Exploring Mentoring Experiences,Perceptions, and Needs of General Internal Medicine Clinician Educators Navigating Academia: a Mixed-Methods Study

BackgroundFew studies examined specific mentoring needs and preferences of clinician educators (CEs). Further research on CEs’ perceptions of mentoring adequacy, as related to educational development and career advancement, is needed.ObjectiveThe study aims were to (1) explore general internal medicine CEs’ experiences as mentees within various mentoring models; (2) examine the perceived quality, nature, and impact of mentoring on career development; and (3) determine whether specific models of mentoring impact their attitudes towards mentoring.DesignSequential mixed methods study design answered the study questions.ParticipantsSociety of General Internal Medicine members identifying themselves as CEs.Main measures/ApproachParticipants completed an anonymous online survey and a subsample participated in two semi-structured focus group discussions. Outcomes of interest were perceptions of mentoring experiences, and perspectives on quality of mentoring as well as mentoring needs specific to clinician educators.Key ResultsOne hundred thirty-nine participants completed the survey (37% response rate) with 20 participants in focus group discussions. Among CEs with perceived high-quality mentor relationships (e.g., reporting strongly agree), peer mentorship was viewed as adequate mentorship (45% (n = 17) vs 24% (n = 24), p < 0.05), as beneficial for career development (77% (n = 40) vs 48% (n = 41), p < 0.01) and as being challenged to become a better CE (58% (n = 30) vs 35% (n = 29), p < 0.05), compared to reporting agree or lower. Qualitative analysis generated four themes: (1) A mentoring team promotes career advancement, (2) peer mentors are important at every stage of a CE’s career, (3) there is inadequate mentoring specific to CE needs, and (4) mentoring needs protected time and skill development.ConclusionsThe traditional dyadic mentoring relationship may not adequately address all professional needs of CEs. A mentoring team can provide valuable perspectives on career goals. Peer mentoring can be powerful for professional growth. Mentoring needs change at different career stages and training in mentoring skills is essential.KEY WORDS: clinician educator, mentoring experiences, peer mentor, mentee, mentor     

Mentorship of Underrepresented Physicians and Trainees in Academic Medicine: a Systematic Review

BackgroundThough the USA is becoming increasingly diverse, the physician workforce contains a disproportionately low number of physicians from racial and ethnic groups that are described as underrepresented in medicine (URiM). Mentorship has been proposed as one way to improve the retention and experiences of URiM physicians and trainees. The objective of this systematic review was to identify and describe mentoring programs for URiM physicians in academic medicine and to describe important themes from existing literature that can aid in the development of URiM mentorship programs.MethodsThe authors searched PubMed, PsycINFO, ERIC, and Cochrane databases, and included original publications that described a US mentorship program involving academic medical doctors at the faculty or trainee level and were created for physicians who are URiM or provided results stratified by race/ethnicity.ResultsOur search yielded 4,548 unique citations and 31 publications met our inclusion criteria. Frequently cited objectives of these programs were to improve research skills, to diversify representation in specific fields, and to recruit and retain URiM participants. Subjective outcomes were primarily participant satisfaction with the program and/or work climate. The dyad model of mentoring was the most common, though several novel models were also described. Program evaluations were primarily subjective and reported high satisfaction, although some reported objective outcomes including publications, retention, and promotion. All showed satisfactory outcomes for the mentorship programs.DiscussionThis review describes a range of successful mentoring programs for URiM physicians. Our recommendations based on our review include the importance of institutional support for diversity, tailoring programs to local needs and resources, training mentors, and utilizing URiM and non-URiM mentors.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06478-7.KEY WORDS: mentorship, underrepresented in medicine     

A year of mentoring in academic medicine

We describe a specific mentoring approach in an academic general internal medicine setting by audiotaping and transcribing all mentoring sessions in the year. In advance, the mentor recorded his model. During the year, the mentee kept a process journal. Qualitative analysis revealed development of an intimate relationship based on empathy, trust, and honesty. The mentor’s model was explicitly intended to develop independence, initiative, improved thinking, skills, and self-reflection. The mentor’s methods included extensive and varied use of questioning, active listening, standard setting, and frequent feedback. During the mentoring, the mentee evolved as a teacher, enhanced the creativity in his teaching, and matured as a person. Specific accomplishments included a national workshop on professional writing, an innovative approach to inpatient attending, a new teaching skills curriculum for a residency program, and this study.     

