Sunday, June 20, 2010

I will remember you (Musings on mentorship)

In an article in the June 2010 issue Transfusion* Nancy Heddle wrote:
"Appropriate training and mentorship will serve as the foundation for the next generations of clinical trial specialists."
* Heddle NM. The randomized controlled trial: in celebration of Transfusion's 50th. Transfusion 2010 Jun;50(6):1173-8 (Published online Jan 15 2010)

This got me thinking about mentorship in transfusion medicine (TM) and how well this tradition is continuing. The blog's title comes from a love song by Canada's Sarah McLachlan, a song that can be applied to diverse relationships.
Mentorship can be defined many ways, but I mean it simply as many informal ways, large and small, that professionals guide less experienced colleagues to help them enhance their knowledge, skills, and careers, while simultaneously gaining much in return.

First, some personal anecdotes. Over the years I've been fortunate to have several mentors, most of whom probably do not realize that I consider them mentors. As you read, consider reflecting on those who have mentored you.

One mentor was the lab manager at my first job working as a lab technologist. The manager encouraged me to read and eventually I devoured the three 'bibles' of the time, known simply as Race & Sanger, Issitt, and Mollison. The gems, both theory and practice, inside those textbooks gave me a solid foundation in TM, an advantage that helped my career progress.

During these early years the odd misstep was also tolerated, as when I decided to change a method in the reference lab (there were no written SOPs at the time), an alteration that I thought was brilliant but, in my ignorance, did not realize could have adversely affected test results. I received a well deserved and controlled verbal 'spanking' along with rationales for why my innovation was bad, but was not fired or otherwise disciplined. Instead I continued as a valued employee who had the ear of the manager and input into lab policies and operations. Despite being pre-quality systems, a culture of blame did not exist, a lesson that has stayed with me to this day.

A second mentor was a transfusion service physician with whom I worked closely for several years after becoming an educator and clinical instructor. Our relationship helped build confidence, especially being accepted as a colleague without any hint of a pecking order. Sharing many a laugh over student responses in oral exams (one example: anti-A1 lectin = Delicious biflorus) significantly contributed to a sense of collegiality.

Working together on a research project and various interactions involving students enhanced my respect for the physician, who had incredible knowledge of immunohematology practices and the techie side of the lab. The confidence gained during this time to deal with physicians on a footing of mutual respect was essential to my career over the ensuing years.

Other mentors included a technologist who encouraged me to get involved with my professional society, which opened up many networking doors and led to lifelong friendships; and a colleague who taught by example valuable teaching skills, particularly the critical importance of respect and empathy for one's students as individuals.

There are many mentorship papers in the literature.
[Note that you can filter results to reviews and free full text - see right side of screen.]

In preparing this blog, I also searched the Internet for mention of mentors in a TM setting. Some examples:

1. ASH has a mentor award.
General criteria to receive the award:

"...awardees will have had a sustained career commitment to mentoring, a significant positive impact on their mentees' careers, and through their mentees have advanced research and patient care in the field of hematology."
2. Several TM physicians discuss mentors and their influence. Random examples:

  • Ira Shulman's profile for BloodMed.Com
  • Paul Ness in an interview in HemOnc Today

    • The value of mentors in medical education is discussed by Natalie J. Belle (known as njbmd on the Student Doctor Network) in her blog entry on pathology (unfortunately, no longer online).

      Of interest: "My pathologist mentor for Transfusion Medicine had a profound influence on the manner in which I practice medicine today. He was an excellent professor with a wonderful staff who was quite willing to show an eager medical student all aspects of Transfusion Medicine."
      • "...willing staff and eager students..." Hmmm...
      Two articles in particular caught my eye, one on each side of the mentorship relationship:

      1. Davis OC, Nakamura J. A proposed model for an optimal mentoring environment for medical residents: a literature review. Acad Med. 2010 Jun;85(6):1060-6.

      In brief, to develop a model of optimal mentoring for medical residents, the authors searched the literature. They found six attributes of a good mentor that were consistent across the 20 papers that met their inclusion criteria and that can serve as interactional foundations that underlie an optimal mentoring relationship:

      • emotional safety
      • support
      • protégé-centeredness
      • informality
      • responsiveness
      • respect
      Among other things, this study suggests that, when guiding students and new staff, by modeling appropriate behaviors, we should convey that

      • not knowing everything is normal and "okay";
      • their needs are more important than ours;
      • they are colleagues (not nuisances); and
      • we respect them by responding to challenges, even those that differ from current dogmas.
      2. On the other side, proteges also have responsibilities as explained in this paper:

