Thank you so much for joining us today and we are looking forward to a fun and intimate conversation and given the size of the room and the folks in it, we'd certainly welcome you to come a little bit closer if you'd like and if you don't like, we understand that too. So we're going to talk about mentorship today and we thought that the best way to do that was to introduce the concept in terms of some basic conceptual frameworks and then share with you some of our personal stories in terms of our respective journeys along our mentor and mentee relationships and we recognize that we are not the only unique individuals in the room who have enjoyed mentor and mentee relationships and so we'd really like to engage this group in a discussion as we go along so we can share and learn from each other's experiences and hopefully enrich our lives and our relationships with other people as time goes on. So with that, I'm going to pass the microphone. We're going to introduce ourselves first. Hi everyone. My name is Naila Ahmed. I'm one of the Pulmonary Curriculum Fellows at Mayo Clinic Rochester. A little bit about me for some context into the discussions we'll have today. I am a foreign medical graduate. I did my medical school in Pakistan and then I came to Connecticut for residency. After doing my IM residency, anybody who is a foreign grad amongst you will recognize you need to go through a process that involves relocation to a different area and so I did my waiver as a hospitalist, as an academic hospitalist at Dartmouth in New Hampshire and then I decided that I didn't want as much free time or as much money for a little bit and so I came back into fellowship and so I'm in my second year of fellowship training right now and interested in medical education. I have no disclosures. My name's Annie Walker and I'm from Australia. I did my basic training in Melbourne, one of the bigger cities and I am a Respiratory and Sleep Specialist now practising in Adelaide and with some clinical education fun that I have on the side. My name is Mark Lavecombe. I'm from Melbourne in Australia as well. I am a Respiratory and Sleep Disorders Physician and also the Deputy Director of Medical Student Education in one of our hospital clinical schools. Hi, my name is Alex Niven. I am a Consultant in Pulmonary and Critical Care Medicine at Mayo Clinic Rochester, Division Chair for Education there and run the Academy for Educational Excellence. Good afternoon everyone. I'm Lisa Moores. I'm Pulmonary and Critical Care trained. My current role is back at the medical school, the Uniformed Services University and I'm the Associate Dean for Assessment and Professional Development so I follow all of our students longitudinally but also run a coaching program for them and I have no conflicts to disclose. So our objectives today is to introduce a little bit of a conceptual framework for you that is well published and described by CRAM in terms of four different stages of mentor relationships and we're going to talk a little bit about the roles and responsibilities that both mentor and mentee should think about bringing to those roles. Again we're going to reflect on these lessons based on our own personal experiences and we really do invite you to share yours as time goes on and we discuss this really important but commonly challenging topic together. So we wanted to give just a quick overview. The thing that I would recommend is if you haven't read a lot on this the references at the bottom aside from the first one the second two are really very good. These talk a little bit about characteristics of the mentee and the mentor as well as you can see what leads to an effective relationship. The point that I would emphasize the most is you can see that this really in many respects although it's a mutual relationship it's driven by the mentee and so keeping that in mind as you hear our stories and how to be an effective mentee no matter what stage you are in but there are some things that help those of us in mentor roles also create that mutual relationship of respect and growth and it's something that I think when I first started thinking about these that the mentee was always going to be the recipient and as you look at that slide I think you can reflect that often times the mentor is also a recipient but both need to bring many characteristics to the relationship. So, we're going to divide our journey into four different stages again following Cram's conceptual framework the reference for which is at the bottom of the slide. So I think many of us think about the start of the journey for a mentor relationship with some anxiety and the label that Cram has for that is the initiation phase and that's really an opportunity for the mentor and the mentee to interact, share their common experiences and values to find out if there is a true match in terms of a little bit of magnetism that creates a relationship but I think just as important as that is the experiences that the mentor brings to the table in terms of background, career interests, professional accomplishments and how well those potentially match with the mentee's aspirations. Once a mentor and mentee select each other and I do firmly believe that that is a two way street then the next phase is one of cultivation and as happens so often in our busy clinical practices after a period of growth together professional situations change, people graduate, change hospitals, move on, perhaps the goals of the original relationship run their course and there is often an episode of separation and in some cases those mentor mentee relationships can be redefined at a later time and that really is the life cycle of Cram's mentor mentee relationships. Again really these discrete elements practically are more of a continuum progressing from more dependence to independence in that relationship as time goes on. So with that I am going to pass the microphone back to Naila who is going to talk a little bit about her personal experience with initiation. Alright, so we have talked a lot about the theory and I will share some of my experiences now. I chose this slide for a reason. I think a lot of times when we think about mentorship everybody has had different experiences and some institutions it is practiced to have a mentor assigned to