Anthetic Inner Critic Work as a Method for Relapse Prevention

Abstract

Relapse prevention is a primary concern in the alcohol and drug treatment fields, and a variety of relapse prevention approaches are currently in use. Cognitive-behavioral and lifestyle change approaches are among the most commonly used, offering strategies the recovering individual may employ. This paper presents Anthetic Inner Critic work, a new approach to relapse prevention that has been shown to be clinically effective because it teaches skills that the recovering individual can use the rest of his or her life.     

Neuropsychological and behavioral correlates of obstructive sleep apnea syndrome in children: A preliminary study

Study Objectives: The purpose of this pilot study was to evaluate a group of children with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) for baseline neurocognitive deficits and behavioral dysfunction. A subset of the sample were also reassessed, using the same test battery, after treatment with adenotonsillectomy.Design: Baseline and post-treatment neuropsychological and behavioral assessment.Setting: Pediatric sleep disorders clinic at a children’s teaching hospital.Patients: 18 children (12 males, 6 females, mean age 7.3 years ±2.0) meeting polysomnographic criteria for OSAS underwent baseline assessment; 8 children (6 males, 2 females, mean age 8.4 years ±2.6) also completed the post-treatment assessment phase.Measurements: An age appropriate neuropsychological battery including measures of global cognitive functioning, language, executive functioning and attention, memory, visual perception/visual motor skills and motor skills; two parent rating scales of behavior.Results: Modest impairments, largely in executive functioning/attention and motor skills, were found at baseline. Parents endorsed a variety of behavioral problems, especially somatic complaints and problems with learning. There appeared to be relatively little association between impairment and disease severity, although there was a trend for the children with less severe disease, who were also older, to have relatively more behavioral problems. Post treatment, there were modest improvements in executive functioning/attention and motor skills, as well as in parent-reported internalizing and externalizing behaviors.Conclusions: The preliminary results with a small sample suggest mild deficits in executive functions and motor skills in children with mild to moderate OSAS, with modest improvements in the same neuropsychological domains post-treatment. A variety of parent-reported behavioral problems were found at baseline, again with modest improvement post-adenotonsillectomy.     

¿Cómo diseñar,aplicar y evaluar un programa de Mentoring en enfermedad renal crónica? evaluación narrativa del impacto en 6 centros asistenciales

Background and objectiveChronic kidney disease (CKD) requires patients to participate in an adaptation process, which may be facilitated with the support of healthcare professionals and trained peers. The objective of this study is to present the implementation of a pilot patient mentoring programme to promote adaptation in patients with CKD.Materials and methodPre-test-post-test design (quantitative and qualitative). The study was carried out in six hospitals in Spain. The instruments used to measure impact were ad-hoc scales (10-point Likert scale response format) on satisfaction and skill acquisition, as well as the creation of focus groups with eight patient mentors and 10 healthcare professionals. The programme was split into four phases: 1. Design and validation of the manualised programme's content, and selection of patient mentors; 2. Mentor training, satisfaction with training and skills acquired by the mentors; 3. Implementation of mutual support groups and profile of those attending these mutual support groups; 4. Assessment and results of the Mentoring programme.ResultsIn total, 39 mentors were trained on group management skills, as well as how to provide emotional support. 22 support groups were held, with 121 participants (22% carers). The 65% of the patients were attending the CKD clinic. 65% of the participating patients considered making some form of lifestyle change after taking part in the programme. All the items assessing satisfaction and usefulness scored very highly, achieving 8.5 out of 10 or above.ConclusionsThis is the first manualised mentoring programme in CKD to be undertaken simultaneously in six Spanish hospitals. The manualised and highly structured nature of the programme make it easy to replicate, minimising the risk of error.     

Implementing an interdisciplinary intergenerational program using the Cyber Seniors® reverse mentoring model within higher education

ABSTRACT

Intergenerational service-learning in higher education positively affects older adults and students, but little is known about the effectiveness of interdisciplinary, reverse mentoring programs that use technology as the medium of bringing generations together. This study describes an intergenerational service-learning program that utilizes reverse mentoring within higher education, the “Engaging Generations Program,” at a midsized public university in New England where students help older adults learn about technology, and students gain communication and teaching skills. In this article, we outline how the program was implemented, present quantitative data on participation outcomes for students and older adults and qualitative data from older adults, and discuss best practices. Analysis of pre/post surveys found that students’ attitudes toward aging improved (p < 0.01) and older adults interest in technology improved (p < 0.05) after program participation. Best practices identified included: multiple meetings with the same pair to deepen friendships, in-person training for student leaders, student responsibility for scheduling, tailoring sessions to each participant, student documentation of meetings, and active involvement by community partners.     

