It's good to talk

Authors: Amy Iversen 

Publication date:  29 Sep 2007


Amy Iversen describes a new peer led mentoring scheme for psychiatrists

In 2004 I started a mentoring scheme for psychiatry trainees at the Maudsley Hospital, London, having recently completed my own training. Contact between mentor and mentee is informal and is separate from appraisal of junior staff, and both parties agree to confidentiality. The scheme has been popular and successful.

The idea

Mentoring is widespread in academic and clinical medicine in the USA and is becoming increasingly common in the United Kingdom.[1] [2] The Royal College of Obstetricians and Gynaecologists has pioneered a successful scheme, and other colleges are keen to follow.[3] [4] The BMA is lobbying for formal mentoring to doctors at all stages of training.[5] Mentoring is promoted as an essential component of the Modernising Medical Careers initiative, and the potential benefits of mentoring are widespread.[6] For the mentee these include opportunities to reflect on strengths and weaknesses as a doctor, improved self confidence and self efficacy, and a chance to explore new ways of problem solving. Benefits for mentors include improved interpersonal and communication skills, and an opportunity to understand challenges faced by colleagues. The benefits for trainees are wide ranging—mentoring fosters an environment where awareness of the problems faced by colleagues is increased, and in time this influences the culture, attitudes, and behaviour of the whole organisation.

Why is mentoring needed?

Until now formal mentoring schemes for psychiatric trainees have not been adopted in the UK. This is perhaps surprising given the nature of our specialty and training. It is well known that psychiatric trainees often find their first year of training difficult and unfamiliar, as clinical psychiatry involves tolerating risk and uncertainty, and learning to manage problems from within a multidisciplinary team. Trainees are inexperienced clinically, and have placements away from the main hospital in, for example, community jobs; they therefore lose informal peer mentoring and a chat over a coffee. An increasingly diverse workforce with a substantial proportion of female trainees, many with children, means that this informal advice might be inappropriate or inaccessible because of time constraints.

Getting started

I surveyed senior house officers to test the acceptability and feasibility of the scheme. As enthusiasm for the scheme was considerable, I trained 30 mentors using a two hour training package with a combination of didactic teaching, small group work, role play, and case discussion. Attendance at the training session was voluntary and it took place after work. After three sessions there were sufficient mentors. Mentors were allocated to recently appointed senior house officers.

Progress of the schemes

Since autumn 2004, more than 100 junior doctors have taken part in the scheme as mentees. All new trainees joining the rotation are given a talk about the mentors' scheme during their induction day and offered a chance to opt out. So far, 98% of new starters have accepted a mentor. Trainees can become mentors once they have worked one year for the trust. Being a mentor continues to be voluntary even though training is part of a junior's schedule. Once trained, 5% have chosen not to mentor.

Mentoring

Mentors are encouraged to meet with their trainee formally for 45 minutes fortnightly for six months, with the opportunity for informal meets, conversations, or e-mentoring between times if the mentor agrees. After six months, mentees and mentors may opt to extend this relationship to a year and more than three quarters of participants have done so.

Training for mentors

The package focuses on core skills such as problem solving and active listening. There is also practical advice on how to initiate contact with a mentee, how to structure sessions, and how to deal with common problems such as how to deal with mentees who are “too busy to meet.” Confidentiality and relationship boundaries are explored and mentors are encouraged to keep a written contract with their mentee.

Supervision for mentors

There are two independent supervision streams available. All mentors receive individual e-supervision from one of two specialist registrar co-coordinators who contact them monthly by email. If necessary, further discussion takes place by telephone or in face to face meetings. Mentors can also contact a trust's consultant psychiatrist or psychotherapist independently of the scheme organiser. This consultant may give advice and support, offer unwell mentees an assessment, and refer on to MedNet ( [Link] ). We have also produced a number of e-information sheets offering practical advice to mentors on issues such as how to help someone who is unwell or who is being bullied.

Evaluation

I evaluated the scheme informally at the end of the pilot. This consisted of giving mentees a short anonymous questionnaire (89% took part—24 out of 27); 74% reported that the mentoring scheme had been helpful or very helpful, and 86% said that they still saw their mentor after six months. Common topics covered in mentoring sessions are described in box 1.

Box 1: Hot topics

  • Clinical support (eg how to deal with difficult patients or violence; how to manage clinical workload and overload)

  • Dynamics with colleagues (eg relationships with supervisors, nursing staff, other members of the multidisciplinary team)

  • Personal issues (eg where to go for help if having difficulties and how to access personal psychotherapy)

  • Career issues (eg advice on research, examinations, job applications).

The future

We intend to continue this scheme during the current upheavals in medical education. We will offer our scheme to trainees in the first year of their specialist training, and mentoring will continue to be provided by senior specialist trainees who have completed at least a year of psychiatry. The move towards workplace based assessments will encourage trainees to use reflective practice to grow professionally. Mentoring offers a unique opportunity to use reflective practice as a learning tool, outside the limitations of a relationship with an educational supervisor who may also be responsible for your appraisal.

Acknowledgements

I would like to thank the specialist registrar co-coordinators for their help with running the scheme. I would also like to thank Mike Travis and Julia Bland for supporting the scheme.

Box 2: Useful websites

  • An overview of current schemes in the UK (2004): [Link]

  • Mentors and mentees talk about their experience: [Link]

  • Further details of the Royal College of Obstetricians and Gynaecologists' scheme: [Link]

  • The BMA's position on mentoring: [Link]

References

  1. Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA  2006;296:1103-15.
  2. Doctors Forum. Mentoring for doctors; signposts to current practice for career grade doctors  . London: Department of Health, 2004.
  3. Bowen-Simpkins P, Mellows H, Dhillon C. Royal College of Obstetricians and Gynaecologists mentoring scheme. BMJ Careers  2004;328:56. careerfocus.bmj.com/cgi/content/full/328/7435/56.pdf.
  4. Royal College of Surgeons of England. Mentoring schemes. 2006. . [Link]
  5. Board of Medical Education. Exploring mentoring  . London: BMA, 2004.
  6. Modernising Medical Careers. The next steps—the future shape of foundation, specialist and general practice training programmes  . London: Department of Health, 2004.

Amy Iversen clinical lecturer  amy.iversen@iop.kcl.ac.uk Maudsley Hospital, London

Cite this as BMJ Careers ; doi: