- Email: [email protected]
Perceived Benefits of a Radiology Resident Mentoring Program: Comparison of Residents With Self-Selected vs Assigned Mentors
Canadian Association of Radiologists Journal 65 (2014) 186e191 www.carjonline.org
Canadian Residents’ Corner / Coin canadien des residents en radiologie
Perceived Benefits of a Radiology Resident Mentoring Program: Comparison of Residents With Self-Selected vs Assigned Mentors Kei Yamada, MDa, Priscilla J. Slanetz, MD, MPH, FACRb,*, Phillip M. Boiselle, MDb b
a Department of Radiology, Emory Radiology and Emory University School of Medicine, Atlanta, Georgia, USA Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Abstract Purpose: It has been suggested that assigned mentoring relationships are less successful than those that develop by free choice. This study evaluates radiology residents’ overall experience with a mentoring program and compares the responses of those who self-selected mentors with those who were assigned mentors. Methods: A voluntary Web-based survey was sent to 27 radiology residents in postgraduate years 3-5. Data collected included the following: year in residency, method of mentor assignment, duration of relationship, frequency and types of communication, perceived value of mentoring, overall satisfaction with the program, and the perceived impact of mentoring. Results: Twenty-five of 27 residents (93%) responded, with 14 having self-selected mentors (56%) and 11 having assigned mentors (44%). Both groups unanimously agreed that mentoring is beneficial or critical to their training; however, those residents with self-selected mentors were significantly more satisfied with the mentoring program (4 vs 3.3; P ¼ .04) and more likely to consider their mentor as their primary mentor compared with those with assigned mentors (11 [79%] vs 4 [36%]; P ¼ .049). Although all residents perceived a benefit, residents with self-selected mentors rated almost all mentoring parameters more positively than those with assigned mentors, although most of these parameters did not reach statistical significance. Conclusion: Residents highly value the importance of mentoring. However, residents who self-select their mentors are more likely to be satisfied with a mentoring program. Resume Objet : Des donnees indiquent que les relations de mentorat etablies par jumelage fonctionnent moins bien que celles nouees librement. Cette etude evalue l’experience globale de residents en radiologie qui ont participe a un programme de mentorat, puis compare les reponses des residents qui ont choisi leur propre mentor a celles des residents qui ont ete jumeles a un mentor. Methodes : Une enqu^ete Web a participation volontaire a ete acheminee a 27 residents en radiologie en troisieme, quatrieme ou cinquieme annee de formation postdoctorale. Les donnees recueillies portaient sur l’annee de residence, la methode d’attribution du mentor, la duree de la relation, la frequence et la nature des communications, la valeur perc¸ue du mentorat, la satisfaction globale a l’egard du programme et les repercussions perc¸ues du mentorat. Resultats : Vingt-cinq des vingt-sept residents (93 %) ont repondu a l’enqu^ete. Parmi ceux-ci, 14 avaient choisi leur propre mentor (56 %) et 11 avaient ete jumeles a un mentor (44 %). De l’avis des deux groupes, le mentorat est benefique, voire essentiel a la formation. Toutefois, les residents ayant choisi leur propre mentor se sont averes sensiblement plus satisfaits du programme de mentorat (4 contre 3,3; P ¼ 0,04) et plus susceptibles de voir leur mentor comme un mentor principal que ceux ayant ete jumeles a un mentor (11 [79 %] contre 4 [36 %]; P ¼ 0,049). Bien que tous les residents aient indique tirer avantage du programme, ceux ayant choisi leur propre mentor ont attribue des notes plus elevees a presque tous les parametres de mentorat que ceux ayant ete jumeles a un mentor, m^eme si dans la plupart des cas, les variations en matiere de resultats n’ont pas atteint un seuil de signification statistique. Conclusion : Les residents accordent une grande importance au mentorat. Toutefois, les residents ayant choisi leur propre mentor sont plus susceptibles d’^etre satisfaits du programme de mentorat que ceux ayant ete jumeles a leur mentor. Ó 2014 Canadian Association of Radiologists. All rights reserved.
* Address for correspondence: Priscilla J. Slanetz, MD, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA.
E-mail address: [email protected] (P. J. Slanetz).
0846-5371/$ - see front matter Ó 2014 Canadian Association of Radiologists. All rights reserved. http://dx.doi.org/10.1016/j.carj.2013.04.001
Self-selected vs assigned mentors / Canadian Association of Radiologists Journal 65 (2014) 186e191
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Key Words: Mentoring; Medical education; Residency
Mentoring is widely considered to be an important aspect of medical training. Indeed, various studies have supported the importance of mentorship in medical training, with evidence that shows benefits in career guidance, research, job satisfaction, and personal development [1e9]. In contrast, the lack of a mentoring relationship has been linked to hindering career advancement [10]. Recently, a survey of radiology program directors showed that mentoring is considered to be a valued resource for the professional development of residents and ultimately as a tool to potentially increase the proportion of residents who choose an academic career [11]. In addition, with a relatively small percentage of women entering radiology compared with other subspecialties, and an even smaller number of women holding leadership positions within the field of radiology, mentoring may play an even greater role in encouraging female trainees to pursue leadership positions [5,7,11]. Despite the recognized importance of mentoring, the frequency with which residents identify mentors during residency is highly variable [4,6,12]. Fortunately, in a recent survey of radiology program directors, nearly 50% of programs stated that they already had incorporated a formal mentoring program into residency training [11]. Although it has been shown that residents are more likely to identify mentors when they are in training programs that assign mentors [4], it has also been suggested that assigned mentoring relationships are less successful compared with those that develop by free choice [7]. ‘‘Having the right chemistry’’ is believed to be critical to a successful mentoring relationship, and this seems to be best accomplished when residents identify their mentor themselves rather than being assigned a mentor[9,10]. From a practical standpoint, formal mentoring programs are logistically easier to implement into a residency program and ensure that every resident potentially will benefit from this experience. However, it is possible to incorporate selfselection of mentors by residents into a formalized program. Such a ‘‘hybrid’’ mentoring program was created at our institution in 2005, whereby residents were able to self-select or be assigned a mentor towards the end of their first year of radiology residency. To our knowledge, a direct comparison between residents with assigned and self-selected mentors has not been previously published. We hypothesize that residents who self-select their mentor will be more satisfied with the overall mentoring experience compared with those with assigned mentors. Therefore, we undertook this study to evaluate our residents’ overall experience with our mentoring program and to determine whether residents with self-selected mentors had greater perceived benefits of mentoring. Materials and Methods The study population is based at an academic medical centre in Boston, Massachusetts, with 38 residents and 66
