Paying it Forward: Four-Year Analysis of the Eastern Association for the Surgery of Trauma (EAST) Mentoring Program

Abstract

Background

Mentorship programs in surgery are utilized to overcome barriers to clinical and academic productivity, research success, and work-life balance. We sought to determine if the Eastern Association for the Surgery of Trauma (EAST) Mentoring Program has met its goals of fostering academic and personal growth in young acute care surgeons.

Methods

We conducted a systematic program evaluation of EAST Mentoring Program’s first four years. Demographic information was collected from EAST records, mentorship program applications, and mentee-mentor career development plans. We reviewed the career development plans for thematic commonalities and results of a structured, online questionnaire distributed since program inception. A mixed methods approach was used to better understand the program goals from both mentee and mentor perspectives, as well as attitudes and barriers regarding the perceived success of this career development program.

Results

During 2012–2015, 65 mentoring dyads were paired and 60 completed the program. Of 184 surveys distributed, 108 were returned (57% response rate). Respondents were evenly distributed between mentees and mentors (53 vs. 55, p=0.768). In participant surveys, mentoring relationships were viewed to focus on research (45%), “sticky situations” [e.g., communication, work-life balance] (27%), education (18%), or administrative issues (10%). Mentees were more focused on research and education vs. mentors (74% vs. 50%, p=0.040). Mentees felt that goals were “always” or “usually” met vs. mentors (89% vs. 77% p= 0.096). Two barriers to successful mentorship included time and communication, with most pairs communicating by email. Most respondents (91%) planned to continue the relationship beyond the EAST Mentoring Program and recommended the experience to colleagues.

Conclusions

Mentee satisfaction with the EAST Mentoring Program was high. Mentoring is a beneficial tool to promote success amongst EAST’s young members, but differences exist between mentee and mentor perceptions. Revising communication expectations and time commitment to improve career development may help our young acute care surgeons.

LEVEL OF EVIDENCE

V

STUDY TYPE

Epidemiological

Background

Many training programs and professional organizations have developed formal mentoring programs to help meet the complex needs of today’s complex world. These needs may include both academic and professional growth, but also the realities of work-life balance, personal well-being and the needs of today’s modern family. Participation in these formal mentoring programs has been shown to improve academic and research productivity and work satisfaction among junior clinical and translational research faculty [1]. While mentorship programs exist throughout departments of surgery and surgical societies across the country, many are unstructured with no clear evidence of routine evaluation or formal analysis of outcomes [2].

In surgery, education and practice are impossible to separate from the concept of mentoring. In fact, the earliest models of surgical education were apprenticeships [3]. Despite many changes in today’s practice of surgery, informal mentoring relationships still remain an integral part of every aspect of surgical life. Yet, despite this rich tradition, the needs of young acute care surgeons likely differ from those of their predecessors and the paradigms under which they now train are different [4]. As graduate medical education has become a more convoluted system of checklists and duty hour restrictions, the young surgical trainee can benefit from structured advice and counsel.

The Eastern Association for the Surgery of Trauma (EAST) is the largest US organization dedicated to professional education, leadership and career development for surgeons active in the care of the injured and acutely ill patient. Building upon a tradition of networking and commitment to its future leaders, EAST established a formal mentoring program in 2012. Although it was initially designed as a two-year extramural experience, the program has now evolved into a one-year experience targeting fellows and junior faculty in acute care surgery, due to increasingly high demand for program participation.

The EAST Mentoring Program has grown to be the largest extramural surgical society mentoring program and continues to evolve with each new cohort; however, as the program enters its fifth year with matching for a sixth cohort of participants, a critical look at the program is necessary in order to strategically plan for the future of the organization. We hypothesized that program strengths and weaknesses and opportunities for improvement could be elicited through a systematic program evaluation that included review of program participants, career development plans and program surveys.

Methods

Approval for this program evaluation was obtained from the University of Miami Institutional Review Board and the EAST Mentoring Committee. The goals of the program are to promote the academic, professional and personal growth of the young acute care surgeon and it pairs an experienced surgeon with junior members of EAST at the resident, fellow or junior faculty level [5]. The matched pairs are expected to collaborate on a structured career development plan with goals based upon the mentee’s needs and to communicate at least monthly. Table 1 shows suggested focus areas for the career development plans. At the conclusion of the assigned mentoring period, the pair may decide whether or not to continue the partnership outside of the program. Additionally, participants are asked periodically to complete a survey to assist with program evaluation.

Table 1.

Suggested areas of focus for mentoring career development plans.

Career Development Plan Focus Areas Strengthening Research Skills Improving Administration Skills Educational Opportunities How to Manage Difficult Situations* Navigate the Organization (EAST) Explore New Ideas Forge a New Career Path Expand Network Build Confidence

^*Work-life Balance, Communication, Promotion, Negotiation, etc.

