The Importance of Mentoring in Preparing the Next Generation of Oncologists

Since the time of Hippocrates, practicing the art of medicine has involved the passage of knowledge and experience from one generation of practitioners to the next. Unlike other fields of study in the sciences and humanities, the process of educating physicians tends to involve a much more intimate relationship between the instructors and trainees. While the earliest years of medical school education are usually carried out in the classroom, there is an early transition to education in small teams, often led by the attending and residents. During the latest years of residency (most often during subspecialty training), the relationship between instructors and trainees gains sufficient permanence; instructors will usually know the trainees well enough to provide detailed guidance in educational and career development. In this aspect, the fellowship training period provides the most intimate one-on-one training in a clinical setting. And, perhaps, the most developed form of this relationship is that of the mentor and mentee.

What is mentorship?

Mentorship has been defined as “a dynamic, reciprocal relationship in a work environment between an advanced career incumbent (mentor) and a beginner (protégé), aimed at the development of both.”¹ Strictly speaking, “mentorship” indicates a personal developmental relationship in which a more experienced (often more senior) individual helps a less experienced or knowledgeable individual who is usually newer to that particular organization. Mentorship should not be confused with similar methods of imparting knowledge, such as tutoring (or instructing, which is the dissemination of knowledge), coaching (which dwells on the development of skills), or serving as a role model (in which one provides examples of specific behaviors). Mentorship incorporates these aspects, but builds upon them with the addition of guidance in career development.

While formal mentorship programs were first launched in corporate America in the 1970s as a way to develop junior staff, they weren’t officially introduced into medical education until the 1990s.² The mentoring process is now considered to be an essential responsibility of medical school faculty in an effort to enhance the educational mission, and is clearly helpful in encouraging career satisfaction and success.^3,4 Despite its inherent added value, mentorship is often not deemed important by the institution (such time is not billable, after all) and thus, is often beset by the competing demands of clinical care and research on both the mentor and mentee. Although not all institutions may have a formal mentorship program in place, it should not deter fellows from being proactive and seeking out mentors in areas of common interest.

The benefits of having a mentor

Mentorship can accord significant potential benefits to fellows, such as providing access to networking, which may be one reason why those who are mentored tend to do well in institutions.¹ Multiple studies have shown that having a mentor has a positive influence on overall career enhancement; one study even demonstrated that those who received mentoring were more than twice as likely to receive a promotion.⁵ Mentoring has also been associated with improvements in research, teaching, and patient care.⁶

A mentoring relationship can be very helpful when deciding on which specialty and subspecialty to pursue. Two of the major decisions that fellows must make are whether to specialize in hematology, oncology, or both; and whether to pursue a career in academics, private practice, or industry. The two decisions are actually closely related. For example, if one desires to enter into a private practice setting, it would be reasonable to become double board certified in hematology and oncology. While there is a move among larger practices to develop some tumor or disease-specific expertise and local recognition, most private practitioners must still function in a fairly general manner.

By itself, hematology as a discipline is more or less restricted to academic centers and larger hospitals, especially nonmalignant hematology. If such arrangements are made between a private practice and either a university or consortium of practices, it may also be possible to participate in “bedside” teaching of students and residents, as well as larger phase II (proof of concept) and phase III (confirmation of activity or benefit) trials, although there may be very little time, infrastructure, or opportunity to initiate and support one’s own clinical research interests. On the other hand, a career in academic clinical research affords many of these opportunities, though usually with somewhat smaller patient loads, protected time to carry out research and teaching, and a lesser amount of financial compensation than seen in private practice.

Those who are more interested in basic research will find an outlet in either academics or private industry, usually with a pharmaceutical company. However, the options in industry also involve the initiation and conduct of clinical trials (though it usually involves little or no patient interaction), while also requiring more than a little business savvy during the process of drug development. Regardless, a mentor can help fellows choose a career track by assisting them in identifying and focusing on their strengths and academic interests, while constructively illustrating any potential areas of weakness and developing methods to seek improvement.

A reciprocal relationship

Mentorship is a bidirectional relationship, with benefits accrued by the mentor as well as the mentee. For example, mentoring enables an individual to demonstrate leadership among his or her peers. The very act of providing personalized guidance in a field in which the mentor is passionate about is invigorating and often positively stimulates the mentor’s teaching and research efforts. Finally, there is the intangible satisfaction that one achieves by the act of “giving something back” and seeing one’s protégé succeed, based in part on the mentor’s efforts. In this respect, established faculty (especially those in mid-career or later) should also actively seek out fellows and newly-minted junior faculty and work closely with them to provide guidance that will enhance not only the careers of their charges, but their own as well.

Leaving the lines of communication open

Fellows must remember that mentorship is a process, not an end in itself. A successful relationship with a mentor may last a lifetime, and he or she will often be willing and able to offer insightful guidance long after the fellowship has been completed. Such relationships can provide myriad benefits to the fellow in the development and direction of their early career, providing access to resources, experience and insight that would not readily be available to fellows on their own. Ultimately, having a mentor can be an invaluable resource for young physicians and provide a measurable boost to their career development and overall success.

Dennie V. Jones, Jr., MD, FACP, is a professor of medicine; medical director of the New Mexico Cancer Care Alliance; medical director of the Clinical Protocol, Data Management and Informatics Group; and chief of the section of thoracic medical oncology in the division of hematology/oncology at the University of New Mexico Cancer Center in Albuquerque.

References

1. Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296(9):1103-1115.

2. Buddeberg-Fischer B, Herta KD. Formal mentoring programmes for medical students and doctors—a review of the Medline literature. Med Teach. 2006;28(3):248-257.

