Mentorship in Dermatology-A Beginner's Guide.

Mentoring albeit is a recently described and popular phenomenon in medicine, is not a new one. All medical specialties have a complex, intertwined relationship between their physicians and trainees who are in different stages of their careers. How a specialty evolves depends on the thread woven by these relationships. This article outlines the concept of mentorship and introduces its various aspects in dermatology. This article attempts to answer what, why, how, when, and where related to mentoring in dermatology, including e-mentorship. The article also includes personal reflections of the authors who are involved in this process. Copyright:

Introduction

Mentoring is a concept first mentioned in Greek mythology. In Homer's Odyssey, 'Mentor' was the son of Alcimus who was a wise and trustworthy adviser responsible for protecting Odysseus's son, Telemachus. The values of mentoring that this relationship provides transcends time, gender, and culture and are of utmost importance in what mentoring in medicine means today.[1]

What is It?

A mentor simply means an “experienced and trusted adviser.” A mentor shares with a mentee his/her career decisions and experiences as well as facilitates professional and personal growth by motivation, guidance, and serving oneself as a role model. Mentoring can arise from informal relationships through shared interests and similar personality characteristics.[2] These relationships develop when people interact at the same time and space and are a chance-based phenomenon. Formal mentoring aims to replicate the benefits of informal mentoring by eliminating chance factors and creating a forum to let this relationship flourish.[2]

Why to Do It?

Mentoring is a lifelong process, quintessential for the development of a career, especially in the field of academic medicine. It helps in the selection and advancement of career, enhancing the productivity of publications, and achieving grants and funds for projects. Under ideal circumstances, it should be dynamic and collaborative under the umbrella of a reciprocal relationship. In a Canadian survey of 53 dermatology residency program directors, 81% of the respondents indicated that mentorship played a 'somewhat' or 'very important' role in their career progression and considered proportionately important for residents to have mentors.[3]

How to Do It?

Straus et al. in their study explored the mentor–mentee relationship with a focus on determining the characteristics of effective mentors and mentees. They also aimed toward understanding the factors influencing successful and failed mentoring relationships. The authors explored the view of the faculty members and experiences of mentorship across two different academic health centers (one in Toronto and the other at San Francisco) that instituted formal mentorship programs. Interesting observations of the study were labeled as “successful” and “failed” mentoring relationships.[4]

To the best of our knowledge, randomized trials evaluating the effects of mentorship have not been conducted, but systematic reviews have been published, the conclusion being effective mentorship has a role in generating faculties who are more productive, have higher chances of promotion, and are more likely to stay in their academic institution. Sambunjak et al.[5] explored the impact of mentorship on the career choices of the faculty members and academic advancements on the basis of 34 cross-sectional self-report surveys. Since 2006, numerous observational studies have been published. A 'successful' relationship is characterized by reciprocity (bidirectional nature of mentoring, including consideration of strategies to make the relationship sustainable and mutually rewarding), mutual respect (respect for the mentor and mentee's time, effort, and qualifications), clear expectations (the expectations of the relationship are outlined at the onset and revisited over time; both the mentor and mentee are held accountable to these expectations), personal connection (the connection between the mentor and mentee), and shared values (around the mentor and mentee's approach to research, clinical work, and personal life). Besides, failed relationships are the result of poor communication (including lack of open communication, failure to communicate tactfully, and inability to listen), lack of commitment (lack of time committed to the relationship or waning interest over time), personality differences (different personal characteristics between the mentor and mentee), perceived (or real) competition (overlapping interests may lead to competition), conflicts of interest (competing agendas between the mentor and mentee), and the mentor's lack of experience (mentor may not have relevant knowledge, skills, or experience).

When to Do It?

Mentoring can be needed in different stages of a career. It can be divided into the following stages:

Pre-training

This can help to define the career path. It is to determine whether a specialty of your choice is what matches your goals and aspirations and what to expect in and after your training.