you and some relationships develop more organically and we have all had experiences of those sorts. So I am going to share two examples from my life that helped me grow more in my experience. So my first earliest recollection of a mentorship relationship was as a foreign medical graduate just fresh out of medical school applying for residency. I am sure a lot of you have either recently been through that or at least remember the angst of that application process for the U.S. medical residency system where you have an application deadline and you have to have everything due by a certain time. So being a foreign medical graduate having less experience in what was needed to make my application stronger when I looked around I tried to find faculty members in my medical school who had been trained in the U.S. system who would be able to help me navigate the process. And I was fortunate enough to find someone who I had worked with who I found incredibly charismatic, very knowledgeable, very approachable. And so I reached out to him and he was kind enough to meet with me, went through my application in a lot of detail, felt that my research aspect was what could be bolstered and actually even helped me set up with a research project. So it was fantastic. Over the next few months we worked really well together. He kept checking in regularly, kept asking me about any issues I might be facing, troubleshooting issues with me. So in my mind he was my mentor. Somebody I had clinical experience with, research experience with, a good rapport with, somebody I admired. Hit all the boxes. And so even though we were talking a lot about research and not really talking about whether I needed to modify any other aspects of my application, I felt there was time and I didn't need to push it. And so we did the research project. Everything went well. And I assumed that at time of application we would go over what was needed. Now come application time, however, his clinical requirements suddenly amped up. And so he was no longer able to let alone look over my application. The letter that I thought would have been the strongest in my application was not only submitted a few weeks after the deadline so as to be essentially unusable for me, leaving me scrambling to look for other letter writers, it essentially was a generic one too. And so you all can imagine how I must have been thinking about him at that point and what I must have been feeling. And I think, you know, in retrospect, having had the hindsight of a number of years to calm down, I think a lot of it goes back to what we were talking about earlier in that it's a two-way street. I knew I wasn't getting the guidance that I wanted, and I wasn't explicit enough to ask for that in a timely manner. I also didn't really ask whether he had the interest or the ability or the bandwidth to be my mentor. In my mind, he fit my criteria, done. But as Dr. Nibman pointed out earlier, it's a two-way street. It has to be. And so in hindsight, if I take back from that example, I think I would have spent the time to try and see whether he truly was interested in being a mentor or just wanted to work on a research project, and also whether there were other people who might have been a better fit. So fast-forward a few years now. I'm out of residency, applying to be a faculty at a prestigious Ivy League institution. Imposter syndrome is hitting hard since I'm now going to be faculty for people who are just one year junior to me, who are studying for their boards, just as I am. And so our division had a policy of having mentors assigned for you, which I think works well in some cases, and could have worked in this case. I was assigned with a mentor whose life experiences and whose generally trajectory was a whole lot different from mine. He was an older gentleman, much more in an administrative faculty, had been at that institution for all his career, and so a lot different from me, who had not stayed in a place for more than four years at a time. So although he was extremely experienced, extremely approachable, I never felt that he would be able to provide me with the perspectives that I was looking for in terms of my experiences. So I ended up finding some peer mentors who I did get along better with and who were able to guide me more in the roles that I wanted, which were more clinical and kind of how to fit in the system and how to lead a team and all the things you need to learn when you're coming fresh out of training. And then once I found my footing, I started looking for ways to branch out in my career. And I realized two things. Firstly, having too many options is sometimes just as bad as having no options. And secondly, you will never know what to do unless, or you won't be successful, I think, at what you do, unless you take the time to introspect and figure out what really impassions you and what makes your day. So I took some time to think about what I wanted, realized that clinical medical education was really what brought me joy. And so I started meeting with some distinguished people in my department who had renowned times and careers in clinical education. And I learned a lot about how their journey went, got some really great tips from them. And it was very good. But in my mind, I was searching for the one mentor whose path I could follow, whose footsteps I could follow in, who I could emulate. And I didn't find anybody who matched that role. And it wasn't until, I think, a few months after this process, I was talking to somebody and realized that if I'm following in somebody's footsteps exactly, then that's not really my path, that's their path. And what I'm looking for is a way to have somebody to guide me down my path. And that was when I realized that what I was really looking for were two mentors, or maybe more, looking for somebody to help me with my clinical career, which I was very passionate about, and somebody to help me with my medical education career, which I was equally passionate about, but knew a whole lot less of. And that was a pivotal moment, because then I realized I knew these people. I just hadn't found one person to fit all buckets. And once I realized that, that was phenomenal. I was able to connect with them. I was able to express exactly what I required from them. They were