I have been fortunate to have had a number of outstanding mentors in my surgical career. I can still hear the voices of the people who guided me through medical school, general surgery residency, a research fellowship, and a clinical fellowship. I am acutely aware that the advice they dispensed and the opportunities of which they either made me aware, or outright provided, were critical in my development as an academic general and trauma surgeon. They continue to influence how I conduct my surgical career each and every day.
As I have transitioned from trainee to faculty surgeon, new mentors are helping me to face the challenges that independent surgical practice and a research career entail. With their assistance, I feel well-prepared to take on these positions because they are natural extensions of the ones I filled during my training.
A different role has emerged in my first two years of practice, though; I am now responsible for mentoring residents and medical students as they navigate their initial development as surgeons, a process that I have only recently completed. This sudden transition, to me, is the epitome of the theme of this Resident and Associate Society of the American College of Surgeons issue of the Bulletin—Surgical Care and Training at the Crossroads—and leads me to ask, “How do I make the transition from being mentored to becoming a mentor, and, perhaps more importantly, how do I pay forward the many gifts—medical knowledge, career advice, opportunities to serve and lead in various surgical organizations—that my mentors provided to me?” Because many young surgeons entering practice must confront this challenge, a review of mentorship with a specific focus on making the transition from mentee to mentor is the thrust of this commentary.
Importance of mentorship
The topic of mentorship in academic medicine has been examined extensively in the literature, with identification of a variety of short- and long-term benefits to the mentees, depending on level of experience. Mentoring medical students has been shown to influence their career choice, and approximately half of general surgery residents indicate that a surgical mentor influenced their decision to pursue surgical training.1-3 Once in training, graduating general surgery residents indicate that their mentors influence their decisions to pursue surgical careers (65 percent), a specialty (45 percent), and a subspecialty (44 percent).4 Finally, both medical students and surgical residents have indicated a greater degree of success in performing research when mentored.4,5 Over a longer period of time, mentorship is associated with improved career satisfaction among mentees.6
Significant qualities of mentors
A positive mentor-mentee relationship depends on characteristics of both individuals, of course, but the supervisory role of the mentor is enhanced by certain behaviors and features. Entezami and colleagues reviewed the existing literature on mentoring in surgery and found a focus on the qualities of mentors to be present in 82 percent of such articles. In this review, they found that professional role modeling, devoting time and effort to the mentor-mentee relationship, providing feedback, exhibiting leadership in the field, and challenging surgical students were deemed essential.7 Sanfey and colleagues add that mentors should ensure mentees reach appropriate academic milestones, promote their integration into the academic environment and help them to establish professional relationships, demonstrate confidence in the mentee, provide an environment of support, and give advice on opportunities that may be of benefit or detriment to the mentee.6
Real and perceived obstacles
Doing the right thing when mentoring is important, but a number of potential stumbling blocks confront surgical mentors. Devoting time to the relationship with the mentee is key, and failing to set up regular times to meet with the mentee poses a significant problem. In Entezami’s review, 68 percent of articles on surgical mentoring mentioned time restrictions as a barrier to effectiveness, and with the time demands of surgical practice, these constraints are perhaps the most challenging aspect of being a good mentor.7 Other challenges may arise from seemingly innocuous pairings of individuals of dissimilar cultural backgrounds, opposite genders, or different generations.6,7 Failing to set appropriate expectations and provide meaningful feedback regarding mentee performance sets the stage for a poor experience for both individuals. This can be particularly problematic if the mentor and mentee are working together to generate an academic product, such as an abstract or presentation, where issues of first authorship, relative contribution, and ownership of intellectual property are important to both individuals. Finally, a mentor needs to understand the limits of the relationship, both in terms of what the mentor can offer and the appropriate personal boundaries needed for a professional relationship.
