Early Career Development and Mentoring of Internal Medicine Residents for Careers as Clinical Investigators and Educators

Transcription

1 Early Career Development and Mentoring of Internal Medicine Residents for Careers as Clinical Investigators and Educators Ilene M. Rosen, MD, MSC Todd D. Barton, MD David J. Aizenberg, MD Outline Resident perspective on mentoring Structured mentoring in residency Resident professional development Small group breakout Large group discussion

2 The Resident Perspective Objectives Barriers to mentorship during residency What are residents looking for in a mentor? Role of an assigned mentor Ingredients to being a successful mentee HPI: Case Presentation DJA 26 y/o intern with career goals (GI) Assigned a mentor intern year Mentor helps set up research project DJA and mentor do not click DJA loses interest in research and GI but is afraid to switch mentors Mentor steps down from role intern year

3 Case Presentation Cont d HPI cont d: Somehow, DJA chosen as a chief resident This gives him time to reflect Actively seeks out advice from people who eventually become his mentors Explores new career options and decides to do academic general medicine Barriers to Mentorship During Residency Pulled in many directions Requires preparation and initiative Assumption of a passive role No perfect way to achieve a good mentor/mentee t relationship Evolving interests

4 What Are We Looking For? Advice about career choices Role models Professional Work / personal life balance Research projects Connections Teaching Residents How to be Mentored Role of the Assigned Mentor Motivating resident to take an active role Identifying questions with the mentee Identifying mentors who will help answer the questions Assist in preparation for initial mentoring meetings

5 Assigned Mentorship Meeting Identify key areas of focus Develop a set of questions Set goals and a timeline Spell out the mentee s role Kolars, JC. Mentoring in Academic Medicine: 2010 Mentee s Role Pick and interact with mentor(s) Schedule regular meetings Ask questions and discuss goals / plans Demonstrate productivity, ask for feedback Be the driver of own career Work hard, be organized and disciplined It is ultimately YOU, not your mentor

6 Assigned Mentorship Meeting - Identify mentee questions - Identify potential mentors - Set goals, timeline Mentorship Meetings - No commitment - Evaluate chemistry - Ask preplanned questions Commitment to Relationship(s) - Set concrete goals - Communicate time availability - Set up next meeting Outline Resident perspective on mentoring Structured mentoring in residency Resident professional development Small group breakout Large group discussion

7 Structured Mentoring Program Evolution Goals History of failed models Intelligent Design Surveying the residents Refining the program Addressing faculty limitations Structured Mentoring Program Goals: Provide small group mentoring to help with transition into internship Provide an advisor who knows the program (but isn t the PD) Provide individual mentoring for: Internship & residency struggles / concerns Career development Fellowship / job applications Work / home balance

8 Structured Mentoring Program History: Laissez-faire model I m sure they ll find a mentor most people do Monitored independent choice model Who is your mentor? You need to find a mentor Assigned program faculty model Our educational leadership should be able to function as excellent mentors Mentoring Program 2005 Six small group dinners annually per mentoring group Suggested curricula Free-form discussion Optional individual meetings Not monitored No protected time

9 Mentoring Program 2005 Some good relationships formed Curricula rarely addressed Many limitations Logistics of dinners poorly considered Heavily reliant on individual motivation Faculty Resident Highly variable experiences Mentoring Program 2007 Move structured interactions to lunchtime Monthly small group meetings with well- researched and designed curricula Set expectations for attendance Encourage (but not mandate) individual meetings

10 Mentoring Program 2007 Clearly worse Logistics somehow thought out even more poorly Faculty turnover Mentoring Program 2009 Revised for more modest goals Surveyed the residents Do they want mentors? Program mentors Subspecialty / career specific mentors Are our mentors reaching out to them? Are our mentors useful?

