Surgical Mentorship for Next Generation Is Changing

In the 18th and early 19th centuries, the art of medicine and surgery was passed on through a close apprenticeship model, with students modeling their own practice after that of a trusted advisor and teacher. As the field of medicine moved into the modern era (early 1900s) and education became more formalized, physicians—including William Osler, MD, and former ACS President Harvey Cushing, MD, FACS—advocated for a mentor-mentee relationship to maintain the benefits of the ancient apprenticeship model.¹

Traditionally, mentorship was viewed as a one-way downstream effort from a senior mentor to a junior mentee (see Figure 1). Fortunately, the changing landscape of healthcare has created new opportunities for collaboration and partnership at different career stages.

Between 2001 and 2009, the number of surgeons who reported having their own self-employed practices decreased from 48% to 33%, and the majority of surgeons are now employed in large group practices or as full-time hospital employees.² Additionally, subspecialty training is a reality for the majority of surgeons entering practice, particularly at academic centers.

Against this backdrop of a changing medical landscape, surgical trainees today also have more demands on their time than ever before, from clinical duties to increasing administrative burden and time spent on electronic health records, to growing pressure to be productive in research, not to mention time spent fulfilling personal and familial obligations.

Given that mentors may have an enormous influence on a resident’s specialty choice, professional niche, and well-being, it is important to pay closer attention to how we form and maintain these relationships.

As newer cohorts of medical students and residents begin to enter the workforce, it is becoming more apparent that generational differences affect medical education, workplace dynamics, and interpersonal relationships. Changes in medical school curricula, including a focus on competency-based education and flexible learning, have made their way into graduate medical training.

Trainees today place a higher emphasis on individual learning styles and preferences, and greater transparency. One study investigating Millennials and Generation Z trainees found that not only are newer generations more collaborative and optimistic than previous generations, but they also are more likely to desire clearly defined expectations with structured approaches to training.³ This desire for clearly defined roles and expectations must be addressed in the mentor-mentee relationship, as well.

A recent survey of medical students posed the following question, “What do you want from a mentor?” The responses included general career guidance, encouragement, networking opportunities, and research expertise—all demonstrating the range of mentoring preferences in students.⁴ This wide variety of needs may be best addressed by different mentors.

In an opinion piece published in the Journal of the American Medical Association, four mentor archetypes are outlined to help mentees succeed in academic medicine.⁵ While these models may be broadly applicable to trainees at all stages, surgical trainees experience a unique type of training. Growing demands on their time require a careful and deliberate crafting of a career that the mentee finds meaningful. Identifying what is meaningful for a surgical trainee is often a difficult and ongoing process, and one in which the mentor may play a key part.

With this in mind, it is important to clearly delineate one’s role in the mentor-mentee relationship. The following sections describe four key mentor roles for surgeons (see Figure 2).

Four Mentorship Styles for Surgical Trainees 

Cheerleader

The cheerleader may be thought of as a professional support system. This approach features a mentor who supports the mentee emotionally throughout their journey. The cheerleader has a willingness to share both positive and negative personal and professional experiences in order to provide a safe and comfortable environment where mentees can express themselves without fear of punishment or judgment.

Previous work has described the importance of finding the “right chemistry” (a mutual connection) in order to foster successful mentorship relationships.⁶ While this concept is important in all professional relationships, the idea of chemistry is perhaps most important in this mentor type.

In addition to providing the mentee with encouragement, the cheerleader may assist in identifying strengths and weaknesses, providing tools for improvement, and encouraging the mentee’s drive toward and focus on their career.

“The key is finding someone who cares about you, and therefore, genuinely prompts and challenges you,” said Jose Prince, MD, FACS, surgeon-in-chief at Cohen Children’s Medical Center in Queens, New York, and current President of the Brooklyn-Long Island ACS Chapter.

Though the cheerleader role can be adopted at any stage in one’s career, closeness in age and life experience may enable a personal connection. Therefore, for the junior resident for example, the cheerleader is most likely to be a junior faculty member, while for the medical student interested in surgery, the cheerleader might be a resident who can provide encouragement and perspective.

Advisor

The advisor is most closely aligned with the traditional mentor role. These individuals have professional experiences and resources to help guide mentees in their career trajectory, aid in scholarly work, and point them toward new career opportunities.

The advisor has a strong understanding of the mentee’s professional potential and helps the mentee identify professional goals. The relationship between the advisor and the mentee may be unidirectional, with advice and guidance coming primarily from the mentor to the mentee. The relationship with an advisor should entail specific and measurable goals and learning outcomes, with regular review of timelines within the mentoring process.

Dr. Prince shares some ways in which mentors can take on the advisor role: “The advisor should really help the mentee answer the question ‘who am I?’ There are many ways to approach this. What kind of surgeon do you want to be? Can you handle the unknown, or do you need to have a plan in the OR? Do you want to be a generalist or a specialist? The advisor should help map out different ways to think about the decisions that a mentee needs to make.”

Coach

The coach is a mentor who can help improve the mentee’s technical skills and expand his or her knowledge base. While research in this field is still developing, early work shows that coaching has the potential to improve performance and overall well-being.