able to share that they had the bandwidth, the interest to meet with me. And I still keep in touch with them. They were able to sponsor me, guide me. And they're still very good friends. And so, you know, looking back, I think a lot of these stories reflect a whole lot more about me as a mentee than they do necessarily even about my mentors. But it also reflects on the relationship itself. And some of the takeaways that I had would be on the next slide, was that, so initiation is in the first few years of the relationship. The needs during that initiation phase depend on where you're at. What I needed as a medical student were a whole lot different from what I needed as a fellow, were a whole lot different from what I needed as a faculty. And that's something that you have to acknowledge yourself. Self-reflection is crucial. Without that, you can never choose the right mentor, because you won't know which way you're going. So it's not possible for somebody to help guide you in the right way. Mentors for various aspects and phases of life should be encouraged, not thought of as an anomaly. One person cannot be all, and one person should not be all. It's too much for them, and it's not going to be effective for you. And peers can be very powerful mentors, too. I think they're going through the experiences that you are, maybe in a slightly different time frame, maybe through a slightly different lens. But they can share perspectives that people who are 5, 10 years, 15 years beyond you won't be able to. The mentee should be able to drive the relationship, but both have to contribute for success. And lastly, which I think is the biggest takeaway and something we all struggle with, is that explicit communication is key, both from the mentee's perspective, but also from the mentor's perspective, because unless clear expectations are laid out, it's very tough to have a productive relationship. So that's my little bit. Any questions? Any thoughts? We'd welcome them either now or towards the end, whatever. I think as adults, we process by discussion and reflection, and I suspect that there are many other experiences and words of wisdom that can be offered from this group. So we'd like to open it up to the audience. Our original plan was to have wireless mics, but that plan appears not to have materialized to date. So we would invite people, it's not a big room, I think you can probably speak up, or if you'd feel more comfortable coming to the mic in the front, please do. Anybody who'd like to share their own experiences and compare and contrast their lessons learned to the ones on the screen here? Go ahead. In the first relationship that you were talking about, that completely crashed and burned, did you ever think about going back and giving it to some people that had the same impact? Yeah, yeah, yeah. Right, just saying, you know, this is where I realize this relationship may have broken down because that person may just not have been aware of how to be a mentor, and oftentimes, you know, that mentee-mentor relationship is learning at the same time, and they just maybe needed a second chance or an opportunity to see things differently. That's a fantastic question. I never did, and being brutally honest, I think part of it is because I don't think I was calm enough to do that for a few years, and then I've not been back since. I think if I did go back and meet him, I think I would probably bring it up in conversation. I haven't had the opportunity to meet him in about eight years or so, so I think you're right. It's one of the biggest things, and we'll all touch upon that in a bit in our own way. It's not something, it comes naturally to some people, but some people need to get some tips, and I think in retrospect, I should have, but I didn't at that time. I have a question around, and this is to everyone, as either a mentee or a mentor, how do you actually formalize the agreement of entering into that sort of relationship? When I think of my experiences of being a mentee and a mentor, they've all been informal. They've been people that I've built rapport with through clinical practice, things like that, consultants that I've worked with as a trainee, who I respect, and they have similar interests to mine, and I always feel comfortable talking to them, but we have never sat down and said, right, this is a relationship, let's meet with this, you know, it sort of to me sounds as if it brings up, you know, a dating experience almost, like asking someone out, so I'm just interested in what your thoughts are about how you go about formalizing. As you were talking, the first thing that came to my mind is if you look across, sticking within medical education and across academic institutions, those that have very formal mentoring programs often have a written mentoring compact, and so it's something that gives a lot of freedom to be flexible in what you're filling out, but it often includes, you know, what are your goals as a mentee? What are you looking for? Some of your life experiences that might help a mentor understand where you have been and where you want to go. It talks a lot about the rules, you know, setting up that environment of trust and how we're going to have conversations. Some of them even go into how frequently are we going to meet? How are we going to hold each other accountable? When are we gonna check in on follow-up? So there are some that have that, to that level. Then there are other institutions where they give you that guide, and they sort of ask you to reflect on these things in those initial conversations. And then all the way to more informal. I think of my mentor team, and it was about half and half. Some of them, I would agree with you, probably looked very informal on the outside, but 30 years later are still part of my team. So I don't know that you have to have that, but it's available, and if you find that that communication is difficult and you're not sure, then that may be something that you would want to try. If I can just add to that, I mean, I know where you live. I used to be your supervisor. I think sometimes in smaller departments, it's a little tricky. You know, if trainees particularly are reporting to someone who has a responsibility for decisions around progression, employment, and so on, that probably