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Mentoring for new consultants

Authors: Helen Jaques 

Publication date:  27 Jun 2012


Some new consultants feel nervous in their first job after getting their certificate of completion of training. Helen Jaques looks at how mentoring can help them

The move from working in a training grade to practising as a consultant is a huge step, as new consultants are entirely responsible for their own caseload and are also expected to take on management, leadership, training, and quality improvement activities.

This step is considered to have become more of a leap in recent years thanks to a couple of factors that have affected the amount of time available to junior doctors for training and thus how well prepared they are for independent practice at the end. The first is the working time regulations, introduced in August 2009, which limit the number of hours junior doctors can work and impose strict rules as to when rest time should be taken. The General Medical Council’s 2011 survey of trainees found that almost a quarter (22.1%) of junior doctors believed that their training needs were not being met in the 48 hour week, and a third (31.2%) said that they were taking longer to achieve their required educational competences.[1]

The second issue is the restructuring of specialty training under the auspices of Modernising Medical Careers in 2005 and 2007. The reforms meant that all new doctors spend a specified amount of time in specialty training rather than continuing indefinitely, as was sometimes the case with the senior house officer role.[2] The independent review of the approach, led by John Tooke, suggested that limiting the duration of specialty training to between three and nine years would have a negative effect on the competency of doctors who receive a certificate of completion of training (CCT).[3]

A subsequent review of medical training in 2010 by John Temple suggested that these pressures on time for training and their effect on the competence and confidence of doctors who have completed specialty training could be mitigated by mentoring and support for newly appointed consultants.

How mentoring can help new consultants

Mentoring can be described as “learning relationships which help people to take charge of their own development, to release their potential, and to achieve results which they value.”[4] Mentoring can also entail counselling, advice, career guidance, and help with day to day activities and decisions, although it should be seen as different from appraisal and performance management.[5]

Mentoring can help new consultants in two key ways, said Frank Joseph, chairman of the Royal College of Physicians’ New Consultants Committee. “One is from the point of view that there’s a bit of a pastoral role to be played easing someone into an institution because you want to make sure that they’re safe and they’re looked after,” he said. “The second is that you don’t want them to be a workhorse, and you want them to start doing things that are better and a bit more becoming of their capabilities.”

Having a mentor can help new consultants to get to grips with the day to day non-clinical aspects of their job—such as staffing, targets, and management—that they might never have had experience of before, said Joseph. “During specialty training you get trained to do all the clinical bits of the consultant role, but you don’t really get trained for all the management and leadership bits that you are expected to undertake,” he said. “Most job plans will have some time set aside for these things, but the point is that no matter how much time you’ve got set aside it’s the knowhow of how to deal with it that’s usually missing.”

In many instances, however, the emphasis of mentoring is on learning and development to help the individual achieve his or her full potential. Mentees will generally get several slots a year with a mentor, who will help them develop insight through reflection and will act as a sounding board. This approach can help new consultants to increase their confidence in how they execute their role and help them to feel in charge of where their career is going, with the knock-on effect of greater job satisfaction and motivation (see boxes).

As far as the NHS as a whole is concerned, mentoring means that organisations can get the most out of new consultants, in particular with respect to the non-clinical activities that senior doctors undertake to maintain and improve the quality of the service, said Ian Wilson, deputy chairman of the BMA’s Consultants Committee.

Having consultants who are engaged in the non-clinical aspects of their role and satisfied with their job can improve the quality of care they deliver too, he said. “In almost all professions you can demonstrate that if you increase the added value and the job satisfaction, then the core role delivery improves as well. If you extrapolate that to medicine, then working hard on the non-medical aspects and the leadership aspects will almost certainly translate into finding ways to improve direct clinical care as well.”

Box 1: Mentoring for new consultants in London

London Deanery has been running a coaching and mentoring scheme since May 2008, with the goal of improving care of patients by helping doctors and dentists reach their full potential (http://mentoring.londondeanery.ac.uk/). Of the 850 dentists and doctors who applied to take part in the London Deanery coaching and mentoring service between 2008 and 2011, nearly a quarter (23.4%) were new consultants or general practitioners.[6]

The scheme in London provides new consultants with space to reflect on their role and come to decisions on how to deal with situations at work. “I think new consultants can be overwhelmed with the size of the job, and I think that they find it helpful to have somewhere where they can set themselves some goals and make sure that what they are doing is focused, so that they can be effective in what they are doing,” said Rebecca Viney, coaching and mentoring lead in the professional development department at London Deanery.

