when i say When I say . . . mentoring Mayur Lakhani
Medicine is a stressful profession. Orton et al.1 showed high levels of burnout in a census survey of general practitioners, in which 46% of respondents reported emotional exhaustion. Mentoring is often cited as an important support mechanism for doctors and it may be particularly applicable at a time of great change and distress in the National Health Service (NHS). So would it help? That depends on what you mean by mentoring! Misunderstandings about mentoring are rife. Mentoring means different things to different people. The language used to describe the concept is problematic: terms such as ‘mentoring’, ‘coaching’, ‘clinical supervision’ and ‘appraisal’ are used interchangeably. Moreover, there is no easy way to access mentoring in the NHS. If the term ‘mentoring’ is used loosely, it can cause significant practical problems and lead to frustration and confusion in terms of expectations for all concerned. For instance, take the common example of the junior doctor (the ‘mentee’) who asks a consultant to be her ‘mentor’ for her chosen career path. The mentor is regarded as a ‘father figure’ or ‘guru’ who is expected to come up with solutions and answers to the mentee’s problems. This is not what I mean by mentoring! Take another common scenario: a doctor is identified through appraisal as performing poorly. His employer insists on appointing a ‘mentor’ as this doctor is subject to a rising number of patient complaints. In this case, ‘mentor’ turns out to be a code word for someone who is tasked with keeping an eye on the doctor on the employer’s behalf. This is not what I mean by mentoring! This is not a
Loughborough, UK Medical Education 2015: 49: 757–758 doi: 10.1111/medu.12737
confidential relationship! Nor is its purpose to help the doctor improve. These are examples of ‘toxic mentoring’. So, when I say mentoring, I mean an activity that is based on ‘learning relationships, which help people to take charge of their own development, to release their potential and to achieve results which they value’.2 I appreciate this definition because it emphasises that the agenda is set by the mentee and focuses on his or her development using educational principles. The purpose of the mentor is then to facilitate change that would not otherwise occur and to enable the mentee to be resourceful. Change is an important outcome in mentoring. This definition also recognises the pivotal importance of the mentoring relationship. This means that it should be based on adult-to-adult conversations that are confidential, non-judgemental and mentee-centred. It requires the highest level of empathy and trust. Mentoring requires a high level of self-awareness and insight on the part of the mentor. A set of principles2 and a competency framework3 for mentoring have been developed. These principles focus on learning, development, outcomes, the change process, the qualities and skills of the mentor, and ethical safeguards.2 Mentoring, like a medical intervention, requires training and an appreciation of benefits, side-effects and complications. A framework such as Egan’s skilled helper model is frequently used.4 This is a three-stage model involving, respectively, ascertainment of the current scenario, the determination of
Correspondence: Mayur Lakhani, Highgate Medical Centre, General Practice, 5 Storer Close, Sileby, Loughborough LE12 7UD, UK. Tel: 00 44 1509 816364; E-mail: [email protected]
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 757–758
757
M Lakhani a preferred future scenario, and the development of strategies for action. This requires using higherorder communication skills, such as active listening, and specific techniques, such as brainstorming and forcefield analysis. Understanding mentoring better is about more than just semantics. The stakes are high. For example, it was reported that poor mentoring contributed to infant deaths after cardiac surgery at the John Radcliffe Hospital in Oxford.5 Hence, getting the meanings and definitions right matters. All institutions should take note that mentoring is not about performance management. For mentoring to be successful, there must also be a supportive and facilitative environment within the institution.6 There should be a move away from a one-way teacher– pupil relationship to a mentee-centred learning relationship. Mentoring can be a powerful force for good, but only if it is implemented correctly. Done well, mentoring can improve productivity, reduce stress and contribute to improvements in patient care.
