Mentorship undoubtedly cultivates careers, but hospital medicine groups face unique challenges in formalizing the process.
First, hospital medicine is a young specialty, with a large proportion of academic hospitalists holding the rank of clinical instructor or assistant professor, said Ethan U. Cumbler, MD, FACP, a professor of medicine and associate director of the hospital medicine division at the University of Colorado School of Medicine in Aurora. “There's not that many senior professors of medicine to go around to mentor a very large group of junior faculty,” he said.
Another challenge is that, rather than focusing on the basic science of other medical specialties, hospital medicine deals with broader areas: innovation, quality improvement (QI), patient care, and clinical education, said Dr. Cumbler. “One of the things that those basic science researchers have spent decades developing is a more formal structure for mentorship in order to allow people to be successful in obtaining federally funded grants,” he said. “We're creating our own structure.”
Indeed, despite these challenges, hospital medicine leaders have successfully built their own iterations of formal mentorship programs, from relatively traditional systems to new twists on such cornerstones as visiting professorships and networking.
Finding what works
During a session at Hospital Medicine 2017 in May, hospital medicine group leaders offered specific examples of how they made mentorship a part of faculty development at their institutions.
About 120 hospitalists (both academic and nonacademic) across three sites participate in the mentorship program at the Duke University Health System in North Carolina, said ACP Member David Gallagher, MD, chief of the hospital medicine service and associate chief medical officer.
The program consists of an initiation phase, where mentoring relationships are assigned, and a cultivation phase, where pairs meet regularly, Dr. Gallagher said. To assign relationships, program administrators email all new hires to ask about their interests and what they are seeking guidance on, from clinical education to living in the area. After assignment, pairs meet about three to five times per year, with the mentor reviewing the mentee's career goals, strengths, and opportunities, using the institution's relevant educational materials.
The program kicked off in 2009, and Duke's Professional Development Institute helped the division set up a working platform and provided administrative support, Dr. Gallagher explained. “Those folks are vital for this. They help with monitoring the meetings that are occurring. . . . Setting the next meeting is absolutely key; otherwise, it'll never happen,” he said. If a pair fails to meet for about six months, he or the medical director will reach out to see if the relationship is working out and, if it isn't, assign a new mentor.
Prior to the program's initiation, the hospital medicine group was a clinical service only, and the physicians had very little academic productivity, said Dr. Gallagher. “As the years have gone by, publications, presentations, posters, etc. really increased on a fairly steady basis every year,” from zero in 2009-2010 to 84 in 2015-2016, he said. “Some of this is related to the mentorship program, and much of it is also related to the individuals who joined.”
The University of Texas Health Sciences Center in San Antonio has also grown with a formal mentorship program. At the outset, the 38-member division of general and hospital medicine had only three professors and eight associate professors, said division chief Luci Leykum, MD, MBA, MSc, FACP. Junior physicians weren't shy about taking on leadership roles (e.g., associate program director), but there weren't many senior faculty to provide specific guidance, she said.
So in 2013, the group began the process of creating a faculty development program to build its mentorship capacity and help junior faculty succeed in leadership roles. Dr. Leykum worked with a career coach to create a peer mentoring program, which includes both individual and group activities.
The individual component features a three-part series of self-assessments: a survey about career goals, an executive summary about personal qualifications and objectives, and an open-ended feedback form. “One of the things that's so important in terms of people's professional development and in mentorship is giving them the ability to reflect on their own work and on their own careers, and giving them a framework and a structure to do that successfully,” Dr. Leykum noted.
Physicians receive one-on-one peer mentoring, as well as feedback from others they worked with regarding specific skills (e.g., appropriate use of email, managing conflict). Dr. Leykum offered an example of how a colleague suggested that one physician had room for improvement in delegating tasks. “This gave feedback that I or their mentors wouldn't have otherwise known in terms of potential issues. . . . These are relatively junior people; they don't even recognize that they can delegate, necessarily,” she said.
Junior faculty also participate in leadership interviews, in which mentees are encouraged to learn more about their potential career focuses, for example, graduate medical education (GME). “Interested in GME? Let's go speak with the vice dean for GME and talk to them about their career path, what key decisions they made, and how those might relate to what you're doing right now,” Dr. Leykum said.
The group component consists of monthly onsite meetings and workshops about such topics as providing feedback, delegating, motivating people, and improving meetings, for junior faculty only. “Even I didn't attend any of these sessions,” she said. “It was really meant to be a safe and open space for them to talk about these issues.”