isn't the right person to be acting as a mentor as well. And so separating those roles is actually really important. And again, if it's a smaller place and there isn't a formal mentoring program, sometimes that's gonna be hard. You're gonna have to be looking outside of your direct place of practice. Some of our professional societies run what you just said, mentoring, dating, speed mentor, match-up sessions to try to get people aligned who don't directly report to one another. I think maybe staying on schedule. I think initiation and cultivation blend well together. So maybe we'll pass things over to Annie. Cool, so the cultivation phase. So that's, as Alex alluded to, is what follows. And Cathy Cram describes this in her seminal paper as it lasts from about two to five years. So it's the meat of the relationship where both the mentor and the mentee really get to discover the value of relating to each other. And it's where both the career and the psychosocial benefits of the relationship really peak. So this is the good stuff. You've already clicked as we've found your tricky mentor and as the story unfolds. So my story. For the first time, I was grappling with the return to work from maternity leave circus, an absolute circus, which, although lots of other people had done before me, I felt like a pioneer suffragette doing it for the first time. And that's when I met my mentor, Jen. So Jen is the quintessential mid-career clinical academic, her career absolutely skyrocketing, someone who I'd always admired, but not someone I'd met in person before. I'd finished my specialty training in respiratory and sleep medicine. And as I alluded to before, I'd recently moved town in Australia. So I'd gone from a big hip happening hospital that had been my base since medical school. And there I'd had several really supportive mentors who had sort of helped me through my junior phases of my career. I'm still very junior, but in my baby phases of my career. But these mentors were now not only 700 kilometres away, but they were all middle-aged men, greying or balding. And they just didn't really get it. So I was a bit lost, to be honest, in my new town. And about, it took four or five years for me to click with someone. As we all know, it can be really hard to find that right mentor. I was also working part-time and I had other junior colleagues and trainees coming to me looking for advice on how to do this part-time mat leave business. And I was like, surely there's someone better at this than me. I've got no idea what I'm doing. I'm half swimming, half struggling, half covered in baby spew. Surely someone else knows. And that's actually how I reached out to my mentor, Jen, because I knew that she'd set up a similar networking women in respiratory event in her state. And I thought, I'm gonna pick your brains and see if I can set one up in my hometown. So unbeknownst to both of us, I reached out via email and that was the beginning of our mentor-mentee relationship. So not a formal structured one. This more organically started. So as well as the, Jen was thousands, hundreds, not thousands, hundreds of kilometers away, but there was also a global pandemic going on. So email and Zoom is how our relationship started and continues. She was honest, responsive, welcoming, and really generous with her time and still is. And I'm super appreciative of that. As this cultivation phase continued for us, we'd connected over my first goal and then we moved on to what next. And that was what on earth to do as a junior specialist and how to get my career to where I wanted it to be. I was really honest about what my needs and priorities were at this phase of my life and my career. And so our relation and all I hope to learn from her. So we continued cultivating our relationship. We continued to meet via Zoom and shared in our research interests. Both of us have the same sub-specialty interests. She was inviting me to be part of her networks and talk and chair at all these things, all of these amazing opportunities. But really importantly to me was each of those opportunities, she would always say, I'm gonna offer you something, but please feel free to say no, I won't be offended. And for me, that out was so liberating that I wasn't gonna be letting her down by saying no. But she did more than just sponsorship. She role modeled for me and she has provided me with a real balance on both academically, but personally. So she's got three school age kids. I've got two baby smelling bundles. So she gets it, she's lived it. And she was really able to provide me with that practical advice from things like how to manage childcare, the relentless illnesses, the expressing at work, the last minute changes in timetables, all of those things that we all deal with. She was able to help me with them and counsel me through some tricky discussions as well. I'm so appreciative and I still am. And I remember distinctly getting off the first few Zoom calls, just feeling so relieved that finally I had a guide again and I'd got this person to be my mentor. And in some ways, I think actually the geographical distance between us really helped because she wasn't at my primary hospital. She was able to really have my best interests at heart. So skip forward a few years, pandemic subsides. Now I've got two kids, got the job that I wanted. But then I start out on this crazy thing called a PhD. So the imposter syndrome peaks, scared, unsure, no idea what I'm doing again. And Jen was there for me, helped me through these things, there when I needed to vent, helped me reflect back at some of my strengths and risks of burnout and work on my weaknesses. So she's been there to keep that imposter at bay. So for me, the circus 100% continues. Definitely no suffragette. I'm just another working mama. And now I've got a pretty sweet ring master who's helping me herd my elephants. Sir, go ahead. I think you bring up very important points. It is crucial to be mentoring trainees. And we all know that. But I think the most difficult transition for people is when they graduate from fellowship. And they're going into, because at that point, we expect that they are independent consultants. You know, we've trained them. They have the medical knowledge and the skills and the expertise to do their work. But