Fostering sustainable interinstitutional peer mentorship groups to support professional goals in hospital medicine

A JOURNEY THROUGH PEER MENTORSHIP

In 2019, Pediatric Hospital Medicine (PHM) fellows from two institutions decided to start an interinstitutional peer mentorship “K club” when they realized they were one of the only late fellow/junior faculty researchers in their PHM divisions. Using their fellow alumni network, and personal connections made through networking at national conferences, and social media, the group grew to have 12 junior faculty PHM researchers across nine different institutions within a year. The group met monthly to brainstorm research ideas, provide feedback on grants and discuss work-life integration issues. At the start of the group, only three researchers had internal career development awards. Over the last 3 years, all members have applied for an internal and/or external career development award, over half of the group has been awarded a career development award, and three are currently making or have made the transition from career development to independent funding. In this perspective, we describe our experience as an interinstitutional peer mentorship group (IIPG) while highlighting the generalizable benefits and logistics.

INTRODUCTION TO PEER MENTORSHIP

Identifying and developing effective mentor/mentee relationships is a challenge for many within academic medicine. As students, trainees, and faculty, we consistently learn new skills and rely on the expertise of experienced mentors to support professional growth. This vertical mentor/mentee dyad mentorship provides many benefits to early career mentees within academic medicine and remains the focus of institutional efforts (Figure 1). Compared to those who lack formal mentorship, those receiving mentorship from senior faculty are more likely to achieve academic promotion and have improved feelings of personal achievement, productivity, and career satisfaction compared to those who did not receive formal mentorship.¹ Although vertical mentorship is essential when developing new skill sets, it often leaves mentorship gaps. For example, the critical lack of diversity of senior mentors makes it difficult for individuals from underrepresented backgrounds to find mentorship from experts with shared experiences or a deeper understanding of barriers facing mentees.^2,3 Vertical mentorship often includes mentors who have institutional influence over a mentee and have an underlying need to fulfill departmental or institutional needs. Therefore, mentees may be reluctant to openly share institutional concerns or barriers to success out of fear of retaliation or criticism given the often-hierarchical nature and power differential in vertical mentorship. These challenges and others are amplified in newer fields like hospital medicine, where there is a need for increased mentorship and support for faculty development but few experienced faculty within the field to provide this support.⁴

FIGURE 1.

Unique and common aspects of vertical (traditional) and horizontal (peer) mentorship

Many challenges of vertical mentorship can be addressed through peer, or horizontal, mentoring. Peer mentorship is a nonhierarchical relationship between people sharing similar career stages, identities, roles, or past experiences.^5–7 Peer mentorship fosters engagement and achievement for groups with common goals and may be especially beneficial for women and individuals underrepresented in medicine who disproportionately lack traditional mentorship.⁸ It can also provide needed emotional or social support by providing a psychologically safe space to openly share stressors and concerns. Informal and facilitated peer mentorship models alike have been used successfully within the field of hospital medicine to complement traditional vertical mentorship and a roadmap exists for creating a peer mentorship group.^9,10 Although the benefits of peer mentorship can be realized among individuals within the same institution, leveraging virtual platforms enables interinstitutional mentoring, thus increasing the pool of potential peer mentors and their collective experiences and expertise.

INTERINSTITUTIONAL PEER MENTORSHIP: THE “WHY”

The impetus for creating an IIPG may arise from both insufficient numbers of local peers who want to foster relationships and the desire to collaborate with peers at external institutions. An IIPG creates opportunities for diversifying exposure to different academic interests and expertise, clinical practices, and life experiences not available at a single institution. The expanded pool of peers afforded by an IIPG can be particularly beneficial for hospitalists who often wear several clinical and administrative “hats” and fill multiple roles at their institutions—and thus may be challenged when attempting to find “one-size-fits-all” mentorship. The potential for an expanded pool of peer mentors must balance with an individual’s needs to ensure that the chosen structure for the IIPG addresses mentorship gaps. Combining individuals into a functional IIPG requires blending separate—albeit related—career and personal goals. Goals that can benefit from mentorship through an IIPG include career development and promotion, clinical program development, personal wellness, work-life integration, and advocacy.

Although shared goals are important for facilitating group success, heterogeneity of thought, background, or methodology among the IIPG membership can provide several lenses through which group goals can be viewed. For example, combining a clinician-researcher experienced in quantitative research with a peer passionate and knowledgeable about qualitative methodology could generate new and unique opportunities for investigation. Also, individuals seeking unique solutions to overcoming institution- and community-specific barriers to success may be limited in their vision without external feedback. IIPGs provide access to external perspectives not immediately available from local mentorship groups. Additionally, participants in an IIPG are uniquely positioned to transparently discuss topics often too sensitive to address with their local colleagues such as protected effort, resource support, promotion, or even pursuing other career opportunities. Finally, IIPGs naturally foster networking among colleagues and facilitate the formation of a rich collaborative community. They also provide unique opportunities for sponsorship, in comparison to traditional sponsorship models that involve a senior mentor, as peers can facilitate access to several networks and people inaccessible to senior personnel within the same institution.

STRATEGIES TO DEVELOP AND SUSTAIN AN IIPG: THE “HOW”

Although not unique to the IIPG approach to peer mentorship, before combining colleagues across different institutions, it is important that each individual identify their expectations for participation. This can be one or more things related to short- or long-term career goals and should be identified explicitly up front, and even written down.¹¹ As an example, our IIPG of pediatric hospital medicine physician–scientists each identified obtaining a “K” career development award as a goal. This individual goal facilitated the identification of peers with similar interests and goals that were necessary to justify the time and effort investment in sustaining an IIPG.

