Thursday, November 20, 2014

The Year of Mentorship

by Betsy Tuttle-Newhall, MD, FACS

As we start a new year of eConnections, and continuation of the mission of the Association of Women Surgeons (AWS) Foundation, the members of the Foundation Board want to dedicate this year of fundraising in honor of Mentors and the Concept of Mentorship.  The overall mission of the AWS Foundation is to provide opportunities for the educational and professional growth of women in Surgery. Many of the signature programs of the AWS are supported by the Foundation including the Kim Ephgrave Visiting Professor program as well as several national awards including the Nina Starr Brunwald Award, Olga Jonassan Distinguished Member Award, Honorary Member Award, Hilary Sanfey Outstanding Resident Award and the Patricia Numann Medical Student Award. The Foundation also supports the Resident and Poster Competition at the Annual AWS meeting to encourage and facilitate interaction between students and residents training in Surgery. The Foundation was started in 1996, and has provided many of the AWS members ways to heighten their visibility and created advancement opportunities. The Foundation and its board have been and continue to be the “mentor” organization for the AWS.

What is mentor? What is mentorship? And why is this important? A mentor is defined as a “wise and trusted teacher, an influential sponsor or supporter”. Many of us during our careers have benefited from people who have taught us, encouraged us and supported us during specific or all phases of our careers. Mentors are often responsible for bringing Surgery to our attention when we are students. They are also responsible for teaching trainees, especially in Surgery, those lessons that are not described in a text or journal article- lessons in such things as rules of surgical culture, compassion, professionalism, communication skills, and ethics.   They also knowingly or unknowingly teach us about personal matters, and self-preservation or lack thereof. Mentors are responsible for teaching us, often lessons that are transferred across generations.

"Mentoring is to support and encourage people to manage their own learning in order that they may maximize their potential, develop their skills, improve their performance and become the person they want to be." Eric Parsloe, the Oxford School of Coaching & Mentoring

There are many ways to mentor- formally via programs in your institution or via society programs such as the American College of Surgeons, or informally, by establishing a relationship to support a trainee or trainees in professional or educational matters. Mentorship relationships can involve formally assigning a faculty member to a trainee, and setting up a schedule for meetings, for adequate time to discuss issues. As for the trainee, there are many themes in a mentor-mentee relationship. These can include issues of the mentor being the professional role model, being compassionate and supportive, acting as a critic or a career counselor. Mentees often need specific goals for their relationships with mentors and they need to appreciate that their goals and expectations must be kept in the context of their training program and their expected level of professional performance.
There are many difficulties in establishing a successful mentor and mentee relationship. The most prevalent barrier to this relationship is lack of time. Mentors are often overcommitted with busy clinical or academic schedules, and trainees have their own time limitations with training hour restrictions and mandatory lectures and labs. Scheduling time in advance and scheduling those meetings at regular intervals can help make these meetings a priority for everyone involved. Secondly, there are often a limited number of faculty members who are interested or qualified to be a mentor. In the current era of declining re-imbursements and lack of funding for educational activities, faculty members are pressured to produce clinically and academically, limiting their time for non-reimbursed or credited activities. Similarly, issues of different generational priorities, gender and cultural differences in the available mentors can adversely affect the establishment of the relationships between the trainee and the mentor. While more and more women, gay and lesbians as well as international trainees are currently training in surgery, the diversity of the academic faculty has not kept up with the diversity of the training population. It is imperative that available mentors are sensitive to issues in the diverse population of trainees that are different than their own, and that issues are evolving over time to ensure that any mentor can have a mentorship relationship with any trainee. Often, it is not one person that is a mentor to a developing surgeon but a group of people over years, that train, influence and support the trainee. It does take a village to raise a child, and I would argue a well-trained surgeon as well.

As an example, for many years, early in my career, I was one of the only women I knew, interested and eventually training in Surgery. Women in Surgery were few and far between in the Southern part of the United States at that time. During my third year medical student rotation, I happened to be on service with teams of all male residents, and all male attendings. I spent a lot of time with several individuals that were professional role models for me including Chuck Harr, MD, Curt Mosteller, MD and Gary Craddock, MD. There was one woman trainee when I was student- Ginger Chiantella, MD and I thought she was marvelous. There were more over time including Catherine Share, MD who had a great influence on me as well.  I also started a life-long friendship with one of the Surgical Attendings, Dr. Jesse Meredith, the “old dad”. When I was student, I would often round with “Old dad” at night, where he would tell me stories, and teach me about what was important to Surgeons- patients ( “who always come first”), compassion (“you can never have enough”), integrity and work ethic. When I was a fourth year student, I did not match in Surgery for post graduate training out of medical school mostly due to my own lack of insight into how the system worked at that time, but also due in part to the attitudes of the program directors and some of the surgeons I interviewed with. I often heard in interviews that as a woman, I did not have the “stamina to train “as a surgeon. I was also accused by some of trying to “take a man’s position”. Despite, the disappointing turn of events, I eventually found my way to Boston to train with the help of many faculty along the way including the Dean of Students at Wake Forest, Patricia Adams, MD who at the time was a transplant nephrologist who would go on to become the first woman President of the United Network of Organ Sharing, a Pediatric cardiac surgeon at West Virginia University, Robert Gustafson, MD and of course, Dr. Meredith. I have never forgotten their support and frankly, their ability to judge my performance not my gender. Training in Boston opened many doors for me with the help of all of the Surgical Faculty at The Children’s Hospital of Boston (especially Drs. Hardy Hendren, Jay Schnitzler, Jay Wilson, and Bob Shamburger). Drs. Al Bothe and Glenn Steele gave me a chance to train at the Deaconess and Dr. Roger Jenkins told me I could do anything I wanted to but to try transplant. It was Dixie Mills, MD that reminded me that there are still issues for women in Surgery, and Susan Pories, MD who taught me a lot about grace under pressure.

