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Critical choices in mentoring the next generation of academic pediatricians: Nine circles of hell or salvation?

2003; Elsevier BV; Volume: 142; Issue: 1 Linguagem: Inglês

10.1067/mpd.2003.mpd033

1097-6833

Dennis Drotar, Ellis D. Avner,

Diversity and Career in Medicine

The challenge of mentoringMentoring is arguably one of the most important and least understood functions of academic pediatric departments. Various authors have eloquently underscored the need for training the next generation of pediatric investigators and clinicians.1Future of Pediatric Education FOPE II Task Force The future of pediatric education II: organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 2Pizzo PA Lovejoy FH. Will current training programs prepare pediatricians to meet the health care needs of children in the 21st century? An opinion.J Pediatr. 2001; 138: 739-740Abstract Full Text Full Text PDF Scopus (8) Google Scholar High-quality mentoring, the process by which role models counsel and guide trainees, is integral to the success of all training endeavors. The next generation of researchers and clinician educators in pediatrics will need to be developed by a cadre of experienced and talented faculty mentors who provide both intellectual and moral leadership.However, there are a number of significant threats to successful mentoring in pediatric departments in the 21st century. The most formidable are work-related stresses of pediatric faculty, who are confronted by the competing demands of clinical practice in an era of managed care; the teaching and training of students, residents, and fellows; and managing successful research careers. In the current economic climate, mentoring is at risk as a “nonreimburseable activity” that is targeted for cutbacks or elimination. Indeed some would justify this Spartan approach on the basis of their own negative experiences. Since they succeeded without help or mentoring, why can't others? They may even reason that talented, motivated trainees will be helped by personally overcoming obstacles to career development without assistance from their mentors.The current workforce crisis affecting pediatric physician-scientists and clinician-educators3Nathan DG for the National Institutes of Health Director's Panel on Clinical Research Clinical research: perceptions, reality, and proposed solutions.J Am Med Assoc. 1998; 280: 1427-1431Crossref Scopus (176) Google Scholar, 4National Academy of Science Meeting the nation's needs for biomedical and behavioral scientists. National Academy Press, Washington (DC)1994Google Scholar, 5Rosenberg LE. Physician-scientists: endangered and essential.Science. 1999; 283: 331-332Crossref PubMed Scopus (206) Google Scholar, 6Jones DM Boat TF Stockman 3rd, JA Clark EB Minaga-Miya K Gilchrist GS. Federation of Pediatric Organizations Subspecialty Forum.J Pediatr. 2001; 139: 487-493Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar mandates aggressive, proactive planning to maximize their academic career development. In addition to specialized approaches for talented women trainees,1Future of Pediatric Education FOPE II Task Force The future of pediatric education II: organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 2Pizzo PA Lovejoy FH. Will current training programs prepare pediatricians to meet the health care needs of children in the 21st century? An opinion.J Pediatr. 2001; 138: 739-740Abstract Full Text Full Text PDF Scopus (8) Google Scholar and continued advocacy for federal training and loan repayment programs, this crisis necessitates a concerted approach to developing mentoring resources and strategies. Academic pediatric departments must protect the privilege and opportunity of faculty mentors to teach and learn together with trainees/junior faculty in the context of a relationship that is characterized by mutual respect, trust, and coordinated goals for career development. But how is mentoring to be facilitated in the very real world of academic pediatrics and health care economics? Moreover, what is good mentoring?Good mentoring, bad mentoring, and mentor's hellTabled 1Table.Dante's InfernoMentor's HellUpper HellHeathenPoor judgement of potentialLustfulFailure to define limitsGluttonousPoor transition from mentor to colleagueAvaricious“Honorary” authorshipWrathfulInappropriate praise/criticismLower HellHereticalFostering selective scientific agendaViolentTaking credit for trainees' workFraudulentPromoting unethical researchTreacherousFurthering a sexual agenda Open table in a new tab The mentoring behaviors of Lower Hell, which we believe are more prevalent than is generally acknowledged, clearly cross over into unethical realms. They include such issues as fostering a selective scientific agenda, eg, fostering mentor's projects at the expense of developing trainees' independent careers; taking credit for trainees' work; promoting unethical research by teaching or tolerating scientific misconduct or fraud; or furthering a sexual or racial agenda through discrimination and/or harassment.Strategies to avoid mentoring hellWhat strategies might prevent professional descent into mentoring hell, which is costly if not criminal in terms of lost human potential? Even more than simply preventing abuses of mentoring, what can be done to promote a proactive departmental agenda that furthers the values of effective mentoring? First of all, prospective faculty mentors (and Departmental Chairs) need to recognize that mentoring is a rewarding privilege of academic life that demands protected time, energy, and extraordinary commitment, which cannot and should