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Editorials
Whither mentoring in training? Andrew Long In Homer’s poem The Odyssey, ‘Mentor’ was a trusted friend of Odysseus who was charged with caring for his son, Telemachus, when Odysseus departed for the Trojan War. In this role, he served as role model, encourager, counsellor, teacher, guardian, protector and ‘kindly parent’. He was a ‘trusted adviser’, and shared wisdom, challenged and promoted Telemachus’ career and actively engaged him in a deep, personal relationship. In their article, Mellon and MurdochEaton1 draw parallels between the educational supervisor role, which has been brought into sharp focus by new General Medical Council (GMC) Standards,2 and the process of mentorship for doctors in training. Their article highlights the challenges of newer models of training with shorter training in reduced hours, lack of an apprenticeship model and loss of a traditional ‘firm structure’ with opportunities for extended informal observation. They address the potential confusion in nomenclature between ‘clinical’ and ‘educational’ supervision and the responsibility for goal setting and ‘competencebased assessment’. They acknowledge that useful feedback may be compromised by a broad curriculum requirement and greater content expertise. However, the professional development of trainees is dependent on effective educational supervision, and trainees’ value less task-focused supervision and more time available for informal feedback from a trusted, experienced colleague. Much has been written about the importance of good role modelling—appropriate intervention and a supportive learning environment to facilitate a safe environment for patient care and security for doctors in training. It is, therefore, timely that this paper focuses on the development of a Correspondence to Dr Andrew Long, Department of Paediatrics, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; [email protected] 812
mentoring relationship for paediatric trainees and raises the question of whether this role should be separate from a supervisory role. Inevitably, questions are raised about the potential conflict between assessment of performance and judgement of readiness to progress and the ‘non-directive’ approach offered within a classic mentoring relationship. There are undoubted difficulties in the power relationship and the organisational responsibilities, particularly in trainees who are struggling, either due to lack of knowledge or skills or, perhaps more importantly, in communication and team working relationships. Trainees in paediatrics experience a wide range of educational supervisors with different skills and attributes during their period of training.3 Many who undertake such roles are challenged by lack of time within job plans, but other influences (eg, interest, expertise, morale) may lead to a poor trainee– trainer relationship. As a direct result of the GMC Standards, more importance is being attributed to training of educational supervisors, for example, Royal College of Paediatrics and Child Health (RCPCH) Effective Educational Supervision (http://www.rcpch.ac.uk/ events/effective-educational-supervision-3). There is also increasing recognition that some clinicians may take on more educational supervisor responsibility (with appropriate time allocation) with colleagues undertaking more clinical supervision and service-delivery commitment. While it is generally accepted that a mentoring relationship should be ‘mentercentred’ and that the mentees should have freedom of choice in their mentor, this is neither easy nor potentially feasible in the educational supervisor relationship. However, as the authors point out, there is the opportunity for a ‘reciprocal relationship’ with mentees taking the initiative for cultivating the relationship with their mentors. Klaber et al4 describe the
potential use of Egan’s model in assisting trainees to take a lead in developing selfawareness and using feedback on performance constructively. The RCPCH has taken some time and care in developing a mentoring strategy. As discussed in this paper, there is the intention to make mentorship more widely available through regional networks of trained mentors with accredited skills. The RCPCH has used the definition produced by the Standing Committee on Postgraduate Medical Education ‘a process by which an experienced, highly regarded, empathic person (the mentor) guides another individual (the mentee) in the development and re-examination of their own ideas, learning and personal development’. However, there has also been experience of peer mentoring between trainees,5 (incidentally a requirement of the RCPCH curriculum) where the degrees of difference in the level of seniority and experience may not be great; however, the value of shared experiences and ‘signposting’ of resources has been valued by both mentee and mentor. Mellon and Murdoch-Eaton also address the issue of ‘coaching’ as being distinct from mentoring; however, in most large series of mentoring relationships, the differences are not as great in practice as they may appear to be in theory. While mentoring is seen to be non-directive, coaching has a role in specific performance development; however, there is a distinct overlap of the skills and processes as discussed by the authors. Although clarity of purpose and outcomes is essential for a ‘safe’ and effective mentoring relationship, trainees value the wisdom and experiential knowledge of someone who has an understanding of the challenges of a career within their own specialty interest. It is undoubtedly true that those pursuing an academic career path value a supervisory relationship that has a greater coaching element. At a time when the medical profession is coming under increasing scrutiny, with increasing pressure of workload in both the primary and secondary sectors, there is a major challenge in maintaining morale —especially as available resources (time and money) are likely to be in increasingly Arch Dis Child September 2015 Vol 100 No 9
Downloaded from http://adc.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Editorials short supply over the next decade. There is a suggestion that there is a significant attrition with trainees moving to other, perceived ‘less-demanding’ specialties. The paediatric workforce initiative has actively encouraged more flexible working arrangements (less than full-time working, annualised hours); however, it is likely that trainees will both expect and need a mentorship relationship, which is not specifically goal-focused, in order to attract and retain them in a career path, which has an increasingly distant retirement age. It is undoubtedly the case that a mentorship relationship offers a significant advantage when undergoing career transition (eg, becoming a consultant). Many readers will reflect on their own experiences of both being supervised and acting as a supervisor. The qualities and skills offered to Telemachus by his own ‘mentor’ will be familiar to some and alien to many. There is an increasing responsibility on all medical professionals to act as a good role model offering varying degrees of encouragement, counselling and support and using their wisdom to ‘signpost’ information resources as appropriate. Whether the paternalistic nature and ‘deep personal relationship’ are wise or appropriate in the 21st century remains to be
Arch Dis Child September 2015 Vol 100 No 9
questioned; however, there is undoubtedly a measure of career counselling and career support within the job description for the educational supervisor. Mellon and Murdoch-Eaton pose the question of whether supervisors should be mentors or whether the roles should be distinct and separate. As with all complex questions that require a binary answer, there is no right or wrong solution. While the challenges will remain over the power relationship and the need for performance management (including formative assessment), it is certainly true that educational supervisors require a range of skills of which mentoring is one. Whether paediatric trainees require to have another mentor separate from the supervisory relationship will remain personal preference (and need). Systems should encourage the opportunity for trainees to be able to choose freely from someone that has the time, skills and behavioural attributes that support a healthy mentoring relationship. The RCPCH is committed to developing a mentoring network that will allow such relationships to develop and flourish despite (or perhaps because of ) the increasing pressures faced by trainees and their trainers on a daily basis. Twitter Follow Andrew Long at @amlong12
Competing interests I am the RCPCH Lead for mentoring, and I have been a coauthor on one of the papers referenced. Provenance and peer review Commissioned; internally peer reviewed. To cite Long A. Arch Dis Child 2015;100:812–813. Received 14 May 2015 Accepted 23 May 2015 Published Online First 11 June 2015
▸ http://dx.doi.org/10.1136/archdischild-2014-306834 Arch Dis Child 2015;100:812–813. doi:10.1136/archdischild-2015-308628
REFERENCES 1
2
3
4 5
Mellon A, Murdoch-Eaton D. Supervisor or mentor: is there a difference? Implications for paediatric practice Andrew Mellon, Deborah Murdoch-Eaton. Arch Dis Child 2015;100:873–8. General Medical Council. Recognising and approving trainers: the implementation plan. 2012. http://www. gmc-uk.org/Approving_trainers_implementation_plan_ Aug_12.pdf_56452109.pdf (accessed 24 Apr 2015). Lloyd BW, Becker D. Paediatric specialist registrars’ views of educational supervision and how it can be improved: a questionnaire study. J R Soc Med 2007;100:375–8. Klaber RE, Mellon AF, Melville CA. Educational supervision. Arch Dis Child Educ Pract Ed 2010;95:124–30. Eisen S, Sukhani S, Brightwell A, et al. Peer mentoring: evaluation of a novel programme in paediatrics. Arch Dis Child 2014;99:142–6.
