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.