As an IIPG is formed, it is also important to create a group mission. A group mission may include a specific task, personal goal, or career advancement milestone and should also be written down. The IIPG participants should hold themselves accountable to this mission, which helps to guide the development of the group and network. For example, an IIPG’s mission may be related to medical education curriculum development or academic promotion for junior faculty. To ensure shared benefit among the IIPG, it is critical that each individual ensures that the group mission aligns with their individual mission. If a physician–scientist is seeking peer mentorship toward a career development award, this would not automatically fit in a group focused on becoming leaders in medical education.

When selecting peers to form an IIPG, it may be easier to identify those who are similar to you. Yet, intentionally fostering diversity is a more effective or impactful strategy because diversity fosters richer conversations, feedback, and advice through the inclusion of multiple perspectives.¹² Diversity can be related to gender, race, ethnicity, sexual orientation, family structure, experiences, training, the academic topic of interest, and of course, institutions. Maximizing diversity of lived experiences while also ensuring that individual goals fit with the group mission is key and more easily achieved when looking for peer mentorship beyond one’s own institution—and is a significant strength of IIPGs.

Identifying peers with a shared mission can be the most daunting part of forming an IIPG. Cast a wide net. One could ask their own traditional mentor(s) about colleagues at other institutions who have mentees who may be interested. Alternatively, one could utilize professional society listservs and discussion boards or reconnect with individuals previously met at national conferences and special interest groups. Social media, in particular, #medtwitter via #JHMChat, can be a helpful resource for identifying peers with common goals and overcoming barriers to collaboration created by traditional hierarchies, particularly those of minoritized communities.¹³

Psychological safety is key to a successful IIPG, ensuring that peers feel comfortable expressing themselves honestly and are willing to take risks (i.e., sharing incomplete work).¹⁴ Peer mentors must know that sensitive information remains confidential. For example, if one participant is interviewing for a position at a new institution, the IIPG can be an incredible resource about position, salary, and benefit negotiations. However, transparent discussions will only happen with trust and perceived safety. Getting to know one another socially, in-person or virtually, is important for building relationships that foster trust, and is necessary for psychological safety, although this may be more challenging with an IIPG.¹⁵ Several practical solutions exist to personalize the IIPG experience. Our IIPG emphasizes personal check-ins and intentional unplanned time during each meeting to allow for natural conversation that has cultivated the growth of interpersonal interactions. Additionally, we have prioritized in-person social gatherings at national conferences to foster the interpersonal trust necessary to facilitate psychological safety.

Sustainability planning is just as, if not more, important than the IIPG launch. Revisiting the mission statement to address whether overall goals are being met should be done regularly (e.g., semiannually). Setting expectations should also be done early to foster sustainability. Questions to consider include: Who will set the agenda, if any, and what are appropriate agenda items? Should all meetings be task-oriented, or is freeform personal check-in okay sometimes? Is it expected that members will have work to do (i.e., review drafts) between meetings or will all work be done during meeting times? Can members email the list of peer mentors whenever questions arise or should they be limited to meeting times? What works for one IIPG may not work for another. While the virtual meeting environment and reliance on longer-distance communication may place IIPGs at greater risk for failure due to disengagement compared to in-person and local groups, the virtual platform can also support flexible timing and scheduling of meetings to simultaneously meet the needs of several different individuals

ACCOUNTABILITY AND OUTCOMES FROM IIPG: THE “WHAT”

Key factors for long-term success also include achieving buy-in and providing accountability. Asking questions such as, What is this IIPG providing that other local mentoring opportunities do not? Are the meetings worth the investment in time and effort? Can lead to open discussions on how to improve the group and retain its members. Asking peer mentors to commit to specific goals they seek to achieve before the next meeting creates accountability when progress is assessed at the next meeting. When forming a peer network, it is important to identify one or more individuals as a point-person to assist with both the logistics of meetings (e.g., scheduling, agenda setting) and long-term goal monitoring. As an example, our IIPG has two individuals who coordinate meeting scheduling and facilitate agenda and goal setting with all members prior to each meeting.

The definition of success will be different for each IIPG and is closely tied to the mission statement. Acknowledging the unique challenges of developing and coordinating IIPGs and identifying realistic (often smaller) goals are as important as loftier success definitions. Based on our group’s experience, having at least 50% meeting attendance can be considered a “win” when juggling demanding schedules. Alternatively, success may be every member making progress or accomplishing a specific goal (e.g., submitting a grant, getting promoted, exercising regularly, spending time with family). Celebrating these achievements, no matter how small, can further solidify camaraderie among the group.

Like vertical mentorship relationships, an important outcome to consider is if (and when) to conclude an IIPG. IIPG and other forms of horizontal mentorship may also progress through Kram’s four stages of mentorship, with important consideration given to the separation and redefinition of mentorship.¹⁶ Individuals and shared interests may change as careers progress. Intentional consideration of the redefinition of individual and group goals, when possible and beneficial to the group, or termination of an IIPG are important for ensuring peer mentorship remains an engaging and impactful experience.

CONCLUSION

Peer mentorship can be a critical component of career development. IIPGs are a novel approach to mentorship that we have found transformative for our careers as pediatric hospital medicine physician–scientists. Our now-established national networks of peers striving toward common goals augment our local vertical mentorship dyads. While the exact structure of individual IIPGs can and should differ to meet the unique needs of its members, several core concepts can be foundational in the success of an IIPG. Groups that stay rooted in the individual and group foundational need for peer mentorship and who pursue meeting, goal setting, and accountability with intention are likely to succeed. As successful IIPGs are launched and sustained, participants should share their experiences to foster the growth of IIPGs. The growth of IIPGs also creates an opportunity for professional societies to support the identification of interested peers and develop frameworks for disseminating interest in IIPGs to improve access for all interested mentees.