From Mentor to MENTOR: What we've learned about advising trainees

Greek mythology and Homer's Odyssey teaches us about early mentorship. Mentor, Odysseus' trusted companion, is left to nurture, support, and care for Odysseus' son Telemachus when Odysseus goes to fight in the Trojan War, and is away for much longer than anticipated [1]. This idea continues to inform the general model of mentorship today. We understand mentorship to mean a more senior or experienced person guiding a more junior individual, likely of a similar career path or with desirable expertise, to facilitate their success. What constitutes a successful mentorship in medicine, specifically for cardiovascular medicine fellows? According to the MENTOR study (AHJO-D-21_00048R1 Odanovic et al), it depends largely on who you ask. Each mentoring relationship is as different as the individuals participating. From a faculty perspective, not all mentees require the same guidance. One trainee may require more career support, while another may seek counsel on how to balance the demands of cardiovascular medicine among their extracurricular interests. While variation among distinct mentee relationships is expected, comprehensive objective examination of FIT and faculty expectations of this important partnership has been scarce.

Mentorship has been touted as a crucial part of successful cardiovascular medicine training, not just for underrepresented populations in the field such as women or minorities, but also for overall career advancement and success [2]. In the medical field, a positive mentor relationship and influence results in a perceived increase in career preparation, overall well-being, and academic productivity [3]. Questions about how an institution fosters mentoring relationships are commonly asked by prospective cardiology fellows across the country during interview season. Programs openly invested in mentor-trainee pairing are attractive to the budding cardiologist for those aforementioned reasons. Additionally, the importance of available mentors has been shown to influence choice of specialty. The impact of mentorship even extends to factors such as subspecialty training location and practice setting [4]. While some programs assign a faculty mentor during the first year of fellowship training who perhaps share similar interests with a prospective mentee, others allow a mentor-mentee relationship to form “organically.” At a national level, the American College of Cardiology (ACC) has created a mentoring program for practitioners at all levels of training, fellows-in-training (FITs) and early career professionals alike. Given the value of mentorship, this crucial aspect of career development for our FITs should not be left up to chance. Instead, it should be a formalized component of cardiology fellowship for FITs. Emphasis on forming meaningful mentor relationships should take priority alongside well-established staples of cardiovascular training, such as interpretation of a transthoracic echocardiogram, identification of ST-elevation myocardial infarction, or hemodynamic assessment of cardiogenic shock.

In this issue of AHJ Plus, Odanovic and colleagues provide a thought-provoking look at the discordance of FIT and faculty satisfaction with regard to the expectations of the mentor-mentee relationship. FITs valued networking for job opportunities, professional contacts, and assistance with research opportunities most highly, which was found to be underappreciated by the faculty in this study. Alternatively, faculty reported thinking clinical mentorship and work-life balance advise were more valued by FITs. Is this simply a reflection of the career stage of the respective respondent groups? As one moves through their journey from residency to fellowship then faculty practice, the needs of that individual change. Studies examining larger cohorts of cardiologists have indicated this as well, suggesting that early career physicians sought mentors who valued the time and effort invested into the mentoring process. Comparatively, mid-career cardiologists were seeking a mentor who could ‘open doors’ to progress their career [5]. While faculty perceived work-life balance and clinical mentorship to be more valuable to FITs in the MENTOR study, perhaps this was a displaced reflection of what they were focusing on in their own lives, and felt that this should be conveyed to trainees earlier in their careers. The focus of a FIT is typically acquiring clinical experience and knowledge. However, there is tremendous momentum and focus on reaching the next step in their path. Trainees may desire prestigious subspecialty fellowships, job positions, a certain level of status in their early career (particularly in academics), or other measures of success. With this in mind, it would stand to reason that fellows would prioritize a more “transactional” relationship based on their individual goals. Training programs should thus help facilitate these goals by emphasizing the importance of mentorship early in training, if not formally requiring it.

How would a formal mentorship process unfold, and what would it look like to ensure a “good fit”? While a fellow may seek a variety of tangible benefits from his or her faculty mentor as discussed in the article, it may be even more reasonable to provide a single trainee a number of different mentors for different aspects of their career. In fact, it would be remarkable for a single individual to fulfill all the perceived mentoring needs of a trainee. This idea is supported by recently acquired data from the Academic Working Group of the Early Career Leadership Council. A cross-sectional survey of 508 attending cardiologists was conducted. These participants were members of the ACC and practicing in an array of practice models. The survey found that those with a higher degree of satisfaction in their mentor-mentee relationships had more than 3 mentors (fewer if one mentor was outside of their home institution or practice group) [5]. With an increase in number of mentors, FITs would also increase the likelihood of achieving a “good fit.” This also suggests that networking with other institutions could provide value and satisfaction to the mentee.

More data, however, is required from FITs specifically to better understand potential expectation gaps on a larger scale and with a cohort that more closely represents all FITs nationally. The MENTOR pilot study was limited in size with 34 FIT and 34 faculty respondents and disproportionately represented women and international medical graduates when compared to national demographics. However, it certainly sheds light on important areas for improvement in cardiology fellow mentorship. Specifically, the study findings highlight the need for better communication, improved mentorship paradigms, and further evaluation of all aspects of FIT mentorship. What is perhaps more telling than the expectation-satisfaction gap is the feedback from those FIT respondents who did not have a mentor (8 out of 34, or 26%). Lack of research opportunity, lack of support in career decision making, and inability to find a mentor with shared interests were common responses among that group. Some even cited having experienced barriers to accessibility of mentors, or knowledge of how to find one. Without further examination using a larger cohort of trainees, cardiology programs may not fully understand the barriers FITs are facing today. Furthermore, it should be noted that the mentor-mentee relationship is one which may evolve over time, but should be expected to be mutually beneficial longitudinally and not simply confined to a trainee experience. Further investigation in a prospective study may help to inform the changing needs of both mentors and mentees. This knowledge is key and worth the investment of training programs to determine how to best bridge the gaps between expectation and reality in mentorship to improve satisfaction on both sides of the divide.

Funding

None.

Declaration of competing interest

None.