      According to the author, who discusses formal mentorship in the USA military, but whose ideas apply more broadly, the 10 most important qualities of ideal proteges (mentees / learners) include
      1. Love of learning
      2. Self -starter
      3. Confidence
      4. Prudent risk taking
      5. Flexibility to rebound after mistakes
      6. Enthusiasm
      7. Open minded to advice and constructive criticism
      8. Commitment to relationship with mentor
      9. Loyalty (keeping confidences)
      10. Gratefulness, to include becoming a mentor to others
      As a former educator, I believe that these qualities constitute what could be considered the ideal student. The only thing I would add is a willingness to challenge established practices and policies rationally (asking why and requesting evidence), as opposed to accepting everything passively or offering knee-jerk opposition to authority (seen in some students, and a normal part of growing up).
      A teacher's reply may often be the equivalent of
      • historical precedence (no good reason - it's always been done this way)
      • practicality (e.g., allows for reduced staffing on weekends)
      • favorite 'hobby horse' of local pooh-bah (colleagues are afraid to challenge pooh-bah's beliefs, especially those of a grand pooh-bah)
      So, do TM professionals entering the field today, whether physician, medical technologist, scientist, or nurse, get the mentorship they need to develop as the 'next generation'? I'll speak to the technologist side of the question as this is what I know best.
      Mentorship in the clinical lab seems on the wane. With ongoing cutbacks and finding ways to do more with the same or less, technologists have little or no time to train new staff fully, let alone mentor them.
      Yes, training and competency assessment occur, as they must, but with few resources everything often devolves to the basic minimum. Is this situation specific to technologists or does it apply to other professionals on the TM team? Feedback is appreciated.
      As well, with fewer technologists as TM specialists, training may not include problem solving skills, since cross-trained staff are directed to pass problems to supervisors. The option to by-pass problem solving by on-the-bench technologists may accommodate current realities, but the question arises,
      • "What if there is eventually no one suitably trained to investigate anomalies and problems?"
      With the anticipated retirement of baby boomers, this issue becomes more relevant. 

      New recruits to TM need mentors. Indeed, without mentors there soon may be no recruits. The challenge is how to foster mentorship with diminished resources.
      If potential recruits see TM as a fulfilling career (financially, intellectually, emotionally) AND if TM professionals view mentoring as an opportunity to make a real difference, mentoring will happen no matter what the challenges.
      I have always been surprised, delighted, and humbled when colleagues acknowledge me as a mentor. There is absolutely nothing - NOTHING - that compares to the satisfaction of knowing that you played a role, no matter how small, in students choosing TM as a career, or that respected colleagues consider you to be a mentor.
      Sarah McLachlan's I remember you offers a fitting sentiment for all mentors and mentees:

      I will remember you
      Will you remember me?
      Don’t let your life pass you by...
      Enjoy Islands in the Stream, a delightful duet by Dolly Parton and Kenny Rogers. 

      Comments are most welcome BUT, due to excessive spam,  please e-mail me personally or use the address in the newsletter notice...and we have some (see below). Thanks to those who posted - great food for thought.


      1. Denise Evanovitch8:52 AM

        Hi Pat,

        Yet another article (mentorship) that is dead on. Our educator/mentorship hearts ache as we witness the decline of teachable moments and reduced opportunities to foster curiosity. We need inquisitive minds to meet the challenges of the future and to question the status quo to find a better way. Our curiosity and necessity to know ‘why’ drew us to the profession laboratory technology in the first place. This quality-or curse-sometimes drives our clinical partners crazy!

        As Canadian healthcare focuses on the almighty buck, many historical, positive aspects of mentorship suffer. Laboratories are moving towards creating ‘generalists’ at the expense of losing discipline-specific expertise. Now, there is a place in the world for generalists—they are valued employees and professionals. They fill a niche and provide a broad wealth of knowledge that specialists most definitely cannot. On the other hand, the increase in generalist positions should not come at the expense of losing specialists. They too fill a valuable role in the broad scheme of laboratory expertise and healthcare in general. Specialists have unique bodies of knowledge, experience and skills to share. One non-transfusion example that comes to mind is the decline of competent morphologists. Technology and concentrating expertise can only go so far. How can these experts mentor up-coming technologists when they are removed from the main stream laboratory to perform these specialized functions?

        The creation of ‘lean and mean’ laboratories has also removed opportunities for coaching, teaching and mentoring. If it’s not unit-producing work, activities are considered ‘fluff’ and may not be supported. Mentoring and teaching occur in various ways—one on one right in the lab, or on break, after work and also in a more formal rounds or symposium format. When technologists are unable to attend the more formal sessions, they lose the opportunity to network and validate new information. Our profession becomes even more invisible.

        It is shortsighted of the health care administrators to dismiss the importance of teaching, coaching and mentorship. Preceptors and mentors in healthcare have a long history for good reason. Consider the success of technologists who actually receive a placement in a functioning laboratory versus those who only have the simulated experience. Who will be the teachers, mentors and experts in the future?

        However, all is not lost and there are pockets of brilliance. People like yourself, Pat, reach out to thousands around the globe to teach from a medium no one would have thought possible a mere 15 years ago. I see our teaching technologists continually giving their best to technologist students and residents from many different disciplines. This interaction is brief, but very powerful. Current experts in the field actively seek out teaching and mentoring opportunities because they appreciate the value and want to give back to the healthcare community. There is only so much one individual can do, so we need to put our heads together to figure out how we can protect laboratory learning and mentorship that we currently have and go one step further to increase these opportunities in our own backyard. Don’t forget those outside our laboratory walls. Laboratory professionals have a great deal of expertise to share that is valuable beyond our field.