The mentors on the scheme, most of whom are consultants or GPs and are educationalists in a different trust from the mentee, hold confidential coaching conversations whereby the mentees are encouraged to actively define their goals and explore how to action them. “[The conversation] doesn’t involve advising and telling people what to do in a passive and maybe slightly advisory and paternalistic way,” said Viney. “It’s finding out the mentee’s values and what they want to achieve, which turns it into a positive conversation rather than seeing what they bring as a problem.”

The mentoring scheme in London is available free to all doctors and dentists in training, those in the first two years of practice after receiving their CCT, and consultants who are taking on new leadership positions. The mentor and mentee will generally meet for four to six sessions of about 90 minutes.

Box 2: Mentoring new consultants in the North West

The North West mentoring scheme provides mentoring for healthcare professionals in Greater Manchester, Cheshire, Cumbria, Merseyside, Lancashire, and across the region (www.nwmentoring.nhs.uk/).

The scheme, which has been in place for about eight years, has three key strands: it provides personal and professional developmental mentoring for healthcare professionals; advises NHS trusts in the region on how to set up their own local mentoring and leadership schemes; and facilitates specialist medical peer support.

The scheme has established its own model of developmental mentoring that encourages autonomy and self development among mentees. The mentee sets his or her own goals through the sessions, and the mentor acts as a facilitator, identifying rather than providing opportunities for development.

“About 70% of our membership has identified their own development needs, takes responsibility for them, and really actively engages with their mentors,” said the scheme’s manager, Rob Booth. “It’s more of a self developmental model as opposed to a more prescriptive improvement model.”

Doctors seeking a mentor are granted access to the scheme’s huge online database of trained mentors from across a wide range of organisations and professional backgrounds in order to find the one they think is best suited to helping them with their personal developmental needs. “This approach gives the person who is trying to identify a mentor a choice of a lot of different people, so they can focus on the particular areas of development they want to work on,” said Booth.

Mentors and mentees generally meet on a monthly or six weekly basis for a period of six months, after which their interaction is evaluated and their relationship continues, if need be. Taking part in the scheme is free for any doctor employed by the NHS in the region.

Accessing mentoring

Last year the Royal College of Physicians wrote to the medical directors of all acute trusts in England to find out about the level of mentoring available to help new consultants meet the “significant challenges” that many face when moving from trainee status to independent specialist. The college has suggested that in future the requirement for mentoring should be included in all consultant job descriptions and that this requirement be made explicit at all advisory appointment committees. The trusts that responded to the letter were “unanimous” in their support for developing mentoring schemes for new consultants.

Even if they haven’t set up a formal mentoring scheme, most hospitals are willing to identify senior doctors who are prepared to act as a mentor, said Joseph. There is the issue of the squeeze on time for supporting professional activities (SPAs), however, which means that senior doctors might not have enough time in their job plan to mentor their new colleagues. “But you also have the various tutors—such as tutors for postgraduate medicine and staff, associate specialist, and specialty doctors—to turn towards,” he said.

Another barrier is consultants’ own professional pride, said Joseph. “I’m not sure all consultants feel confident enough to let down their guard and show that they are vulnerable and ask for help,” he said. “But I think new consultants have to overcome that, because I think at any stage of a consultant’s career there’s always someone who has a bit more experience of having done something that you’re going to have to do.”

With all the changes set out in the Health and Social Care Bill, the changing relation between primary and secondary care—in particular the move to deliver more care in the community, which will have a knock-on effect on the case mix received by consultants—the cost efficiency agenda, and the continuing professional development requirements for revalidation, new consultants are likely to need even more mentoring support in the future.

Competing interests: None declared.

References

  1. General Medical Council. National training survey 2011: key findings. Nov 2011. www.gmc-uk.org/NTS_trainee_survey_2011.pdf_45270429.pdf.
  2. Modernising Medical Careers. About Modernising Medical Careers. www.mmc.nhs.uk/medical_education/about_modernising_medical_care.aspx.
  3. Tooke J. Aspiring to excellence: findings and recommendations of the independent inquiry into Modernising Medical Careers. Sep 2007. www.mmcinquiry.org.uk/MMC_InquiryReportREVD3.pdf.
  4. Connor M, Pokora J. Coaching & mentoring at work: developing effective practice. Open University Press, 2007.
  5. BMA. Mentoring and coaching: a guide for doctors. http://bma.org.uk/developing-your-career/career-progression/mentoring-and-coaching.
  6. Viney R, Paice E. Reaching out: a report on London Deanery’s Coaching and Mentoring Service 2010-2012. London Deanery, 2012. http://mentoring.londondeanery.ac.uk/downloads/files/FIRST%201000%20-low%20res.pdf.

Helen Jaques news reporter BMJ Careers

 hjaques@bmj.com

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