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Mentorship in Urology Residency Programs in the United States Eric Bortnick MD , Jeffrey Stock MD , Vannita Simma-Chiang MD PII: DOI: Reference:
S0090-4295(19)31008-8 https://doi.org/10.1016/j.urology.2019.09.053 URL 21852
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Urology
Received date: Revised date: Accepted date:
25 June 2019 25 August 2019 11 September 2019
Please cite this article as: Eric Bortnick MD , Jeffrey Stock MD , Vannita Simma-Chiang MD , Mentorship in Urology Residency Programs in the United States, Urology (2019), doi: https://doi.org/10.1016/j.urology.2019.09.053
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Mentorship in Urology Residency Programs in the United States Eric Bortnick, MD; Jeffrey Stock, MD; Vannita Simma-Chiang, MD Department of Urology, Mount Sinai Hospital, Icahn School of Medicine, New York, NY Corresponding Author: Eric Bortnick, MD Urology Resident, Department of Urology Icahn School of Medicine at Mount Sinai New York, NY
[email protected] 212-241-4812 Declarations of Interest: none Keywords: mentorship, residency, education, physicians, satisfaction Objectives: To characterize the status of mentorship programs for Urology residencies in the United States, highlight the importance of mentorship in the career of an urology resident, and identify the obstacles of implementing a mentorship program. Methods: With IRB exemption and approval from the Society of Academic Urologists (SAU), a survey was sent to the Program Directors (PDs) of the Urology Residency programs in the United States containing questions about the presence and structure of a mentorship program in their department. Results: Response rate was 54%. 75% of respondents approved of formal mentorship programs. 58% of respondents had one established. 5% of programs had an official training course for faculty mentors. 38% of programs had no requirement on mentor/mentee meeting frequency. The most common reason for not having a formal mentorship program was because the program felt that informal mentorship sufficed. Conclusions: While the vast majority of PDs for Urology Residency programs in the United States approve of formal mentorship programs, only a little over half have one established. Programs should strive to create a formal mentorship program in their residency programs due to their recognized importance. Introduction: Mentorship is an important part of any profession, and this is especially true in the medical field. There is proven benefit of mentorship programs for both the mentor and mentee in medicine, and specifically surgical subspecialties, including improvement in personal development, career guidance, research productivity, and prevention of burnout. Although these benefits exist, Kibbe
et al showed that only half of surgical residency programs in the United States have established mentorship programs, with variations in structure, oversight, and feedback.1
Different types of mentorship methods exist, with the most common historically being a dyadic relationship between a senior person as the mentor and a junior or less experienced colleague as the mentee. This mentorship relationship can occur in an informal setting that arises organically through the mentor and mentee, or can be made through a formal program within a department that matches the mentor and mentee through commonalities and mutual interests. Informal mentorship programs may self-select for trainees that are more outgoing or have socially dominant traits, and may exclude those that are more introverted, and Cohee et al found that formal mentorship programs can be just as successful and increase the prevalence of mentorship formation if facilitated appropriately.2 Other forms of mentorship models exist, including informal group facilitated sessions between multiple senior faculty and junior residents. This model has been shown to have the benefit of both vertical and horizontal mentorship which makes the program more time efficient and inclusive. 3
Given the importance and benefits of mentorship programs in the surgical field, it is necessary to understand the prevalence of mentorship programs in Urology. To our knowledge, there is no publication looking at mentorship programs in Urology residencies throughout the United States. In this study, we aim to characterize the status of mentorship programs for Urology residencies in the United States, identify the obstacles and challenges of implementing a mentorship program, and summarize the contemporary literature on mentorship for surgical specialties.