they come into this new environment where they're thrown into the swimming pool, and then they don't know which way to go. So I think that that's a really crucial time when you have to mentor people to navigate that, at least for the initial few years, how do you handle all the responsibilities that are cast upon you? You know, I think that's a fantastic question. Maybe I'll turn it back to others in the room first, because I suspect that there are individuals who are part of groups or divisions that have systems that perhaps address that transition. Because I agree, it's a huge step, probably one of the most important ones in our professional careers. Anybody have any thoughts? And many people, especially in academics, they leave because they're unable to navigate the system. So I'll nerd out a little bit with this, because people that know me know that I worry a little bit about the details. So I completely agree with you that that transition from training to practice is probably one of the most important ones that one can make. And it really requires two very deliberate things. The first, and I'll go back to Naila's comments before, is helping to develop a clear sense of purpose and passion, which I think is something that tends to be under-emphasized in the hierarchical system of medicine that we all work in. And as a result, I think people too often fall into pathways of convenience that perhaps they regret down the road. And so doing the work up front to think about what really drives you in the morning to get out of bed, and perhaps that's not a question that could be answered immediately as one moves into practice, and that's okay. A professional career is a marathon, not a sprint. I think the second step to that then is deliberately planning what pathway or what potential pathways one must explore with some reasonable touchpoints in terms of what things you want to accomplish at three, six, 12, 24 months. And those touchpoints ideally are done within the context of a mentor relationship. And really the biggest challenge there is what sort of support framework should be in place to make sure that that mentorship relationship thrives. And there, I think the literature is all over the place. So I think it really depends on the environment that you're in and the complexity of the situation. I don't know. Other comments? No? No? Yes? I have a question, if I may. So you do two to five years cultivating. For those of us who are involved more as an educational program director, you do like two to three years. Should you be more of a coach? I don't think two to five years is a fixed requirement. I think Cram was describing what she saw in a business setting of how certain relationships developed. So I think you can take that with some flexibility. I think there probably is a role both for a coach and a mentor, and they, as you allude to, serve different purposes. I don't know what it's like for a program director, because I'm from Australia, but I know that, you know, having supervised trainees, our time with them is short, and so often it's about trying to get the most into that time as possible, and then trusting that they'll move on to other supervisors who help develop them further. Yeah, I think the key is that for any of the roles, whether it's coach, mentor, advisor, sponsor, there's distinctness to them, but there's so much overlap. And oftentimes we do have to fulfill all of those roles, and it just depends on what phase of the career your mentee or coachee is in, or what they're looking for, or how much they align with where they want to go, versus, can you help me in the next two years? Can you help me really succeed in fellowship, and then I'll find a mentor in my area of research interest, or something like that. But you're going to find yourself. I think the one thing I've learned is to name it. Let me put my coach hat on now. Let me put my sponsor hat on. I think otherwise, moving between the roles can sometimes muddy that clear communication that makes the relationship work. And there needs to be independence. You know, like you mentioned, you don't feel constrained by your mentor, and that's extremely important to have that, so that the mentee doesn't feel boxed in to the way you want them to be. And you know, we experience this every day. I mean, we have training fellows in the clinic and by the bedside. We give them independence, but we also watch over them, and when they're not doing things right, then we tell them, this is not the way to do it. So that's a mentor relationship. Yeah, absolutely. Some really great comments there, so thanks team. So just to summarise on the cultivation phase, it wouldn't be a MedEd session without an acronym, so I've got to put up one of my favourites, also quite well known here by Sobha et al., the mentor. This summarises more from the mentor's perspective than the mentee's, but touches on some of those points, so a mentor to motivate, to empower and encourage, as well as nurture their self-confidence, teach by example, as well as offering some wise counsel, as alluded to, raising that performance bar, so keep on asking for more, but the last one, shine in reflected light, so not being a competitor with your mentor, they can really succeed through your success, and I think that is then some of the joy that you get out of being a mentor. So from there, we'll go on to the separation phase. Thank you. So Cram talks about separation in terms of structural and psychological changes, so structural where there is a clear change in the organisation of how the relationship works, and then the psychological ones, the experience of the mentee and the mentor as that relationship changes, and often being associated with possibly a sense of loss, anxiety and so on. So I'm going to tell a story of a separation that I have been through as a mentee, and I guess I will preface it by saying, you know, I'm sitting up here co-chairing a session with four amazing faculty and so on, but back in the day, I really, I started out as a pretty not great medical student, a pretty anxious intern, and I didn't really even know quite a lot of the time whether I was going to stay in medicine, and I tried out various different internal medicine roles, rotations on clinical services, and I found that I resonated