Author + information
- Jonathan N. Flyer, MD and
- Anna Joong, MD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Anna Joong, Division of Pediatric Cardiology, Columbia University/Morgan Stanley Children’s Hospital, 3959 Broadway, CHN Suite 229, New York, New York 10032.
The hierarchy of post-graduate medical training is predictably seasonal: every summer new trainees arrive, junior physicians advance, and the most weathered house staff graduate. Progress within medical training systems, however, is often accompanied by apprehension. To ease the anxiety of increasing clinical responsibilities, new rotations, and academic presentations, house staff traditionally seek advice and guidance from their peers. These informal relationships often serve as a pillar of medical training, and we sought to strengthen and formalize this tradition within our pediatric cardiology fellowship by instituting a structured peer mentorship program. To the best of our knowledge, this was the first formal peer mentorship system within a pediatric subspecialty training program.
The Accreditation Council for Graduate Medical Education (ACGME) was established in 1981, and recently updated with the Next Accreditation System to standardize medical training and evaluate trainees according to subspecialty-specific and developmentally based milestones (1). Although mentorship was not identified as 1 of the 6 ACGME core competencies, it is essential to a physician’s development and career. Despite these educational and programmatic reforms, there is still a paucity of emphasis on formal mentorship within medical training. In a recent 2015 Fellows-in-Training (FITs) & Early Career page, Sinha and Cullen (2) recognized mentorship as the “linchpin of success,” and addressed the need for FITs to develop nonclinical competencies.
Although the importance of mentorship is well known (3,4), the idea of formal programmatic peer mentorship within medical education and general and subspecialty training remains widely variable and underutilized (5,6). Many training programs recognize this need for mentorship by implementing programs composed of a faculty mentor paired with a trainee (3,4,7). Perceived mentorship within a training program can be associated with increased fellowship (8) and career satisfaction (9), can assist with academic career choices (10), and can improve self-confidence in research endeavors (9,11). We believe that beyond traditional faculty-trainee mentorship programs, there exists an additional and underutilized resource of peer mentors within every training program that meets the unique and seasonal needs of the house staff (5,6).
Formal peer mentorship programs are used in many academic settings, often at the collegiate level, to provide support, foster community spirit, and cultivate leadership skills (6). Within subspecialty post-graduate medical training, senior fellows have advanced clinical and institutional experience and are therefore well suited to provide peer mentorship to junior fellows. Senior fellows can also create a culture of commonplace peer mentorship to help ease the initial transition from residency to fellowship, and can continue to provide additional support throughout training. We aimed to improve the transition for first-year fellows embarking upon a busy clinical fellowship through the development of a novel structured peer mentorship program led by senior fellows.
The House System: A Pilot Peer Mentorship Program for FITs
Prior to July 2015, our pediatric cardiology fellowship at Columbia University Medical Center had a traditional mentorship program that paired 1 faculty mentor with a fellow mentee; however, there was no formal fellow-based peer mentorship program. In June 2015, we conducted a baseline anonymous retrospective survey of then current fellows (n = 15) and asked them to reflect upon their first year of fellowship training. The survey revealed that most fellows were either equivocal or dissatisfied with peer mentorship: 43% were “somewhat” to “very dissatisfied” and 29% were “neither satisfied nor dissatisfied” (Figure 1). On the basis of the survey results, our rising senior fellowship class decided to institute a formal peer mentorship program and measure fellow satisfaction in peer mentorship throughout the 2015 to 2016 academic year.
Program Design and Implementation
In July 2015, our pediatric cardiology fellowship started a Fellow “House” Peer Mentorship Program that matched senior (third-year) and junior (first- and second-year) fellows into a “house” that included 3 fellows—1 from each class—and 1 faculty member. Importantly, the third-year fellows were identified as the respective leaders of their houses, and developed goals and designed and agreed upon all elements of the program.
In the first one-half of the year, senior house members were responsible for contacting their first-year house members to assist with the transition to fellowship, to regularly “check in” about clinical rotations, and to provide additional in-house “back up” for their initial independent calls. Additionally, seniors reviewed all case management presentations of junior house members to provide timely feedback prior to conferences. Houses also met throughout the year to discuss general fellowship topics including development of research projects, building a curriculum vitae, and early career planning. At the end of the year, all first-year fellows (n = 5) indicated that they were “very satisfied” with the house mentorship program (Figure 1).
The implementation of a Fellow House Program over the 2015 to 2016 academic year was our first formal peer mentorship experience within our pediatric cardiology fellowship program. During its inaugural year, the program dramatically improved the culture and overall satisfaction of peer mentorship. The house program also provided additional nonclinical opportunities for senior fellows to develop leadership and mentorship skills.