not be made by everyone.Furthermore, each of the nine circles of Mentors' Hell has a potential road to salvation that defines effective mentoring. Pathways to Salvation from Upper Mentoring Hell include knowing trainees' abilities and communicating clear expectations, defining the mentoring relationship, being certain that authorship for research and educational curricula reflects an appropriate level of involvement, providing appropriate and timely praise and criticism, and promoting trainees' unique characteristics and career development.The prevention of a headlong descent into Lower Mentoring Hell is an ethical responsibility of faculty at all levels. We suggest the following preventive strategies: designation of a substantial amount of time in advanced postdoctoral training for trainees' independent research and/or educational projects; always crediting trainees by clearly identifying their efforts in data presentation and publication; active participation of mentoring faculty and trainees in institutional biomedical research ethics training programs; emphasizing diversity in the recruitment of trainees and faculty; and using a team of mentors for each trainee to alleviate the burden of exclusive, potentially manipulative and/or destructive relationships.In our own department, we have developed a program of mentoring committees through which committed senior faculty regularly review junior faculty career planning and progress. The mentoring committee system was developed based on the concept that a single mentor cannot meet all the faculty members' career development needs, and is modeled on the format of a PhD dissertation committee. These committees generally include 3 to 5 members, such as the division chief and multiple mentors with specific expertise related to the junior faculty's area of work. The committees use senior, experienced researchers/educators; involve the mentored faculty members in selecting the committee agenda; review the faculty member's work; and prepare comprehensive mentoring reviews that include feedback concerning career development and specific research and/or educational projects. The committee, which typically meets at least twice a year and more frequently as needed, provides research direction, expertise with grant or manuscript preparation and review, strategic planning for academic development and identification of needed departmental, eg, protected-time, educational seminars. Such committees provide detailed feedback to the Chair, particularly when a need for specific resource allocation to maximize a faculty member's career trajectory is identified, as well as to the faculty member.An additional and related strategy in faculty development is the use of departmental resources including developmental and endowment funds and faculty expertise. These resources are allocated in concert with the overall mentoring plan for a faculty member. Some specific examples include: providing “seed” grants to help junior faculty develop data for extramural funding; peer review by senior departmental researchers to help junior investigators refine their ideas; development of a rich infrastructure of resources to support education and research; and close linkage between faculty mentoring and the overall Departmental strategic plan.Finally, to encourage the salvation of mentors and their trainees, we advocate a scholarly, ethics-based approach to mentoring including critical analyses of the abuses of mentoring as well as exemplars of competent and innovative mentoring. Research should document the specific elements of mentoring that are perceived by trainees and faculty as most influential in their career development. Moreover, careful evaluation of the career development of trainees who have received different types of mentoring will facilitate comprehensive, evidence-based strategies for the future mentoring of academic pediatricians.In closing, we acknowledge and thank the many talented trainees and faculty who have helped to lead us away from Mentor's Hell and show us a more humane and informed path. They inspire and continue to challenge us to be better mentors. The challenge of mentoringMentoring is arguably one of the most important and least understood functions of academic pediatric departments. Various authors have eloquently underscored the need for training the next generation of pediatric investigators and clinicians.1Future of Pediatric Education FOPE II Task Force The future of pediatric education II: organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 2Pizzo PA Lovejoy FH. Will current training programs prepare pediatricians to meet the health care needs of children in the 21st century? An opinion.J Pediatr. 2001; 138: 739-740Abstract Full Text Full Text PDF Scopus (8) Google Scholar High-quality mentoring, the process by which role models counsel and guide trainees, is integral to the success of all training endeavors. The next generation of researchers and clinician educators in pediatrics will need to be developed by a cadre of experienced and talented faculty mentors who provide both intellectual and moral leadership.However, there are a number of significant threats to successful mentoring in pediatric departments in the 21st century. The most formidable are work-related stresses of pediatric faculty, who are confronted by the competing demands of clinical practice in an era of managed care; the teaching and training of students, residents, and fellows; and managing successful research careers. In the current economic climate, mentoring is at risk as a “nonreimburseable activity” that is targeted for cutbacks or elimination. Indeed some would justify this Spartan approach on the basis of their own negative experiences. Since they succeeded without help or mentoring, why can't others? They may even reason that talented, motivated trainees will be helped by personally overcoming obstacles to career development without assistance from their mentors.The current workforce crisis affecting pediatric physician-scientists and clinician-educators3Nathan DG for the National Institutes of Health Director's Panel on Clinical Research Clinical research: perceptions, reality, and proposed solutions.J Am Med Assoc. 