Training

Mentoring helps to streamline one's decisions and helps to face the difficulties offered by every specialty. It helps to get the best of your formative years. Most training programs across the world have an educational supervisor or equivalent, and usually, they have a lot of influence on them. Mentoring can still play a role when the interests of the trainees and their supervisors are different. This can be facilitated by the mentor or through other formal and informal mentoring channels. One of the international societies, 'The Women's Dermatologic Society (WDS)' offers a Mentorship Program to dermatology residents [Figure 1].

Figure 1

Dr. Rashmi Sarkar, Mentor, Women's Dermatologic Society (WDS) with Mentee Dr. Erika Reid, Resident from the USA, as a Mentee from WDS Mentorship Program at the Department of Dermatology, Maulana Azad Medical College, New Delhi, India

Early years as a physician dermatologist (<10 years since completion of training)

These years are challenging for every dermatologist. Most of them are brimming with unchiseled zeal and mentoring can channelize it depending on the priorities of the mentee. These can be a special interest, change in geography, establishing a private practice, choosing a job, or even handling competition and stress.

Late years as a physician dermatologist (>10 years since completion of training)

This is the time when most dermatologists would have found their niche and the rest of the question is whether they are thriving or surviving. At this time, mentoring from senior physicians can help strike a work–life balance, manage stress, and address other aspects of their career which can only come with experience.

Where to Do It?

There are a number of opportunities available depending on the geography, interest, and stage of career where one is. These are outlined in Table 1. This is not an exhaustive list and it is highly recommended that the candidates do their research as per their geographic area, career stage, and interests. Some of these programs may be affected by the COVID-19 pandemic.

Table 1

National and international mentoring opportunities for dermatology physicians/trainees[6]

Society	Programs for development	Additional information
Women’s Dermatology Society	Mentorship programs available.	Resident membership is free
https://www.womensderm.org/	Funding is available but for residents of the USA/Canada [Figure 2]
International Society of Dermatology	Mentorship programs available with funding	Concession for residents
https://www.intsocderm.org/	ISD Virtual International Mentorship Program (2020 onward)
Skin of Color Society	Mentorship programs	Free for resident members
https://skinofcolorsociety.org	No funding available
European Academy of Dermatology Venereology	Grants and Scholarships (including the ones offering free membership and EADV meeting registration)	Reduced membership fee for residents
https://www.eadv.org	Courses and e-learning for residents
Indian Association of Dermatology Venereology and Leprosy (IADVL)	Travel grants	Highly recommended for Indian trainees and dermatologists
	IADVL Mentorship Program (2014)
	Observership grants
	International dermatopathology scholarship grant
Association of Cutaneous Surgeons of Indiahttps://acsinet.net	Observership in dermatosurgery	Usually 4 week’s observership. No financial support
Medical Dermatology Societyhttps://www.meddermsociety.org	Mentorships (funding available)	Free membership for residents/fellows
American Society for Dermatologic Surgeryhttps://www.asds.net/ medical-professionals	Fellowship, mentorship and preceptorship programs available	Grants and scholarships available. Some programs are open for international graduates as well

What to Do?

Stages of mentorship

Initiation

Preparation of self: The mentee must be able to clearly delineate as to what his objectives are with respect to

Personal Development (creating work–life balance, building confidence)

Professional Development (networking, establishing goals, choosing fellowships, or jobs)

Skill Development (communicating, managing time, increasing clinical skills)

Academic Guidance (learning administrative skills, understanding department values, developing collegial relationships)

Research (collaborating, developing methodology, drafting manuscripts, and applying for grants).

Finding a mentor

A good mentor has some desirable characteristics.

Effective listening and communication skills: Someone who can recognize the needs of the mentee and use their life experiences to guide the mentee in the right direction.[7] Prolific mentees are expected to surpass their mentors, and senior mentors in a timeframe, and a mentor should be open to accept and take pride in this possibility.[7]

Identify in which realm you are looking to find a mentor as per the stage you are at, and then, identify the mentors who could help you. Over a period of time, you may have multiple mentors appropriate to your stage of career.

Ask around. It always helps to identify a few mentors who may match your expectations and values.

