benefits, opportunities and barriers to mentorship are highlighted along with a discussion of four issues that need to be addressed in order to ensure that all dermatology residents have access to and achieve benefit from high-quality mentoring. The term mentor will be used to refer to an individual who takes an interest in the career development of someone more junior (i.e., the mentee) and offers wisdom, guidance, encouragement and opportunity to that individual in order to help them learn specific skills or achieve specific goals. The mentoring relationship is usually long term, but may include short term mentor-mentee relationships with more limited goals.

Mentorship in 2009

Several publications in the dermatologic literature have outlined the views of residents on mentoring issues. The majority of surveyed dermatology residents consider it important to have mentors [1] and many, but not all, are able to identify someone they consider to be a mentor [2]. However, the quality and availability of mentors are a concern to some residents [1, 2]. Surveys of residents have also provided insight into the potential benefits of mentoring as well as the consequences of not having a mentor. In one study, increased mentoring was associated with increased overall satisfaction with resident training [2]. In a second study, a lack of mentorship was associated with a loss of interest in pursuing a career in academic dermatology [3]. Studies of trainees in other fields of medicine suggest that mentorship has additional benefits, including helping with career decisions [4, 5], finding a job [4], productivity with research [5], and even reducing stress [6].

Many residency training programs have developed mentorship programs for residents, especially within the last few years. Some mentorship programs assign residents to mentors whereas other programs encourage informal, 'spontaneous' mentoring. Many national dermatologic organizations have also created mentorship programs to assist residents find mentors with specific subspecialty interests (Table 1). In many cases, funding is available to enable residents to travel to other centers to work with mentors. In 1993, the Women's Dermatologic Society became the first of several subsequent national dermatologic organizations to provide funding for resident mentoring (Table 1). Although the mentoring opportunities listed in Table 1 are of short duration, their strengths as a mentorship opportunity come with the relationships that are established and the potential for ongoing dialogue between mentor and mentee.

The Next Phase of Mentorship

Figure 1

A supportive mentoring environment is being developed within the dermatology community. There are now several fundamental issues that require further assessment and study in order to ensure that all dermatology residents have the opportunity to participate in high-quality mentoring relationships (Fig. 1). These issues include: 1) the need to differentiate between the terms mentoring and role modeling, 2) the need for additional high-quality studies on mentoring, 3) the need to address mentoring barriers, and 4) the need to address mentoring strategies for future clinician-educators, clinician-scientists, and those interested in private practice.

Issue 1: Definition of a 'Mentor'

Although most people understand what is implied by the term 'mentor,' there is no standard definition. It was recently estimated that at least twenty definitions appear in the literature [7]. The lack of a standard definition makes it more difficult to compare published studies on mentorship. Furthermore, the term 'mentor' is sometimes incorrectly used to describe someone who might more accurately be called a 'role model.' The meaning of the two words is different, with mentoring referring to an active process and role modeling referring to a more passive process. A mentor interacts one-on-one with a mentee and offers wisdom, guidance and encouragement. In doing so, the mentor frequently comes to know the mentee on a personal level. The greater time commitment of mentoring compared to role modeling usually limits the number of mentees that a given individual can mentor. In contrast, a dermatologist may be a role model to one or even hundreds of residents without necessarily meeting those residents. A role model usually has specific personal or academic qualities that others seek to emulate. Both mentoring and role modeling are valuable to residents and a given individual may act as a mentor to some residents and role model to others. However, it is important to distinguish between these terms, especially when designing studies on mentoring. The career paths of our dermatology residents, and thus of our future dermatologists, are influenced to a greater degree by those who will mentor them than by those who will serve as their role models.

Issue 2: High Quality Studies of Mentoring

Most people would agree that having a mentor has several benefits. The recent publications of mentoring topics in top medical and scientific journals further support this notion [8, 9]. Yet, high-quality evidence is lacking to support the assumption that mentorship is beneficial. The majority of published studies of mentoring are survey-based studies and draw conclusions based on self-report data and small sample sizes. In fact, a recent systematic review of 39 studies on mentoring was unable to offer any definitive conclusions on the benefits of mentorship [8]. There are certainly several potential harms from mentoring of residents, including the potential for conflicts of interest to develop between educational supervisory roles of mentor and the actual mentoring role. Additional well-designed studies are needed to evaluate the merits of mentorship.

High-quality studies will require accurate definitions of the terms mentors, mentoring and mentorship (Issue 1, above). Ideally, the design of such studies will enable comparison of outcomes between mentored and non-mentored residents. This will allow conclusions to be made regarding the magnitude with which mentorship affects outcomes such as resident satisfaction, subspecialty choice, choice of academics vs. private practice and research productivity. It will also be important to develop tools to evaluate the quality of a mentoring relationship. The ability to implement change in dermatologic education will be greatly enhanced if it can be demonstrated that residents who participate in high-quality mentoring relationships achieve specific outcomes with greater frequency than residents who are less effectively mentored. At present, there are no standardized methods for evaluating mentoring relationships, although some authors have suggested possible methods [7]. Furthermore, it will important to fully evaluate the potential benefits of mentoring for the mentor as well as the institutions in which the mentoring takes place. These issues have not been adequately addressed in the literature.