clinical and 13 research faculty mentors. We developed a 24-item Web-based survey, which contained multiple choice questions, scaled responses, and an open-ended narrative question (Appendix 1). In June of 2009, an e-mail that contained an invitation to complete the voluntary Web-based survey was sent to 27 radiology residents who were currently in their second, third, or fourth year of radiology training and all of whom had participated in our department’s mentoring program for at least 6 months. The 11 residents in postgraduate year 2 in their first year of radiology residency were excluded because they had not participated in the program at the time of the study. A second request to complete the survey was sent in July 2009. All survey responses were completed online and electronically returned for collection and tabulation. The institutional review board for human studies deemed this study to be exempt because all responses were de-identified. Questionnaire The questionnaire contained 2 parts (Appendix 1). Part 1 focused on information about the resident and the mentor, such as the year in residency, the method of assignment to the mentor, the length of assignment with the current mentor, frequency and types of communication between mentor and mentee, and whether residents considered their assigned faculty member as their primary mentor. In this section, the residents were also asked to rate the extent to which their mentor contributed to various aspects of their training. Part 2 of the survey focused on the residents’ perception about the mentoring process and its impact on residency training, including perception of the general value of mentoring, level of satisfaction with the mentorship and residency programs, and the perceived impact of mentoring. Respondents were also asked to rate their satisfaction with the mentoring and residency programs, and to state their level of agreement with several statements regarding the potential impact of mentoring on their training. Mentoring Program Participation in the mentoring program is mandatory for residents in our department. Mentoring assignments are made during the latter part of the first year of residency based upon resident responses to the questionnaire. In the questionnaire, the residents have the option of either requesting a specific mentor (by confirming an existing mentoring relationship or by requesting a specific faculty member for a new mentoring relationship) or completing a checklist of preferred attributes (eg, sex, level of academic rank, areas of expertise) for an assigned mentor. Assignments are made by a committee that includes the mentoring program director, residency program directors, and chief residents. Faculty
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mentors were composed of radiology faculty members who voluntarily participated in the program. Residents and faculty mentors are encouraged to meet at least 3 times yearly. Participants were provided a ‘‘Mentoring Encounter Form’’ that is intended to guide the course of mentoring meetings and includes items such as academic progress, research and teaching participation, publications and/or presentations, reading and/or study habits, fellowship and career plans, goals for the next 6 and 12 months, and personal life issues (Appendix 2). Statistical Analysis The data are summarized and presented as the percentage of responses to items and mean ratings when applicable. Comparisons between the groups were performed either by using the Mann-Whitney U test or the Fisher exact test, with significance determined at P .05. To determine the scale reliability of the 13 ranked items on the questionnaire, the Cronbach a test was used. Results Of the 27 residents to whom the survey was sent, 25 completed the questionnaire (93%), including 10 fourth-year residents (40%), 10 third-year residents (40%), and 5 secondyear residents (20%). Of the 25 responding residents, 14 had self-selected mentors (56%) and 11 had assigned mentors (44%). The mean length of mentoring relationships for all respondents was 2.1 years (range, 0.5-3.5 years) with 2.4 years (range, 1.5-3.5 years) for those with self-selected mentors and 1.9 years (range, 0.5-3.5 years) for the assigned group (P ¼ .16). The modal frequency of meeting with mentors for all respondents was every 4-6 months. Among the 14 respondents with a self-selected mentor, 6 met with their mentor every 3 months (43%), 7 met every 4-6 months (50%), and 1 met annually (7%). Of the 11 residents with an assigned mentor, 1 met with their mentor every 3 months (9%), 5 met every 4-6 months (46%), 4 met annually (36%), and 1 never met (9%). Of the total 25 respondents, 15 (60%) considered their faculty mentor their primary mentor, with those having selfselected mentors significantly more likely to consider their faculty mentor as their primary mentor than those with an assigned mentor (11 [79%] vs 4 [36%]; P ¼ .049]). In the subset of 8 residents with a self-selected mentor who requested a specific mentor but did not have a mentoring relationship before the mentorship program, 5 considered their faculty mentor as their primary mentor (63%). In contrast, all 6 of the residents (100%) with self-selected mentors who already had an established mentoring relationship before the mentoring program considered their faculty mentor as their primary mentor. Among all 25 respondents, when asked whether they considered their mentor a ‘‘good fit,’’ the mean rank on a scale of 1 (not at all) to 5 (extensively) was 4 (range, 3-5). The mean value for
respondents with self-selected mentors (4.2) was slightly higher than for those with an assigned mentor (3.7) but did not meet statistical significance (P ¼ .1). As shown in Table 1, mean rankings for the total group of respondents for assessing the contributions of mentoring to their training were modestly positive, ranging from 3.4-4.0 on a scale of 1 (not at all) to 5 (extensively). Although respondents with self-selected mentors had higher mean overall rankings than those with assigned mentors for almost all parameters, these differences did not meet statistical significance. With regard to overall satisfaction with the departmental mentorship program, the mean ranking on a 1-5 Likert scale was 3.7 (range, 2-5). Respondents with a self-selected mentor reported significantly higher satisfaction with the mentoring program than those with an assigned mentor (4 vs 3.3; P ¼ .04). The mean ranking given by the total respondents in regard to their satisfaction with the residency program was 3.9 (range, 3-5). Respondents with a selfselected mentor had higher mean rankings for satisfaction with the residency program than those with an assigned mentor, but this difference did not meet statistical significance (4.1 vs 3.6; P ¼ .1). All respondents, regardless of how their mentors were chosen, believed that mentoring was either beneficial (n ¼ 16 [70%]) or critical (n ¼ 7 [30%]) to radiology training. As shown in Table 2, mean rankings for the total group of respondents for assessing the perceived impact of mentoring on various parameters were modestly positive, ranging from 3.3-3.7 on a scale of 1 (strongly disagree) to 5 (strongly agree). Although respondents with self-selected mentors had higher mean overall rankings than those with assigned mentors for all parameters, these differences did not meet statistical significance. In summary, the 13 ranked mentoring parameters in the survey (goodness of fit, satisfaction with mentorship, satisfaction with residency, career decision, research support, professional development, personal development, clinical skills, educational support, success to date, becoming a future mentor, mentoring role in future career, continue mentoring relationship) showed a high intercorrelation with a validity score of 0.984 when using the Cronbach a test. This suggests that these mentoring parameters are related to a similar