        Thanks for letting me expound on a topic very near and dear to my heart.

        Regards, Denise Evanovitch

      2. Bev Padget10:17 AM

        Hi Pat,

        I too have had the privilege of being mentored by some incredible individuals – some of the ‘greats’ in transfusion medicine in Edmonton, Alberta and Canada. My career would not have been nearly as fulfilling without the knowledge and empowerment passed on to me by these physicians and technologists.

        My first ‘mentor’ came into my life when I was a very young student and her influence continues to this day (when I am not so very young any more). As one’s career path evolves, we encounter new mentors – or the role of the mentor evolves as well.

        It’s interesting to think about one’s mentors and to realize that it really is a very individual, personal relationship. One of my mentors was perhaps not recognized by many of my colleagues as the type of person who supported or recognized the skills and achievements of others. Yet, for me personally, the mentorship given by this individual had a definite positive influence on my career.

        And (you had to know this was coming) – of course, one of the greatest mentors in my career – both past and present – is you, Pat. The attributes of a good mentor as described by Davis and Nakamura - emotional safety, support, protégé-centeredness, informality, responsiveness and respect – seem to have been written with you as a model. Your guidance and support, even when you don’t realize you are guiding and supporting, means the world to me! I only hope that I have exhibited some of the qualities of an ideal mentee…..
        Your musings on the state of mentorship in today’s world unfortunately really do represent the reality. Transfusion Medicine professionals must make the effort to mentor and encourage their younger colleagues. This needn’t be an onerous task – as with most everything else in life, if everyone devotes just a little time to this goal, the end result can be significant.


      3. Anonymous10:58 AM

        I delight in the examples that the author gives of mentorship received: being encouraged to read the transfusion medicine ‘bibles’, a flexible climate in which to rebound after a bright idea was revealed to be misguided, feedback that was palatable and helpful, respect for her and for what she brought to the table. Her gratefulness for what she attained is clearly evident - definitely she was an ideal protégé who has gone on to a life of most valuable mentoring!

        Attribute #4 in the list of qualities of ideal mentees, prudent risk taking reminds me of today’s Edmonton Journal. Bruce Barcott comments on the parents who allowed their 16-year old to attempt to sail solo around the world. Although we might argue about prudence in this particular case, Barcott maintains that it requires subversion in order to raise bold children who might attempt risk-taking.

      4. Denise - Thanks for such thoughtful feedback. As a mentor 'par excellence'you know from where you speak.

      5. Bev - thanks for these comments.

        You pointed out a key truth that often gets lost in the shuffle:

        "...if everyone devotes just a little time to this goal, the end result can be significant."

        Mentoring's positive effects can grow exponentially. As you note, even small efforts can deliver results.

        Also interesting that you mention that mentors are not always seen as such by the group. Points out the personal, almost intimate, nature of some mentoring that occurs between 2 individuals. Also that mentors, being human, are invariably flawed like all of us. (grin)

      6. Re -prudent risk taking:

        Anonymous wrote, "... Bruce Barcott comments on the parents who allowed their 16-year old to attempt to sail solo around the world....Barcott maintains that it requires subversion in order to raise bold children who might attempt risk-taking."

        Thanks, anonymous. The willingness to take risks is rare today and requires considerable knowledge, skill, confidence, and a healthy dose of common sense.

        I love the notion that subversion plays a role in developing risk takers. How true!

      7. Denise, appreciate your many insights and want to comment on this one in particular:

        *"When technologists are unable to attend the more formal sessions, they lose the opportunity to network..."

        The considerable cutbacks to supporting attendance at conferences that has occurred over the past few years does have a multiplier negative effect:

        * Staff feel devalued. This reality can undermine so much that happens, or often does not happen, in the workplace.

        * They lose learning opportunities that happen only via firsthand experience such as asking questions as part of a presentation or afterwards, more informally and often more frankly.

        * Staff do not get to network. Networking is critical to career development and to fostering innovation. The main learning that occurs at meetings often happens by informal networking.

        Many employers (not all), whether private or public, take a short-sighted approach and seem to hope that the future will take care of itself.

      8. Roger Strange8:25 PM

        Hi Pat - loved the article - how true and how sad that mentorship is a dying art. I had some wonderful ones, and also hope that I was in some small way a mentor the the many lab students that came through my hands here in Victoria. The lack of "time" today, and knowledge, perhaps explains why I got an email after 7 years of retirement asking for some info from my old lab!
        Re: the books you mentioned. Race and Sanger of course, but what about Boorman and Dodds, and Dunsford and Bowley (the last 2 pre-date Isitt by a long shot, but I cut my teeth on them!).
        Still love reading your blogs - keep them coming.