813
Downloaded from http://adc.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Whither mentoring in training? Andrew Long Arch Dis Child 2015 100: 812-813 originally published online June 11, 2015
doi: 10.1136/archdischild-2015-308628 Updated information and services can be found at: http://adc.bmj.com/content/100/9/812
These include:
References Email alerting service
This article cites 4 articles, 4 of which you can access for free at: http://adc.bmj.com/content/100/9/812#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
Editorials
Whither mentoring in training? Andrew Long In Homer’s poem The Odyssey, ‘Mentor’ was a trusted friend of Odysseus who was charged with caring for his son, Telemachus, when Odysseus departed for the Trojan War. In this role, he served as role model, encourager, counsellor, teacher, guardian, protector and ‘kindly parent’. He was a ‘trusted adviser’, and shared wisdom, challenged and promoted Telemachus’ career and actively engaged him in a deep, personal relationship. In their article, Mellon and MurdochEaton1 draw parallels between the educational supervisor role, which has been brought into sharp focus by new General Medical Council (GMC) Standards,2 and the process of mentorship for doctors in training. Their article highlights the challenges of newer models of training with shorter training in reduced hours, lack of an apprenticeship model and loss of a traditional ‘firm structure’ with opportunities for extended informal observation. They address the potential confusion in nomenclature between ‘clinical’ and ‘educational’ supervision and the responsibility for goal setting and ‘competencebased assessment’. They acknowledge that useful feedback may be compromised by a broad curriculum requirement and greater content expertise. However, the professional development of trainees is dependent on effective educational supervision, and trainees’ value less task-focused supervision and more time available for informal feedback from a trusted, experienced colleague. Much has been written about the importance of good role modelling—appropriate intervention and a supportive learning environment to facilitate a safe environment for patient care and security for doctors in training. It is, therefore, timely that this paper focuses on the development of a Correspondence to Dr Andrew Long, Department of Paediatrics, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3JH, UK; [email protected] 812
mentoring relationship for paediatric trainees and raises the question of whether this role should be separate from a supervisory role. Inevitably, questions are raised about the potential conflict between assessment of performance and judgement of readiness to progress and the ‘non-directive’ approach offered within a classic mentoring relationship. There are undoubted difficulties in the power relationship and the organisational responsibilities, particularly in trainees who are struggling, either due to lack of knowledge or skills or, perhaps more importantly, in communication and team working relationships. Trainees in paediatrics experience a wide range of educational supervisors with different skills and attributes during their period of training.3 Many who undertake such roles are challenged by lack of time within job plans, but other influences (eg, interest, expertise, morale) may lead to a poor trainee– trainer relationship. As a direct result of the GMC Standards, more importance is being attributed to training of educational supervisors, for example, Royal College of Paediatrics and Child Health (RCPCH) Effective Educational Supervision (http://www.rcpch.ac.uk/ events/effective-educational-supervision-3). There is also increasing recognition that some clinicians may take on more educational supervisor responsibility (with appropriate time allocation) with colleagues undertaking more clinical supervision and service-delivery commitment. While it is generally accepted that a mentoring relationship should be ‘mentercentred’ and that the mentees should have freedom of choice in their mentor, this is neither easy nor potentially feasible in the educational supervisor relationship. However, as the authors point out, there is the opportunity for a ‘reciprocal relationship’ with mentees taking the initiative for cultivating the relationship with their mentors. Klaber et al4 describe the
potential use of Egan’s model in assisting trainees to take a lead in developing selfawareness and using feedback on performance constructively. The RCPCH has taken some time and care in developing a mentoring strategy. As discussed in this paper, there is the intention to make mentorship more widely available through regional networks of trained mentors with accredited skills. The RCPCH has used the definition produced by the Standing Committee on Postgraduate Medical Education ‘a process by which an experienced, highly regarded, empathic person (the mentor) guides another individual (the mentee) in the development and re-examination of their own ideas, learning and personal development’. However, there has also been experience of peer mentoring between trainees,5 (incidentally a requirement of the RCPCH curriculum) where the degrees of difference in the level of seniority and experience may not be great; however, the value of shared experiences and ‘signposting’ of resources has been valued by both mentee and mentor. Mellon and Murdoch-Eaton also address the issue of ‘coaching’ as being distinct