A Geriatric Summer Research Fellowship Program with Preceptors and Undergraduate Medical Students

Abstract

This article describes the incorporation of aging-related research into a medical school curriculum through a summer fellowship program. The geriatric office at a medical school designed the program to increase the research orientation and skills of undergraduate medical students and provide them with a mentoring experience in the field of geriatrics. A survey of students and preceptors participating in the program over an eleven-year period indicated a high level of acceptance of the program by both students and faculty. Students perceived applications from their fellowship experience for both their practice with the elderly and their critical thinking about issues related to older patients. The program served to stimulate interest in research and introduced undergraduate medical students to the research/scholar role of the physician.     

A Year of Mentoring in Academic Medicine

We describe a specific mentoring approach in an academic general internal medicine setting by audiotaping and transcribing all mentoring sessions in the year. In advance, the mentor recorded his model. During the year, the mentee kept a process journal.
Qualitative analysis revealed development of an intimate relationship based on empathy, trust, and honesty. The mentor's model was explicitly intended to develop independence, initiative, improved thinking, skills, and self-reflection. The mentor's methods included extensive and varied use of questioning, active listening, standard setting, and frequent feedback. During the mentoring, the mentee evolved as a teacher, enhanced the creativity in his teaching, and matured as a person. Specific accomplishments included a national workshop on professional writing, an innovative approach to inpatient attending, a new teaching skills curriculum for a residency program, and this study.
A mentoring model stressing safety, intimacy, honesty, setting of high standards, praxis, and detailed planning and feedback was associated with mentee excitement, personal and professional growth and development, concrete accomplishments, and a commitment to teaching.     

The Utility of Mentoring Homeless Adolescents: A Pilot Study

Background: Despite the intuitive appeal and popularity of mentoring programs, mentoring has shown only limited success for positively impacting children’s psychosocial functioning. Furthermore, we were not able to identify a study that examined the potential utility of mentoring for homeless adolescents. Objective: The purpose of this pilot study was to examine the impact of mentoring among a group of homeless adolescents who were also receiving substance abuse treatment. Methods: This pilot study examined the impact of mentoring among homeless adolescents (n = 90) between the ages of 14 and 20 years who also received substance abuse treatment. A longitudinal design was used in which adolescents were assessed at baseline, 3 months, and following the completion of treatment at 6 months postbaseline. Results: Findings showed that adolescents with a history of physical or sexual abuse attended more mentoring sessions. Also, mentoring in addition to treatment was associated with a decrease in problem consequences associated with substance use. However, more mentoring with fewer treatment sessions was associated with an increase in internalizing behaviors. Only these two outcomes were associated with mentoring. Conclusions and Scientific Significance: While not providing resounding support for mentoring, this study suggests that examining the mentor/mentee relationship may be a fruitful line of future research given that significant variability among the mentor/mentee pairs was noted for some outcomes of interest.     

Self-guided strategy-adaption training for older adults: Transfer effects to everyday tasks

ObjectivesThe goal of the present research was to examine the potential of a learner-oriented approach to improving older adults’ performance in tasks that are similar to real-life situations that require strategic deployment of cognitive resources. A crucial element of this approach involves encouraging older adults to explicitly analyze tasks to consider how to adapt trained skills to a new task context. In an earlier study, a specialist-directed intervention produced training gains and transfer to some untrained memory tasks.MethodIn the present study, older adults received a manual instructing them about principles of task analysis, two memory strategies, and strategy adaptation. Self-guided strategy-adaption training involved practicing some memory tasks as well as instructions on how the trained skills could be applied to new tasks that were not practiced. The criterion tasks involved practice tasks, non-practiced tasks that were discussed in the manual, and transfer tasks that were never mentioned in the manual. Two of the tests were from the Everyday Cognition Battery (inductive reasoning and working memory).ResultsAs compared to a waiting-list control group, older adults assigned to self-guided strategy-adaption training showed memory improvements on tasks that were practiced or discussed during training. Most important, the learner-oriented approach produced transfer to the everyday tasks.ConclusionOur findings show the potential of instructing task appraisal processes as a basis for fostering transfer, including improving older adults’ performance in simulated everyday tasks.     