Making the transition
In the early years of practice, living up to the ideals of quality mentoring (and avoiding the pitfalls of subpar mentoring) requires additional work and preparation for most surgeons. Before the first meeting with a prospective mentee, the mentor should review any information they may have regarding this individual, such as curriculum vitae, transcripts, personal statements, or other documents pertinent to the mentee’s professional role. This documentation may provide insights into the mentee’s career plans, strengths, and weaknesses, and suggest areas where more activity, effort, or guidance might be beneficial. At the initial meeting, spending time learning about the mentee’s educational, cultural, and social background will pay dividends by helping to create a holistic relationship. As mentioned previously, cultural and gender differences between mentor and mentee may be potential barriers, but with a sensitive approach on the part of the mentor, the experience can be enriching for both parties.8
With respect to mentoring someone of the opposite gender, data from the surgical literature suggests that the majority of trainees do not have a preference for a mentor of the same sex.9 However, women surgeons are more likely to identify a lack of mentoring as an impediment to career success than are men, and among residents, women are more likely to feel that a same-sex mentor would be more understanding of their needs.10 That said, opposite-gender mentoring does not diminish the academic productivity of the partnership, and a thoughtful and considerate mentor can provide the environment necessary to promote success and understanding, regardless of gender.11
This awareness of the need for sensitivity regarding gender differences dovetails with awareness of generational variances; priorities with regard to family, outside interests, and work-life balance may vary between mentor and mentee. Although the junior faculty mentor may look like a generational counterpart to the mentee, a five- to 10-year gap in age and experience may separate the new practicing surgeon from an intern, and it should not be assumed that their priorities run parallel.
Once the pairing of mentor and mentee has been established and understanding of expectations have been communicated to the mentee, the mentor needs to apply a consistent approach. Although the mentee needs to share in the responsibilities required of the partnership, determining the frequency of meetings should not be among these. The effective mentor will ensure that time is set aside on a regular basis to discuss goals and reassess their current relevance, revisit ongoing projects, and inquire about social changes that may be affecting the mentee’s life. An open-door policy can be reassuring to the mentee and should be the standard, but schedule demands may come into play and make this difficult. The busy surgeon-mentor can use alternate methods (e-mail, text, telephone) to maintain contact when needed, and some mentors in academic health care have found this strategy to be effective.12
In terms of providing meaningful feedback, the mentor should avoid the trap of being a cheerleader because a lack of critical evaluation will not lead to professional growth for the mentee; conversely, being a harsh critic is perhaps even more detrimental, as it erodes confidence and may generate resentment. Ultimately, providing thoughtful feedback based on previously established expectations will lead to the best outcomes, as it allows for both compliment, critique, and building confidence by highlighting achievements reached while simultaneously identifying areas for continued improvement.
The junior faculty member who is rising to the challenge of mentoring can clearly prepare and succeed in this new role. There may be areas, though, where the young mentor may feel unable to help or needs to recognize that additional assistance is necessary. As mentioned earlier, being a leader in one’s field is viewed by mentees as a key quality of a strong mentor, while new faculty are unlikely to be viewed in this light by their own institution, much less by one’s specialty peers. This image does not render the mentor incapable of assistance.
In the course of training, while presenting in academic forums and interviewing for fellowship and job positions, surgeons are fortunate enough to come into contact with a number of leaders in their field, most of whom will respond favorably to a request for assistance from a junior colleague. By using these contacts, the young mentor can provide experience by proxy. Likewise, the new mentor is someone who is also learning to navigate the academic environment and may not be best suited for making introductions or determining the relative benefits of one career pathway over another. When the mentee requires guidance that the mentor cannot deliver, a referral to a senior surgeon is not a failure, but evidence of sound judgment that is focused on providing the best experience for the mentee.
Issues may arise in the life of the mentee that require the assistance of a nonsurgeon. Substance abuse, disruptive behavior, and psychiatric illness may all manifest in the course of a relationship between mentor and mentee. For the health and well-being of the mentee, support should be offered, but attempts by the mentor to correct the problem on behalf of the mentee are generally misguided and may be damaging to both individuals. These are situations in which a referral for counseling or treatment is the most appropriate action.
