Finding the right advice

New attention is being paid to how formal mentoring programs can help the mental health and wellbeing of medical students and junior doctors

In 2005, MJA editor Martin Van Der Weyden observed sadly that increasingly busy schedules could spell the end for the Australian medical profession’s long tradition of mentoring.¹

“We have all been influenced by mentors who have inspired and supported us, and invested effort and time on our behalf”, he wrote. “Unfortunately, such precious mentoring is slowly disappearing from our time-poor, fragmented and dehumanised health systems, and perhaps even from our medical schools.”

Fast forward nearly a decade and mentoring is once again part of the conversation.

In the past fortnight the Australian Medical Students’ Association (AMSA) has appointed its first national mentoring coordinator and in March, the New South Wales branch of the Australian Medical Association (AMA) launched the latest of a growing number of AMA-sponsored intern–doctor, student–doctor and junior doctor–senior doctor mentorship programs around the country (see Box).

At the same time, the Australasian College for Emergency Medicine (ACEM) and other colleges have begun a host of formal programs to recruit and train mentors. Many, such as the Royal Australasian College of Physicians, now also present annual mentoring awards.

Amid all this action, there remain many and varied definitions of what mentoring really means in the medical workplace, but the description most widely quoted in the profession was put forward in 1998 by the United Kingdom’s Standing Committee on Postgraduate Medical and Dental Education (SCOPME):

“The process whereby an experienced, highly regarded, empathic person (the mentor) guides another individual (the mentee) in the development and re-examination of their own ideas, learning, and personal and professional development.”

Mental health benefits

Mentoring has long been considered beneficial from an academic or career perspective, but there is increasing recognition that it may also benefit the psychological outlook of students, interns and doctors-in-training in particular.

Published evidence remains scarce, but a recent evaluation of a UK paediatric mentoring program showed that mentoring relationships improved both the self-confidence and professional outlook of junior doctors.²

More attention is being paid to this aspect of mentoring following last year’s findings from beyondblue that Australian doctors and medical students suffer high rates of burnout, suicidal thoughts and psychological stress compared with the general population.

The survey showed that medical students were particularly at risk, with nearly half reporting minor psychiatric disorders such as depression or anxiety.

A literature review of the links between mentoring and mental health and wellbeing, and an evaluation of the current Australian medical student mentoring programs is part of the new AMSA mentoring coordinator’s brief, says AMSA President Jessica Dean.

“It’s been around for a very long time in various forms, but I think that the reason that so much attention is being paid to formal mentoring processes is because we’re starting to realise the benefit of it in terms of evidence”, Ms Dean tells the MJA.

“Rather than seeing mentoring as an academic pursuit — which is what the original objective was in the various medical societies — instead it’s being seen as an effective mental health intervention.”

Mentoring for all

The vast majority of on-campus mentoring programs are overseen by student medical societies and remain opt-in arrangements. However, the School of Medicine and Pharmacology at the University of Western Australia (UWA) is leading the way with an innovative initiative that sees all students (up to 240 each year) liaise with a clinical mentor during the transition to clinical training.

“We know that this is always a stressful time”, Associate Professor Dr Paul McGurgan, who coordinates the school’s personal and professional development program which incorporates both clinician–student and student–student mentoring, says.

The clinician–student UWA program encourages students to find their own mentor but, if that’s not possible, will make the arrangements on their behalf.

By covering all students it ensures that those who need help but who may not otherwise volunteer for mentoring get the benefit of one-on-one guidance. This commences when they transition to clinical training and continues until they graduate.

The approach appears to be working well. Eighty-six per cent of the mentoring doctors rated the program highly in a 2012 evaluation and there was a similar response from the final-year med students.

Beyond the nation’s campuses, mentoring for interns and junior doctors is also being offered in many hospitals around the country, with a similar focus on the mental health and wellbeing benefits it can bring.

In addition to his academic role at UWA, Professor McGurgan is a consultant obstetrician–gynaecologist at Perth’s King Edward Memorial Hospital and has set up a program bringing together the hospital’s junior doctors and their senior colleagues for mentoring relationships outside the regular realm of clinical skills appraisal.

He says that it helps to overcome the perception that every time a junior doctor interacts with a senior clinician it is related to assessment. This can be particularly valuable when mistakes are made or cases don’t go according to expectations.

“That is a cross that a lot of people used to bear silently, with a lot more morbidity arising because of that. They need a person to walk them through that.”

He adds that it can also help to provide some perspective on work–life balance when it appears unattainable.

“When you’re trying to address how you manage to have a family, look after your kids and loved ones, and also put in 60 hours of work, you have someone to ask ‘How do you best cope with that?’”

Teaching the mentors

Being sensitive to when a mentoree needs extra support — such as when something has gone wrong — is part of the training many mentors now receive. The ability to properly educate mentors to be alert to such signs is one of the benefits of the shift from informal to formal mentoring.

Happily, in the 5 years that Professor McGurgan has overseen the UWA program, he has only received a handful of responses from mentors about struggling students and unprofessional behaviour.

Instead, he has sometimes been surprised by students coming forward to express concern about their mentors.

“I hadn’t expected to have that sort of issue. That’s a good demonstration that both parties get a lot from it when it comes to the emotional intelligence that you’re trying to develop in these sometimes quite young people first going into medical practice.”

AMSA is also looking at mentor training as an opportunity to break some of the cycles — such as bullying — identified by beyondblue as the cause of some of the mental health issues experienced by young doctors.

By educating mentors how to behave, lessons in preventing bullying can be passed by osmosis to a whole generation of younger doctors, says Ms Dean.

“In being able to educate mentors in the importance of addressing inappropriate behaviours such as workplace bullying, they can share the wonderful elements of the medical profession such as the work, support and collaboration, while limiting the inheritance of the less desirable aspects such as humiliation.”

Not all formal mentoring relationships are a raging success, with many ending shortly after the minimum required period. When they succeed, however, it can be an enormous benefit for everyone.

“It’s one of those things, when you have a good mentor–mentoree relationship, it really just adds huge value”, Professor McGurgan says.

And it can be a genuinely win-win-win situation, says Ms Dean, for the mentor, the mentee and the profession.

“It’s so mutually beneficial. No one is not getting anything out of it; the mentors and mentorees receive wonderful skills, experiences and support services, and that helps everyone.”

Despite Professor Van Der Weyden’s misgivings, it appears that mentoring, albeit with some modifications, is here to stay.

1. Van Der Weyden M. Mentors and mentoring [editorial]. Med J Aust 2005; 182: 601.
2. Eisen S, Sukhani S, Brightwell A, et al. Peer mentoring: evaluation of a novel programme in paediatrics. Arch Dis Child 2014; 99: 142-146.