The Role of Gender in Careers in Medicine: a Systematic Review and Thematic Synthesis of Qualitative Literature

AbstractBackgroundGender disparities exist in the careers of women in medicine. This review explores the qualitative literature to understand how gender influences professional trajectories, and identify opportunities for intervention.MethodsA systematic review and thematic synthesis included articles obtained from PubMed, Cochrane Central Register of Controlled Trials (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), and GenderWatch (ProQuest) on June 26 2020, updated on September 10, 2020. Included studies explored specialty choice, leadership roles, practice setting, burnout, promotion, stigma, mentoring, and organizational culture. Studies taking place outside of the USA, using only quantitative data, conducted prior to 2000, or focused on other health professions were excluded. Data were extracted using a standardized extraction tool and assessed for rigor and quality using a 9-item appraisal tool. A three-step process for thematic synthesis was used to generate analytic themes and construct a conceptual model. The study is registered with PROSPERO (CRD42020199999).FindingsAmong 1524 studies identified, 64 were eligible for analysis. Five themes contributed to a conceptual model for the influence of gender on women’s careers in medicine that resembles a developmental socio-ecological model. Gender influences career development externally through culture which valorizes masculine stereotypes and internally shapes women’s integration of personal and professional values.ConclusionMedical culture and structures are implicitly biased against women. Equitable environments in education, mentoring, hiring, promotion, compensation, and support for work-life integration are needed to address gender disparities in medicine. Explicit efforts to create inclusive institutional cultures and policies are essential to support a diverse workforce.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06836-z.KEY WORDS: physician careers, gender, careers in medicine     

Gamma knife radiotherapy in a neurofibromatosis type 1 Chinese pedigrees with NF1 gene frameshift mutation: A case report

Rationale:Neurofibromatosis type 1 (NF1) is a common autosomal dominant genetic disorder. NF1 is a multisystemic disease and its pathogenesis involves mutations in the NF1 gene on chromosome 17q11.2 causing RAS overactivation to stimulate abnormal cell proliferation. In this article, a Chinese family with neurofibromatosis type 1 was reported and the relationship between the phenotype and gene mutation was analyzed.Patient concerns:The patient was a 9-year-old-male child diagnosed with right eye exophthalmos combined with right eye glioma, optic edema, and peripheral visual field defect. There were multiple cafe-au-lait spots in the whole body of the child. His mother had multiple cafe-au-lait spots, and the eye examination showed no abnormalities.Diagnosis:The proband was diagnosed with NF1 and a heterozygous frameshift mutation (c. 6641delG p. Arg2214Asnfs*30) in the NF1 gene was identified, and his mother also carried the same pathogenic mutation.Interventions:To protect the vision of the right eye, he was treated with gamma knife radiotherapy.Outcomes:After therapy, his fundus optic disc edema was decreased and the best corrected visual acuity of the right eye was increased.Lessons:Gene detection is helpful to diagnose the disease and guide the treatment. Gamma knife radiotherapy can preserve better neurological function.     

The Greek study in the effects of colchicine in COvid-19 complications prevention (GRECCO-19 study): Rationale and study design

ObjectiveColchicine has been utilized safely in a variety of cardiovascular clinical conditions. Among its potential mechanisms of action is the non-selective inhibition of NLRP3 inflammasome which is thought to be a major pathophysiologic component in the clinical course of patients with COVID-19. GRECCO-19 will be a prospective, randomized, open-labeled, controlled study to assess the effects of colchicine in COVID-19 complications prevention.MethodsPatients with laboratory confirmed SARS-CoV-2 infection (under RT PCR) and clinical picture that involves temperature >37.5 oC and at least two out of the: i. sustained coughing, ii. sustained throat pain, iii. Anosmia and/or ageusia, iv. fatigue/tiredness, v. PaO2<95 mmHg will be included. Patients will be randomised (1:1) in colchicine or control group.ResultsTrial results will be disseminated through peer-reviewed publications and conference presentations.ConclusionGRECCO-19 trial aims to identify whether colchicine may positively intervene in the clinical course of COVID-19. (ClinicalTrials.gov Identifier: NCT04326790).     

Why gerontology and geriatrics can teach us a lot about mentoring

Gerontology, geriatrics, and mentoring have a lot in common. The prototype of this role was Mentor, an older adult in Homer’s The Odyssey, who was enlisted to look after Odysseus’ son, Telemachus, while his father was away fighting the Trojan War. Portrayed as an older man, the name “mentor” literally means “a man who thinks,” which is not a bad characterization generally for faculty members in gerontology! In particular, gerontological and geriatrics education can teach us a lot about the importance of mentoring and provide some critical insights into this role: (1) the importance of interprofessional leadership and modeling, (2) the application of the concept of “grand-generativity” to mentoring, (3) “it takes a community” to be effective in mentoring others, and (4) the need to tailor mentorship styles to the person and the situation. This discussion explores these topics and argues that gerontological and geriatrics educators have a particularly important role and responsibility in mentoring students, colleagues, and administrators related to the very future of our field.     