758
REFERENCES 1 Orton P, Orton C, Pereira Gray D. Depersonalised doctors: a cross-sectional study of 564 doctors, 760 consultations and 1876 patient reports in UK general practice. BMJ Open 2012;2:e000274. 2 Connor M, Pokora J. Coaching and Mentoring at Work. Developing Effective Practice. Maidenhead: Open University Press 2007. 3 European Mentoring and Coaching Council. Competency Framework. 2009. http:// www.emccouncil.org/webimages/EU/EQA/ EMCC_EQA_Competency_Framework.pdf. [Accessed 23 January 2015.] 4 Egan G. The Skilled Helper. A Problem-Management and Opportunity-Development Approach to Helping, 10th edn. Belmont, CA: Brooks Cole 2013. 5 Carlowe J. Poor mentoring is blamed for infant deaths after cardiac surgery at John Radcliffe hospital. BMJ 2010;341:c4157. 6 Sambunjak D, Straus S, Marusic A. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J Gen Intern Med 2010;25:72–8. Received 18 October 2014; editorial comments to author 19 December 2014, accepted for publication 17 February 2015
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 757–758
Medicine is a stressful profession. Orton et al.1 showed high levels of burnout in a census survey of general practitioners, in which 46% of respondents reported emotional exhaustion. Mentoring is often cited as an important support mechanism for doctors and it may be particularly applicable at a time of great change and distress in the National Health Service (NHS). So would it help? That depends on what you mean by mentoring! Misunderstandings about mentoring are rife. Mentoring means different things to different people. The language used to describe the concept is problematic: terms such as ‘mentoring’, ‘coaching’, ‘clinical supervision’ and ‘appraisal’ are used interchangeably. Moreover, there is no easy way to access mentoring in the NHS. If the term ‘mentoring’ is used loosely, it can cause significant practical problems and lead to frustration and confusion in terms of expectations for all concerned. For instance, take the common example of the junior doctor (the ‘mentee’) who asks a consultant to be her ‘mentor’ for her chosen career path. The mentor is regarded as a ‘father figure’ or ‘guru’ who is expected to come up with solutions and answers to the mentee’s problems. This is not what I mean by mentoring! Take another common scenario: a doctor is identified through appraisal as performing poorly. His employer insists on appointing a ‘mentor’ as this doctor is subject to a rising number of patient complaints. In this case, ‘mentor’ turns out to be a code word for someone who is tasked with keeping an eye on the doctor on the employer’s behalf. This is not what I mean by mentoring! This is not a
Loughborough, UK Medical Education 2015: 49: 757–758 doi: 10.1111/medu.12737
confidential relationship! Nor is its purpose to help the doctor improve. These are examples of ‘toxic mentoring’. So, when I say mentoring, I mean an activity that is based on ‘learning relationships, which help people to take charge of their own development, to release their potential and to achieve results which they value’.2 I appreciate this definition because it emphasises that the agenda is set by the mentee and focuses on his or her development using educational principles. The purpose of the mentor is then to facilitate change that would not otherwise occur and to enable the mentee to be resourceful. Change is an important outcome in mentoring. This definition also recognises the pivotal importance of the mentoring relationship. This means that it should be based on adult-to-adult conversations that are confidential, non-judgemental and mentee-centred. It requires the highest level of empathy and trust. Mentoring requires a high level of self-awareness and insight on the part of the mentor. A set of principles2 and a competency framework3 for mentoring have been developed. These principles focus on learning, development, outcomes, the change process, the qualities and skills of the mentor, and ethical safeguards.2 Mentoring, like a medical intervention, requires training and an appreciation of benefits, side-effects and complications. A framework such as Egan’s skilled helper model is frequently used.4 This is a three-stage model involving, respectively, ascertainment of the current scenario, the determination of
Correspondence: Mayur Lakhani, Highgate Medical Centre, General Practice, 5 Storer Close, Sileby, Loughborough LE12 7UD, UK. Tel: 00 44 1509 816364; E-mail: [email protected]
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 757–758
757
M Lakhani a preferred future scenario, and the development of strategies for action. This requires using higherorder communication skills, such as active listening, and specific techniques, such as brainstorming and forcefield analysis. Understanding mentoring better is about more than just semantics. The stakes are high. For example, it was reported that poor mentoring contributed to infant deaths after cardiac surgery at the John Radcliffe Hospital in Oxford.5 Hence, getting the meanings and definitions right matters. All institutions should take note that mentoring is not about performance management. For mentoring to be successful, there must also be a supportive and facilitative environment within the institution.6 There should be a move away from a one-way teacher– pupil relationship to a mentee-centred learning relationship. Mentoring can be a powerful force for good, but only if it is implemented correctly. Done well, mentoring can improve productivity, reduce stress and contribute to improvements in patient care.
758
REFERENCES 1 Orton P, Orton C, Pereira Gray D. Depersonalised doctors: a cross-sectional study of 564 doctors, 760 consultations and 1876 patient reports in UK general practice. BMJ Open 2012;2:e000274. 2 Connor M, Pokora J. Coaching and Mentoring at Work. Developing Effective Practice. Maidenhead: Open University Press 2007. 3 European Mentoring and Coaching Council. Competency Framework. 2009. http:// www.emccouncil.org/webimages/EU/EQA/ EMCC_EQA_Competency_Framework.pdf. [Accessed 23 January 2015.] 4 Egan G. The Skilled Helper. A Problem-Management and Opportunity-Development Approach to Helping, 10th edn. Belmont, CA: Brooks Cole 2013. 5 Carlowe J. Poor mentoring is blamed for infant deaths after cardiac surgery at John Radcliffe hospital. BMJ 2010;341:c4157. 6 Sambunjak D, Straus S, Marusic A. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J Gen Intern Med 2010;25:72–8. Received 18 October 2014; editorial comments to author 19 December 2014, accepted for publication 17 February 2015
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 757–758
