Physician Peer Mentoring: Implementing and Evaluation of a Group Peer Mentoring Program
A review and discussion inspired by the recent article “Implementation and evaluation of a group peer mentoring and leadership development program for research faculty in academic medicine”
After reviewing the recent article from the Journal of Clinical and Translational Science, I need to bring up physician peer mentoring. The article’s title is “Implementation and evaluation of a group peer mentoring and leadership development program for research faculty in academic medicine”. The authors of this study are Linda H Pololi, Janet T Civian, Mark Brimhall-Vargas, Vasillia Vasilou, Arthur T Evans, Kacy Ninteau, Lisa A Cooper, Brian T Gibbs, and Robert T Brennan. The corresponding author is Linda H Pololi. Institutions represented by these authors include the National Initiative on Gender, Culture and Leadership in Medicine: C-Change, the Institute for Economic and Racial Equity, The Heller School for Social Policy and Management, Brandeis University (Waltham, MA), the School of Business, Clark University (Worcester, MA), Weill Cornell College of Medicine (New York, NY), Johns Hopkins School of Medicine (Baltimore MD), and UMass Memorial Health Care (Worcester MA).
The study stands on many strengths. Moreover, several messages stand out in this study that I believe are important to our community of academic physicians and scientists, considering the current challenges to academics in general and the specific threats to academic medicine.
GENERAL BACKGROUND ON PHYSICIAN PEER MENTORING
Academic medicine is a uniquely demanding career path that integrates clinical care, scholarship, education, and administrative responsibilities. Moreover, changes in medical economics over the last 30 years have further increased demands upon academic physicians and scientists. In general, more productivity is expected, and less support is given. This is a problem because these academic physicians and scientists are the people who are not only taking care of us now but are also responsible for our future healthcare through the education of the next generation and research.
In response, many suggest that physician peer mentoring can play a critical role in supporting professional survival, development, and success by providing the guidance necessary to navigate the complexities of academic medical centers. However, empirical evidence has historically been lacking to support the value of physician peer mentoring. Previous studies have been limited by relying on cross-sectional self-report surveys, small sample sizes, and variable response rates. However, there has been a surge in more rigorous studies over the last couple of years. This current study fits into that ‘more rigorous’ category.
Most people in the field would agree that effective mentoring relationships share common characteristics. These include the following.
Mutual respect
Turst
Shared values
Clearly identified goals
Commitment from both parties
Maintaining confidentiality
Effective regular communication
Safe haven for both parties
I believe mentoring serves two broad functions: a career function and a psychosocial function.
The’ career function’ aims to equip the mentee with tools and information for general advancement and includes sponsorship for opportunities, strategic advice, career planning, research guidance, and navigating the academic infrastructure.
The ‘psychosocial function’ deals with the interpersonal aspects of the mentor–mentee relationship. This includes emotional support, encouragement, confidence-building, role modeling, counseling, affirmation, and friendship.
I consider both functions necessary for success in the matrix world of the academic physician. If the relationship is truly reciprocal, both functions may contribute to a mentee’s mental sense of competence and professional identity and the mentor’s well-being.
The concept of a mentoring network or team also needs to be mentioned. It would be rare for a single individual to fulfill all the diverse mentoring needs of an academic physician and/or scientist, considering the range of needs that span research, teaching, clinical work, career navigation, sponsorship, and psychosocial support. A mentoring network or team provides access to broader expertise and perspectives. It empowers the mentee to take ownership of their developmental needs and build resilience by not depending on a single mentor.
THE STUDY
This study is based on the reality that academic physicians and scientists struggle with burnout and subsequent attrition. Moreover, few academic physicians and scientists report receiving adequate mentoring.
This study stands upon an established peer mentoring program, the C-Change Mentoring and Leadership Institute. These authors recently and previously reported on the institute’s impact on vitality, self-efficacy, cross-cultural awareness, and valuing diversity. This current study builds upon the previous research by evaluating the program’s mentoring effectiveness, documenting the participants’ mentoring experience, and providing a detailed description of the curriculum and processes.
The C-Change Mentoring and Leadership Institute utilizes a logic model involving the following.
Inputs (resources, theoretical approach)
Implementation (Intervention activities, program outputs
Culture change outcomes (measurable outcomes, impact).
As per my read of this study, the institute’s goal is to address academic physicians’ and scientists’ perception of demoralization and isolation by providing an opportunity to be in a relational environment defined by reciprocity and not competition.