The Use of Standardized Patient Encounters for Evaluation of a Clinical Education Program on the Development of HIV/AIDS-Related Clinical Skills

Abstract

The success of medical education is traditionally gauged by performance on written examinations. However, clinical proficiency in real-world situations is difficult to assess by written examinations alone. We developed a novel evaluation tool to measure the development of HIV-specific clinical skills using Standardized Patient Encounters (SPEs). Trainees were evaluated at baseline and after an HIV clinical training module by (1) self-reported confidence with HIV-specific clinical skills and (2) performance assessments using SPEs. Case scenarios were designed to incorporate unique issues associated with HIV that may present to a primary care provider. SPEs were scored based on written documentation including problem list and plan as well as a review of the videotapes by HIV specialists evaluating key elements of clinical skills and decision making. Improvements were noted in multiple facets of the encounters. The use of SPEs enables evaluation of clinical training interventions on the development of HIV-related clinical skill sets.     

Iron-overload cardiomyopathy: pathophysiology, diagnosis, and treatment

BackgroundThe prevalence of primary (hereditary) hemochromatosis and secondary iron overload (hemosiderosis) is reaching epidemic levels worldwide. Iron-overload leads to excessive iron deposition in a wide variety of tissues, including the heart and endocrine tissues.Methods and ResultsIron-overload cardiomyopathy is the primary determinant of survival in patients with secondary iron overload, while also being a leading cause of morbidity and mortality in patients with primary hemochromatosis. Iron-induced cardiovascular injury also occurs in acute iron toxicosis (iron poisoning), myocardial ischemia-reperfusion injury, cardiomyopathy associated with Friedreich ataxia, and vascular dysfunction. The mainstay therapies for iron overload associated with primary hemochromatosis and secondary iron overload is phlebotomy and iron chelation therapy, respectively. L-type Ca²⁺ channels provide a high-capacity pathway for ferrous (Fe²⁺) uptake into cardiomyocytes in iron-overload conditions; calcium channel blockers may represent a new therapeutic tool to reduce the toxic effects of excess iron.ConclusionsIron-overload cardiomyopathy is a an important and potentially reversible cause of heart failure at an international scale and involves diastolic dysfunction, increased susceptibility to arrhythmias and a late-stage dilated cardiomyopathy. The early diagnosis of iron-overload cardiomyopathy is critical since the cardiac dysfunction is reversible if effective therapy is introduced before the onset of overt heart failure.     

Retenção das Habilidades de Ressuscitação Cardiopulmonar nos Estudantes de Medicina

BackgroundReduction of mortality and sequelae of cardiac arrest depends on an effective and fast intervention, started as soon as possible. Basic life support involves a series of steps that may be initiated out of the hospital setting and taught to any person in specific courses. However, it is important that the rescuers retain the knowledge and skills to perform cardiopulmonary resuscitation (CPR), as one never knows when they will be required. Studies have shown that a loss of skills occurs as early as 30 days after the training course, with variations according to personal and professional characteristics.Objectivesto assess whether medical students are able to retain skills acquired in a BLS course for more than six months.MethodsProspective, case-control, observational study. Medical students attended a 40-hour course on sudden death and cardiac arrest. Skills acquired during the course were evaluated immediately after and six months after the course. Students’ individual scores were compared between these time points, the percentage of correct answers was evaluated, and overall performance was rated as excellent, good, and poor. Observers and evaluation criteria were the same immediately after the course and six months later. Data were analyzed using the paired t-test and the McNemar test. The 95% confidence interval was established, and a p < 0.05 was set as statistically significant.ResultsFifty students (27 female) in the first year of medical school aged from 18 to 24 years (mean of 21 years) attended the course. The number of steps successfully completed by the students at six months was significantly lower than immediately after the course (10.8 vs 12.5 p < 0.001). Neither sex nor age affected the results. Overall performance of 78% of the students was considered excellent immediately after the course, and this percentage was significantly higher than six months later (p < 0.01). After six months, the steps that the students failed to complete at six months were those related to practical skills (such as a correct hand positioning).ConclusionA significant loss of skills was detected six months after the BLS course among medical students, compromising their overall performance.