the most with respiratory and sleep medicine, which is how I ended up in there. But probably the main reason that occurred was that I worked for someone both in internal medicine, he also worked in respiratory medicine, who became an informal mentor. He didn't have a contract as such, but we worked very closely together over multiple years, and he fulfilled that role. I was so anxious at times, and uncertain at times, that I really appreciated the fact that my mentor was available. I could go and knock on his office door and ask all of my questions, and he never seemed to show that he was frustrated with me or wanted me to stand on my own two feet. Maybe he did, but he kept it inside. He would sometimes just turn up on the ward at times. I don't know how he knew that I was going to need to run some things past him, but I was struggling with a particular patient or whatever, and he would be there and help out. And really, I think that relationship, it's very clear looking back how much impact that had on my decision to go into this field. It was where I had a mentor who made sense to me and who looked after me at a time when I was trying to figure out who I was and how I was going to practice. So after four years of intermittently working with him, and then two years directly working for him, it was time for me to move hospitals to another organisation to complete my specialty training, and I was pretty, I sort of, I had developed a sense of confidence in this one workplace where I knew how things worked, but I was pretty anxious about starting in a new one. I knew that I needed to become more independent and, for want of a better phrase, grow up a little bit, embrace the role a little bit and develop into a self-reliant practitioner, but I didn't know what I was going to do about this relationship, and I perhaps should have asked. When I left, it wasn't clear what would be okay. Should I get in touch, check in from time to time? All of that was sort of left unsaid, and perhaps it would have been better if it wasn't, because I would frequently wonder, look, I wonder if I should talk about this or talk this over, seek some advice. Soon after I left, my mentor, his mentor, actually died, and I had also worked for that chap, and at that time I was thinking, should I contact my mentor and ask how he's doing? That seems to be a human thing to do, but I didn't really know what the relationship was and if it was appropriate or not, and I felt so uncertain about it. I went to the funeral, but unfortunately my mentor had been kept overseas and he missed the funeral as well. Eventually after a couple of years, I completed my training, I started to find work, and I did get in touch again with my old mentor socially, and he was very happy to get together and catch up and find out about what I had done and what I'd been doing and talk things over about what he'd been doing as well. Now, some years down the track, we have a different relationship, which is intermittent contact. We'll email or be on Twitter or something, or I'll see him at a conference and we'll catch up, and that's really good, but I don't need to rely on him like I did before. Perhaps that's why the relationship was needed at that time, and perhaps it was natural for it to change as I developed into a functioning practitioner in my own right. Just to close the loop, I've now actually returned to that original workplace, and I have an office, which is my old mentor's office, and I can still see where his name was stenciled on the door. They've not put mine up. Anyway. But now trainees come and ask me questions like I used to go and ask him, and so it's a funny world. Thank you. Open it up to anybody for comments, experiences of their own that they'd like to share. Mark, now reflecting on the change that you went through and the separation, if you could go back now, how would you approach it? Thank you. I think the thing that I guess I've heard as the five of us have met and talked about this session really is around sort of mentees driving things, and I feel like we should have had a conversation, and it's probably on both of us. It wasn't a formal relationship, but it was clear that it was a relationship, so I probably should have asked. I think in retrospect, I would have. In retrospect, I think also, you know, I was a grown man who wasn't sure if he should send condolences to a friend and colleague. I probably should have just done those things rather than wondering if it was appropriate. Anything else from you? Oh, yeah. Does there need to be separation? So Cram talks about it as part of the growth of the mentee and that it perhaps doesn't need to be traumatic or whatever, and in fact hopefully it's not. Hopefully both parties approach it prospectively, but it is a necessary step for the mentee to develop their own independent self outside of that relationship. How is that implemented? All I can say to that is a joke. The 15-year fellow syndrome, yes, I hear that. Thoughts or insights? I'm not sure if I have one right off the top of my head. Has anybody stayed at an institution and redefined their role with their mentors over time? Well, I'm a lifer at my institution. I've been there forever. I'm not sure that I think of separation as a transition of relationships. You mentioned it up here, Mark, and you all skated out to your slide. Transitioning from more of a junior. I think of that as different from separation. Yeah, and maybe, I mean, that's Cram's terminology. Maybe it is too harsh sounding a word for what doesn't, as I said, doesn't have to be necessarily unpleasant or a termination. I think what we're about to hear is, you know, about that redefinition of junior, senior, and so on. Yeah. Yeah. You want to move on? Yeah. Todd, you want? Separation is necessary, but I don't think it means that you no longer have a mentor. Sure. You know, I have lots of career and have been mentors for people. But I hope in many aspects of my professional career, I still have mentors. And it's not the same one that got me through fellowship and got me, I do a lot of research, not gotten me to get my research career. But, you know, as I take over as director of the ICU or as I do administratives. And then the second thing I'd say is that I experienced So I think that's, you know, a huge