The highway runs both ways

Many of you know that I have a strong interest in mentoring and the impact of mentoring on career development in academic surgery. I’ve been wrestling with this question in one form or another since the middle of my own residency.  It’s easy enough for us to be prescriptive about qualities of effective mentors or structures that foster effective mentor-mentee relationships.  What we focus on less commonly is the mentee’s role in the relationship; the reality is that a mentor can be the best mentor in the world, but if the mentee isn’t active in the relationship, it’s doomed to failure (see analogy here: you can lead a horse to water…).

Since the academic year is about to change, I figured there’s no time like the present to provide tips and tricks for being an effective mentee.  Full credit goes to some mid-career and senior women surgeons who I interviewed from 2013-2015, and who provided the following concepts of being an effective mentee.

  • Put yourself in the driver’s seat– No, I’m not telling you to boss your mentor around.  What I am telling you is to be clear about what you want/ need/ expect from the mentoring relationship.  Not only do you need to actively seek mentorship, you need to have a purpose in that relationship. If you come into my office and ask me to mentor you, I’m pretty likely to ask you to think about in what your goal is for our mentoring relationship…and send you away to think about it.
  • You are accountable, and it’s up to you to report back– Let’s pretend that you came to my office and asked me to mentor you, but you didn’t have clarity around what you wanted that to look like or what exactly you wanted from me.  I gave you the task of figuring that out and told you I was happy to meet again once your ideas are better formulated. In general, I’m not going to come find you to get some idea how your brainstorming is going.  It’s your job to do your homework (so, put on your thinking cap) and reach out to me when the time is right.  I’m not clairvoyant so I can’t guess, and if you do your homework then come back I know that you’ve got skin in the game. I’ll make time for you, and please don’t worry about me being busy- I am, but if you’re invested I am invested too.
  • Be receptive to feedback- A high-performing mentor will have to perform acts of radical candor if they’re doing their job effectively. That means that the feedback they give you may not always be sunshine, rainbows, and bunnies.  When I am having to give you hard feedback, I’ll do my best to deliver it respectfully and thoughtfully as long as you try to stay tuned in.  I know how challenging hearing negative things is because I’m not perfect either and have heard plenty of them over the course of my career.  I’m also giving you the challenging feedback because I suspect it’s not part of who you aspire to be, and my job is to help you be the best version of you. Oh, and after I say the hard things? Please act on them!
  • If I open doors for you and provide you with opportunities, please capitalize on them- This is self-explanatory.  Go out there and shine bright if I’ve sponsored you for something!
  • While this may be a long-term relationship, we’re not married- I know that you’ll likely outgrow me someday, or that I may help you meet the goal that you set in working with me as a mentor. If we’ve had a successful run together, I’m always going to be interested in what you’re doing, even when I’m not directly part of it, and it’s not going to hurt my feelings if you tell me you’ve got another mentor(s).  Quite honestly, my best success is shown when you’re succeeding, and perhaps when your own success exceeds mine.

Any other “best mentee ever” tips out there, readers?  Please share!


Nature vs. Nurture

Based entirely upon observational/ anecdotal data, I believe there are two categories of students who choose careers in surgery.

1.  The “born surgeon” and

2. The clerkship convert

I suspect that a number of my readers, and I know that many of my colleagues, were of the first variant.  They are those people who have known since they were 2 years old that they would be a surgeon when they grew up, and the trajectory of their entire life has been focused on that goal.  They were driven, obsessed even, in a way that few can understand.  When asked why they want to be a surgeon, they’re the ones who will give you a crazy look as if thinking, “Well, why would someone be anything else?”

While I find their determination admirable, I was decidedly not a member of that category.  I went to medical school thinking that I was going to do something in pediatrics; not general pediatrics because I knew that red ears and Mommy calls were not aligned with my personality traits, but a pediatric specialty.  Pediatric ICU and Pediatric ER were the two front-runners for my first two years of med school because I would get to take care of children but it would be acute and would require me to be decisive and DO things…quickly.  I also functioned under the (entirely unfair and generally untrue) assumption that surgeons were by nature unpleasant and difficult people, and I didn’t want to become that or work around it all the time.  I’ve been teased more than once about my proclamation during gross anatomy lab as an MS1, “I’m not going to be a surgeon so I don’t understand why some of these details matter!”

Foreshadowing take-home lesson:  Never say never.

And then, my conversion happened.  During our pediatrics rotation we had one elective week.  In the interest of seeing something different from the pediatric subspecialties I already knew a bit about, I opted for pediatric surgery.  I spent a week with the man who would ultimately become my mentor as a student- and who I still channel in the OR from time to time (“bunny ears” for 1 cm tails when cutting suture is a Danny Custer phrase that I have coopted).  I saw that he got to work with kids and that his job met many of my criteria for how I wanted to work; I also realized that he had the relatively immediate gratification of taking a problem and being able to fix it.  He is in no way unpleasant and difficult.  If anything, his absolute joy in what he got to do and his ability to convey that while teaching made him an inspirational clinical teacher.

