It takes a village: Rheumatology trainees require multiple mentors, commitment
From the latter stages of medical school to the precarious steps involved in carving out a subspecialty, and throughout the turbulent transitions experienced by young physicians, the advice and guidance of mentors is often invaluable.
Although mentors are important figures for any developing professional, in medicine the presence of a strong role model has the potential to alter the path of the trainee’s entire career. As such, it is likely impossible to overstate the importance of the role mentors play in the professional lives of young physicians.
“Whether your career in rheumatology is going to be clinical/private practice, or academic/medical education, or in research, having mentors is important,” Jean Liew, MD, a clinical researcher and rheumatologist at Boston University, told Healio. “They are not only valuable from an academic or research standpoint, but from a career development standpoint.
“They are an invaluable source of support and guidance,” Liew added.
According to Kathryn Dao, MD, an associate professor with the department of internal medicine, and the division of rheumatology, at the University of Texas Southwestern Medical Center, one major role mentors serve in the course of a young physician's career is in acting as a positive role model and as an example of what the specialty can offer practitioners.
“When I entered medical school, I had no idea what my career would look like,” Dao told Healio. “I kept an open mind, trying basic research, rotating through different disciplines, and asking doctors why they chose to specialize in their fields.”
For Dao, the revelation came upon meeting Wayne Yokoyama, MD, during her internal medicine residency at Barnes Jewish Hospital in St. Louis, Missouri. Yokoyama, Dao said, had knowledge of a wide range of specialties and seemed to be able to conquer any case thrown his way.
In addition to Yokoyama, Richard Brasington, MD, exemplified an excitement in teaching, Dao said.
“Before I knew I needed a mentor, Dr. Yokoyama and Dr. Brasington mentored me and ushered me into the world of rheumatology,” she added. “Mentors are role models. They exemplify their discipline and attract students who want to be like them. This is the first glimpse of whom the student wants to be — the life they imagine they will lead. Were it not for my observation and interaction with my mentors, I would have chosen a different specialty.”
As such, it possible for an individual mentor — or two — to have an immense impact on their trainee. However, for a trainee to achieve the highest heights possible, it is often important for them to call on different mentors for different situations.
‘A village of mentors’
Throughout a career, a provider will forge relationships with many potential mentors. To make the most of these mentors’ training and knowledge, it is important to know who to call upon, and when.
“One person will likely not be able to deliver on all the roles,” Puja Mehta, MD, a rheumatologist and clinical research fellow in respiratory medicine at University College London, told Healio. “It is almost unfair to put all of the responsibility on person.”
According to Mehta, different mentors can offer their own individual insights and advice on work-life balance, making meaningful contributions to the world of academia, and the process of developing a niche in a specific subspecialty.
“I think a village of mentors is really important to help shape that mentee’s well-rounded career,” she added.
Liew agreed, stating that one person cannot and should not provide advice for all possible aspects of one’s career.
“You need some differing perspectives, and you also need people with differing expertise,” she added. “It’s also good to have people in different phases of their career. Sometimes you need to meet with a lot of people to find the right person to mentor you for a specific thing. That’s okay, too.”
What makes a mentor?
If one were to ask 100 rheumatologists or providers what qualities distinguish a “good” mentor, the resulting 100 unique answers would likely far outstrip the space available here. However, common answers tend to include a contagious and enthusiastic love for the field, availability, a willingness to share their experiences and advice, and a mutual respect between mentor and trainee.
“I think the more involved you are, the more you show enthusiasm for the field — I think that is infectious,” Robert W. Levin, MD, of the University of South Florida, told Healio.
In addition to making the specialty appealing to young doctors, it is important to stay positive and maintain a sense of humor, Levin added.
Meanwhile, for Mehta, although positivity and enthusiasm are important, the qualities that best suit a mentor are empathy, a certain amount of selflessness, and time.
“I think, probably, the most important quality for a mentor is that they want the best for the trainee, and that they are willing to invest time and effort,” Mehta said.
