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A survey of dermatology residency program directors' views on mentorship

  • Author(s): Donovan, Jeff
  • et al.
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A survey of dermatology residency program directors' views on mentorship
Jeff Donovan MD PhD
Dermatology Online Journal 15 (9): 1

Division of Dermatology, University of Toronto, Toronto, Ontario, Canada. jeffrey.donovan@utoronto.ca

Abstract

Background: It is increasingly recognized that mentoring is important in the career development of resident physicians. The purpose of the study was to determine the views of residency Program Directors on mentorship through a cross sectional survey. Methods: Respondents included program directors of academic dermatology departments in the United States. Results: Fifty-three of 108 program directors completed an on-line survey (response rate 49%). Eighty-one percent of respondents indicated that mentorship played a 'somewhat' or 'very important' role in their own career development and a similar proportion considered it important for residents to have mentors. Fifty percent of program directors identified a need for more structured mentorship within the residency program. Compared to male program directors, a greater proportion of female program directors stated that mentorship played a very important role in their career development (89% vs. 36%, p=0.007) and a lesser proportion stated that it was important for female dermatology residents to specifically have access to female mentors (11.1% vs. 67.4%, p=0.003). Conclusion: Program Directors viewed mentoring as an important resource for their residents' professional development. A need was identified for additional strategies to help residents find mentors.



Introduction

Mentoring is an active process whereby a more experienced individual (i.e., the mentor) takes an interest in the career development of someone more junior (i.e., the mentee) and offers wisdom, guidance, and encouragement to help the less experienced individual achieve specific goals. It is increasingly recognized that mentoring isimportant in the career development of physicians. Mentoring is closely linked to excellent career preparation, personal development, research productivity, establishment of networking relationships, and retention of physicians in academics [1, 2].

Among dermatology residents, mentoring was associated with increased overall satisfaction with training [3]. Although the majority of dermatology residents consider it important to have mentors [4], not all residents are able to identify someone they consider to be a mentor [3]. Women, in particular, are more likely than men to cite lack of a mentor [5]. In one study, lack of mentorship was associated with a loss of interest to pursue a career in academic dermatology [6]. Mentoring relationships may have an important role in stimulating interest among residents in a wide array of career tracks, including academic, private practice, research, administrative, and leadership pursuits. Overall, dermatology residents desire more mentorship from their faculty [4].

Program directors of residency training programs have an important role to influence the structure of the training environment for dermatology residents. The views of program directors on issues pertaining to mentorship are important to evaluate because these views may ultimately influence decisions that impact on opportunities for mentorship within a given residency training program. This study was undertaken to evaluate the views of program directors on mentoring. It was hypothesized that program directors would view mentoring relationships as being important for residents, but would recognize that not all of their residents had successfully found mentors.


Methods


Study population

The study was approved by the Ethics Review Board of the University of Toronto. A cross-sectional, anonymous and voluntary survey was e-mailed to program directors of 108 academic residency training programs in the United States. E-mail addresses were provided by the Association of Professors of Dermatology. Participants were provided with an e-mail link to an internet survey (www.surveymonkey.com). Two additional reminders were e-mailed to non-responders at three-week intervals before the survey was closed.

For the purposes of the study, a 'mentor' was defined as a dermatology faculty member who takes interest in a dermatology resident's career development with the purpose of guiding the resident to achieve one or more goals. A "mentorship program" was defined as a formal or informal program within the residency training program that provided opportunities for establishing faculty-resident mentoring relationships.

The survey enabled collection of program directors' basic demographic information, years of practice, and years as program director. Specific features of the residency training program, including the size of the residency program, the proportion of female residents, and whether or not the program had a mentorship program were also collected. In addition, program directors' views on the ability of a mentorship program to increase the proportion of graduating residents that pursue academic positions or positions of leadership were assessed. Program Directors were surveyed regarding the role mentorship played in their own careers and whether or not they were part of a mentorship program during their own residency training. A five-point Likert scale was used to evaluate program directors' views on a series a series of statements about mentorship (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, 5=strongly agree). Scores were averaged to produce a mean score. The components of the survey are shown in the series of tables that accompany the results section.

Statistical analyses were conducted using SAS statistical software, version 8.2 (SAS Institute, Cary NC). Chi-square and Fisher exact tests were used for analysis of categorical data. p<0.05 was considered statistically significant for all analyses.


Results


Demographics of respondents and residency programs

Fifty-three of 108 program directors responded to the survey (49% response rate). Forty-four (83%) respondents were male and 9 (17%) were female (Table 1). The median number of years in practice was 10 years and the median number of years serving as program director was 4.5 years (Table 1). The median size of the residency program was 10 residents. Female dermatology residents were in the majority in most residency programs.