11 Mentoring Program Surveys Likert scale 1-5 agree / disagree Results from spring 2009 & 2010 compiled Anonymous Asked for gender and level of training 5-10 minute quick Survey Monkey process 60 70% response rate Mentoring Program Surveys Interns 75% agreed that a program mentor was important 85% were invited to at least 2 events Only 60% were able to attend at least 2 events 75% were invited to an individual meeting Only 50% were able to actually have the meeting Nearly all of those who did have a meeting agreed that it was helpful

12 Mentoring Program Surveys Interns 30% already identified a subspecialty or career mentor 75% felt that a subspecialty or career mentor was important at their stage of training Mentoring Program Surveys Upper year residents 60% agreed that a program mentor was important Only 50% were invited to an individual meeting with a program mentor Only 35% were able to actually have the meeting Many didn t try to use established program mentors for fellowship / career advice Nearly all of those who did have an individual meeting agreed that it was helpful

13 Mentoring Program Surveys Upper year residents 60% had an identified subspecialty / career mentor Almost all had met individually with this mentor 70% used these mentors for advice on fellowship or job applications Mentoring Program Surveys Conclusions interns Not meeting goal of engaging interns early Subspecialty / career mentors were more important (and prevalent) than we perceived Conclusions residents Many still did not have established mentoring relationships One size does not fit all Residents who had gotten in the door to a mentoring meeting found it useful

14 Mentoring Program Surveys Conclusions faculty Program mentors (by resident report) had significant variability in attempts and success at reaching out to residents This feedback was useful Faculty turnover was an unsolved problem affecting a small but concerning minority of our residents Faculty-level level limitations to successful mentoring largely unaddressed breakout Mentoring Program 2011 Early internship establishing relationships Assigned to program mentor on arrival Meet in small groups twice during the fall Mandated individual meeting with program mentor during fall ambulatory elective

15 Mentoring Program 2011 Later internship or early residency meeting their needs and expectations ti Begin to define career goals More individual meetings not mandated Identification of research mentor(s) Identification of career mentor(s) Use of core faculty Use of career development elective Mentoring Program 2011 Later residency fostering growth and career development Continued individual contact with program mentor Multiple mentor model Help with fellowship / job applications Help defining career goals Help with work / home balance

16 Outline Resident perspective on mentoring Structured mentoring in residency Resident professional development Small group breakout Large group discussion Curriculum Must-Haves Engaged Leadership Faculty in charge of curriculum Visible and Responsive Plan for specific mentorship Clearly Stated Goals and Objectives Structure (at least some) Deliverables Course Feedback/Evaluation

17 Develop Elective Structure Expectations Attendance, assignments, etc Course Outline Daily schedule Pathways Syllabus Themed Lectures Sample Elective Small group discussions with faculty Workshops Independent Activities Consider describing various pathways residents can choose from

18 Describe resources Syllabus Copies of the lectures slides Relevant articles for review Evaluations Mentor s Role Teach, guide, and support Supervise research, help with study design, abstracts & papers Help set personal & professional goals Give feedback Recommend participation on committees, papers, reviews, chapters Teach grant writing skills Help foster career advancement

19 Small Group Breakout Building a professional development curriculum that t can serve universal needs Challenges to mentoring faculty perspective Challenges to mentoring resident perspective Mentoring Target Audiences Gender differences? Our small surveys have shown no major differences in resident expectations or outcomes of mentoring

20 Mentoring Generational Issues Younger and older generations agree that there may be significant differences between them. These may have particular relevance in the culture of academic medicine.

21 Mentoring Addressing Conflict Generational differences may be present, but they are not viewed as likely causes of conflict. Mentoring Generations Traditionalist Baby Boomer Generation X Millenials / Y Birth Year Before After 1981 Influences Depression World War II Civil Rights Vietnam Era Cleaver family End of Cold War Two working parents Education A dream A birthright A means to an end Work Dedicated Driven Seeking Ethic Loyal Defined by balance work Authority Attitude Respect for authority Seniority = authority Skeptical of authority Globalism Internet Protective parents Important but expensive Ambitious Will push, but also seek guidance from authority

22 Mentoring Generations Department chairs, Division chiefs, are more likely l to be Traditionalists t or Boomers Many APD s and Core faculty may be Generation X The residents are all Generation Y / Millenials Successful individual mentoring will require faculty understanding of their own