A small audience of healthcare providers gathered in a theater on West 27th Street for a private performance of the one-man play, Side Effects, written and performed by Michael Milligan. My closest friend from medical school sat to my right. The house lights cut to black. For the next hour, Milligan's character—a primary care doctor and heir to his father's practice—eerily reenacted the frustrations of being an American physician. He exuded his resentment toward the larger healthcare system; his exhaustion; and his sense of helplessness and the consequent alienation from his patients, loved ones, and ultimately himself. Milligan's character was a tragic archetype who hit a little too close to home for many of us. When the house lights came on, we sat tearful and stunned. During the Q&A, a commonality emerged. No one needed a theatrical performance to watch a physician worry about his marriage or hear whispers about a colleague's leave of absence for a "mental health emergency." The burnout epidemic in healthcare is well-documented across all levels of clinicians, not only experienced doctors but interns as well. As attending physicians and residents navigate the choppy waters of modern healthcare, how can trainees best rely on their mentors for guidance about burnout prevention? The role of "mentor" within medicine is evolving. Today's doctors cannot simply mimic the teaching styles of their mentors who preceded them. As Wilkes and Feldman wrote in their January Lancet article, "Mentoring Clinical Trainees: A Need for High Touch"[1]: Typically, a trainee engaged in book learning and progressive clinical responsibilities until the senior physician was confident that the trainee was capable of providing patient care independently. This transfer of knowledge and skills was expected to take place through an apprenticeship-like arrangement between the senior clinician and his or her trainee, a relationship we would now recognise as mentoring. Before the past decade, mentorship was not explicitly taught or articulated; there was an assumption that this relationship was mutually beneficial and arose naturally. They go on to describe the current state of affairs. Trainees have limited time to develop strong mentor-mentee relationships. Yet, their needs now extend beyond clinical learning; they also need to create the emotional capacity to do their work. Given the constraints around mentorship, alongside the necessity for it, here are some steps to cultivate a supportive mentor-mentee relationship during your training. Although much of this advice is specific to trainees and young doctors, some of it applies to clinicians at all levels. Step One: Choosing Your Mentor As Wilkes and Feldman mention, in the past, the mentoring relationship arose naturally. Nowadays, many residency programs have a faculty mentoring system in place. The matchmaking process varies widely across programs. In some cases, preceptors are assigned to mentees during the onboarding process. In other cases, a resident identifies a research mentor during intern year. Whether assigned or chosen, successful mentors have four general qualities: The mentee wants to emulate them; The mentor is approachable and trustworthy; The mentor can, wants to, and will help the mentee; and The mentor makes himself or herself available to their mentee and is responsive. Trainees tend to gravitate toward mentors who seem familiar, whether it be because they share an alma mater, come from the same hometown, or have a cultural connection. Relatability is extremely valuable, regardless of the specific commonality. It helps the mentee envision herself in her mentor's shoes one day. Meanwhile, the mentor may have a more holistic context for the mentee's goals and factors that play a role in potential burnout. Finally, many interns are tempted to pursue mentors based on a professional rank or academic achievement. Those connections have obvious potential advantages. Nonetheless, the value of your mentee experience—and the quality of what you get out of it—is rooted more deeply in the mentor-mentee relationship than in prestige by association. Step Two: Building the Relationship The time constraints that lead to burnout are, ironically, the exact reason you must devote time to create a valuable relationship with your mentor. Consider it an investment in self-care and endurance and, therefore, a priority. Face time with your mentor might happen easily, without intentionally scheduling "mentor time." Your mentor may be your research advisor or an attending with whom you work often. Even with plenty of contact, designating time to "check in" every so often—and more frequently when you sense burnout creeping in—is important. Some people make this a ritual, such as once a month, to guarantee that it happens. These moments are essential to creating a strong relationship as they afford you the space to reflect on any recent challenges without the hurricane of hospital duties swirling around you both. Step Three: Asking for What You Need Your mentor is not your therapist. However, they are a resource to help you thrive. As noted by Wilkes and Feldman, residency faculty members are not always given formal training on how to mentor. On that account, telling your mentor when the demands of residency outweigh your reserve to cope with them is important. A framework of burnout was delineated by Dunn and colleagues[2] in their article, "A Conceptual Model of Medical Student Well-Being: Promoting Resilience and Preventing Burnout." Your mentor is your advisor. Dunn and colleagues cite mentorship as a "replenishing factor" for the "coping reservoir," alongside psychological support, social activities, and intellectual stimulation. The authors recommend frank discussions about work-life balance; the mentee may even ask about the mentor's own experience. As the article states, "We would argue that some degree of personal self-disclosure (ie, discussing one's internal experiences along the route of medical training, describing one's own methods of dealing with competing demands) is not only appropriate but beneficial." Your mentor is your teacher. Mentors can clarify gaps in medical knowledge and instruct on improving clinical skills. Gaining mastery is not only practical. For many residents, it relieves performance anxiety that contributes to burnout and builds confidence. Your mentor is your advocate, which is perhaps most important of all. Good mentors do not just provide an ear to listen. They can act as a microphone to amplify your voice. As is apparent by the epidemic proportions of burnout, several systemic factors are at play. In especially malignant environments (ie, work-hour violations, disproportionate amounts of scut work, breaches in ethical conduct), residents should not be blamed for their burnout any more than the lung of a smoker can be blamed for its emphysematous tissue. Disclosure of environmental contributors to burnout enables mentors to raise concerns with hospital administration—a step towards creating a healthier workplace for you and your colleagues. Step Four: Dos and Don'ts In a recent segment of JAMA's "A Piece of My Mind—Mentee Missteps," by Vaughn and colleagues, six archetypes of bad mentees were described.[3]Here are a few mentee behaviors to avoid, followed by some important things to keep in mind. Do Not Overcommit; Avoid confrontation; Do unnecessary menial work in order to please your mentor; Send countless emails, text messages, and meeting requests; Be overly confident, appearing to not need or want a mentor; or Backstab co-residents to appear competent while avoiding responsibility. Do Express gratitude to your mentor; Communicate honestly and directly about your goals; Reach out for specific well-thought-out reasons; and Recognize when you need to improve clinically and ask for help. Although the danger of burnout remains, and no one solution can prevent it altogether, having a quality mentor-mentee relationship may just make a major difference. Source