1998; 280: 1427-1431Crossref Scopus (176) Google Scholar, 4National Academy of Science Meeting the nation's needs for biomedical and behavioral scientists. National Academy Press, Washington (DC)1994Google Scholar, 5Rosenberg LE. Physician-scientists: endangered and essential.Science. 1999; 283: 331-332Crossref PubMed Scopus (206) Google Scholar, 6Jones DM Boat TF Stockman 3rd, JA Clark EB Minaga-Miya K Gilchrist GS. Federation of Pediatric Organizations Subspecialty Forum.J Pediatr. 2001; 139: 487-493Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar mandates aggressive, proactive planning to maximize their academic career development. In addition to specialized approaches for talented women trainees,1Future of Pediatric Education FOPE II Task Force The future of pediatric education II: organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 2Pizzo PA Lovejoy FH. Will current training programs prepare pediatricians to meet the health care needs of children in the 21st century? An opinion.J Pediatr. 2001; 138: 739-740Abstract Full Text Full Text PDF Scopus (8) Google Scholar and continued advocacy for federal training and loan repayment programs, this crisis necessitates a concerted approach to developing mentoring resources and strategies. Academic pediatric departments must protect the privilege and opportunity of faculty mentors to teach and learn together with trainees/junior faculty in the context of a relationship that is characterized by mutual respect, trust, and coordinated goals for career development. But how is mentoring to be facilitated in the very real world of academic pediatrics and health care economics? Moreover, what is good mentoring? Mentoring is arguably one of the most important and least understood functions of academic pediatric departments. Various authors have eloquently underscored the need for training the next generation of pediatric investigators and clinicians.1Future of Pediatric Education FOPE II Task Force The future of pediatric education II: organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 2Pizzo PA Lovejoy FH. Will current training programs prepare pediatricians to meet the health care needs of children in the 21st century? An opinion.J Pediatr. 2001; 138: 739-740Abstract Full Text Full Text PDF Scopus (8) Google Scholar High-quality mentoring, the process by which role models counsel and guide trainees, is integral to the success of all training endeavors. The next generation of researchers and clinician educators in pediatrics will need to be developed by a cadre of experienced and talented faculty mentors who provide both intellectual and moral leadership. However, there are a number of significant threats to successful mentoring in pediatric departments in the 21st century. The most formidable are work-related stresses of pediatric faculty, who are confronted by the competing demands of clinical practice in an era of managed care; the teaching and training of students, residents, and fellows; and managing successful research careers. In the current economic climate, mentoring is at risk as a “nonreimburseable activity” that is targeted for cutbacks or elimination. Indeed some would justify this Spartan approach on the basis of their own negative experiences. Since they succeeded without help or mentoring, why can't others? They may even reason that talented, motivated trainees will be helped by personally overcoming obstacles to career development without assistance from their mentors. The current workforce crisis affecting pediatric physician-scientists and clinician-educators3Nathan DG for the National Institutes of Health Director's Panel on Clinical Research Clinical research: perceptions, reality, and proposed solutions.J Am Med Assoc. 1998; 280: 1427-1431Crossref Scopus (176) Google Scholar, 4National Academy of Science Meeting the nation's needs for biomedical and behavioral scientists. National Academy Press, Washington (DC)1994Google Scholar, 5Rosenberg LE. Physician-scientists: endangered and essential.Science. 1999; 283: 331-332Crossref PubMed Scopus (206) Google Scholar, 6Jones DM Boat TF Stockman 3rd, JA Clark EB Minaga-Miya K Gilchrist GS. Federation of Pediatric Organizations Subspecialty Forum.J Pediatr. 2001; 139: 487-493Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar mandates aggressive, proactive planning to maximize their academic career development. In addition to specialized approaches for talented women trainees,1Future of Pediatric Education FOPE II Task Force The future of pediatric education II: organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century.Pediatrics. 2000; 105: 163-212Google Scholar, 2Pizzo PA Lovejoy FH. Will current training programs prepare pediatricians to meet the health care needs of children in the 21st century? An opinion.J Pediatr. 