thing. And I think, to your point, speaking as somebody still earlier in their career, I think it doesn't have to be, as everybody's saying, doesn't have to be traumatic, but it's a two-way street, and if you have a mentor who has your interests at heart, at some point, both of you will realize that your needs are no longer necessarily being met, and if you find another mentor, usually they welcome it, and they help facilitate it, and I've had that happen for me as well, where I outgrew some of the advice that my mentors could provide, and they referred me on to somebody else who had experience in what I was looking for. And so I think that's a way of transitioning rather than separating, but it is a separation of sorts. Yeah. Thanks so much for that great conversation. I think, let's talk a little bit about redefinition, because I think this conversation is naturally migrating in that direction. So Cram defines redefinition as the phase in the mentor relationship that is primarily characterized by friendship. So as time goes on, the mentor and the mentee will often interact less frequently, but will still interact with regards to episodes or opportunities for sponsorship, sharing and advice, even coaching at times. This phase of the relationship is marked by the mentee gaining more experience and independence, and the ability to subsequently achieve different goals, and with that, the relationship, again, changes, because the mentor looks for opportunities to assist that are perhaps different from the way they interacted with mentee in the past, and enjoys the rewards of their efforts in terms of watching their mentee's accomplishments. And the mentee who is functioning much more as an independent manager approaches the relationship on much more equal footing, and can reflect back on the benefits of that relationship, and what they've enjoyed from that benefits with gratitude. So I'm very proud to have the opportunity to introduce my longest-term mentor, sitting next to me, Dr. Lisa Moores. So Lisa was my fellow when I was an intern in the ICU, and at the end of the month, she said, you know, you should be a pulmonologist. And I wasn't a really very reflective intern, so I said, sure, okay. And so I did a research project, and I was really excited the following year that I got my research project picked up as an oral presentation at ATS in San Francisco. And I arrived, and immediately became absolutely horrified, because I realized that my co-authors, which is not Lisa, and pretty much every other member of my division was planning to leave before my talk. So that was exciting. So Lisa changed her ticket, came to my session, sat in the front row, and bought me dinner that night. And after that, I was pretty much all in. So the Army's a pretty small place, and we were both active duty at one time, and so Lisa continued to serve as my mentor for pretty much the rest of my Army career, 21 years. And she was always available there to give me advice. She sponsored my start in chess, along with many other things. And she took the time to nominate me for awards, and all the good things that a mentor does. It was towards the end of my Army career that an opportunity came up to potentially work in Lisa's office, a job opened up. And that was a really tempting opportunity, but I didn't apply for it, because it was the wrong fit for my family at the time, and that was really hard. I think Lisa helped me in that situation, because I explained it to her, and she told me that I was making that decision for the right reasons. And I knew that she would make the same decision using the same values, and that made a difficult conversation a little bit easier. So I retired from the Army, and I went to Mayo Clinic. And I always tell people that mid-career transitions are not for the faint of heart. So over the course of the next couple years, I had a fair amount of opportunities to reflect about my evolution, both personally and professionally, as I settled my family into a new location, dealt with a mother with ailing health, and reestablished myself personally and professionally in a brand new big medical system. But I'd finally found my feet, and was feeling pretty good about where I was. And Chess that year was in San Antonio, and I found myself sitting next to Lisa on a bus going to dinner. And so I was excited to tell her sort of everything that had happened, and we started to talk, and she told me that she was getting ready to leave the military herself, and I'll let her tell you the details of that. And started talking about some of the challenges that she was facing, and the problems associated with that transition. And it took me back a little bit, because it was the first time that I think I'd really sat down and talked to her about a problem where she didn't seem to have the answer. So I sort of settled in, and sort of focused my active listening skills. And a couple of minutes later, I had to smile a little bit inside, because I realized that those skills that I was using were skills that she taught me, and modeled so often. And so it was really fun to pay that back. I knew I was gonna have trouble following that story. I'll do my best to keep my composure here. As Alex said, we were both at one time active duty army. I spent most of my career, I've had over 30 years in the healthcare front lines, if you wanna put it that way. I think my professional identity was sort of an intricate weaving of a white coat, and the uniform. And that was how I saw myself. And my journey kind of took me from the front lines of patient care, to really more the corridors of medical education as it evolved. And about halfway through this 30 year career, I was fortunate enough to apply for and be selected to be an assistant dean in the office for student affairs at the military medical school. So I was gonna be in charge of the students within their clerkship phase of their curriculum. And that was exciting, and terrifying. Because once I got the job, I realized I was gonna be in an office in the medical school. And I wasn't gonna be in the hospital, and I wasn't gonna be with the students, and the interns and residents and the fellows. And boy, talk about a professional identity formation sort of crisis. And I would get up in the morning and look in the