Issue 3: Mentorship Barriers

Despite the potential benefits of mentoring, there are barriers that prevent mentors and mentees from establishing mentoring relationships and barriers that prevent residents who have found mentors from fully benefitting from the mentoring experience (Fig. 1). These barriers can best be understood by considering factors related to the mentee, factors related to the mentor and factors related to the mentoring environment. For example, the motivation, responsibility and independence of the resident, the quality and availability of the mentor and the value placed on mentorship by the academic institution all impact on the success of a mentee. Certain personal qualities are associated with a greater likelihood of finding a mentor. It has been suggested that residents with good self-monitoring skills and emotional stability may be more likely to find a mentor [10]. However, some residents have not even considered the option of seeking a mentor [5]. Further study of mentoring barriers may provide insight into why at least one-quarter of dermatology residents are without mentors [2].

Gender-specific barriers to mentoring also exist. Many studies indicate that female residents are less likely to report having a mentor compared to male residents. Lack of mentorship may have significant negative consequences on the professional development of female dermatologists. For example, in a study of junior faculty at the University California at San Francisco, 24 percent of women stated that lack of a mentor was among the most negative experience they had during their careers [11]. Furthermore, even when female residents do find mentors, they may not benefit to the same extent as men [4, 12].

How might we address these barriers to mentoring? The design of high-quality studies (Issue 2, above) should help to better define why barriers exist and highlight potential strategies to overcome these barriers. It will be important to continue to discuss mentoring issues with residents and faculty and encourage and support mentoring wherever possible. This may include the creation of programs to strengthen the mentoring skills of mentors [13, 14, 15] and 'mentorship programs' to help mentees find mentors. The goal of these programs should not be to help residents find a single mentor but rather a network of mentors to help them achieve their various goals.

A criticism of resident mentoring programs that assign faculty mentors has been that they are potentially not as effective as spontaneous mentoring where mentees choose their mentors [16]. However, given the difficulties that many residents, especially female residents, may have in forming mentoring relationships, the assignment of a mentor might be a beneficial starting point. The skills and confidence that residents gain in these formal mentoring relationships might be readily transferable to the spontaneous mentoring relationships that these residents develop in the future. A study of 127 internal medicine residents at Brigham and Women's/Faulkner Hospital revealed that 90 percent felt that it was important to be assigned a mentor [17]. Interestingly, in addition to the assigned mentorships, 50 percent of residents also developed spontaneous mentorships with other faculty mentors. Thus, both assigned and spontaneous mentoring may be beneficial to residents and perhaps even desired.

Finally, we need to determine if, and how, mentoring relationships differ between female and male residents (Figure 1). This is especially important given that female dermatology residents comprise the majority of residents in many dermatology training programs. In contrast, male dermatologists outnumber female dermatologists in many academic institutions and this may limit the access of female residents to female mentors. However, it is not clear if this is detrimental to female residents. Some studies have shown that same sex mentor-mentee matches are beneficial to the mentoring process [18, 19, 20] whereas other studies have not shown them to be important [21, 22, 23]. Regardless, we must continue to assist female dermatology residents find high-quality mentors.

Issue 4: Career-Specific Mentoring Strategies

Residents interested in careers as private practitioners, clinician-educators, basic researchers, or careers with a mix of academic and private practice may all have different mentoring needs (Fig. 1). In some cases, a mentor may not only be important for nurturing the development of a specific career-track, but may actually be essential.

The potential role of mentorship to increase the number of academic dermatologists continues to be explored. There is a shortage of dermatologists in both academic and private practice, but the shortage is thought to be greatest in academic centers. Both recruitment and retention of clinician-investigators and clinician-scientists are important considerations [24, 25]. For many years, mentoring has been recognized to influence the decision to pursue a career in academic dermatology [26] and it has been proposed that mentorship may be one means to increase the number of residents who pursue careers as clinician-investigators or clinician-educators. However, there is no evidence, as of yet, that actively mentored residents develop greater interest in academic careers over that of private practice [2, 27]. On the other hand, a lack of mentorship may be associated with a loss of interest in pursuing an academic career [3].

Several strategies have been developed to mentor residents interested in careers as clinician-scientists and clinician-educators. The Society of Investigative Dermatology hosts a yearly retreat for 50-60 residents. Attendees have the opportunity to meet and network with clinician-educators and clinician-scientists and learn more about careers in academic dermatology. To support the mentoring needs of future clinician-educators, a Clinician-Educator Fellowship was developed at the University of Pennsylvania [28]. Residents interested in education may also attend a one-day Teacher Development Seminar held every three years in conjunction with the Fall meeting of the Association of Professors of Dermatology.

Given the relative shortage of academic dermatologists, there is a risk that the mentoring needs of residents and fellows interested in academic careers may overshadow the mentoring needs of residents interested in careers in private practice. Mentorship may play an equally important role in recruitment of graduates to private practice settings [2, 27]. How to best support these residents and provide access to mentors requires further study (Figure 1).

Charting the Right Course

A supportive and encouraging environment for mentoring is being developed in dermatology. We need to ensure that residents who want mentors are able to find high-quality mentors. Similarly, we need to ensure that dermatologists who want to mentor are able to find time to mentor within a medical system that is only increasing its demands on physicians. Is mentoring beneficial to residents and, if so, how beneficial is it? These are only two of many questions that need to be addressed. The anecdotes shared by dermatologists on the value of mentorship, the preliminary studies on mentoring in the literature and the considerable resources invested by various local and national dermatologic organizations to support mentoring gives us hope that mentoring may ultimately prove to have tremendous benefit. For now, we are charting the right course and more definitive answers are certainly on the horizon.

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