Establishing a mentoring system for anaesthetic trainees.
A Quinn, D Moore.
Beaumont Hospital, Beaumont Road, Dublin 9
Mentoring for doctors has been identified as an area requiring development. Currently, there is a void of trained mentors available. This article considers the evidence basis to support mentoring, and outlines the mentoring programme recently introduced by trainees in the College of Anaethetists.
Mentoring in medicine is a term that is slowly creeping into the common parlance. The Mac Craith report1, published in 2014, identified mentoring as one of the many aspects that could be developed to support doctors in their post graduate training. The term mentoring implies a myriad of different meanings from the patronage of a senior consultant providing career advice to a junior, to an educator, facilitator or coach2,3. The publication by the HRB acknowledges the different definitions. 4 Perhaps it is most useful to think of mentoring as skilled helping without telling. This is the ideology that we adopted when developing the mentoring system in the College of Anaesthetists.
The HRB4 report acknowledges the lack of a robust evidence basis to support mentoring and indicates that the benefits of mentoring are somewhat elusive and hard to define. There would appear to be a trend towards employee satisfaction, improved performance, better networking and career development opportunities and perhaps a trend towards employee retention. In 2013 upon his election to president of the IMC, Prof Wood indicated the need for supports to be developed and available to doctors at every stage of their training and clinical practice5. Mentoring is a possible option to achieve these aims, as it may be of benefit to people to prevent career stagnation, and in time to help the transition towards retirement
The General Medical Council in the UK, highlight the importance of mentoring on their website6. Doctors registered with the GMC are obliged to undertake mentoring if offered by their employers. Furthermore doctors in a position of responsibility are required to act as mentors to their juniors, and to ensure they are competent to perform this mentoring role.
The National Institute of Academic of Anaesthetists in the UK have investigated the after effects of introducing local mentoring schemes in the UK7,8. Mentees report numerous positive elements including the platform to talk through opportunities and issues in a safe environment, having current schemata challenged in a supportive manner, and the opportunity to engage in reflective practice. A further major positive element to emerge was the ability to generate one’s own solution to a problem following a mentoring session9. People who engaged with mentoring programmes were better able to take advantage of opportunities at work, and to cope with change.
The Your Training Counts Survey 201410 highlighted the stark numbers of trainees experiencing bullying at work, and short-term depression happiness scale scores putting trainees at risk of mental ill health. There is a lack of formal structured career development support and a void in terms of mentoring supports available to Irish trainees, and indeed consultants. In attempt to address this, the Committee of Anaesthetic Trainees (CAT) under the auspices of the College of Anaesthetists in Ireland, set about developing a mentoring system for anaesthetic trainees. Evidence suggests that to be meaningful, the mentor should be trained11. Two trainees therefore underwent a mentor-training course in London, facilitated by the Association of Anaesthetists Great Britain and Ireland. This four-day course laid out the fundamentals of one particular model of mentoring – the Egans Skilled helper model. There were a variety of other participants on the course, mostly consultants based in the UK.
Development of Mentoring Scheme
The skilled helper model provides a nine step framework allowing a mentee explore an issue from different perspectives, identify a component that is important to them to deal with first, and generate a plan complete with timeline to tackle the issue. A key component of this model is the partnership and balance between the mentor and mentee. The mentor provides expertise on the process; the mentee provides expertise on the issue, and their response to it. This balanced partnership means that the mentor does not need to have specific expertise on the issue that is being discussed. For example this is not a forum for a mentor to tell a mentee how, in the mentor’s opinion to become a cardiac anaesthetist as quickly as possible. Rather this is a forum for the mentee to figure out they want to become a cardiac anaesthetist in the first place, and to develop a plan that works for them in achieving the goal12.
A common misconception relating to mentoring is that the issue being discussed is generally something negative, or that the mentee is at crisis point or undergoing remedial intervention. This effectively deprives many people from the benefits of mentoring. Mentoring is a means of helping a person unlock their potential. Any issue, challenge, dilemma or opportunity could be unpicked in a session. In business domains mentoring may be called coaching, and is a tool utilised by captains of industry.