A dedicated committee of EAST members administers the mentoring program. This group reviews all mentee applications, recruits mentors, performs pairings, and liaisons with pairs throughout the year. EAST has also provided additional mentoring education to the EAST community through workshop offerings at the Annual Scientific Assembly. Additionally, recognizing the growing demand for mentoring in all areas, the committee has developed an online mentoring resource repository [1]. Starting in 2014, in collaboration with the EAST Military committee, the program recognized the unique needs of EAST military members and began to specifically recruit mentors and mentees with a military affiliation.

Demographic data was obtained from program records and mentor/mentee applications. Submitted career development plans were reviewed for thematic commonalities amongst the many varied goals. Finally, data obtained from a structured, standard online questionnaire that has been distributed since program inception was reviewed.

We used a mixed methods approach using quantitative and qualitative analysis to understand the goals of the mentoring program from the perspective of mentees and mentors. Quantitative methodology used non-parametric analysis as appropriate (p<0.05). Qualitative methodology employed text analysis to generate hypotheses. We performed free-text analysis to code, sort and categorize open-ended responses into recurrent themes. We also explored attitudes and barriers regarding the perceived success of this mentoring program as a useful tool for mentees for career development.

Results

Demographics

Between 2012–2015, 65 mentoring dyads were matched and 60 completed the program. While a large percentage of the mentee program participants were female, most mentors were male. Of the mentorship pairs, 12% overall were military-related pairings. Table 2 illustrates the demographics of the program participants during this first four years. An additional cohort of 30 pairs for 2016 is currently participating in the program; however, limited data is available for these individuals at this time.

Table 2.

EAST Mentoring Program Mentee-Mentor Demographics

		Matched M entee Rank
Program Year	Matched Pairs	Resident	Fellow	Junior Faculty	Failed Pairs	Military Mentees Among Active Pairs	Female Mentees Among Active Pairs	Female Mentors Among Active Pairs	P Value
2012–2014	10	1	2	7	1	1	4/9	1/9	0.294
2013–2015	15	2	6	7	2	0	6/13	2/13	0.21
2014–2015	16	2	7	7	2	2	6/14	3/14	0.401
2015–2016	24	3	6	15	0	4	6/24	1/24	0.047*
Total	65	8/65 (12%)	21/65 (32%)	36/65 (55%)	5/65 (8%)	7/60 (12%)	23/60 (38%)	6/60 (10%)	<0.001*

^*P<0.05, P Value references gender differences between Female Mentors/Mentees

Analysis of Career Development Plans

We reviewed 61 career development plans and abstracted 246 discrete goals that were grouped by theme. All career development plans involved several themes with the most frequently cited being research (26%), involvement in professional organizations (18%) and career development (16%). Figure 1 shows the distribution of all extracted career development plan goals.

Figure 1.

Distribution of EAST Mentee Career Development Plan Goals

Program Survey Results

Throughout the four-year period, a structured, online survey was provided to all program participants. 184 surveys were distributed and 108 were returned (57% response rate). Respondents were evenly distributed between mentees and mentors (53 vs. 55, p=0.768).

Survey respondents felt the mentoring relationship focused on research (45%), navigating “sticky situations” [e.g., personal conflict, challenging cases, work-life balance, communication, promotion, negotiation] (27%), education (18%), or administrative issues (10%). Overall, significantly more mentees were focused on research and education as goals, as compared to mentors (74% vs. 50%, p=0.040). Mentees were more likely to feel that goals were “always” or “usually” met, as compared to mentors, (89% vs. 77% p= 0.096). Figure 2 illustrates these differing perceptions within the mentoring dyads with regards to goal achievement.

Figure 2.

Perceived Differences between Mentee and Mentors with respect to Goal Achievement

Qualitatively, the program was highly regarded as it offered the opportunity for extramural career development (i.e., beyond one’s own institution). The majority of respondents (91%) planned to continue the relationship beyond the EAST Mentoring Program. 85% of mentee respondents stated that they would recommend the experience to peers.

Reported barriers to successful mentorship included a lack of time, a need for more formalized structure and challenges with communication. Virtually all mentorship pairs used telephone and/or email as the primary method of communication. Surprisingly, only two respondents reported using video-based communication tools, such as FaceTime, Skype, or GoToMeeting (Figure 3).

Figure 3.

Frequency of Communication Methods by EAST Mentoring Pairs

Organizational Impact

Participation of EAST leaders in the Mentoring Program has been stellar. Six EAST Past-Presidents have served as mentors, while over one third of the remaining slate consists of current or previous members of the EAST Board of Directors or EAST Committee Chairs. 86% of the mentors have served on an EAST committee within the last 10 years.

Six past EAST mentees have now payed it forward with service as mentors within the program. Five prior mentees have served on the EAST Board of Directors or as Committee Chairs and 45% of mentee participants have served on an EAST committee. Leadership data includes the 2016 mentoring cohort that is not otherwise included in this program evaluation since it is still in progress and did not participate in the survey.