2001; 138: 739-740Abstract Full Text Full Text PDF Scopus (8) Google Scholar and continued advocacy for federal training and loan repayment programs, this crisis necessitates a concerted approach to developing mentoring resources and strategies. Academic pediatric departments must protect the privilege and opportunity of faculty mentors to teach and learn together with trainees/junior faculty in the context of a relationship that is characterized by mutual respect, trust, and coordinated goals for career development. But how is mentoring to be facilitated in the very real world of academic pediatrics and health care economics? Moreover, what is good mentoring? Good mentoring, bad mentoring, and mentor's hellTabled 1Table.Dante's InfernoMentor's HellUpper HellHeathenPoor judgement of potentialLustfulFailure to define limitsGluttonousPoor transition from mentor to colleagueAvaricious“Honorary” authorshipWrathfulInappropriate praise/criticismLower HellHereticalFostering selective scientific agendaViolentTaking credit for trainees' workFraudulentPromoting unethical researchTreacherousFurthering a sexual agenda Open table in a new tab The mentoring behaviors of Lower Hell, which we believe are more prevalent than is generally acknowledged, clearly cross over into unethical realms. They include such issues as fostering a selective scientific agenda, eg, fostering mentor's projects at the expense of developing trainees' independent careers; taking credit for trainees' work; promoting unethical research by teaching or tolerating scientific misconduct or fraud; or furthering a sexual or racial agenda through discrimination and/or harassment. The mentoring behaviors of Lower Hell, which we believe are more prevalent than is generally acknowledged, clearly cross over into unethical realms. They include such issues as fostering a selective scientific agenda, eg, fostering mentor's projects at the expense of developing trainees' independent careers; taking credit for trainees' work; promoting unethical research by teaching or tolerating scientific misconduct or fraud; or furthering a sexual or racial agenda through discrimination and/or harassment. Strategies to avoid mentoring hellWhat strategies might prevent professional descent into mentoring hell, which is costly if not criminal in terms of lost human potential? Even more than simply preventing abuses of mentoring, what can be done to promote a proactive departmental agenda that furthers the values of effective mentoring? First of all, prospective faculty mentors (and Departmental Chairs) need to recognize that mentoring is a rewarding privilege of academic life that demands protected time, energy, and extraordinary commitment, which cannot and should not be made by everyone.Furthermore, each of the nine circles of Mentors' Hell has a potential road to salvation that defines effective mentoring. Pathways to Salvation from Upper Mentoring Hell include knowing trainees' abilities and communicating clear expectations, defining the mentoring relationship, being certain that authorship for research and educational curricula reflects an appropriate level of involvement, providing appropriate and timely praise and criticism, and promoting trainees' unique characteristics and career development.The prevention of a headlong descent into Lower Mentoring Hell is an ethical responsibility of faculty at all levels. We suggest the following preventive strategies: designation of a substantial amount of time in advanced postdoctoral training for trainees' independent research and/or educational projects; always crediting trainees by clearly identifying their efforts in data presentation and publication; active participation of mentoring faculty and trainees in institutional biomedical research ethics training programs; emphasizing diversity in the recruitment of trainees and faculty; and using a team of mentors for each trainee to alleviate the burden of exclusive, potentially manipulative and/or destructive relationships.In our own department, we have developed a program of mentoring committees through which committed senior faculty regularly review junior faculty career planning and progress. The mentoring committee system was developed based on the concept that a single mentor cannot meet all the faculty members' career development needs, and is modeled on the format of a PhD dissertation committee. These committees generally include 3 to 5 members, such as the division chief and multiple mentors with specific expertise related to the junior faculty's area of work. The committees use senior, experienced researchers/educators; involve the mentored faculty members in selecting the committee agenda; review the faculty member's work; and prepare comprehensive mentoring reviews that include feedback concerning career development and specific research and/or educational projects. The committee, which typically meets at least twice a year and more frequently as needed, provides research direction, expertise with grant or manuscript preparation and review, strategic planning for academic development and identification of needed departmental, eg, protected-time, educational seminars. Such committees provide detailed feedback to the Chair, particularly when a need for specific resource allocation to maximize a faculty member's career trajectory is identified, as well as to the faculty member.An additional and related strategy in faculty development is the use of departmental resources including developmental and endowment funds and faculty expertise. These resources are allocated in concert with the overall mentoring plan for a faculty member. Some specific examples include: providing “seed” grants to help junior faculty develop data for extramural funding; peer review by senior departmental researchers to help junior investigators refine their ideas; development of a rich infrastructure of resources