Role of mentoring in program directors' career development

The majority of program directors surveyed indicated that mentorship had an important role in their career development (Table 2). Approximately one-third (33%) of respondents stated that mentorship played a 'somewhat important role' and approximately one-half (48%) stated that mentorship had a 'very important role' in their career development. Most program directors (47/51, 92%) had not participated in a mentorship program during their own residency training. Of the 4 respondents who had been participants in a mentorship program, 3 stated that mentorship played a 'very important role' in their overall career development and 1 indicated that mentorship had a 'somewhat important role.'


Role of Mentoring to Influence the Career Choices of Residents

Mentoring is frequently discussed within the context of factors having the potential to influence the career direction of residents [1]. Recruitment of residents to careers in academic dermatology or to leadership roles within the dermatology community may be influenced by mentoring relationships. Thirty-one (60%) of respondents indicated a desire to see more of their residents pursue academic tracks and 44 (86%) wanted to see more residents pursue positions of leadership. Overall, 85 percent of respondents (44/52) felt that a mentorship program had the potential to increase the number of residents pursuing careers in these areas. Those program directors having the opinion that a mentorship program did not have the potential to influence the recruitment of residents to academics or leadership positions were more likely to state that mentorship had not played a very important role in their career (78% vs. 2.3%, p<0.001).


Views of program directors using a Likert rating Scale

A five point Likert rating scale was used to evaluate program directors' opinions on a series of statements pertaining to a) mentoring issues in the program director's current program and b) general statements pertaining to mentorship (Table 3). The vast majority (84%) of program directors agreed or strongly agreed that they currently served as mentors to one or more residents and a similar proportion (82%) concurred that other colleagues were serving in a mentoring role. Overall, approximately 80 percent agreed or strongly agreed that it was important for residents to have mentors, but only one-half of program directors (53%) agreed or strongly agreed that many of their current residents had identified a mentor. Fifty percent of program directors identified that there was a need for more structured mentorship within their residency training program. Only 9 respondents (18%) indicated that they had been asked by their residents to increase mentorship in their residency training program.


Mentoring issues pertaining to female physicians

Compared to male residents, female residents may have greater difficulty finding mentors [7]. In one study, the availability of mentors was of greater concern to female residents than to male residents [8]. Elucidation of differences in the views of male and female program directors may offer valuable insight into mentoring issues that are of specific importance to female physicians. In the present survey, there were three survey responses that differed significantly between male and female program directors (Table 4). For example, although just over one-third (35.7%) of male program directors indicated that mentorship had a 'very important role' in their career development, 8 of the 9 female program directors (88.9%) indicated that mentorship had a 'very important role' (p=0.007). In addition, there were two survey responses in which female program directors were statistically less likely than males to agree with the survey item. For example, 2 of 9 (22.2%) female program directors indicated a desire to see female residents pursue academic careers compared to 26 of 41 (63.4%) of male program directors (p=0.03). Furthermore, only 1 of 9 female program directors (11.1%) agreed that it was important for female residents to specifically have access to female mentors compared to 29 of 43 (67.4%) of male program directors who agreed with this statement (p=0.003).

Finally, respondents were surveyed as to whether or not the residency program they directed had a mentorship program (Table 5). Thirty-seven (70%) of respondents had a mentorship program at their institution and in the majority of cases (65%) the mentorship program had been newly established within the past five years (Table 5). In approximately one-half of cases, the mentorship program involved the assignment of a dermatology resident to a faculty mentor and in the other one-half of cases, residents were encouraged to choose their own faculty mentors. The establishment of a mentorship program was not associated with program size, program director gender, program director experience, or program director views on the importance of mentorship in his or her career development (data not shown).


Discussion and Conclusion

Despite the paucity of high quality evidence that mentorship is beneficial for residents, several studies lend support to the notion that mentoring is helpful to the career development of residents [1]. In the present study, a majority of program directors concurred that it was important for residents to have mentors. Moreover, many program directors agreed that mentoring programs had the potential to increase the proportion of residents pursuing careers in areas where their skills are greatly needed, such as in academic dermatology or in leadership positions. It was interesting that the vast majority of program directors indicated a desire to see more of their residents pursue leadership positions. Of note, the American Academy of Dermatology established an Academic Dermatology Leadership Program to provide mentoring in leadership skills to recent residency graduates. The role of mentoring assisting residents to acquir advanced leadership skills during their residency training rather than in the years following graduation is an important subject for additional study.

Despite having an overall positive view about the role of mentoring, only one-half of program directors agreed that many of their current dermatology residents had found mentors. There are many barriers that prevent residents from establishing mentoring relationships [9] and some resident trainees have not even considered the need to seek a mentor [10]. Further study of mentoring barriers may provide insight into why approximately one-quarter of dermatology residents have not found someone they consider to be a mentor [3].