Having experienced the benefits of mentoring, we developed a system for use by anaesthetic trainees. A fundamental component of this system is that it is confidential, and we constantly re-iterate that the identity of a mentee is never reported back to the CAI. A second critical component is that this is a voluntary system, and the mentee choose to opt in to it. This helps ensure that both parties are truly engaged with the process. Appointments can be requested by email in the first instance, and a mutually convenient time and location is arranged. Sessions are never held within the college itself, to promote the feeling of balance between parties. Consent is an issue of importance to any doctor, and although we do not take official informed consent, we do provide our code of practice to all prospective mentees. This document is received in advance of the session to allow time for it to be digested prior to the session. It outlines our commitment to confidentiality, and to operating within the confines of the Irish Medical Council. There is a slow burgeoning of interest in the scheme, and an uptake of the facility. A broad range of items discussed includes career direction, interview preparation, bullying at work, time management, and maximizing training opportunities. Some of the contact is made through the official avenue of emailing the mentor address for an appointment. An equal proportion of individuals arrange mentoring via personal communication with the mentors.
The scheme was advertised in several different ways. Trainees embarking on the training scheme were targeted. Ideally we would like mentoring to be a tool that people frequently turn too. This would involve a significant culture change to current established practice. We email all Specialist Anaesthetic Trainees in their first year, outlining how the scheme works, and the benefits of mentoring. Further information is provided on the college website. College tutors also received information regarding mentoring, and an opportunity to watch a demonstration session at the College Tutor day in 2015. Mentoring was also on the agenda at the Irish Standing Committee Meeting of the AAGBI, where Nancy Redfern a UK anaesthetist and mentoring guru did a joint presentation with one of the trainees who established the scheme here. Regular reminders and updates are published on the CAT Facebook page.
Currently we have three trained mentors, with two further people being trained this year. We hope this will provide a better geographic spread with one of the mentors being based in Cork this year. The number of mentors may seem rather small at present, but it is sufficient to deal with current demand. We envisage that with sufficient care the scheme will develop organically and that more mentors will be available as required over the course of time. Mentoring benefits both mentee and mentor, and helps establish a sense of community and mutual wellbeing7. Changes in working hours, and the introduction of rota systems may erode traditional in hospital team structures. This has the potential knock on effect of leaving NCHDs without the usual support structures from their peers. This issue is of particular relevance to anaesthetic trainees, as although the anaesthetic team may be large, consistent points of contact between individuals may be sporadic.
The costs associated with running the scheme are both financial and time. The cost of the training course is £595 per person. The time involved varies from week to week. The satisfaction of helping a person develop their potential out weighs this. Further mentors have reported that the skills they have developed in their role as mentor have also served them well in clinical practice.
In conclusion, mentoring and supportive structures have benefits for both the mentor and the mentee. Developing a mentor scheme involves changing culture. This is always going to take time. There is a historic ethos of doctors not admitting weakness or asking for help. We would suggest that engaging with mentoring helps a person develop their potential, aids a person making decisions, makes bad situations bearable by generating realistic solutions and just as importantly elevates the good to exceptional.
Conflict of Interest
There are no conflicts of interest with regard to this paper.
Aoife Quinn, Beaumont Hospital
1. Strategic Review of Medical Training and Career Structure, Report on medical Career Structures and Pathways Following Completion of Specialist training. Dept of Health 2014
2. Jarvis P. Towards a philosophical understanding of mentoring. Nurse Education Today.1995;15:414–9.
3. Gupta RC, Lingam S. Mentoring for doctors and dentists. Oxford: Blackwell Science; 2006.
4. Keane. Mentoring in post-graduate medical education and specialist training
Dept of Health Review 2015
5. Mudiwa L. Freddie Wood elected IMC President. Irish Medical Times June 2013
6. General Medical Council
http://www.gmc-uk.org/guidance/ethical_guidance/11825.asp ( accessed April 2016)
7. Oxley J, Fleming W, Golding L, Pask H, Steven A. Mentoring for doctors: enhancing the benefit. A working paper produced on behalf of the Doctors’ Forum 2004 Available at: http://www.ncl.ac.uk/medev/assets/documents/Mentoringbenefits.pdf.
8. Steven, A, J Oxley, and WG Fleming. Mentoring for NHS Doctors: Perceived Benefits across the Personal–professional Interface. Journal of the Royal Society of Medicine 101.11 (2008): 552–557. PMC. Web. 5 May 2016.
9. Connor MP, Bynre AG, Redfern N, Pokora N, Clarke J. Developing senior doctors as mentors: a form of continuing professional development. Report of an initiative to develop a network of senior doctors as mentors. Med Educ. 2000;34:747–53.
10. Your Training Counts, Results of the National Trainee Experience Survey, 2014, Irish Medical Council
11. Freeman R. Faculty mentoring programmes. Med Educ. 2000;34:507–8.
12. Connor M. Coaching And Mentoring At Work: Developing Effective Practice: Developing Effective Practice 2nd Edition Open University Press, McGraw Hill Education 2012