Mentoring: The forgotten fourth leg of the academic stool

EDITOBIAL Mentoring: The forgotten fourth leg of the academic stool e in academic medicine sit, not always comfortably, on a three-legged stool that supposedly defines our profession: teaching, research, and patient care. Over my 40 years in academe, I have suspected--subliminally to be sure--that something was missing in this definition of what we are about and that a fourth leg was being ignored. I discovered the missing leg while listening to an eloquent and moving lecture given at a recent annual meeting of the American Clinical and Climatological Association. Jerry Barondess, its then president, spoke about mentoring and its fundamental importance to what we academicians do. An essay by Dr. Barondess, excerpted from this lecture, appears on page 487 in this issue of the Journal. Sitting at the ACCA talk that day, I was able to transfer the aforementioned subliminal niggle to an epiphany-generating part of my brain. Of course! Mentoring is what we senior faculty do much of the time (if we're lucky enough to be at universities and in departments that foster this priceless activity). Priceless, I mused, but generally uncompensated, at least monetarily, in this era of "bottom-line" accounting. In fact, at the time of the Barondess lecture my department co-chair and good friend, Tom Ferris, and I were working out a new strategy to measure and reward the "productivity" of our faculty. This, to set stipends in a more formulated manner than that hitherto attempted in our department. Our departmental accountants could track clinical billings and research stipends with astounding accuracy, and surely those would become measures of "productivity." But, we reckoned, "productivity" does not equal worth in our profession--a profession grounded in the Hippocratic mandate that mature physicians transmit wisdom and experience to imaginative and energetic apprentices; that is, the mandate that we mentor. Although we and most other department of medicine chairs recognized at the time that compensation formulas must include the difficult-to-quantify education efforts of faculty members, attainment of this laudatory goal-albeit the topic of abundant rheto-

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J Lab Clin Med 1997;129:486. Copyright © 1997 by Mosby-Year Book, Inc. 0022-2143/97 $5.00 + 0 5/1/80640

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ric--remains to this day pretty murky in most institutions. At best, quantity--but rarely quality--of teaching is taken into account by diverse formulas. As unsettling as this deficiency might seem, the Barondess essay raised for me an even greater source of unease: namely, that my just-recognized fourth leg of the academic stool--mentoring--is generally ignored completely in accounting spreadsheets used to figure faculty compensation. Yet Barondess informs us that "mentoring activities represent a powerful focus as we address academic concerns in medicine, because they contribute crucially to the priorities, academic styles, and career patterns of future faculty, and in this way shape the medicine of the future." As an example-one to which I particularly resonate--he notes that through mentoring a "protege learns whether it is truly important, in the course of the case presentation, to go to the bedside, or whether such visits are proforma, on the basis that these days the patient is the data and the data are the patient. Such distorted priorities [represented by the latter choice] are easy to learn and difficult to unlearn." Moreover, it seems to me, they result from mentor deficiency. If these distortions are to be avoided, we in leadership positions had better start honoring and encouraging the mentoring efforts of our faculty, who, without such encouragement, will surely turn their harried backs on this endeavor to pursue more readily accountable tasks. Should this occur, the academic stool, lacking a sturdy fourth leg, will be wobbly. Too bad for the stool, and too bad for the faculty who will be robbed of a most satisfying privilege of our profession-the chance to emulate Mentor, the friend, educator, and character-shaper of Ulysses' son, Telemachus. Moreover, the robbed faculty will look not unlike that which Alfred North Whitehead, the noted Harvard philosopher-mathematician, defined as unfit nearly a century ago; in his words: "The danger is that it is quite easy to produce a faculty entirely unfit--a faculty of very efficient pedants and dullards. The general public will only detect the difference after the university has stunted the promise of youth for scores of years." HARRY S. JACOB, MD

Editor-in-Chief