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Interesting and unexpected things that came up during the process of setting up a mentoring program – an opinion piece
27 February, 2023
I (Martina Zib, Chair, CICM Education Committee) work at the John Hunter Hospital in Newcastle, NSW. What follows are some reflections on the program that we established at our unit. I hope that our experience will be able to inform your journey, should you decide to establish a mentorship program in your unit.
We set up a mentoring program because we wanted to improve support and communication among our medical staff. The COVID strain that all of us have been experiencing focused our efforts, but in truth we had been thinking about a mentorship program for quite some time.
As with all worthwhile endeavours, a lot of time and effort went into our program. There is a wonderful Network of Educators mentoring subgroup and I would encourage all of you to think about joining it. Instead of all independently ‘re-inventing the wheel’, our hope is that we can combine our learning and experience, to move together as whole.
The discussion that is generated by starting something is often as important as getting the initial thing done.
Who needs the support mentorship provides?
We started our paired mentorship program with CICM trainees and specialist intensivists. This was a practical decision because we then were dealing with finite numbers. It was also unconsciously reflective of the fact that much of the welfare and mentoring discussions focus on trainee welfare. This is rightly so, as the process of training is challenging. Many of the difficulties that arise have been navigated by more senior intensivists, who are therefore in a position to advise and support. In addition, trainees have a life outside of work – family and existential issues are often pressing.
Over time, I hope our mentorship program grows to include junior doctors not yet on a training pathway, as well as mentorship for senior doctors themselves. I think that as consultants we need the support of our colleagues. Work does not become easier as you become more senior; the challenges merely change. If we are honest, many of us can recall a time when we would have loved a shoulder to lean on or some wise guidance from someone with a lived experience. Finding that shoulder can be hard when you feel that you need to be outwardly the strong and coping leader.
Senior intensivists who are approaching retirement have a lot of valuable experience, but they are approaching a stage in their career that their experience has not yet prepared them. To whom should they turn? Looking for someone even more senior may not be the answer. If we get mentoring right, then they can support, and be supported by, a junior colleague.
There is no easy way to bring the right people together.
After research and consideration, we decided to pair mentors with mentees, based on what seemed like similar interests and personalities. We hoped to include everyone and hoped to spread the commitment across the groups. Overall, I think this approach worked, but some surprising trends emerged.
Although a group of us put a lot of thought into the pairings, we recognised that we would not always get it right. Therefore, we explicitly set up a ‘no blame’ exit from the pairing, available to both the mentor and the mentee. At any time, either party could contact our unit welfare group or we would re-organise the pairing with no questions asked. We discussed this ‘no blame’ strategy widely during the introductory phase and it was well received. However, some mentees were still reluctant to use it and tried to organise pairings by themselves. The gymnastics the mentees went through; and the embarrassment to all concerned stopped me in my tracks. What was the reason they would not access a simple process set up for them? Had we conditioned our juniors to fear us so much that they were unable to engage? Had I communicated my plan poorly? I do not know the answer. I realised trust and culture change will take time to build.
A number of mentees were very specific about the characteristics they wanted in their mentor – same gender, same age children, same outside interests. This is practically very hard to achieve, but more than that, it made me wonder whether the request was truly for the ‘perfect fit’ or whether it was an expression of wanting to opt out of the mentorship program. Are some people uncomfortable sharing experiences? Did we have the pairings wrong? On the other hand, was the assumption we all would benefit from mentoring incorrect? People have different communication styles and needs, and different levels of comfort with relationships. Maybe this was a reminder for me not to be carried away in my enthusiasm.
The burden of helping a struggling colleague cannot be underestimated.
We are not trained in counselling. We also do not have, nor should we have, a therapeutic relationship with our mentees. We are not equipped to deal safely and effectively with problems such as mental or physical illness. With this in mind, we established a specialist unit welfare interest group to support each other in our mentoring/SOT/education/rostering/welfare advocacy roles. The aim was to decrease the strain that a struggling trainee can inadvertently place on an individual specialist.
I had not anticipated the difficulty, real and perceived, that this shared approach created for confidentiality. Colleagues of mine very reasonably questioned how they could provide a confidential sounding board for a trainee if that trainee knew that they were part of a welfare interest group that included the SOT, for example.
I personally worry about the burden on the individual of guaranteeing and maintaining a priest-like confidentiality. I also understand that confidentiality is just that, confidential. My suggestion was to be clear with mentors and mentees that if a problem seemed to be dangerous, other people would need to know. Has the explicit statement that confidence could be breached made people less likely to confide in their mentors or colleagues? There would be no way in which we could reliably audit that.
We got support from a senior hospital-based psychiatrist to be a contact and resource person should we need urgent psychiatry assistance. She readily agreed, but was surprised I was worried about mentees possibly being in danger. I was surprised that she was surprised! Despite the all-round surprise, we now have a safety net.
We are beginning to put together a library of resources for those interested in mentoring and welfare. The obvious areas we hope to cover are models of mentoring, the difference between coaching and mentoring, red flags to watch out for in your mentees, colleagues, or in yourself.
As doctors, we often fall into the trap of thinking we have to be able to, and can, do everything. This is not true. Medical training does not prepare us for mentoring. Not that that stops us trying, in the same way as we try to manage administration, human resources, conflict resolution, statistics - the list goes on.
I have concerns about the role of our unit welfare advocate and the burden that may accompany it. As a relatively new portfolio, the unit welfare advocate role may often fall to the most recently employed consultant, who is likely to be grappling with all the challenges of being a new consultant. It is clearly an important role, but a potentially complex one. CICM guidelines (IC-31) can form the basis for local programs. Over time, I hope we can more clearly define the role, boundaries and supports that need to be in place for the welfare advocate.
The final observation that has occurred to me while reviewing our mentoring and welfare program is how rarely conflict or problematic behaviour is ‘worked through’. The tendency is to tolerate the conflict until a point is reached when an acrimonious and sudden split occurs, traumatising all concerned. Communication and openness would be the optimal environment for such mediation and resolution to occur. Ultimately, the ideal outcome when introducing a mentoring and a welfare culture is an open and supportive environment where communication across disciplines and hierarchy flourishes.
For more information on the Network of Educators subgroup or on mentorship, please contact
Additional resources can also be found on the
Members Health & Wellbeing section of the website.
I wish you well on your mentorship journey and hope that we can continue to support and learn from one another in the process.
Chair, CICM Education Committee