Meetings with the mentor

Cultivation: During the initial stages of the mentoring, a discussion regarding the following should be done to gauge and manage expectations.

Meeting frequency: For example, an hour every 2–4 weeks. Long-distance mentoring models have been adopted[8] and can prove effective in adopting virtual methods during and after the COVID-19 pandemic. This has been adopted in the International Society of Dermatology (ISD) in the wake of travel restrictions due to COVID-19 from 2020 [Figure 2]. It was also an online long-distance mentorship in the first phase of the Indian Association of Dermatology Venereology and Leprosy (IADVL) Mentorship Program adopted in 2014, which was mainly over the telephone and follow-ups between the mentor and mentee. This can now evolve further.

Figure 2

International Society of Dermatology (ISD) Virtual Mentorship Program 2021—Dr. Rashmi Sarkar, Chair ISD Mentorship Committee and Mentor with her virtual long-distance Mentees from the Philippines, Albania, and Nigeria

Key responsibilities and needs of each party: For example, the mentor's availability outside of meetings, and networking opportunities for the mentee.

Mutual expectations and goals: For example, the mentor will review the writing; the mentee will ask for feedback.

Concrete measures of progress and success: For example, the mentee will eventually present an abstract at a meeting.

Mentoring is a two-way street.[7] Though the initial stages may involve the mentor to play the guiding role, as the relationship matures, it is steered by the mentee as well. The mentor also benefits from the energy and enthusiasm of the mentee as well as connecting with the new generation, hence, weaving the fabric for the specialty.

Separation

Ideally, there will be a planned separation as mentees advance their careers, attain their goals, and become more collegial with their mentors. To promote productive future interactions, the mentor or mentee should directly address the transition. Part of the mentoring relationship is to communicate about any issues so that, as one mentoring relationship evolves, a mentee begins thinking about the next steps and potential future mentors, if needed. The mentee needs to have clear expectations from the mentor who can facilitate and guide only the initial part of their career.

Disadvantages of mentoring for the mentor and mentee

Overall, mentorship is a very satisfying experience for most mentors and mentees. However, there are certain pitfalls and disadvantages, namely mismatched mentor–mentee pair; the frustration of the mentor with the slow development of the mentee; blurring of boundaries which need to be adequately set up in the beginning; over-dependence and possessiveness of either the mentor or mentee. All these can be taken care of by a gentle closure which allows a mentee to explore his/her career options and remain in lesser touch with the mentor if he/she desires. The disadvantages of e-mentoring are the requirement of a good speed Internet, technological knowledge, non-establishment of rapport; inability to convey thoughts at times, and loss of visual cues; could be more time-consuming than face-to-face mentorship.[9]

Personal experience and comments by the authors

The first two authors Isha Narang (IN), Anupam Das (AD) were essentially mentees of Dr Rashmi Sarkar (RS) [Figures 3 and 4]. While IN established RS as a mentor during her dermatology training while being in the same institute, RS being in a supervisory position; AD acquired her as a mentor through informal ways while working together in the newly set up IADVL Resident's Committee. RS has been involved in mentoring through both formal and informal channels. Formal channels have included IADVL, WDS, ISD, and Skin Of Color Society approved mentoring programs. We (IN, AD) have been involved in research, publications, organizing scientific conferences, and developing ourselves academically and as a clinician with RS, IN feels privileged to have a woman mentor who understands the challenges faced by women on the personal front. AD was further associated with RS through publications, similar committees, the editorial board of a journal, and organizing conferences. AD has now evolved as a mentor himself weaving the fabric of dermatology.

Figure 3

On the occasion of the release of Residream, the newsletter of IADVL Resident's Committee at the Dermacon 2016, National Conference of IADVL (Left to right: Dr. Shyamanta Barua, Dr. Yogesh Marfatia, Dr. Devesh Mishra, Dr. Rashmi Sarkar, Dr. Anupam Das, and Dr. Venkataram Mysore)

Figure 4

Dr. Isha Narang as an invited faculty in a meeting organized by Dr. Rashmi Sarkar

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.