Is Perception Reality?

Throughout much of the history of medical education, learning has occurred as an apprenticeship with the adage “see one, do one, teach one.” This is particularly important during training in the final years of medical school, residency, fellowship, and early attending years. The practice of medicine, however, has changed over the past 2 decades and even more so during the pandemic. In 2003 the Accreditation Council for Graduate Medical Education imposed an 80 h/week work limit for residents to address physician fatigue and medical error. This has had resulted in less exposure to the clinical care of patients, and in many cases, there is not a clear means of compensating for this decrease in clinical experience. In addition, much of the learning time is now being occupied by clerical work with the growth of the electronic medical record in which both the residents and teaching physicians spend a good portion of their working day as part of the documentation process. Toward this end, now more than ever, mentoring is necessary to fill the void in education left by these changes.

Mentorship is a relationship in which a more experienced or more knowledgeable person (mentor) supports and encourages less experienced individuals (mentees) to manage their own learning and development to maximize their potential and develop their skills to improve their long-term performance. Though philosophically similar, mentoring should be distinguished from coaching in which the former is more development driven and the later performance driven. Mentoring has existed since early Greek mythology and was inspired by the character Mentor in Homer’s Odyssey (1). In this story, Odysseus goes to fight in the Trojan War during which time he entrusts his young son Telemachus to the care of Mentor, his trusted companion. Unexpectedly, Odysseus is away for decades, and during that time Mentor nurtures and supports the boy, from which the origins of the term “mentorship” has been formed.

In medicine, mentoring has been perceived to increase career success by improving job satisfaction, career preparation and growth, general well-being, and academic productivity. But, how successful have we truly been with executing mentorship? Is perception reality? Despite the claimed benefits, are we doing a good job in mentoring? In a survey of students at a single osteopathic medical school, 59% of respondents felt that they did not receive enough mentorship in medical school and only 64% felt that the quality of mentorship was at best very good. Compared with men, women responded that the amount of mentorship they received was significantly less but despite this the quality and quantity of mentorship had a more positive influence on their medical school decisions including rotation choices, residency programs, field of practice, and career trajectory (2).

In a systematic review of 39 studies that explored the prevalence of mentorship and the relationship to career development, mentorship was reported to have an important influence on personal development, career guidance, career choice, and research productivity, including publication and grant success (3). However, it was noted that <50% of medical students and in some specialties <20% of faculty members claimed to have had a mentor. The prevalence ranged from as low as 19% to as high as 93%. Women found it more difficult to find a mentor than men did. From this systematic analysis, the investigators felt that the poor quality of the majority of included studies did not allow conclusions to be made of the size effect that mentoring played on any aspect of academic or professional development and that the perceived importance of mentorship as part of academic medicine is not supported by evidence. Of the included studies, 87% were self-report studies that did not utilize a comparison group.

Along similar lines, a more recent large-scale survey of cardiologists found that neither mentor number, nor satisfaction with the mentoring experience was associated with objective, quantifiable outcomes of success, although mentorship satisfaction was significantly associated with perceived satisfaction in achieving professional goals (4). In this survey of 4,883 U.S. members of the American College of Cardiology, almost all the 10.4% who responded to the survey reported having at least 1 mentor during their career. The respondents, who were 78% male, noted more satisfaction when they had more than 3 mentors or a mentor from outside of their practice or institution. Although mentorship satisfaction was associated with overall perceived professional satisfaction, there was no association between professional satisfaction and career outcomes. For the academic cardiologist, outcomes included serving on national committees, teaching or research awards, or research funding. For the clinical cardiologist, outcomes included earlier time to partnership, leadership roles, or relative value unit productivity. What made a good mentor according to those surveyed? The most important characteristics valued by a mentee included experience and willingness to share expertise, leading by example, and integrity. A limiting factor of this study was the low response rate and that <25% of the respondents were women and <10% were Black or Hispanic cardiologists.

It is evident from these data, that mentorship does not universally result in sponsorship and that mentorship alone is not sufficient to alter career trajectory and impact outcomes. Although there are many barriers to cross and many ways in which to cross these barriers, mentorship must start somewhere. Toward this end, the editorial board of JACC: Case Reports has begun its own mentoring program, having accepted its first class of applicants to serve as manuscript reviewers. These individuals will work side-by-side with the editorial board of JACC: Case Reports in reviewing manuscripts and attending a 6-month lecture series engaging and educating fellows in training and early career cardiologists with the aim of fostering an opportunity to become further involved in editorial work and future leadership roles. A goal of the program is that experience in reviewing will translate to success for the trainees in the subsequent writing and publishing of their work.

There are many disparities in medicine highlighted now more than ever by the coronavirus disease 2019 pandemic. Given the complexities of our medical system, it becomes of paramount importance to address these disparities to improve the care we provide to our patients. To this end, many have suggested we look toward the training of our next generation of physicians. Establishing strong mentoring programs will be necessary to achieve this end. Although there is a lack of objective evidence of the universal success of mentorship, there remains a perception of its success. It is time we got beyond perception and execute mentorship with an eye toward ensuring the success of mentees and mentors at all levels.