The unique attribute of the Fellow House Program is that it immediately provides a new trainee with several levels of mentorship within a peer group, in contrast to typical 1-on-1 peer mentorship programs. We believe that including all classes offered diverse perspectives on fellowship training, thereby strengthening house meetings, increasing trainee professionalism, and helping to forge friendships beyond clinical boundaries. In addition to structured houses, fellows noted a vast improvement in the general culture of peer mentorship and support, with junior trainees noting that they frequently experienced mentorship by senior fellows even “outside” of their assigned houses.
We believe the cornerstone of our peer mentorship program was that mentoring goals and objectives were designed and implemented by the senior fellows. Following the program’s successful inaugural year, there was a unanimous fellowship vote to continue house mentorship, with immediate plans to construct new houses for the coming academic year. To better welcome incoming fellows, the new house leaders (rising third-year class) held a meeting to review and update the yearly goals of the house program, building upon the tradition of a fellow-driven peer leadership program. The long-term success of this program will be determined by the fellows themselves, and its performance can thus be measured by junior fellows’ satisfaction and experience each year as they advance to new clinical roles.
The house program could be adopted by other fellowship programs in 2 steps: 1) ask current fellows to identify areas for improvement in peer mentorship, for example: “Reflecting upon your first-year experience, what areas of the fellowship do you think could benefit from peer mentorship?”; and 2) introducing the house model to the senior fellows and propose that they help shape the system to meet their program’s specific needs. On the basis of our experience, distributing brief outgoing surveys to graduating fellows is helpful to obtain valuable feedback and generate new peer mentorship ideas. Future program directions could include mentoring during cardiac catheterization rotations, collaboration on quality improvement projects, and incorporation of recent alumni into the houses for additional career guidance.
From our experience, we believe a formal fellow-driven peer mentorship program can be a useful adjunct to traditional faculty-trainee mentorship programs. In agreement with Sinha and Cullen (2), fellows “who have benefited from mentoring must become mentors themselves” to help teach the principles of medicine to the next generation of physicians. Future work is needed to implement and grow formal peer mentorship programs within our post-graduate medical training system. And, perhaps we are not far from the day when mentorship itself is named by the ACGME as the seventh core competency.
- Andrew Long, MBBS, MA ()
RESPONSE: Peer Mentorship
Movement From a Core Competency to a Requirement
I was delighted to be given the opportunity to respond to the paper by Drs. Flyer and Joong on peer mentorship within subspecialty training. Within the United Kingdom, there is a fresh focus on “generic professional capabilities” (1), which map to the ACGME Core Competencies. However, there is an increased emphasis on defined aspects of leadership and team-working, including the expectation of “supervising, challenging, influencing, appraising and mentoring colleagues and peers to enhance performance and support development.”
The escalating pressures of patient expectations, increased workload, and enhanced scrutiny of professional practice has led to greater anxiety among doctors in training (2), which has in turn led to questions being raised about the resilience of the current generation of medical trainees. However, Drs. Flyer and Joong rightly identify the acknowledged benefits of mentorship for increased satisfaction, improved self-confidence, fostering community spirit, and aiding transition through increasing responsibility in training programs. The authors quite correctly recognize the benefits and the weaknesses of traditional faculty/trainee mentor pairing (3) and have developed a successful “formal” peer mentorship program.
The novel aspect of the Fellow House Program is the contribution from faculty as well as senior fellows in a “triplet,” but with mentoring goals and objectives being set by the senior fellows. It is assumed that with increasing confidence, the junior fellows develop their own mentorship goals; thus, they fulfill the central concept of mentoring that the mentee sets the agenda. This has been 1 of the principal challenges of developing a successful mentorship relationship with those undertaking a supervisory, and therefore assessment, role. The advantages of improving the culture of peer mentorship and support across the whole of the program cannot be underestimated. The challenge, inevitably, with such a program is maintaining enthusiasm, but once cultural change is established, it is often self-perpetuating. The authors’ suggestions for extension to other fellowship programs are helpful.
Our experience with peer mentorship in training programs (4) is that mentors and mentees not only continue to remain actively involved with mentoring, both formally and informally, but also actively promote mentorship programs and take on leadership roles themselves. The day is not far removed when mentorship is not only recognized as a core competency in its own right, but also seen to be an underpinning requirement for all doctors from the start of undergraduate training through to retirement from professional practice.
- ↵General Medical Council. Development of generic professional capabilities. Available at: http://www.gmc-uk.org/education/23581.asp. Accessed October 29, 2016.
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The authors are grateful to their program director, Dr. Julie Glickstein, for her enthusiasm and support of the House Program; to their former senior fellow colleagues, Drs. Jaclyn McKinstry, Nithya Swaminathan, and Kristal Woldu; as well as to all Columbia University pediatric cardiology fellows, for their endless energy and commitment to the development and success of the peer mentorship program.
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