Rewards of mentoring
Becoming a mentor to a junior surgeon is challenging. To borrow a phrase from Gen. George Patton, accepting challenges, such as becoming a mentor, allows us to feel the exhilaration of victory. Victory shows itself in many ways when surgeons take on the role of mentor. We take pride as our mentees learn new skills, when they succeed in achieving their personal and professional goals, and when they develop the independence that allows them to go on to mentor others.
Surgeon mentors learn about differences in cultural, generational, and gender concerns when we listen carefully to our mentees, and this knowledge strengthens our ability to understand these issues when we care for patients and work with our colleagues. Finally, when we mentor, we amplify the ability to provide quality care to patients. By serving as appropriate role models, we show our mentees how to be surgeons, knowing that they will go on to provide that same great care to others.
In the past year, bridging my first and second years in practice, I have been fortunate to have had the opportunity to formally mentor one medical student and two general surgery trainees. For each mentee, I have tried to practice what I have preached in this article—actively listening, providing good feedback, and encouraging them to take advantage of good opportunities and avoid bad ones. I have watched my student matriculate into her top choice for general surgery residency training, one of my residents compete in and win a trauma papers competition, and the other find an activity outside of work to decompress from the stressful days of residency training and achieve better work-life balance. I am equally thrilled by the achievements of each of these three outstanding young women and have enjoyed providing guidance to them as they navigate the various stages of their surgical careers. I look forward to working with each of them in the future, monitoring their progress, and seeing their successes.
I can only hope to become the kind of mentor that my mentors were for me, and I can certainly see why they did what they did on my behalf. Of the many joys that my surgical career brings to me, helping my mentees grow and develop into accomplished young surgeons infuses my career with energy and life and inspires me to be a better surgeon and person.
- Osborn EH. Factors influencing students’ choices of primary care or other specialties. Acad Med. 1993;68(7):572-574.
- Rubeck RF, Donnelly MB, Jarecky RM, Murphy-Spencer AE, Harrell PL, Schwartz RW. Demographic, educational, and psychosocial factors influencing the choices of primary care and academic medical careers. Acad Med. 1995;70(4):318-320.
- Lukish J, Cruess D. Executive Committee of the Resident and Associate Society of the American College of Surgeons. Personal satisfaction and mentorship are critical factors for today’s resident surgeons to seek surgical training. Am Surg. 2005;71(11):971-974.
- Thakur A, Fedorka P, Ko C, Buchmiller-Crair TL, Atkinson JB, Fonkalsrud EW. Impact of mentor guidance in surgical career selection. J Pediatr Surg. 2001;36(12):1802-1804.
- Aagaard EM, Hauer KE. A cross-sectional descriptive study of mentoring relationships formed by medical students. J Gen Intern Med. 2003;18(4):298-302.
- Sanfey H, Hollands C, Gantt NL. Strategies for building an effective mentoring relationship. Am J Surg. 2013;206(5):714-718.
- Entezami P, Franzblau LE, Chung KC. Mentorship in surgical training: A systematic review. Hand (N Y). 2012;7(1):30-36.
- Moller MG, Karamichalis J, Chokshi N, Kaafarani H, Santry HP. Mentoring the modern surgeon. Bull Am Coll Surg. 2008;93(70):19-25.
- Gurgel RK, Schiff BA, Flint JH, et al. Mentoring in otolaryngology training programs. Otolaryngol Head Neck Surg. 2010;142(4):487-492.
- Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: A systematic review. JAMA. 2006;296(9):1103-1115.
- Levinson W, Kaufman K, Clark B, Tolle SW. Mentors and role models for women in academic medicine. West J Med. 1991;154(4):423-426.
- Straus SE, Johnson MO, Marquez C, Feldman MD. Characteristics of successful and failed mentoring relationships: A qualitative study across two academic health centers. Acad Med. 2013;88(1):82-89.