3. Gray J, Armstrong P. Academic health leadership: looking to the future. Proceedings of a workshop held at the Canadian Institute of Academic Medicine meeting Québec, Que., Canada, Apr. 25 and 26, 2003. Clin Invest Med. 2003;26(3):315-326.

4. DeAngelis CD. Professors not professing. JAMA. 2004;292(9):1060-1061.

5. Wise MR, Shapiro H, Bodley J, et al. Factors affecting academic promotion in obstetrics and gynaecology in Canada. J Obstet Gynaecol Can. 2004;26(2):127-136.

6. Illes J, Glover GH, Wexler L, Leung AN, Glazer GM. A model for faculty mentoring in academic radiology. Acad Radiol. 2000;7(9):717-724.

Finding a Mentor and Maximizing Your Relationship

By John Rhee, MD

Why should I obtain a mentor?

A successful career path in oncology is not accomplished alone. Whether your ultimate aspirations are in academic medicine, community practice, or industry, having one or more mentors during your fellowship is of vital importance.

A mentor can be an invaluable source of practical knowledge; as you have probably realized, the management of patients with cancer is complex and involves as much art as science. A mentor can provide insight on the nuances of oncology that are not learned from textbooks or journals. When needed, he or she can also aide in stress management.

Perhaps the most obvious role of a mentor is to assist in research. It is unrealistic for a fellow to accomplish much research without substantial guidance. A research mentor can help write protocol, as well as generate, present, and publish data.

Lastly, a mentor can help you choose between various oncology careers. If your mentor has been in both academic medicine and private practice, he or she will be especially suited to give you the pros and cons of each. Near the end of your fellowship training, a phone call from your mentor can make the difference in obtaining a faculty position at a prestigious institution or landing a private practice job in the location of your choice.

How do I find a good mentor?

While many training programs have a formal mentor assignment process, finding a good mentor will take some initiative. A first step may be to ask yourself where you see yourself in five to 10 years. Ascertain your interests— are you more interested in patient care or research? Do you want to pursue clinical or basic science research? Does your ideal career involve working with a specific tumor type such as lung cancer or lymphoma, or in a discipline such as immunology or pharmacology? Most likely you are undecided right now, but identifying your interests can help you determine which mentor may be the best fit.

The next step is to identify potential mentors. Review faculty profiles and read some of their publications. Speak to the senior fellows or junior faculty for recommendations (certain faculty members may have a track record as successful mentors). Look for mentors who have published with current or previous fellows. A mentor who is on the editorial board of a journal is a bonus, but certainly not mandatory. If you are interested in community practice, strongly consider identifying some of the clinical faculty as potential mentors. For those who plan to go into private practice, a community practitioner who is affiliated with an academic institution typically has a keen interest in teaching and can be an outstanding mentor.

There are pros and cons to working with senior versus mid-career versus junior faculty. While senior faculty may have national and international reputations, they likely will have less time to commit to mentoring fellows. Junior faculty members may lack experience and may be more driven in advancing their own careers. Mid-career faculty, then, may be best suited to be mentors.

When I was a fellow, one particular faculty member had at least three fellows and residents under his wing during any given year. Being the fourth or fifth mentee creates a less favorable ratio. A good mentor has sufficient time and interest in your career and is someone you feel comfortable talking to about your career goals.

Finally, make contact with potential mentors. You may be lucky to connect with the perfect mentor during a consult month, clinic assignment, or ward rotation. Otherwise, send an email or call the faculty or his or her administrative assistant. It is a compliment to faculty to hear that you are interested in their research or in rotating through their clinic.

How do I maximize my relationship with my mentor?

As always, communication is paramount and being proactive will enable you to get the most out of your relationship. By mid-fellowship, you should be meeting periodically with your mentor and discussing your career aspirations. Naturally, academic faculty hope that you’ll follow in their footsteps, but are understanding if your interest lies in community practice. In the end, it’s your career and life.

Do you want to publish? If so, discuss your original ideas, but realize that it may be unrealistic to initiate a research study and publish during your fellowship. Ask to be involved in the interpretation of ongoing data and potentially assist in writing the manuscript. Mentors may receive invitations to write case reports or review articles or book chapters. Early in your fellowship, these assignments may be a source of satisfaction and pique your interest in a specific area.

The mentor/mentee relationship is a two-way street. Even if not specifically assigned, volunteer to rotate through your mentor’s clinic a half or full day per week throughout the year if your schedule will allow. While in clinic, be eager to complete dictations or contribute in other ways. These actions can gain your mentor’s favor in the future.

If you realize that you are not working with the right mentor, there’s no need to panic. You may realize that another faculty member’s research or clinical interests mirrors yours more closely. Or, if your mentor is too busy to be involved, you may seek career guidance or mentorship from someone else.

Although I worked with a number of outstanding faculty during my fellowship training, a handful of mentors were key in my career development. A faculty member who was well renowned in an area of my interest initially served as my mentor. When he left our institution during my fellowship, I worked with a non-clinical faculty member doing laboratory research and quickly realized that research was not my calling. Soon after, I picked up several clinical mentors, one of whom had connections with a practice and helped me land a job there immediately after fellowship.

One last bit of advice—maintain communication with your mentors after you’ve finished your fellowship and moved on. After spending five years at my first position, I realized that I wanted to move back to where I trained for family reasons. An unsolicited telephone call from one of my mentors led to an interview with my current practice. Needless to say, I got the job!

John C. Rhee, MD, is an oncologist at UPMC Cancer Centers, Oncology Hematology Associates, in Pittsburgh, Pennsylvania.

This edition of Oncology Fellows is supported by Genentech, a member of the Roche Group.