Materials and Methods: After obtaining exemption status from the Internal Review Board (IRB) of the Icahn School of Medicine at Mount Sinai (ISMMS) and approval from the Society of Academic Urologists (SAU), an anonymous nineteen question survey was sent to the program directors of all urology residency programs in the United States. The survey contained questions about the presence and structure of the mentorship program in their department. The survey was sent, and responses were analyzed using the online website SurveyMonkey . TM
Results: The response rate was 54%, with 72 surveys completed out of a possible 133. 75% of respondents approved of formal mentorship programs. Forty-one respondents (58%) stated they had a residency mentorship program already established, with the majority, 21 (50%), stating the program had been established for over five years. In 70% of mentorship programs, the resident is formally assigned to a specific mentor. Only 5% of mentorship programs had an official training course for faculty mentors, and only 20% of mentorship programs had a career development course for trainees (Figure 1). 38% of mentorship programs had no formal requirement on how often the mentor/mentee pair should meet, 24% were required to meet every three months, and 26% were required to meet every six months (Figure 2). In 56% of mentorship programs, faculty mentors are required to fill out an evaluation form of the resident mentee, yearly in 7%, twice yearly in 12%, after every formal meeting in 32%, and in no defined interval in 5% (Figure 3). These forms are reviewed by the mentor and mentee in 25%, the division or department administrator in 2.5%, the division chief in 2.5%, department chair in 20%, and by a departmental mentoring committee or its equivalent in 28% (Figure 3). In those residencies that did not have a formal mentorship program, the most common reason was because the program felt that informal mentorship was enough (54%). Other barriers to
implementation of a formal mentorship program included not enough time (14%), not enough funding/resources (12%), and not enough faculty (10%) or resident (10%) interest (Figure 4).
Comment and Conclusion: The value that mentorship has in any profession, both for the mentor and mentee, is undeniable. This continues to hold true for the medical profession. Studies have shown benefits for both the mentee and mentor, with improvements in career satisfaction, stress management, academic productivity and work-family balance for mentees and, for mentors, increased research productivity, personal satisfaction, and opportunities for career advancement. 4 A survey of graduating Vascular Surgery trainees and program directors revealed the belief that mentorship increased access to research opportunities, professional networking, and job opportunities.5 Similarly, in a survey of Switzerland Surgical Society members, male mentees had significantly higher subjective career advancement and career development scores than those without a mentee.6
Mentorship can also help prevent and/or improve rates of burnout during residency. In a separate survey of Vascular Surgery trainees, those without a self-identified mentor were significantly more likely to report burnout, and those with lower burnout scores were associated with program mentorship.7 In Otolaryngology, a study of a residency program by Zhang et al showed that after implementation of a formal mentorship program, scores on a Perceived Stress Survey were significantly reduced at twelve months as compared to prior to program implementation, as well as statistically significant improvement in emotional scores, levels of depersonalization, and personal achievement at twelve months based on Maslach Burnout Inventory (MBI). An overall improvement in quality of life was also seen at twelve months compared to prior based on the World Health Quality of Life (WHOQOL-BREF) Questionnaire.8
The benefits of mentorship for reduction of burnout throughout different surgical subspecialties should not go unnoticed, as Urology is not immune to its effects. A recent report by North et al from the 2016 AUA Annual Census found that 38.8% of practicing urologists meet criteria for burnout,9 and more concerningly a recent survey of urology trainees found that 68% reported symptoms of burnout.10 Marchalik sent a recent questionnaire sent to United States urology residents on causes of burnout found that their respective institutions having a structured mentorship program was associated with decreased burnout (p=0.019). 11 While the available data does not delineate whether one mentorship model is superior to another in terms of its benefits, Cohee et al did find that formal mentorship programs can be just as successful as informal mentorship programs. Informal mentorship programs can potentially increase the prevalence of mentorship formation if facilitated appropriately. 2
