The importance of mentoring for junior doctors

Mentorship and the NHS

Mentorship has been described as a complex, intermutual process that occurs between two people of different levels of knowledge and expertise.2 This professional interaction integrates and enhances career, educational, interpersonal, and psychological development. The close one to one relationship between the mentor and mentee continually develops through a series of stages, resulting in the two colleagues working together in a professional relationship based on consideration, support, and productivity. In addition to the transfer and acquisition of knowledge, mentorship has a role in helping mentees further their personal development and gain valuable knowledge and skills.3

Mentoring has become well established in areas outside medicine, such as teaching and business. It has an invaluable role in helping mentees discuss problems, fulfil goals, and overcome difficulties. It is an essential tool for professional development and enhances productivity and career progression.

In Time for Training, John Temple suggested that because trainees spend less time with their individual trainers, “It has become apparent that the experiential model of learning has to change dramatically if the NHS is to continue to produce well-trained and safe professionals.” 4 Educational supervision needs to be strengthened, and mentoring and support for trainees must be improved, he concluded. Furthermore, the emphasis for junior trainees is on the successful completion of their assessments and e-portfolio, which may detract from their day to day professional concerns and personal development.

There is a need across all specialties of medical training to provide junior trainees with a mentor, a senior colleague of registrar level (specialist trainee year 3 status or above) who will work closely with them and provide frequent informal feedback, professional support, and advice. The introduction of a mentorship scheme will provide invaluable guidance and support in an era when shorter working weeks and more shift work make the traditional medical apprentice relationship between trainees and consultants unlikely. Good mentoring with greater regular support will instil more confidence in junior trainees, subsequently helping in the form of improved appraisals and assessments.

For a mentoring scheme to be successful, there is a need to distinguish and set apart formal work based assessment from mentorship. Mentoring is not intended to replace the important role of the educational supervisor, who has the task of overseeing the trainee’s progress with emphasis on assessment and the e-portfolio. The mentor is there to provide the trainee with additional and more frequent support in day to day concerns. Their role bridges the gap between the trainee and educational supervisor.

The Kent, Surrey and Sussex O&G mentorship scheme

One of the authors (FC) pioneered a successful mentoring scheme for general surgery trainees when she was a foundation year 2 doctor in the East Kent Trust. After this project she progressed to a year 1 specialist trainee post (ST1) in O&G, and with the help of Sarah Flint, consultant and lead in O&G for Kent, Surrey and Sussex Deanery, introduced a similar but much larger scheme for all O&G ST1 trainees across the Kent, Surrey and Sussex Deanery. The scheme ran successfully in its first year from October 2011-12 and demonstrated the importance of junior trainees who had just started their specialty training having a senior colleague to provide confidential, work related, and career advice.

The mentors in this scheme are O&G ST3 trainees or above who are able to give regular confidential professional advice, guidance, and support. They should be in frequent contact with their mentee in the workplace—for example, during theatre sessions, outpatient clinics, and on-call shifts. Mentors are deliberately of the same generation as their mentees so that they will have recent experience of going through the same training, overcoming the same hurdles, acquiring the same knowledge and practical skills, and preparing for the same membership examinations.

At the start of the scheme and six months into it, all 21 ST1s and their mentors were sent online questionnaires for feedback purposes; the response rate for the October and April questionnaires was 100% and 81%, respectively. Before starting the mentoring scheme, more than three quarters (81%) of ST1s surveyed had experienced work related difficulties for which they needed to seek advice and guidance. Similarly, most (86%) of the mentors had been approached by junior trainees for guidance.

Three quarters (76%) of ST1s believed there was a member of staff in their department with whom they could discuss work or career related concerns and who could be their mentor. A similar proportion of mentors could identify a possible mentee. All mentors and ST1s surveyed agreed it would be of value for all ST1s to have a formal mentor. It was also suggested that trainees of all levels should have a mentor they could turn to for advice.

Mentors and mentees agreed that mentors should be empathic to trainees and their needs, be open and honest in their responses, be accessible, have a thorough understanding of the core curriculum, provide useful career advice, be able to problem solve and seek solutions, and be willing to put forward concerns to a higher level.

Questionnaires were also sent to mentors and mentees in April 2012, six months after the scheme had been running. The feedback from this second survey indicates that almost all (93%) ST1s thought it had been helpful to have a mentor for advice and support. Three quarters of them had experienced work related or training difficulties during the first six months of the scheme for which their mentor had been there to provide support and advice.

Specialist trainees believed their mentor had helped with many aspects of their training, such as preparing for the membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) part 1 examination, completing their logbook, in work based assessments, advising during on calls, providing career advice, guidance with audits and publications, and advising on patient and staff related problems.

All mentors had attended a Kent, Surrey and Sussex mentorship training workshop or completed an online mentoring module before starting the scheme. In the April feedback survey, all mentors believed the training had helped them in their role, and thought that mentoring was worthwhile and rewarding. All mentors thought they were providing the correct level of support; nearly all ST1s agreed. Most had regular informal meetings in the workplace every week, some more frequently, even daily.

It was clear from the survey that all ST1s would prefer to choose their own mentor. This creates difficulties because at the start of a new placement, trainees are not familiar with all the mentors available. In contrast, most (70%) mentors did not object to being allocated a mentee.

Conclusions

The General Medical Council’s national training survey 2012 attempted to measure junior doctors’ overall satisfaction and quality of training. Specialties scoring the lowest in trainee satisfaction were surgery, O&G, and medicine, three of the largest training specialties.1 The results of our surveys of the Kent, Surrey and Sussex O&G mentorship scheme show that junior specialty trainees and their senior colleagues believe mentoring is an essential part of their training, providing further encouragement and confidential emotional and academic support. The scheme has provided additional support to trainees in a number of areas, including examination preparation; work based assessments; audits; publications; and career, patient, and staff related concerns.

The Kent, Surrey and Sussex Deanery team have analysed the feedback received about the local mentoring scheme and have made improvements for the October 2012 intake of ST1 trainees. This year, ST1 mentees have been allowed to choose their mentors, and have the first two weeks of training to do so. They will quickly be rematched should a mentor or mentee move to a different hospital or deanery. To increase the opportunities for contact, compatible rotas were taken into consideration when matching mentors to mentees.

Potentially this scheme could be adopted across all specialties within the United Kingdom to provide a useful support aid for junior trainees and to allow higher trainees to develop their leadership and management skills.5

Mentorship is invaluable, especially in an era of making early decisions on future careers, contending with steep learning curves, and changes in working hours and curriculums. The Kent, Surrey and Sussex O&G mentorship scheme has been a great success and has provided ST1 trainees with the support and guidance needed when starting out in obstetrics and gynaecology. We are very proud of what has been achieved, and the scheme continues and is available to all O&G trainees within the Kent, Surrey and Sussex Deanery.