Instead of trying to create a younger version of themselves, Mehta said, mentors should be focused on bringing the best out of their trainees and raising them to their own heights.
This is not about trying to recreate or relive their past,” Mehta said. “It is about trying to do the best for that individual mentee.”
Impactful mentors are also willing to go the extra mile to bring up their trainees when they are not around. In this way, mentors can open doors for trainees and help gain access to new possibilities.
“Saying somebody’s name when they are not in the room (sponsorship) is very important,” Mehta said.
Finally, it is important that good mentors give their trainees the opportunity to say “no” to potential opportunities.
“Not every opportunity is the right one for me at that specific moment,” Liew said, referencing her early career. “Letting me make the final, informed decision is a sign of respect for my time.”
Emphasizing the benefits of direct feedback and meaningful connections, Liew added that even “liking” a text, or spending the extra 5 minutes at the end of a busy day — even past business hours — to respond to a message, will be appreciated.
“A little bit of a mentor’s time can mean a lot to a mentee,” she said.
However, it is also important for mentors to understand how much time they are able to invest in their trainees, Liew added.
This is about not spreading yourself too thin,” she said. “You want to be there for your mentees, but you have to be there in a meaningful way, and without upsetting your own work-life balance.”
At the end of the day, the mentor-mentee relationship is a two-way street, and it is important that mentees come prepared and with a concrete goal in mind.
The responsibility of the mentee
Whether mentors and mentees are preparing to meet for the first or 40th time, it is crucial that mentees arrive to meetings with a goal for the session — and the future.
“It is very difficult to mentor somebody when there is not a clear goal for what they are trying to achieve,” Mehta said.
To this end, it is important for mentees to show appreciation for their mentors’ time and keep organized. Mehta suggested bringing a discussion topic to each meeting, while Liew said mentees should be responsible for setting the agenda.
“A good mentee is one who is willing to be mentored,” said Dao.
To meet this requirement, Dao added that a trainee must recognize they need help, they must seek out that help, and they must follow-through with the relationship to be successful.
“This means identifying someone who might help you with your career or research, discussing your ideas and ways to move forward with the ideas, and meeting regularly with the mentor so that you will be held accountable for your action or inaction,” Dao said. “Repeat the cycle — sometimes, you have to seek a new mentor for different stages of your career, and sometimes, it takes more than one mentor to help you.”
According to Levin, a good mentee is someone with an open mind who is receptive to the knowledge being offered by the mentor.
“All the things that make us excellent clinicians are the baseline, but they also need to be receptive and want to learn while having a certain compassion,” he said.
The future of rheumatology
It is no secret that rheumatology is suffering from a labor shortage, and impactful mentors have an opportunity to reach students in medical school to make an impact and draw more attention to the specialty.
“You have to get people’s excitement up about what our field has to offer,” Levin said. “Med school is a really good time to attract folks.”
Students in medical school are often, at that point in their journey, still uncertain where their career may lead.
“I had someone who served this role for me when I was in medical school,” Liew said. “They were so engaging and clearly loved what they did, and clearly wanted to help their patients.
“They were also big into educating students as well as their patients,” she added. “Those are characteristics that will help our field grow, and help trainees want to do additional training in rheumatology.”
However, positive role models may not be enough to stave off a worsening labor shortage, particularly regarding pediatric rheumatology.
According to the American College of Rheumatology, just 62.8% of available pediatric rheumatology program slots were filled for the 2023 appointment year as part of the National Residents Matching Program. Meanwhile, adult rheumatology programs filled 97.8% of their available slots during the most recent Match Day. In all, 75% of applicants for adult rheumatology, and 96% of applicants for pediatric fellowships, successfully matched into programs for the 2023 appointment year.
“The year that I applied for rheumatology fellowship, only about 70% of those who applied were able to get a position through the match,” Liew said. “We need more rheumatologists in the United States and we need more rheumatologists globally.”
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