Table 1 Mean rankings, on a scale of 1 (not at all) to 5 (extensively), of the perceived contributions of mentoring by all respondents, respondents with a selfselected mentor, and respondents with an assigned mentor
Parameter
Ranking (range) of all respondents (n ¼ 25)
Ranking of self-selected (n ¼ 14)
Ranking of assigned (n ¼ 11)
Career decision Research support Professional development Personal development Clinical skills Educational support
3.8 3.4 3.9 3.9 3.5 4.0
4.0 3.8 4.1 4.0 3.6 4.0
3.5 2.9 3.7 3.8 3.4 4.0
(2-5) (1-5) (2-5) (3-5) (1-5) (3-5)
Self-selected vs assigned mentors / Canadian Association of Radiologists Journal 65 (2014) 186e191 Table 2 Mean rankings, on a scale of 1 (strongly disagree) to 5 (strongly agree), of the perceived impact of mentoring on various parameters by all respondents, respondents with a self-selected mentor, and respondents with an assigned mentor
Parameter Success to date Becoming a future mentor Mentoring role in future career Continue current mentoring relationship after graduation
Ranking (range) Ranking of Ranking of of all respondents self-selected assigned (n ¼ 23) (n ¼13) (n ¼10) 3.4 (1-5) 3.3 (1-5) 3.7 (2-5)
3.7 3.3 3.8
3.1 3.2 3.6
3.5 (2-5)
3.7
3.3
construct and, as such, the mean summative scores of the 13 ranked parameters were compared collectively between respondents with a self-selected mentor and those with an assigned mentor, which showed a trend towards higher values in the self-selected group (mean [SD] 52.5 10.96) compared with the assigned group (44.5 10.2) (P ¼ .08). Discussion Mentoring is widely recognized as an important aspect of medical training and future career success [1,2,4,6,7,9,10,12]. Nearly half of radiology residency programs have formal mentoring programs, many of which were recently established [11]. Structured mentoring programs in which all residents are assigned to mentors are logistically easier to incorporate into residency programs and ensure that all residents have the opportunity to participate in the mentoring process. However, some physicians believe that such programs create less ideal mentoring relationships compared with those that develop more spontaneously, thereby potentially compromising the full benefits of the mentoring process [10]. A formal assessment of our mentoring program, which contains elements of both formal and informal processes, showed that the perceived benefits were modestly positive among all participants and that residents who freely selected their mentors were significantly more satisfied with the mentoring program and more likely to consider their mentor as their primary mentor compared with those with assigned mentors. As a result, we now only assign mentors to our entering first-year radiology residents after they have been in the department for nearly a year. In addition, we have implemented a monthly mentoring meeting in which faculty present topics related to academic success. Residents involved in mentoring programs have been shown to have significantly higher rankings for satisfaction with their mentoring environment than those without a mentoring program [1]. A recent survey of radiology residency program directors found that programs with formal mentoring programs are relatively evenly split between those whereby residents are assigned to faculty mentors and
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programs whereby residents are encouraged to choose their faculty mentors [11]. Our study showed that even the subset of residents with assigned mentors reported modestly positive benefits across a broad range of parameters from participation in our mentoring program. Although all of the residents appeared to benefit from participation, residents with self-selected mentors tended to rate almost all mentoring parameters more positively than those with assigned mentors, although the results did not reach statistical significance. These findings are in keeping with previous studies in other specialties that found that resident satisfaction with mentoring relationships is equal or greater with free-choice mentoring relationships than with assigned matches, with more frequent communication and more reported contribution to resident growth and development [1,8]. Analysis of our survey also showed that radiology residents believed that mentoring was beneficial or critical to their training regardless of whether a mentor was assigned or specifically chosen. Based upon our experience, to achieve greater satisfaction with mentoring among all residents, we believe that residency programs should seek ways to enhance the ability of residents to successfully choose their own mentors within a formal mentoring program. One way to ensure both high levels of resident participation and high satisfaction may be to delay participation until residents have been in the department for at least 1 year and to provide a climate that fosters close interaction between first-year residents and faculty so that more residents will be able to successfully self-select a mentor. There are several limitations of our study. First, despite representing a relatively large residency program, the sample size was small and the duration of participation in the program was variable. Therefore, many of the differences between the 2 subgroups did not reach statistical significance. Second, because it was not a randomized study, it is possible that there are inherent differences between the 2 subgroups based upon different personality traits (eg, introvert or extrovert). Third, although the mean length of mentoring was approximately 2 years (or half of the duration of residency training), we lack longitudinal data after residency and thus cannot assess the potential long-term impact of mentoring upon career satisfaction and career choices. However, a recent poll of alumni from the past 5 years revealed that approximately 60% of our graduates are currently in academic positions. Fourth, because there was no ‘‘control’’ group that did not undergo mentoring, we were unable to quantify the added benefits of participation in a mentoring program compared with nonparticipation. Finally, we acknowledge that our study lacks outcome data that compared the 2 groups. We plan to perform a longitudinal follow-up study of mentoring program participants after graduation from our residency program to provide such outcome data in a future study. In summary, we showed that residents highly value the importance of mentoring and that a formalized mentoring program was associated with modestly positive benefits during residency training. Even within a formalized mentoring
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program, self-selection of mentors provided substantially greater overall satisfaction with the mentoring program. Therefore, we recommend that resident mentoring programs consider incorporating mechanisms by which residents can maximize the opportunity to self-select a mentor while ensuring that all residents have an opportunity to benefit from a mentoring relationship during their training. Key Points -
-
Although all of the residents valued mentoring, the residents who self-selected their mentor were substantially more satisfied with the mentoring program compared with those with assigned mentors. Residency training programs should incorporate selfselection of mentors into their mentoring programs to maximize the perceived benefits of the mentor-mentee relationship.
References [1] Flint J, Jahangir A, Browner B, et al. The value of mentorship in orthopaedic surgery resident education: the residents’ perspective. J Bone Joint Surg Am 2009;91:1017e22.
[2] Freeman SR, Greene RE, Kimball AB, et al. US dermatology residents’ satisfaction with training and mentoring: survey results from the 2005 and 2006 Las Vegas Dermatology Seminars. Arch Dermatol 2008;144: 896e900. [3] William L, Levine J, Malhotra S, et al. The good-enough mentoring relationship. Acad Psychiatry 2004;28:111e5. [4] Ramanan R, Taylor W, Davis R. Mentoring matters: mentoring and career preparation in internal medicine residency training. J Gen Intern Med 2006;21:340e5. [5] Ramanan R, Phillips R, Davis R, et al. Mentoring in medicine: keys to satisfaction. Am J Med 2002;112:336e41. [6] Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA 2006;296:1103e15. [7] Mainiero MB. Mentoring radiology residents: why, who, when and how. J Am Coll Radiol 2007;4:547e50. [8] Galicia AR, Klima RR, Date ES. Mentorship in physical medicine and rehabilitation residencies. Am J Phys Med Rehabil 1997;76: 268e75. [9] Slanetz PJ, Boiselle PM. Mentoring matters. AJR Am J Roentgenol 2012;198:W11e2. [10] Jackson VA, Palepu A, Szalacha L, et al. ‘‘Having the right chemistry’’: a qualitative study of mentoring in academic medicine. Acad Med 2003;78:328e34. [11] Donovan A. Views of radiology program directors on the role of mentorship in the training of radiology residents. AJR Am J Roentgenol 2010;194:704e8. [12] McKenna AM, Strauss AE. Charting a professional course: a review of mentorship in medicine. J Am Coll Radiol 2011;8:109e12.
Appendix 1. Resident Mentoring Survey PART 1: About You and Your Mentor: 1. What year in residency are you? ____ 1st ____ 2nd ____ 3rd ____ 4th 2. For how long have you been assigned to your current mentor? ____ <1 year ____ 1-2 years ____ 2-3 years ____ 3-4 years 3. Which one of the following statements best describes the selection of your current mentor in the mentoring program? ___ I had already established a mentoring relationship with my mentor, which was subsequently formalized by the mentoring program ___ I requested a specific mentor who was assigned to me by the mentoring program (but we did not have a mentoring relationship before this assignment) ___My mentor was selected for me by the mentoring program and was not specifically requested by me 4. On average, how frequently have you met in person with your mentor? ____ Monthly ____ Quarterly ____ Every 4-6 months ____ Annually ____ We have never met ____ Other (please list: ___________________________________) 5. On average, how frequently have you had other types of communication (eg, e-mail or phone call) with your mentor? ____ Monthly ____ Quarterly ____ Every 4-6 months ____ Annually ____ We have never communicated ____ Other (please list: ___________________________________) 6. Do you use the Mentoring Encounter Form to guide meetings with your mentor? ___ No (if no, please skip to question 8) ___ Yes (if yes, please answer question 7) 7. On a scale of 1 (not at all helpful) to 5 (extremely helpful), please rate the usefulness of the encounter form for guiding mentoring meetings and documenting your goals: ___5___4___3___2___1
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8. Do you consider the faculty person assigned to you by the mentoring program to be your primary mentor? ___ Yes ___ No, I have another mentor whom I consider to be my primary mentor. Please check whether your primary mentor is a member in our department: ___ Yes. He or she is a member of our department. ___ No. He or she is a member of another department. 9. On a scale of 5 (extensively) to 1 (not at all), please rate to what extent your primary mentor: a. Contributes to your professional development? 5 4 3 2 1 b. Supports your personal development? 5 4 3 2 1 c. Aids you in making career decisions? 5 4 3 2 1 d. Provides advice regarding clinical skills? 5 4 3 2 1 e. Assists you with research advice? 5 4 3 2 1 f. Supports your educational experience? 5 4 3 2 1 g. Is a ‘‘good fit’’ for you? 5 4 3 2 1 10. By using general terms name one or more actions or decisions that you have made that were influenced by your participation in the mentoring program (eg initiated a research project adopted a new study habit changed fellowship choice). If none please write ‘‘none.’’ PART 2: About the Mentoring Process and Residency Training: 11. Which one of the following most closely describes your perspective regarding the importance of mentoring to your training as a radiologist? a. Critical to my training b. Beneficial but not critical to my training c. Not important to my training d. Obstructive to my training 12. On a scale of 5 (extremely satisfied) to 1 (not at all satisfied), please rate your level of satisfaction with our departmental mentoring program: 5 4 3 2 1 13. On a scale of 5 (extremely satisfied) to 1 (not at all satisfied), please rate your overall level of satisfaction with our residency program: 5 4 3 2 1 14. On a scale of 5 (strongly agree) to 1 (strongly disagree) please rate your level of agreement with these statements: a. As a result of participating in this mentoring program I am more likely to become a mentor myself. 5 4 3 2 1 b. I believe that mentoring has played an important role in my success to date. 5 4 3 2 1 c. I believe that mentoring will play an important future role in my career. 5 4 3 2 1 d. I intend to continue my mentoring relationship with my current mentor even after I leave Beth Israel Deaconess Medical Center. 5 4 3 2 1 15. Optional Narrative: please enter any comments that you may have regarding the mentoring program, including suggestions for improving the program:
Appendix 2. Mentoring Encounter Form Resident-Faculty Mentoring Encounter Resident Name: Faculty Name: Residency Year: Date: 1. Resident perception of academic progress (including areas of perceived strength and areas for improvement): 2. Research and teaching participation (medical student/chiefs rounds presentations, case reports, research abstracts, and articles): 3. Publications, presentations (planned, in progress, completed): 4. Reading/study habits: 5. Area of subspecialty interest? Fellowship plans? Postresidency plans? 6. Goals for the next 6 months: 7. Goals for the next year: 8. Life issues (engagements, marriages, new children, illnesses, child or parent care, etc):
Canadian Residents’ Corner / Coin canadien des residents en radiologie
Perceived Benefits of a Radiology Resident Mentoring Program: Comparison of Residents With Self-Selected vs Assigned Mentors Kei Yamada, MDa, Priscilla J. Slanetz, MD, MPH, FACRb,*, Phillip M. Boiselle, MDb b
a Department of Radiology, Emory Radiology and Emory University School of Medicine, Atlanta, Georgia, USA Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
Abstract Purpose: It has been suggested that assigned mentoring relationships are less successful than those that develop by free choice. This study evaluates radiology residents’ overall experience with a mentoring program and compares the responses of those who self-selected mentors with those who were assigned mentors. Methods: A voluntary Web-based survey was sent to 27 radiology residents in postgraduate years 3-5. Data collected included the following: year in residency, method of mentor assignment, duration of relationship, frequency and types of communication, perceived value of mentoring, overall satisfaction with the program, and the perceived impact of mentoring. Results: Twenty-five of 27 residents (93%) responded, with 14 having self-selected mentors (56%) and 11 having assigned mentors (44%). Both groups unanimously agreed that mentoring is beneficial or critical to their training; however, those residents with self-selected mentors were significantly more satisfied with the mentoring program (4 vs 3.3; P ¼ .04) and more likely to consider their mentor as their primary mentor compared with those with assigned mentors (11 [79%] vs 4 [36%]; P ¼ .049). Although all residents perceived a benefit, residents with self-selected mentors rated almost all mentoring parameters more positively than those with assigned mentors, although most of these parameters did not reach statistical significance. Conclusion: Residents highly value the importance of mentoring. However, residents who self-select their mentors are more likely to be satisfied with a mentoring program. Resume Objet : Des donnees indiquent que les relations de mentorat etablies par jumelage fonctionnent moins bien que celles nouees librement. Cette etude evalue l’experience globale de residents en radiologie qui ont participe a un programme de mentorat, puis compare les reponses des residents qui ont choisi leur propre mentor a celles des residents qui ont ete jumeles a un mentor. Methodes : Une enqu^ete Web a participation volontaire a ete acheminee a 27 residents en radiologie en troisieme, quatrieme ou cinquieme annee de formation postdoctorale. Les donnees recueillies portaient sur l’annee de residence, la methode d’attribution du mentor, la duree de la relation, la frequence et la nature des communications, la valeur perc¸ue du mentorat, la satisfaction globale a l’egard du programme et les repercussions perc¸ues du mentorat. Resultats : Vingt-cinq des vingt-sept residents (93 %) ont repondu a l’enqu^ete. Parmi ceux-ci, 14 avaient choisi leur propre mentor (56 %) et 11 avaient ete jumeles a un mentor (44 %). De l’avis des deux groupes, le mentorat est benefique, voire essentiel a la formation. Toutefois, les residents ayant choisi leur propre mentor se sont averes sensiblement plus satisfaits du programme de mentorat (4 contre 3,3; P ¼ 0,04) et plus susceptibles de voir leur mentor comme un mentor principal que ceux ayant ete jumeles a un mentor (11 [79 %] contre 4 [36 %]; P ¼ 0,049). Bien que tous les residents aient indique tirer avantage du programme, ceux ayant choisi leur propre mentor ont attribue des notes plus elevees a presque tous les parametres de mentorat que ceux ayant ete jumeles a un mentor, m^eme si dans la plupart des cas, les variations en matiere de resultats n’ont pas atteint un seuil de signification statistique. Conclusion : Les residents accordent une grande importance au mentorat. Toutefois, les residents ayant choisi leur propre mentor sont plus susceptibles d’^etre satisfaits du programme de mentorat que ceux ayant ete jumeles a leur mentor. Ó 2014 Canadian Association of Radiologists. All rights reserved.
* Address for correspondence: Priscilla J. Slanetz, MD, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, Massachusetts 02215, USA.
E-mail address: [email protected] (P. J. Slanetz).
0846-5371/$ - see front matter Ó 2014 Canadian Association of Radiologists. All rights reserved. http://dx.doi.org/10.1016/j.carj.2013.04.001
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Key Words: Mentoring; Medical education; Residency
Mentoring is widely considered to be an important aspect of medical training. Indeed, various studies have supported the importance of mentorship in medical training, with evidence that shows benefits in career guidance, research, job satisfaction, and personal development [1e9]. In contrast, the lack of a mentoring relationship has been linked to hindering career advancement [10]. Recently, a survey of radiology program directors showed that mentoring is considered to be a valued resource for the professional development of residents and ultimately as a tool to potentially increase the proportion of residents who choose an academic career [11]. In addition, with a relatively small percentage of women entering radiology compared with other subspecialties, and an even smaller number of women holding leadership positions within the field of radiology, mentoring may play an even greater role in encouraging female trainees to pursue leadership positions [5,7,11]. Despite the recognized importance of mentoring, the frequency with which residents identify mentors during residency is highly variable [4,6,12]. Fortunately, in a recent survey of radiology program directors, nearly 50% of programs stated that they already had incorporated a formal mentoring program into residency training [11]. Although it has been shown that residents are more likely to identify mentors when they are in training programs that assign mentors [4], it has also been suggested that assigned mentoring relationships are less successful compared with those that develop by free choice [7]. ‘‘Having the right chemistry’’ is believed to be critical to a successful mentoring relationship, and this seems to be best accomplished when residents identify their mentor themselves rather than being assigned a mentor[9,10]. From a practical standpoint, formal mentoring programs are logistically easier to implement into a residency program and ensure that every resident potentially will benefit from this experience. However, it is possible to incorporate selfselection of mentors by residents into a formalized program. Such a ‘‘hybrid’’ mentoring program was created at our institution in 2005, whereby residents were able to self-select or be assigned a mentor towards the end of their first year of radiology residency. To our knowledge, a direct comparison between residents with assigned and self-selected mentors has not been previously published. We hypothesize that residents who self-select their mentor will be more satisfied with the overall mentoring experience compared with those with assigned mentors. Therefore, we undertook this study to evaluate our residents’ overall experience with our mentoring program and to determine whether residents with self-selected mentors had greater perceived benefits of mentoring. Materials and Methods The study population is based at an academic medical centre in Boston, Massachusetts, with 38 residents and 66
clinical and 13 research faculty mentors. We developed a 24-item Web-based survey, which contained multiple choice questions, scaled responses, and an open-ended narrative question (Appendix 1). In June of 2009, an e-mail that contained an invitation to complete the voluntary Web-based survey was sent to 27 radiology residents who were currently in their second, third, or fourth year of radiology training and all of whom had participated in our department’s mentoring program for at least 6 months. The 11 residents in postgraduate year 2 in their first year of radiology residency were excluded because they had not participated in the program at the time of the study. A second request to complete the survey was sent in July 2009. All survey responses were completed online and electronically returned for collection and tabulation. The institutional review board for human studies deemed this study to be exempt because all responses were de-identified. Questionnaire The questionnaire contained 2 parts (Appendix 1). Part 1 focused on information about the resident and the mentor, such as the year in residency, the method of assignment to the mentor, the length of assignment with the current mentor, frequency and types of communication between mentor and mentee, and whether residents considered their assigned faculty member as their primary mentor. In this section, the residents were also asked to rate the extent to which their mentor contributed to various aspects of their training. Part 2 of the survey focused on the residents’ perception about the mentoring process and its impact on residency training, including perception of the general value of mentoring, level of satisfaction with the mentorship and residency programs, and the perceived impact of mentoring. Respondents were also asked to rate their satisfaction with the mentoring and residency programs, and to state their level of agreement with several statements regarding the potential impact of mentoring on their training. Mentoring Program Participation in the mentoring program is mandatory for residents in our department. Mentoring assignments are made during the latter part of the first year of residency based upon resident responses to the questionnaire. In the questionnaire, the residents have the option of either requesting a specific mentor (by confirming an existing mentoring relationship or by requesting a specific faculty member for a new mentoring relationship) or completing a checklist of preferred attributes (eg, sex, level of academic rank, areas of expertise) for an assigned mentor. Assignments are made by a committee that includes the mentoring program director, residency program directors, and chief residents. Faculty
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mentors were composed of radiology faculty members who voluntarily participated in the program. Residents and faculty mentors are encouraged to meet at least 3 times yearly. Participants were provided a ‘‘Mentoring Encounter Form’’ that is intended to guide the course of mentoring meetings and includes items such as academic progress, research and teaching participation, publications and/or presentations, reading and/or study habits, fellowship and career plans, goals for the next 6 and 12 months, and personal life issues (Appendix 2). Statistical Analysis The data are summarized and presented as the percentage of responses to items and mean ratings when applicable. Comparisons between the groups were performed either by using the Mann-Whitney U test or the Fisher exact test, with significance determined at P .05. To determine the scale reliability of the 13 ranked items on the questionnaire, the Cronbach a test was used. Results Of the 27 residents to whom the survey was sent, 25 completed the questionnaire (93%), including 10 fourth-year residents (40%), 10 third-year residents (40%), and 5 secondyear residents (20%). Of the 25 responding residents, 14 had self-selected mentors (56%) and 11 had assigned mentors (44%). The mean length of mentoring relationships for all respondents was 2.1 years (range, 0.5-3.5 years) with 2.4 years (range, 1.5-3.5 years) for those with self-selected mentors and 1.9 years (range, 0.5-3.5 years) for the assigned group (P ¼ .16). The modal frequency of meeting with mentors for all respondents was every 4-6 months. Among the 14 respondents with a self-selected mentor, 6 met with their mentor every 3 months (43%), 7 met every 4-6 months (50%), and 1 met annually (7%). Of the 11 residents with an assigned mentor, 1 met with their mentor every 3 months (9%), 5 met every 4-6 months (46%), 4 met annually (36%), and 1 never met (9%). Of the total 25 respondents, 15 (60%) considered their faculty mentor their primary mentor, with those having selfselected mentors significantly more likely to consider their faculty mentor as their primary mentor than those with an assigned mentor (11 [79%] vs 4 [36%]; P ¼ .049]). In the subset of 8 residents with a self-selected mentor who requested a specific mentor but did not have a mentoring relationship before the mentorship program, 5 considered their faculty mentor as their primary mentor (63%). In contrast, all 6 of the residents (100%) with self-selected mentors who already had an established mentoring relationship before the mentoring program considered their faculty mentor as their primary mentor. Among all 25 respondents, when asked whether they considered their mentor a ‘‘good fit,’’ the mean rank on a scale of 1 (not at all) to 5 (extensively) was 4 (range, 3-5). The mean value for
respondents with self-selected mentors (4.2) was slightly higher than for those with an assigned mentor (3.7) but did not meet statistical significance (P ¼ .1). As shown in Table 1, mean rankings for the total group of respondents for assessing the contributions of mentoring to their training were modestly positive, ranging from 3.4-4.0 on a scale of 1 (not at all) to 5 (extensively). Although respondents with self-selected mentors had higher mean overall rankings than those with assigned mentors for almost all parameters, these differences did not meet statistical significance. With regard to overall satisfaction with the departmental mentorship program, the mean ranking on a 1-5 Likert scale was 3.7 (range, 2-5). Respondents with a self-selected mentor reported significantly higher satisfaction with the mentoring program than those with an assigned mentor (4 vs 3.3; P ¼ .04). The mean ranking given by the total respondents in regard to their satisfaction with the residency program was 3.9 (range, 3-5). Respondents with a selfselected mentor had higher mean rankings for satisfaction with the residency program than those with an assigned mentor, but this difference did not meet statistical significance (4.1 vs 3.6; P ¼ .1). All respondents, regardless of how their mentors were chosen, believed that mentoring was either beneficial (n ¼ 16 [70%]) or critical (n ¼ 7 [30%]) to radiology training. As shown in Table 2, mean rankings for the total group of respondents for assessing the perceived impact of mentoring on various parameters were modestly positive, ranging from 3.3-3.7 on a scale of 1 (strongly disagree) to 5 (strongly agree). Although respondents with self-selected mentors had higher mean overall rankings than those with assigned mentors for all parameters, these differences did not meet statistical significance. In summary, the 13 ranked mentoring parameters in the survey (goodness of fit, satisfaction with mentorship, satisfaction with residency, career decision, research support, professional development, personal development, clinical skills, educational support, success to date, becoming a future mentor, mentoring role in future career, continue mentoring relationship) showed a high intercorrelation with a validity score of 0.984 when using the Cronbach a test. This suggests that these mentoring parameters are related to a similar
Table 1 Mean rankings, on a scale of 1 (not at all) to 5 (extensively), of the perceived contributions of mentoring by all respondents, respondents with a selfselected mentor, and respondents with an assigned mentor
Parameter
Ranking (range) of all respondents (n ¼ 25)
Ranking of self-selected (n ¼ 14)
Ranking of assigned (n ¼ 11)
Career decision Research support Professional development Personal development Clinical skills Educational support
3.8 3.4 3.9 3.9 3.5 4.0
4.0 3.8 4.1 4.0 3.6 4.0
3.5 2.9 3.7 3.8 3.4 4.0
(2-5) (1-5) (2-5) (3-5) (1-5) (3-5)
Self-selected vs assigned mentors / Canadian Association of Radiologists Journal 65 (2014) 186e191 Table 2 Mean rankings, on a scale of 1 (strongly disagree) to 5 (strongly agree), of the perceived impact of mentoring on various parameters by all respondents, respondents with a self-selected mentor, and respondents with an assigned mentor
Parameter Success to date Becoming a future mentor Mentoring role in future career Continue current mentoring relationship after graduation
Ranking (range) Ranking of Ranking of of all respondents self-selected assigned (n ¼ 23) (n ¼13) (n ¼10) 3.4 (1-5) 3.3 (1-5) 3.7 (2-5)
3.7 3.3 3.8
3.1 3.2 3.6
3.5 (2-5)
3.7
3.3
construct and, as such, the mean summative scores of the 13 ranked parameters were compared collectively between respondents with a self-selected mentor and those with an assigned mentor, which showed a trend towards higher values in the self-selected group (mean [SD] 52.5 10.96) compared with the assigned group (44.5 10.2) (P ¼ .08). Discussion Mentoring is widely recognized as an important aspect of medical training and future career success [1,2,4,6,7,9,10,12]. Nearly half of radiology residency programs have formal mentoring programs, many of which were recently established [11]. Structured mentoring programs in which all residents are assigned to mentors are logistically easier to incorporate into residency programs and ensure that all residents have the opportunity to participate in the mentoring process. However, some physicians believe that such programs create less ideal mentoring relationships compared with those that develop more spontaneously, thereby potentially compromising the full benefits of the mentoring process [10]. A formal assessment of our mentoring program, which contains elements of both formal and informal processes, showed that the perceived benefits were modestly positive among all participants and that residents who freely selected their mentors were significantly more satisfied with the mentoring program and more likely to consider their mentor as their primary mentor compared with those with assigned mentors. As a result, we now only assign mentors to our entering first-year radiology residents after they have been in the department for nearly a year. In addition, we have implemented a monthly mentoring meeting in which faculty present topics related to academic success. Residents involved in mentoring programs have been shown to have significantly higher rankings for satisfaction with their mentoring environment than those without a mentoring program [1]. A recent survey of radiology residency program directors found that programs with formal mentoring programs are relatively evenly split between those whereby residents are assigned to faculty mentors and
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programs whereby residents are encouraged to choose their faculty mentors [11]. Our study showed that even the subset of residents with assigned mentors reported modestly positive benefits across a broad range of parameters from participation in our mentoring program. Although all of the residents appeared to benefit from participation, residents with self-selected mentors tended to rate almost all mentoring parameters more positively than those with assigned mentors, although the results did not reach statistical significance. These findings are in keeping with previous studies in other specialties that found that resident satisfaction with mentoring relationships is equal or greater with free-choice mentoring relationships than with assigned matches, with more frequent communication and more reported contribution to resident growth and development [1,8]. Analysis of our survey also showed that radiology residents believed that mentoring was beneficial or critical to their training regardless of whether a mentor was assigned or specifically chosen. Based upon our experience, to achieve greater satisfaction with mentoring among all residents, we believe that residency programs should seek ways to enhance the ability of residents to successfully choose their own mentors within a formal mentoring program. One way to ensure both high levels of resident participation and high satisfaction may be to delay participation until residents have been in the department for at least 1 year and to provide a climate that fosters close interaction between first-year residents and faculty so that more residents will be able to successfully self-select a mentor. There are several limitations of our study. First, despite representing a relatively large residency program, the sample size was small and the duration of participation in the program was variable. Therefore, many of the differences between the 2 subgroups did not reach statistical significance. Second, because it was not a randomized study, it is possible that there are inherent differences between the 2 subgroups based upon different personality traits (eg, introvert or extrovert). Third, although the mean length of mentoring was approximately 2 years (or half of the duration of residency training), we lack longitudinal data after residency and thus cannot assess the potential long-term impact of mentoring upon career satisfaction and career choices. However, a recent poll of alumni from the past 5 years revealed that approximately 60% of our graduates are currently in academic positions. Fourth, because there was no ‘‘control’’ group that did not undergo mentoring, we were unable to quantify the added benefits of participation in a mentoring program compared with nonparticipation. Finally, we acknowledge that our study lacks outcome data that compared the 2 groups. We plan to perform a longitudinal follow-up study of mentoring program participants after graduation from our residency program to provide such outcome data in a future study. In summary, we showed that residents highly value the importance of mentoring and that a formalized mentoring program was associated with modestly positive benefits during residency training. Even within a formalized mentoring
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program, self-selection of mentors provided substantially greater overall satisfaction with the mentoring program. Therefore, we recommend that resident mentoring programs consider incorporating mechanisms by which residents can maximize the opportunity to self-select a mentor while ensuring that all residents have an opportunity to benefit from a mentoring relationship during their training. Key Points -
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Although all of the residents valued mentoring, the residents who self-selected their mentor were substantially more satisfied with the mentoring program compared with those with assigned mentors. Residency training programs should incorporate selfselection of mentors into their mentoring programs to maximize the perceived benefits of the mentor-mentee relationship.