Previous studies suggest that the vast majority of residents consider it is important to have mentors [2]. However, it is likely that many residents consider the establishment of mentoring relationships to be their own responsibility rather than the responsibility of their Program Director or the residency training program. For example, only a minority of Program Directors surveyed in this study had been asked by their residents to increase mentorship. Nevertheless, there is considerable interest in issues pertaining to mentorship when residents are directly asked about these issues. A recent survey of dermatology residents showed that residents wanted more mentorship from their faculty [4]. How to optimize mentoring within residency training programs needs further study.

Many residency training programs in this study had developed resident mentorship programs. Although this study was not designed with the intention to evaluate the structure or merits of various types of mentorship programs, this too is an important subject for further study. A common criticism of resident mentoring programs that assign residents to faculty mentors has been that they are potentially not as effective as 'spontaneous' mentoring, in which mentees find their own mentors [11]. However, given the challenges that many residents have in developing high quality mentoring relationships, the assignment of a mentor might be a beneficial starting point. The skills and confidence that residents gain in assigned mentoring relationships might be readily transferable to the spontaneous mentoring relationships that these residents develop in the future. Interestingly, a study of 127 internal medicine residents at Brigham and Women's/Faulkner Hospital revealed that 90 percent felt that it was important to be assigned a mentor [12]. Moreover, in addition to acquiring mentors through the assigned mentorships, 50 percent of residents also developed spontaneous mentorships with other faculty mentors. Thus, both assigned and spontaneous mentoring may be beneficial to residents. Approximately one-half of program directors in this study identified a need for more structured mentoring within their program.

It is important to ensure the availability of mentors for female residents. A survey of 501 residents in surgical training revealed that the availability of mentors was of greater concern to women than to men [8]. Further study is needed to determine how best to ensure adequate mentorship for female residents. Although female dermatology residents now comprise the majority of residents in many dermatology training programs, male dermatologists outnumber female dermatologists in many academic institutions and this may limit the access of female residents to female mentors. However, the evidence is mixed as to whether male or female faculty members are better mentors for female residents [13, 14, 15, 16]. It is interesting that in this study, a lesser proportion of female Program Directors compared to male Program Directors (11% vs. 67%) felt that it was important for female residents to have access specifically to female faculty mentors. It is likely that finding high quality mentors, regardless of their gender, is fundamentally the most important concern to female physicians.

Good mentoring relationships are considered to be among the most important factors that promote the success of women in academic medicine [17]. Further study is needed to determine if mentoring relationships are valued to a greater extent by female physicians than male physicians. It was interesting that 89 percent of female program directors in this study stated that mentorship played a very important role in their career development compared to only 36 percent of male program directors. If the dermatology community is to develop additional strategies to mentor female residents, it will be important to understand specific challenges that female physicians encounter. In the present study, only 22 percent of female program directors indicated a desire to have more of their female residents pursue academic careers compared to 63 percent of male program directors. The reasons for these differences are not clear, but may reflect some of the concerns that female program directors have about the present day working environment. These concerns were also reflected in a recent survey-based study of 68 female program directors and 131 male program directors from various specialties across Canada (Donovan, unpublished). Here, a lesser proportion of female program directors compared to male program directors indicated an interest to see more of their female residents pursue academic careers (19.1% vs. 33.8%, p=0.03). Uncovering the exact reasons for these differences in opinion is of great importance if we are to fully understand how best to mentor future female academicians.

This study has several limitations. First, a potential response bias from those with an interest in mentorship may have skewed the results towards more favorable opinions of the role of mentorship. Second, the definition of 'mentorship program' was purposely kept broad in order to best capture the prevalence of these types of programs. The majority of mentorship programs reported in the literature lack a concrete structure, and the survey was designed to avoid a restrictive definition. Nevertheless, it is possible that these terms were misinterpreted. Third, the survey was not intended to evaluate the relative merits of assigned versus 'spontaneous' mentorship programs. These are important issues for further study. In addition, this study did not evaluate other factors that may influence mentoring such as institutional recognition or reimbursement (financial, protected time) and did not evaluate differences how best to mentor residents interested in specific careers (private practice, academics, research). These issues deserve further study. Finally, the number of female program directors in this study was small. These gender analyses, although statistically significant, are limited by the small number female respondents.

In conclusion, program directors regard the establishment of mentoring as an important resource for their residents' professional development. Although many residency programs have developed mentoring programs, a need for additional mentoring opportunities was identified.

Acknowledgements: This study was supported with a grant from the Canadian Medical Association.

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