to support education and research; and close linkage between faculty mentoring and the overall Departmental strategic plan.Finally, to encourage the salvation of mentors and their trainees, we advocate a scholarly, ethics-based approach to mentoring including critical analyses of the abuses of mentoring as well as exemplars of competent and innovative mentoring. Research should document the specific elements of mentoring that are perceived by trainees and faculty as most influential in their career development. Moreover, careful evaluation of the career development of trainees who have received different types of mentoring will facilitate comprehensive, evidence-based strategies for the future mentoring of academic pediatricians.In closing, we acknowledge and thank the many talented trainees and faculty who have helped to lead us away from Mentor's Hell and show us a more humane and informed path. They inspire and continue to challenge us to be better mentors. What strategies might prevent professional descent into mentoring hell, which is costly if not criminal in terms of lost human potential? Even more than simply preventing abuses of mentoring, what can be done to promote a proactive departmental agenda that furthers the values of effective mentoring? First of all, prospective faculty mentors (and Departmental Chairs) need to recognize that mentoring is a rewarding privilege of academic life that demands protected time, energy, and extraordinary commitment, which cannot and should not be made by everyone. Furthermore, each of the nine circles of Mentors' Hell has a potential road to salvation that defines effective mentoring. Pathways to Salvation from Upper Mentoring Hell include knowing trainees' abilities and communicating clear expectations, defining the mentoring relationship, being certain that authorship for research and educational curricula reflects an appropriate level of involvement, providing appropriate and timely praise and criticism, and promoting trainees' unique characteristics and career development. The prevention of a headlong descent into Lower Mentoring Hell is an ethical responsibility of faculty at all levels. We suggest the following preventive strategies: designation of a substantial amount of time in advanced postdoctoral training for trainees' independent research and/or educational projects; always crediting trainees by clearly identifying their efforts in data presentation and publication; active participation of mentoring faculty and trainees in institutional biomedical research ethics training programs; emphasizing diversity in the recruitment of trainees and faculty; and using a team of mentors for each trainee to alleviate the burden of exclusive, potentially manipulative and/or destructive relationships. In our own department, we have developed a program of mentoring committees through which committed senior faculty regularly review junior faculty career planning and progress. The mentoring committee system was developed based on the concept that a single mentor cannot meet all the faculty members' career development needs, and is modeled on the format of a PhD dissertation committee. These committees generally include 3 to 5 members, such as the division chief and multiple mentors with specific expertise related to the junior faculty's area of work. The committees use senior, experienced researchers/educators; involve the mentored faculty members in selecting the committee agenda; review the faculty member's work; and prepare comprehensive mentoring reviews that include feedback concerning career development and specific research and/or educational projects. The committee, which typically meets at least twice a year and more frequently as needed, provides research direction, expertise with grant or manuscript preparation and review, strategic planning for academic development and identification of needed departmental, eg, protected-time, educational seminars. Such committees provide detailed feedback to the Chair, particularly when a need for specific resource allocation to maximize a faculty member's career trajectory is identified, as well as to the faculty member. An additional and related strategy in faculty development is the use of departmental resources including developmental and endowment funds and faculty expertise. These resources are allocated in concert with the overall mentoring plan for a faculty member. Some specific examples include: providing “seed” grants to help junior faculty develop data for extramural funding; peer review by senior departmental researchers to help junior investigators refine their ideas; development of a rich infrastructure of resources to support education and research; and close linkage between faculty mentoring and the overall Departmental strategic plan. Finally, to encourage the salvation of mentors and their trainees, we advocate a scholarly, ethics-based approach to mentoring including critical analyses of the abuses of mentoring as well as exemplars of competent and innovative mentoring. Research should document the specific elements of mentoring that are perceived by trainees and faculty as most influential in their career development. Moreover, careful evaluation of the career development of trainees who have received different types of mentoring will facilitate comprehensive, evidence-based strategies for the future mentoring of academic pediatricians. In closing, we acknowledge and thank the many talented trainees and faculty who have helped to lead us away from Mentor's Hell and show us a more humane and informed path. They inspire and continue to challenge us to be better mentors.