While the benefits of a mentorship program are well established, there is still a lack of implementation throughout the surgical field. In a study of surgical residency program chairs, Kibbe et al showed that only 54% of responding surgical residency programs in the United States have established mentorship programs, with variations in structure, formality, oversight, and feedback (Kibbe, 2016).1 In a Canadian survey of 179 general surgery residents, only 53% reported a mentorship program, even though 97% felt that mentorship was important and 74% favored having a required mentorship program. 12 A survey of 565 surgical trainees from the United Kingdom and Ireland found that less than half were able to identify a mentor even though the majority desired mentoring on professional topics. 13 In a survey of 243 Orthopedic surgery residents, results showed that only two-thirds of orthopedic surgery residency programs had a formal or informal mentorship program, even though 95.8% indicated belief that mentorship played an important role with respect to development as a resident and surgeon.14 The survey of Switzerland Surgical Society members by Kaderli et al noted that only 6.7% of respondents reported having a structured mentorship program.6
In this study, we surveyed program directors of Urology Residency programs in the United States about the status and structure of mentorship programs in their respective departments. To our knowledge this is the first study to study mentorship programs in Urology. While the vast majority of program directors for Urology Residency programs in the United States approve of formal mentorship programs, only a little over half have one established. It is possible that this number may actually be lower due to response bias, as those program directors that do have a mentorship program in place may be more likely to respond to the survey. These programs vary in meeting requirements, feedback, and review by program leaders. Furthermore, rotation schedules for some programs match an individual resident with a single attending for a set period of time, which may be considered a “mentorship model.” While not specifically a mentorship program, and not specifically asked about in our survey, this model could be seen as mentorship in general. It is unclear at this time if mentorship model rotation schedules have the same benefits of structured mentorship programs Concerningly, only 5% of residencies with formal mentorship programs had official training courses on mentorship for faculty mentors. It has been shown that mentorship is a learnable skill that can be taught by similar means as other skills including books, seminars, and workshops. 15
As mentorship is an important part of urologic training and has proven benefits for both the mentor and mentee, all programs should strive to create a formal mentorship program in their residency programs. It is our opinion that mentorship programs are not expensive and can easily be implemented into the Residency Program. Further research should be done to understand which type of mentorship program is looked on most favorably by both residents and faculty, as well as comparing programs that do and do not have mentorship programs to see if there are major difference in career satisfaction, personal growth or development, and research productivity by either the resident or faculty member.
References: 1. Kibbe et al. Characterization of Mentorship Programs in Departments of Surgery in the United States. Jama Surgery 2016 Oct 1;151(10):900-906
2. Cohee et al. Results of a Formal Mentorship Program for Internal Medicine Residents: Can We Facilitate Genuine Mentorship? Journal of Graduate Medical Education 2015 Mar;7(1):105-8
3. Champion et al. Providing mentorship support to general surgery residents: a model for structured group facilitation. Canadian Journal of Surgery 2015 Dec;58(6):372-3
4. Welsh et al. The Women in Emergency Medicine Mentoring Program: An Innovative Approach to Mentoring. J Grad Med Education 2012 Sep;4(3):362-6
5. Smeds et al. Effects of Mentorship on Graduating Vascular Surgery Trainees. Ann Vasc Surg 2017 Oct;44:234-240
6. Kaderli et al. Mentoring in general surgery in Switzerland. Med Educ Online 2015 Mar 31;20:27528
7. Jenko et al. Burnout, depression, perceived stress, and self-efficacy in vascular surgery trainees. J Vasc Surg 2019 Apr;69(4):1233-1242
8. Zhang et al. Formal Mentorship in a surgical residency training program: a prospective interventional study. J Otolaryngol Head Neck Surg. 2017 Feb 13;46(1):13
9. North AC et al. Burnout in Urology: Findings from the 2016 AUA Annual Census. Urology practice 2018
10. Marchalik et al. The Impact Of Burnout On Professional And Academic Goals And Career Regret In Urology Trainees Journal of Urology 2019 Jul;202(1):45-46
11. Marchalik et al. The Impact of Institutional Factors On Physician Burnout: A National Study of Urology Trainees. Urology 2019 Jun 11.pii:S0090-4295(19)30516-3
12. Delisle et al. National Survey of mentorship in Canadian general surgery residency programs: Where are we and what do we need? Can Med Educ J. 2017 Dec 15;8(4):e42-e53
13. Sinclair et al. Mentorship in surgical training: current status and a needs assessment for future mentoring programs in surgery. World J Surg 2015 Feb;39(2):303-13
14. Oladeji et al. Mentorship in Orthopedics: A National Survey of Orthopedic Surgery Residents. J Surg Educ 2018 Nov;75(6):1606-1614
15. Kashigawi et al. Mentoring programs for physicians in academic medicine: a systematic review. Acad Med 2013 Jul;88(7):1029-37
Figures:
Figure 1 – Incidence of Faculty Training Course and Resident Career Development Course
Required Frequency of Mentor/Mentee Meeting 1 ([PERCENTAGE])
4 ([VALUE]) 16 ([PERCENTAGE])
11 ([PERCENTAGE]) 10
([PERCENTAGE])
Figure 2 - Required Frequency of Mentor/Mentee Meeting
No Formal Requirement Every 3 Months Every 6 Months Yearly
Figure 3 - Evaluation Form Requirements
Figure 4 - What is the reason for not having a formal mentorship program?