from mentoring; however, in most large series of mentoring relationships, the differences are not as great in practice as they may appear to be in theory. While mentoring is seen to be non-directive, coaching has a role in specific performance development; however, there is a distinct overlap of the skills and processes as discussed by the authors. Although clarity of purpose and outcomes is essential for a ‘safe’ and effective mentoring relationship, trainees value the wisdom and experiential knowledge of someone who has an understanding of the challenges of a career within their own specialty interest. It is undoubtedly true that those pursuing an academic career path value a supervisory relationship that has a greater coaching element. At a time when the medical profession is coming under increasing scrutiny, with increasing pressure of workload in both the primary and secondary sectors, there is a major challenge in maintaining morale —especially as available resources (time and money) are likely to be in increasingly Arch Dis Child September 2015 Vol 100 No 9
Downloaded from http://adc.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Editorials short supply over the next decade. There is a suggestion that there is a significant attrition with trainees moving to other, perceived ‘less-demanding’ specialties. The paediatric workforce initiative has actively encouraged more flexible working arrangements (less than full-time working, annualised hours); however, it is likely that trainees will both expect and need a mentorship relationship, which is not specifically goal-focused, in order to attract and retain them in a career path, which has an increasingly distant retirement age. It is undoubtedly the case that a mentorship relationship offers a significant advantage when undergoing career transition (eg, becoming a consultant). Many readers will reflect on their own experiences of both being supervised and acting as a supervisor. The qualities and skills offered to Telemachus by his own ‘mentor’ will be familiar to some and alien to many. There is an increasing responsibility on all medical professionals to act as a good role model offering varying degrees of encouragement, counselling and support and using their wisdom to ‘signpost’ information resources as appropriate. Whether the paternalistic nature and ‘deep personal relationship’ are wise or appropriate in the 21st century remains to be
Arch Dis Child September 2015 Vol 100 No 9
questioned; however, there is undoubtedly a measure of career counselling and career support within the job description for the educational supervisor. Mellon and Murdoch-Eaton pose the question of whether supervisors should be mentors or whether the roles should be distinct and separate. As with all complex questions that require a binary answer, there is no right or wrong solution. While the challenges will remain over the power relationship and the need for performance management (including formative assessment), it is certainly true that educational supervisors require a range of skills of which mentoring is one. Whether paediatric trainees require to have another mentor separate from the supervisory relationship will remain personal preference (and need). Systems should encourage the opportunity for trainees to be able to choose freely from someone that has the time, skills and behavioural attributes that support a healthy mentoring relationship. The RCPCH is committed to developing a mentoring network that will allow such relationships to develop and flourish despite (or perhaps because of ) the increasing pressures faced by trainees and their trainers on a daily basis. Twitter Follow Andrew Long at @amlong12
Competing interests I am the RCPCH Lead for mentoring, and I have been a coauthor on one of the papers referenced. Provenance and peer review Commissioned; internally peer reviewed. To cite Long A. Arch Dis Child 2015;100:812–813. Received 14 May 2015 Accepted 23 May 2015 Published Online First 11 June 2015
▸ http://dx.doi.org/10.1136/archdischild-2014-306834 Arch Dis Child 2015;100:812–813. doi:10.1136/archdischild-2015-308628
REFERENCES 1
2
3
4 5
Mellon A, Murdoch-Eaton D. Supervisor or mentor: is there a difference? Implications for paediatric practice Andrew Mellon, Deborah Murdoch-Eaton. Arch Dis Child 2015;100:873–8. General Medical Council. Recognising and approving trainers: the implementation plan. 2012. http://www. gmc-uk.org/Approving_trainers_implementation_plan_ Aug_12.pdf_56452109.pdf (accessed 24 Apr 2015). Lloyd BW, Becker D. Paediatric specialist registrars’ views of educational supervision and how it can be improved: a questionnaire study. J R Soc Med 2007;100:375–8. Klaber RE, Mellon AF, Melville CA. Educational supervision. Arch Dis Child Educ Pract Ed 2010;95:124–30. Eisen S, Sukhani S, Brightwell A, et al. Peer mentoring: evaluation of a novel programme in paediatrics. Arch Dis Child 2014;99:142–6.
813
Downloaded from http://adc.bmj.com/ on November 17, 2015 - Published by group.bmj.com
Whither mentoring in training? Andrew Long Arch Dis Child 2015 100: 812-813 originally published online June 11, 2015
doi: 10.1136/archdischild-2015-308628 Updated information and services can be found at: http://adc.bmj.com/content/100/9/812
These include:
References Email alerting service
This article cites 4 articles, 4 of which you can access for free at: http://adc.bmj.com/content/100/9/812#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