Discussion

In this systematic program evaluation, we found that program strengths and weaknesses and opportunities for improvement could indeed be elicited through a systematic program evaluation and that the Eastern Association for the Surgery of Trauma (EAST) Mentoring Program has met its goals of fostering academic and personal growth in young acute care surgeons. In her EAST 2015 Presidential Address, Dr. Kimberly Davis quotes filmmaker Steven Spielberg as he describes that “the delicate balance of mentoring someone is not creating them in your own image, but giving them the opportunity to create themselves”[5]. In order to accomplish this mission, the EAST Mentoring Program’s objectives are broadly structured to encompass the needs of all members from burgeoning academic surgeons to young community and military acute care surgeons. An unintended effect of this wide-reaching format has been the discordant perception between mentees and mentors with regards to both the EAST Mentoring Program’s overall purpose and the participants’ individualized goals as highlighted by the survey results. However, despite the high overall satisfaction among program participants, future incorporation of more structured tools for goal development and communication, as well as improvements in mentor training will likely benefit this program. This initiative represents the largest academic surgical society Mentoring Program in the country and represents a blueprint for success for other societies on a national and perhaps international level.

The potential benefits for academic and career growth through participation in a mentoring program are well established. Improved clinical, administrative, and research productivity are often cited as goals of such programs. Additionally, numerous organizations now offer mentoring programs for their young surgeons or trainees interested in their specialties [6–15]. In addition to the EAST Mentoring Program, the American College of Surgeons Committee on Trauma now offers a mentoring program for selected young trauma surgeons within five years of completing fellowship training [15].

While mentorship continues to be an integral part of the professional training and career of surgeons, little time has been focused upon the development of the surgeon as a successful mentor. However, programs like the University of California San Francisco’s highly effective mentor development program have proved the benefit of formalized mentor training. This program includes several universally applicable open access resources that are available online [16–18].

Five initially matched pairs failed to complete the program (8% attrition). While the goal of the program is certainly to provide an optimal mentoring experience for all participants, a certain percentage will not succeed due to a variety of factors. Straus et al. interviewed over 50 faculty from two academic health centers determined characteristics of success and failure in mentoring relationships. Successful mentoring relationships were characterized by reciprocity, mutual respect, clear expectations, personal connection, and shared values, while failed mentoring relationships were plagued by poor communication, lack of commitment, personality differences, perceived (or real) competition, conflicts of interest, and the mentor’s lack of experience [19].

Within our program, a notable discrepancy was apparent between the relatively large number of female mentees participating in the program, while very few of the mentors were female. While not a specific goal of the program, it will be important to recruit additional experienced female surgeons for the mentor pool, although there is conflicting evidence as to the importance of same-sex mentorship pairing [20]. The same holds true in mentoring other groups of individuals who have been historically underrepresented in trauma surgery, due to real or perceived barriers. Additionally, military surgeons rising through unique hierarchy’s (e.g, Army, Navy, Air Force, Marine), engaged in combat casualty related-research, or transitioning to civilian practice may also face unique barriers and challenges. This represents an important area of future exploration within the EAST Mentoring Program, to ensure that identified mentees are indeed those that may benefit from such a program. Still, a continued need for targeted mentoring of young women in surgery exists [21–24] and several other programs have been specifically designed to address the needs for this growing demographic [9–12].

There are several other limitations to this study. First of all, the majority of the data is self-reported. While the notable differences in perception between mentee and mentor are interesting, more concrete data will be useful in determining its significances. While career development plans with very specific goals were collected, the post-participation survey asked very broad questions regarding program purpose and goal completion leaving much room for interpretation. In the future, survey re-design coupled with a specific exit report or interview would be helpful to document compliance with career development plans. Mentor-mentee focus groups would be another rich source of qualitative data to continue with program improvement through future iterations. Furthermore, the addition of more specific deliverables (e.g, EAST contributions, academic promotions, grants, publications) to the participant survey will be beneficial in objectively quantifying the ongoing benefits of the program.

Conclusion

Mentoring is a beneficial tool to promote success amongst EAST’s young members, but differences exist between mentee and mentor perceptions. Overall, mentee satisfaction with the EAST Mentoring Program was high. Achievement of program goals may be limited by discordant perceptions of goals between mentees and mentor as a result of interpersonal communication difficulties within mentoring dyads, as well as need for more programmatic structure and enhanced mentor training. In the future, the EAST Mentoring Program may benefit from improved matching techniques, structured tools for goal development and communication, and increased use of electronic media for mentor-mentee communications. The mentoring relationship is a special one that is built on trust, encouragement, and targeted development. Although the EAST Mentoring Program continues to evolve, it remains a highly successful program dedicated to the personal, professional and academic development for young acute care surgeons.