References [1] Flint J, Jahangir A, Browner B, et al. The value of mentorship in orthopaedic surgery resident education: the residents’ perspective. J Bone Joint Surg Am 2009;91:1017e22.
[2] Freeman SR, Greene RE, Kimball AB, et al. US dermatology residents’ satisfaction with training and mentoring: survey results from the 2005 and 2006 Las Vegas Dermatology Seminars. Arch Dermatol 2008;144: 896e900. [3] William L, Levine J, Malhotra S, et al. The good-enough mentoring relationship. Acad Psychiatry 2004;28:111e5. [4] Ramanan R, Taylor W, Davis R. Mentoring matters: mentoring and career preparation in internal medicine residency training. J Gen Intern Med 2006;21:340e5. [5] Ramanan R, Phillips R, Davis R, et al. Mentoring in medicine: keys to satisfaction. Am J Med 2002;112:336e41. [6] Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA 2006;296:1103e15. [7] Mainiero MB. Mentoring radiology residents: why, who, when and how. J Am Coll Radiol 2007;4:547e50. [8] Galicia AR, Klima RR, Date ES. Mentorship in physical medicine and rehabilitation residencies. Am J Phys Med Rehabil 1997;76: 268e75. [9] Slanetz PJ, Boiselle PM. Mentoring matters. AJR Am J Roentgenol 2012;198:W11e2. [10] Jackson VA, Palepu A, Szalacha L, et al. ‘‘Having the right chemistry’’: a qualitative study of mentoring in academic medicine. Acad Med 2003;78:328e34. [11] Donovan A. Views of radiology program directors on the role of mentorship in the training of radiology residents. AJR Am J Roentgenol 2010;194:704e8. [12] McKenna AM, Strauss AE. Charting a professional course: a review of mentorship in medicine. J Am Coll Radiol 2011;8:109e12.
Appendix 1. Resident Mentoring Survey PART 1: About You and Your Mentor: 1. What year in residency are you? ____ 1st ____ 2nd ____ 3rd ____ 4th 2. For how long have you been assigned to your current mentor? ____ <1 year ____ 1-2 years ____ 2-3 years ____ 3-4 years 3. Which one of the following statements best describes the selection of your current mentor in the mentoring program? ___ I had already established a mentoring relationship with my mentor, which was subsequently formalized by the mentoring program ___ I requested a specific mentor who was assigned to me by the mentoring program (but we did not have a mentoring relationship before this assignment) ___My mentor was selected for me by the mentoring program and was not specifically requested by me 4. On average, how frequently have you met in person with your mentor? ____ Monthly ____ Quarterly ____ Every 4-6 months ____ Annually ____ We have never met ____ Other (please list: ___________________________________) 5. On average, how frequently have you had other types of communication (eg, e-mail or phone call) with your mentor? ____ Monthly ____ Quarterly ____ Every 4-6 months ____ Annually ____ We have never communicated ____ Other (please list: ___________________________________) 6. Do you use the Mentoring Encounter Form to guide meetings with your mentor? ___ No (if no, please skip to question 8) ___ Yes (if yes, please answer question 7) 7. On a scale of 1 (not at all helpful) to 5 (extremely helpful), please rate the usefulness of the encounter form for guiding mentoring meetings and documenting your goals: ___5___4___3___2___1
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8. Do you consider the faculty person assigned to you by the mentoring program to be your primary mentor? ___ Yes ___ No, I have another mentor whom I consider to be my primary mentor. Please check whether your primary mentor is a member in our department: ___ Yes. He or she is a member of our department. ___ No. He or she is a member of another department. 9. On a scale of 5 (extensively) to 1 (not at all), please rate to what extent your primary mentor: a. Contributes to your professional development? 5 4 3 2 1 b. Supports your personal development? 5 4 3 2 1 c. Aids you in making career decisions? 5 4 3 2 1 d. Provides advice regarding clinical skills? 5 4 3 2 1 e. Assists you with research advice? 5 4 3 2 1 f. Supports your educational experience? 5 4 3 2 1 g. Is a ‘‘good fit’’ for you? 5 4 3 2 1 10. By using general terms name one or more actions or decisions that you have made that were influenced by your participation in the mentoring program (eg initiated a research project adopted a new study habit changed fellowship choice). If none please write ‘‘none.’’ PART 2: About the Mentoring Process and Residency Training: 11. Which one of the following most closely describes your perspective regarding the importance of mentoring to your training as a radiologist? a. Critical to my training b. Beneficial but not critical to my training c. Not important to my training d. Obstructive to my training 12. On a scale of 5 (extremely satisfied) to 1 (not at all satisfied), please rate your level of satisfaction with our departmental mentoring program: 5 4 3 2 1 13. On a scale of 5 (extremely satisfied) to 1 (not at all satisfied), please rate your overall level of satisfaction with our residency program: 5 4 3 2 1 14. On a scale of 5 (strongly agree) to 1 (strongly disagree) please rate your level of agreement with these statements: a. As a result of participating in this mentoring program I am more likely to become a mentor myself. 5 4 3 2 1 b. I believe that mentoring has played an important role in my success to date. 5 4 3 2 1 c. I believe that mentoring will play an important future role in my career. 5 4 3 2 1 d. I intend to continue my mentoring relationship with my current mentor even after I leave Beth Israel Deaconess Medical Center. 5 4 3 2 1 15. Optional Narrative: please enter any comments that you may have regarding the mentoring program, including suggestions for improving the program:
Appendix 2. Mentoring Encounter Form Resident-Faculty Mentoring Encounter Resident Name: Faculty Name: Residency Year: Date: 1. Resident perception of academic progress (including areas of perceived strength and areas for improvement): 2. Research and teaching participation (medical student/chiefs rounds presentations, case reports, research abstracts, and articles): 3. Publications, presentations (planned, in progress, completed): 4. Reading/study habits: 5. Area of subspecialty interest? Fellowship plans? Postresidency plans? 6. Goals for the next 6 months: 7. Goals for the next year: 8. Life issues (engagements, marriages, new children, illnesses, child or parent care, etc):