Coaching offers the opportunity to individualize teaching and instruction based on the style and preference of the coach and mentee. As coaches provide short-term or singular guidance, they may have many mentees, and vice versa; a mentee may have many coaches.

“As a coach, even if your time with your mentee is short, setting clear expectations helps orient your mentee and figure out what their goals should be during your time together,” said Susana Benitez Sanchez, MD, chief resident at Long Island Jewish Medical Center/Northwell Health in New York. “This helps build an atmosphere of open communication and ensures both coach and mentee are working toward the same endpoint.”

For residents, the coach often will be a more senior resident or faculty member who does not necessarily have the time to devote to a long-term relationship but can provide immediate feedback. Examples include senior residents teaching junior residents how to suture, perform a hand-sewn bowel anastomosis, or complete a complex surgical consultation.

For medical students, surgical residents may be the most appropriate type of coach, both for teaching technical skills such as suturing, as well as sharing knowledge on logistical and institutional processes.

Sponsor

The sponsor is a mentor who provides important networking opportunities, is able to facilitate professional relationships, and can introduce the mentee into different academic circles. The experience and connections come into play when speaking on the mentee’s behalf to committees and organizations and introducing them to new career opportunities.

The sponsor, unlike the cheerleader or advisor, may not be involved in the day-to-day life of the mentee; rather, a sponsor helps oversee the mentee’s broad career trajectory.

For residents, sponsors should be leaders in their field, such as a department chair or institute director, who can use influence and position to propel mentees to the next stage of their career.

For medical students, a sponsor may not necessarily be a national leader in the field but should be in a leadership position within the institution. This might include a department chair, surgical residency program director, or dean of the medical school. Ideally, the sponsor also will have a large professional network to connect students with faculty in different fields for shadowing, research, or clinical opportunities.

Growing Your Mentor Network

Often, mentorship is informal in surgical training and may be sporadic as schedules are difficult to align and trainees and faculty have shifting responsibilities. A recent editorial in The American Journal of Surgery outlines strategies for identifying a mentor at different stages of training.⁷

The authors suggest that in order to form meaningful mentorship relationships, medical students should “contact residents, junior faculty, and more senior faculty from different specialties they are interested in pursuing. While the initial introductions might occur during a clinical rotation or by email, arranging a follow-up meeting is critical to solidifying the mentoring relationship.”

For residents, the authors suggest that “strategic mentors are the foundation for future professional growth and will most likely require an active effort as they arise from both internal and external connections within and outside the field.” Much of this advice also may be incorporated by early career faculty.

However, maintaining a diverse mentor network requires an additional step: Assessing one’s professional needs and identifying potential mentors whose strengths align with those needs. By carefully considering the four mentor roles and one’s own personal learning style and growth needs, mentees can successfully grow their mentor network.

Women and Underrepresented Minorities in Surgery

It has been well established that disparities in academic medicine often are linked to ineffective mentorship and sponsorship at multiple levels.^8,9

Unconscious bias and stereotypical thinking by mentors and colleagues may pose additional barriers for women and those underrepresented in medicine (URiM) who are frequently passed over for job opportunities in favor of their white male counterparts.¹⁰ Acknowledgment of this unconscious bias is crucial, as mentors for surgical trainees often play a significant role in career advancement of the mentee. Additionally, it is important for leaders in the field to seek out mentees from a diverse range of backgrounds.

“With an increasing diversity of faculty, it is now easier to find a good fit for a broad variety of mentees,” explained Laura Hansen, MD, FACS, assistant professor of surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, and a junior faculty member with a strong record of mentorship. “For me, having a female surgeon as a mentor who, like me, had children during training, helped me navigate different aspects of my career at different times. I wouldn’t have received that advice from someone who hadn’t faced similar challenges.”

To help promote success for women and URiM trainees on a larger level, institutions and programs could consider measuring and compensating faculty members who engage in mentorship and serve as advocates for trainees, as well as implementing institutional policies to address structural barriers.

Dr. Shruti Koti is a postgraduate year 4 (PGY4) categorical general surgery resident currently on her 2-year professional development time in conjunction with Cold Spring Harbor Laboratory and the Northwell Health Cancer Institute in New Hyde Park, NY.

Dr. Jennifer Xie is a PGY4 categorical general surgery resident at Northwell Health Long Island Jewish Medical Center in New Hyde Park, NY. Drs. Koti and Xie are active members of the Residents-as-Teachers Committee in their training program.

Maya Chopra is a third-year medical student at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, NY.

Dr. Vihas Patel is an acute care surgeon at Northwell Health Long Island Jewish Medical Center and vice chair for academic affairs at the Northwell Health Department of Surgery in New Hyde Park, NY. She also is an associate professor of surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

References

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9. Westring AF, Sammel MD, Speck RM, Tuton LW, et al. Career trajectories of women from underrepresented minority groups at an academic medical center. JAMA Netw Open. 2021;4(3):e212723.
10. Kaatz A, Carnes M. Stuck in the out-group: Jennifer can’t grow up, Jane’s invisible, and Janet’s over the hill. J Womens Health (Larchmt). 2014 Jun;23(6):481-484.