mirror and say, well, you play a doctor on TV now. So you've heard the imposter syndrome, it came rushing right back. But as I settled into the job, and I started working with students, I realized that really they were now my patients, if you wanna put it that way. And my role had evolved into nurturing them and helping them in their initial development of their identity and their specialty choice. And to help struggling students through when they were hitting bumps that all of us hit in medical school. And I just relished those one-on-one relationships. And it was easy to get up in the morning, and I just kept saying, I can't believe they pay me to do this job. So time went on, and I hit 30 years. And in the military, unless you become what we call flag rank, so that would be a general officer in the army, an admiral in the Navy. And if you don't hit that rank, then at 30 years, you must retire. And I had made a decision early on, I did not want that rank, because that would have meant not being an educator, it would have meant being a commander. And I didn't wanna do that. So I knew, and in fact, I got an email from our human resources, Colonel Moores, you will retire on this date. I said, yeah. But I went kicking and screaming, because I was now, at that point, the dean of students. But the dean insisted that that had to be an active duty person. So I had to give up that role. And I just thought, wow, here we go again. I see myself as a physician, an educator, a mentor, an officer. And I was looking at giving all of those up at once and starting this identity formation all over again. It was a gut punch. And so as Alex said, I was sitting next to him on the bus. And at the time that I was really contemplating, the school had offered me another position, the one that I actually am now. But at the time, I thought, I don't want to stay to stay. I love the institution, I graduated from it. But I needed to have a purpose, and I wanted to be able to contribute. And I wasn't sure I could do that. And I was working through all that. And I didn't hesitate to lean on Alex. Our relationship, I feel, was built on mutual growth, mutual support. As Alex said, and many of other panelists said, my goal as a mentor was to see Alex exceed all of his personal goals, and to see him grow into his own place of professional happiness, I guess is the term I would use, become an expert in his own right. And he had done that years ago. So it was my turn, I got to be the mentee. And Alex was a good person for me at that point because he understood, he knew what it meant to take off the uniform. And it's not an easy thing to do. And then to also transition your career. But then Alex also knew me. He knew my strengths. He knew opportunities for improvement. He knew my values. And he was able to give me a fresh perspective, a glimmer of hope that maybe this other position was a good fit for me. But his empathy at that time really helped with my uncertainty. So for me, the journey certainly had come full circle. And it made me think that what was so neat about our relationship really wasn't just his professional growth, which I was very proud of, but just that whole redefinition and seeing things come full circle. And I haven't hesitated to lean on Alex even since that time. Thoughts, comments, other stories from the group? I wanted to share something, and I certainly am not trying to elevate myself. But one of the most impactful moments in my life, I had just finished giving a talk at the ATS meeting. And one of the people in the audience walked up to me and said, do you remember me? So I said, yeah, vaguely. And he said, I was your student. So we started talking, and then I started remembering more and more about him. And then I said, what are you doing now? And he was a public medical care medicine fellow at a major university. I said, wait a minute, what are you doing, going to do HEMAR? And he said, you know that month I spent with you? I changed my life. I really had goosebumps. So it doesn't need to be a formal relationship sometimes, just a very role model for your students, and trainees can make tremendous difference in their lives. I've often heard people say that people select specialties based on the people that they interact in those specialties as much if not more than the subject matter itself. I think that's very true. Have you ever changed your mentoring since you approached me in and out of the health center? I don't think so. I think the context is a little bit different, and we have to provide a little bit more background to each other now than when we were working in the same system. I don't know, would you say the same or not? No, I agree. I think as I mentor other folks, whether they're in or out of uniform, we have MD, PhD students that aren't always in uniform. So helping them navigate their career looks very different if you're in uniform than if you're not. So I think understanding that is really helpful. So I guess to Alex's point, I don't know Mayo, and he would have to give me that background so that I could help in that instance. Well, this has been a wonderful conversation, but I also recognize that we're at time. I guess I'll just leave this last chapter with just a few key points. I think as I get a little bit older and start moving to the point where some of my mentor-mentee relationships are being redefined, I recognize that as a mentor, it's up to me to potential signal some of the transition of that role by expressing some of my own vulnerabilities and sharing things with myself with my former mentees. And again, I think that there's still lots to be gained as that relationship evolves in terms of mutual support and personal and professional growth. I will say we ran through an awful lot of background literature preparing for this session. If anybody has an interest, we've sort of curated a short list of articles that you can access on the QR Dropbox link. And if you're interested in learning more about this, and we also have the slides with the take-home bullets from each of our stories. And thank you very much for joining us and really enjoyed the conversation. Thank you.

mentorship

mentor-mentee relationship

clear communication

expectations

contribution

self-reflection

adjustment

evolution

redefinition

benefits