As I have progressed over my career, I have had many challenges, and while there has been a significant increase in the number of women training in Surgery, the number of senior women in Surgery in leadership positions academically has not kept pace for many reasons. At the completion of my training in Boston, I eventually completed a Transplant Surgery fellowship at Duke University Medical Center. I was the first woman fellow in Surgery at Duke, and the first woman attending in General Surgery to be pregnant and have children. Without the support of my chairman Dr. Robert Anderson and my Division Chief and friend, R Randall Bollinger, MD it would have been impossible for me to continue my career and have my children. My mentor and fellowship director, Dr. Pierre A. Clavien, now Professor and Chief of the Department of Surgery in Zurich Switzerland, taught me many things clinically, as well as teaching me how to be academically productive and know “how” to support and mentor junior faculty.  

I never had a formal relationship with any agendas working with these people who were and are my mentors, but I learned by listening and watching, occasionally asking for guidance and support. I still call the “old dad” often who is now 90 to discuss issues of management and development as he has more common sense than anyone I know. As for mentors in how to progress in academic rank, time management and my career, I have the members of the AWS to thank for that guidance and support. Without the support of past and present members of the council, the Foundation Board and the management personnel, I would never have known how to write a real CV, a letter of recommendation, a division chief and chairman prospectus, a budget and many other things. Thank you Drs. Ephgrave, Hooks, Numann, Walsh, Scott, Bergen, Cochrane, Sanfey, Dunn, Nuemeyer, Gantt and so many others. I have had the opportunity to be supported and work with so many wonderful mentors. How do I honor them? By being a mentor myself. I have tried as I have risen through the academic ranks, to support, encourage, and train women with a focus on teaching clinical care, and precise operative skill. I have a list of trainees with whom I feel particularly close on my CV and who I have advised and promoted during my career. I now find myself the only woman Division Chief at my institution and have been a woman chair. In order to honor our mentors, we must work tirelessly to make sure no matter where we are, that there are the basics for equitable treatment (ex: a maternity leave policy and paternity policy), and performance based assessment for every trainee. We as more senior members, need to take advantage of our seniority and position to often place ourselves “in the line of fire” to demand justice and fairness for all of trainees and junior faculty- if the need arises. We need to be the mentors that some of us didn’t have and give out career advice and support, and make phone calls to ensure that the all of our trainees, but especially the women, have access and opportunities to train at the best places they can train. Times are changing and it is a great time to be a surgeon. We are all beneficiaries of the people who have supported us and trained us over our lifetimes, and we can honor them by being mentors to our cadre of students. I would encourage all of our members to honor their mentors with a donation to the foundation, so that the AWS can continue what we do to support all of us. This is their year !

My favorite “old dad” story:

Dr. Jesse H. Meredith is currently Professor of Surgery, Emeritus at Wake Forest University. He was a pioneer in many aspects of surgery including portal hypertension surgery, renal transplantation, reattaching severed limbs and the formation of Critical Care Units. He won the AMA’s distinguished service award in 2011 for his meritorious service in the science and art of Medicine and the Order of the Long leaf Pine in 2010, from then Governor of North Carolina Beverly Purdue. However, he is originally from Fancy Gap Virginia, plays a great fiddle and speaks with the native tongue of the South. He is a man of few words but when he speaks, everyone listens. When I was a third year medical student, I was rotating on trauma surgery of which Dr. Meredith attended. Being my first rotation, and being extremely uncomfortable and not knowing how to actually “do” anything, I would stand as close to the wall in the trauma bay when our team had a trauma patient, hoping no one would notice me and I could watch but not be in the way. One night, a young man came to the ED with a stab wound to the chest and was rolled in the trauma room in full arrest. There was a flurry of activity and everyone seemed to be moving at once, drawing blood, giving blood, examining the patient, achieving IV access. It was a hive of activity. Finally, the chief resident called out that there was a stab wound over the left nipple and he was going to open the chest. The chest tray was opened, calm came across the room and the incision was made, the retractor placed and the pericardium opened. A large hemopericardium was released with some improvement in the patient’s hemodynamics;  however a small laceration was noted in the right ventricle that started spurting blood over the patient and the tray. It seemed like time stood still, with everyone watching the blood spurt when a gloved hand came through the back of the crowd, and a long gloved finger plugged the hole in the heart. Suddenly you heard the “old dad” say “well.., y’all know what to do now don’t cha…..” and off they went to the OR in a rush. He had appeared as if he were out of nowhere to solve the issue and save the patient. I do not remember to this day if anyone called him, he just knew when he was needed and he showed up. 


Do you have a story to share about your mentor? Email us at or tweet us @womensurgeons and #HonorYourMentor. 

Or make a donation to the AWS Foundation to #HonorYourMentor today. 

No comments:

Post a Comment