I was hooked.

My surgery rotation itself was my last rotation of 3rd year, but it reinforced that I really love what we get to do as surgeons, and that many surgeons are wonderful humans.  I learned to cut.  I learned to sew.  I learned how to make sense of critically ill and injured patients.  And while I didn’t end up as a pediatric surgeon, I do still get to care for children.  When I was a 4th year student and was in town, Danny would call me if he had a really great case on to see if I could come scrub with him.  That’s a master class in how to be an exceptional mentor.

I tell this story for learners to encourage you to keep an open mind- you simply never know what experience is going to grab you and change your life, and if you’ve closed yourself off you might just miss out on a big adventure.  I tell it for teachers to remind us of the importance of communicating our passion for what we do to our students.  Had Danny been someone who sat around grousing about being on call every other night (because he was) or about different facets of the business of health care, I’m pretty certain I wouldn’t be doing what I am doing now.  Instead he showed me someone who valued his patients and their families, who loved his role he played for them, and who believed that teaching students was one of his most important tasks.

The great pretender

With all of the responses and comments I got about last week’s post on women and the confidence issue, it inspired me to take on a different facet of the same set of issues.

The impostor phenomenon or impostor syndrome.

First described in 1978 by Pauline Rose Clance, the fundamental premise is that despite tremendous professional accomplishment, those who are affected by the impostor phenomenon persist in sincere denial of their capability and believe that they have “fooled” others and the system to achieve their status.  Found disproportionately among high-achieving women, the impostor phenomenon is characterized by minimizing achievement, be it a promotion, a high test score, or a specific achievement that is meaningful in a woman’s professional world.  The fear that underlies this syndrome is that of being “found out”- for example, the anxiety harbored by many young women surgeons that when they take their certifying exam, their examiners will discover that they actually have little to no surgical knowledge.  Admit it, ladies:  at least a couple of you felt this way (and yes, gentlemen, I know that some of you did too).  The impostor phenomenon is likely to also disproportionately impact women in male-dominated fields, meaning that academic surgery…well, let’s just say it might be a set-up.

Several months ago, our WIMS office at the University of Utah hosted a terrific panel in which several very accomplished female faculty members discussed how the impostor syndrome impacted them and their career development.  If I were to use the model they used, my introduction would start something like this:

” It all started when I was admitted to college.  They were going to allow me to start at age 17, the end of my junior year?  My senior year as I applied to graduate school I somehow was mysteriously offered scholarships for my graduate work from all 3 of my top choices.  Then my course correction into medical school- I had the “wrong” academic background coming from the liberal arts, and had bailed on grad school shortly before comps.  Why would medical school want me with that pedigree?  Every day in basic sciences I was certain that a mistake had been made.  For the first time in my life, something academic felt hard to me.  Really hard.  Then I hit my clinical years where I felt insecure but not like a true impostor.  Until I hit internship, that is.

I matched at my first choice program in general surgery with a profile that my Dean had told me was unlikely to result in success in applying for a residency at an academic surgical program (note:  all of my surgical mentors counseled otherwise).  In Fall of my intern year, after participating in the application pre-review process, one of my co-interns and I looked at each other and commented that we both were certain we had been rank list errors; everyone whose applications we were looking at seemed so much more accomplished than we were!”

Here’s the thing:  Impostor syndrome likes dark, quiet places to hang out, where people don’t talk about their fears and insecurities.  It feeds on the shame of inadequacy.  That moment with my classmate was illuminating for me because it was the first time that I had “come clean” about wondering how I got to where I was with someone I really respected.  To find that she had the same fears was a BIG deal and the basis for a lot of sanity-preserving conversations over the next 5 years- with her and with another resident who started the year after us.  We learned from each other to take credit when good things came our way, and we were able to normalize one another’s anxieties as women surgeons.  Most importantly, when one of us needed guidance and constructive criticism, we had a safe community to provide that.

I’ll admit that I still have moments of stopping to look around and be awed by where I am professionally, and humbled by some of the opportunities I receive.  I’ve also learned how to simply say, “Thank you, I appreciate the honor,” rather than bumbling through why it was predicated on luck or timing or who I know.  I have a community with whom I can be honest when I’m feeling overwhelmed and mentors who both nurture and nudge.  I still keep looking for ways to grow, professionally and personally.  Are these things cures for the impostor syndrome?  I’m not sure, but they certainly help keep it at bay.