40 assistant or associate professors with significant research success applied/volunteered to participate in this institute and study. These participants engaged in activities that I believe to be remarkably constructive.
The participants identified professional and personal goals spanning ten years. Their peers subsequently mentored them to identify tasks necessary to attain these goals.
The participants worked towards understanding their core values by examining their past choices and motivations. The participants were asked to ponder further the alignment of these choices and motivations with their current situation and future professional and personal goals.
The participants work towards understanding their strengths by reviewing their past successes.
The participants discussed frameworks of effective leadership amongst themselves and reflected upon their leadership roles and behavior patterns.
The above activities, and others, occurred under the umbrella of formal reflective practices and mindfulness activities. The reflective activities included formal daily writing exercises. The mindfulness activities included discussions on the practice of mindfulness and potential benefits.
A characteristic of a study that I particularly appreciated is an attempt to include all learners: extroverts and introverts. An introvert, I have struggled with multiple institutional retreats that asked me to share in front of dozens, if not hundreds, to my intense discomfort. Kudos and huzzah.
The study found the following.
82% of the academic physicians and scientists who participated in the process and mentoring felt very satisfied with the results, and the other 18% were somewhat satisfied.
88% of the academic physicians and scientists found that the mentoring was helpful to a large or very large extent in formulating their career goals.
82% of the academic physician and scientist participants felt that the program and mentoring helped them assess whether the professional activities aligned with their values.
More than 66% of the academic physicians and scientists participants felt that the mentoring helped them formulate their research goals.
Other results were generally positive, though it is noteworthy that only 50% felt that the process and peer mentoring helped participants find the resources to advance their career through sponsorship and/or a champion. I suspect this is when a team mentoring network or approach that includes a senior, experienced mentor may help.
Many institutions have implemented mandatory mentoring programs, often at the onset of a faculty member’s career. I have seen them included in the offer letters. These usually fail because they do not account for the individual personal nature of the mentoring relationship.
In a previous institution, my team set up a voluntary mentoring program in which mentee and mentor selected each other, designed goals that became part of their incentive plan, and tracked their mutual progress. The formalization of the relationship and mutual goals made it easy to justify the support of the mentorship with resources. We found this worked well because there was institutional support and mutual ownership of the process by mentor and mentee. These are often lacking in an approach to forced mentor-mentee relationships.
I want to remind folks that mentoring is very different than coaching. A degree of separation exists in coaching that allows a partnership that focuses solely on the coachee's agenda and success, while still being supportive and challenging. In mentorship, mutual benefit - albeit different in character - should occur between mentee and mentor.
A pivotal aspect of their approach is that the participants or volunteers who wanted to be in the program received their mentorship from peers. A pivotal aspect of their approach is that the participants or volunteers who wanted to be in the program received their mentorship from peers.
I give a great deal of credit to the supporting institutions and the authors for this program. These types of programs are needed more than ever before. The depth of the process and the thoughtfulness of the approach make their efforts cutting edge within academic medicine.
BOTTOM LINE
The primary takeaway is that the process mentoring crafted and supported by the C-Change Mentoring and Leadership Institute positively affected the academic physicians and scientists who participated.
My brilliant colleagues will point out some theoretical weaknesses in this study, particularly in light of some comments in the background section. These will include that this is not a ‘random’ group of midlevel academic physicians and scientists. These are people who are motivated and already successful. This set of participants is the cream of the crop and are highly motivated. Other quibbles may be that the document showed how everyone 'felt' after such a supportive community experience. Still, this study did not demonstrate a long-term objective effect, positive or negative. Finally, this study did not use formal objective assessment tools in their processes, such as the Profile XT assessment for strengths or the Checkpoint XT as a 360-degree assessment.
These are fair comments, and I credit the authors for acknowledging many of them. However, if the authors allow me, I would defend them (I have no doubt that they can defend themselves, but I am a passionate advocate for what these authors are doing).. The study we reviewed and discussed was the proper study at the time and place, based on where the C-Change Mentoring and Leadership Institute program currently stands. I have no doubt that the authors will continue to build upon their approach, and I fully expect there to be further mitigations of the quibbles with the above. In particular, I am looking forward to a long-term follow-up study with a well-matched case-control approach and applying their process and peer group mentoring to a less accomplished and earlier-in-career cohort.