The division now has 60 to 70 physician faculty members, including 10 professors and 15 associate professors. Feedback about the mentorship program has been positive, but Dr. Leykum said that seeing the junior physicians develop has been most meaningful to her. “They saw each other as resources for solving problems so that when they spoke to me, it wasn't ‘Here's this problem, how do I solve it?’” she said. “It actually became, ‘Here's this problem. Here are the solutions that I'm envisioning. This is the one that I think is going to be most effective. Do you have any thoughts on that?’”
With three peer cohorts having completed the program, more junior physicians are starting the process, which poses some problems, Dr. Leykum said. “We recognize that we need a more vertical peer mentoring and not just people on the same level, so we're in the process of restructuring this,” she said.
Now, in addition to its peer mentorship components, the program comprises six vertical mentoring groups, each with two professors, three to five associate professors, and the remainder assistant professors, said Dr. Leykum. “They're going to discuss the same topics, just in a slightly different format, in terms of navigating your career,” she said.
Both traditional and newer mentorship programs target junior faculty, but physicians often crave mentoring relationships even earlier in their careers.
By the end of his internship year at Stanford University School of Medicine, ACP Member Andre Kumar, MD, knew he was interested in hospital medicine but had no access to a formal curriculum or mentorship process for residents who want to become hospitalists. The following year, he teamed up with another resident to create the Stanford Hospitalist Advanced Practice & Education (SHAPE) program.
SHAPE participants must complete certain hospital medicine-focused requirements before the end of their third year of residency. In addition to completing certain clinical rotations (e.g., medicine consult, critical care, ultrasound diagnostics), each resident is matched with three hospitalist mentors and must fulfill certain nonclinical responsibilities, such as attending 10 hospitalist lectures and presenting a project at an academic conference or submitting it to a journal.
The process of developing the program began with a needs assessment, which found that 22 out of 111 categorical residents were interested in hospital medicine and that mentorship was the top issue the residents wanted to address, said Dr. Kumar.
However, the first year of the program was challenging because residents weren't meeting with their mentors on a regular basis, he said. “We didn't really give them a specific timeline of when they could meet, didn't really discuss what should be brought up at the meetings, and as a result, some of the meetings didn't happen, and when they did occur, there wasn't a specific agenda to them,” Dr. Kumar said.
The following year, the program established quarterly mentorship meetings with specific agendas to guide them, he said. Residents are assigned three mentors, each with a specific niche, and may select one main mentor to follow their progress through these quarterly meetings. “We wanted to give the residents a tasting of the different flavors that can occur in hospital medicine because the roles are expanding so much,” said Dr. Kumar.
Now a clinical instructor at Stanford, Dr. Kumar said his own mentors, who were savvy in QI, education, and research, were a “perfect pairing” because of his interest in academic medicine. “I've been fortunate enough to stay on as one of the hospitalists at Stanford,” Dr. Kumar said. “Had it not been for that mentorship and the guidance of how to secure a job, how to be a competitive applicant—especially in the competitive marketplace that is academic hospital medicine nowadays—I don't think I would've been able to achieve that.”
In similar fashion, the Visiting Professorship in Hospital Medicine Program supports early-career hospitalists by tailoring the concept of the visiting professor to the specialty of hospital medicine, said Dr. Cumbler, who founded the program about five years ago at the University of Colorado School of Medicine. The reciprocal visiting professorship was designed with two goals in mind: spreading innovation and addressing an identified gap in mentoring relationships, he said.
One challenge faced by the University of Colorado's academic hospitalists going up for promotion is that they need to demonstrate a national reputation with three letters of recommendation from external institutions, said Dr. Cumbler. “For many of our faculty, that was a challenge,” he said. “We also know that there is a well-documented deficit of mentorship within hospital medicine for junior faculty.”
A traditional visiting professor would typically be a professor of medicine who, having completed his or her terminal promotion, comes to present basic science research at another institution, noted Dr. Cumbler. “We flipped that on its head and said, ‘The visiting professor should be someone who would be capable of getting maximal benefit from the exposure of the visit to the external academic medical center,’” he said.
Usually, the program's visiting professors are physicians at the late assistant or early associate professor level within one to two years of promotion, Dr. Cumbler said. “I see this as meeting mutual needs: The junior faculty need to be able to get mentorship and get advice from someone with a new perspective from an external institution; the visiting professor needs to be able to share their innovation and make connections for people to know about their reputation nationally,” he said.
The program continues to expand to more institutions, and the Society of Hospital Medicine has adopted it to support its national expansion, Dr. Cumbler said. “What I envision over time is instead of a series of independent reciprocal relationships, that we're actually creating a more tightly integrated network of academic hospital medicine groups actively sharing innovations and building to a true national community,” he said.