Dr Hiten Patel is a specialist registrar in cardiology at the Kent, Surrey and Sussex deanery. He and Professor Nikhil Patel explain the creation of a mentoring scheme they have created for trainees at their hospital.
Mentorship is a popular tool used in major organisations outside of medicine, in which an individual has an appointed mentor to help guide them through any potential problems faced in day-to-day work. A mentor can also provide guidance on career development, as well as serving as an empathic voice of reason.
Although this type of programme is popular in the corporate environment, individualised mentorship programmes are not routinely available for trainees in the NHS. Such schemes are now needed more than ever given the current pressures of working in the health system. Patient load is increasing and the complexity of presentation is increasing. As a result the workload put on our current trainees is resulting in higher rates of burnout and attrition.
Figures released by the BMA found that only 50.5% of trainees were thinking of progressing from foundation training to core training in 2016, down from 70.4% in 2011. There were also issues with regards to specialty recruitment. Overall, there was found to be a 6% reduction in fill rates for specialty training. Nearly three-quarters of all medical specialties faced under-recruitment for 2016. Current attrition rates experienced by some acute specialties have reached worrying levels, not just for the short-term issues in staffing rotas and wards, but also for the future specialist consultant workforce.
Some aspects of mentorship are already covered by the provision of an educational and clinical supervisor, mostly at consultant level. Although this has the proven benefit of having a senior ‘mentor’ to help ensure educational needs and professional development are met, many trainees find it difficult to approach a senior consultant for help with day-to-day problems and help with preparation for ongoing exams and interviews. Cowan and Flint have suggested: ‘[The mentors’] role bridges the gap between the trainee and educational supervisor.’ This is where registrar mentorship can come into play. Providing a registrar or a sub-consultant mentor can potentially remove the hierarchical barriers to seeing a mentor, as well as providing a friendly, more in-touch voice of reason, particularly for the simpler day-today questions a trainee or mentee might have.
The MENTOR-US programme
This programme was named after the Greek mythological character Mentor, from whom the word is derived. Mentor was a teacher, coach, and counsellor. Our programme, based at Eastbourne District General Hospital, was set up after conducting surveys on trainee wellbeing, morale and the level of support given for career development. We also wanted to see if there was an impact on retaining trainees and encouraging them to progress onto specialty training, thereby reducing attrition rates. All aspects generally received low scores.
Only 40% of our trainees were intending on progressing onto specialty training. With this information, we devised a personal programme, pairing one mentor with one mentee, rather than designing a generic, impersonal mentorship programme involving a group of mentees being with a mentor. The more individualised approach allows the mentor to be more available on an ad hoc basis to one individual, but also allows better development of the mentor/mentee relationship. We were fortunate, as all of our registrars that were approached were very willing to be mentors.
The programme involved the pairing of a core medical trainee with a medical registrar in a specialty of their interest. The aim was to provide clinical support for trainees, especially for those undergoing specialty interviews. Mentors were able to provide assistance and guidance for portfolio development, interview preparation and answer queries, eg on-call advice, clinical advice etc.
Mentors were initially encouraged to meet with their mentees on a fortnightly basis, in order to provide general clinical support over a 4–6 month period from the start of their rotations, leading up to specialty interviews. Mentors would assist in portfolio development, quality improvement projects, as well as providing interview practice.
The results of a follow-up survey showed a significant uplift in trainee morale and a considerable improvement in the amount of trainees feeling supported and listened to. 100% of our trainees reported excellent rates of satisfaction with the programme, and feedback stated it was well-received and provided focus and direction when it came to applying to higher specialties. All trainees mentioned improved confidence levels when it came to applying for higher specialty training. We also noted that 100% of our eligible trainees are intending to apply for specialty training, an improvement from 40%. We also noted our rota gaps were always covered by trainees volunteering to cover shifts; perhaps attributable to the indirect effects of improved morale.
The programme also resulted in benefits for the mentors who participated, who reported increased satisfaction in helping a junior colleague, as well as having a better platform for developing inter-professional relationships. This in turn improved the team dynamics in the more challenging aspects of the job, eg on-call shifts.
I believe there is a place for mentorship in addition to the traditional educational/clinical supervisor role to bridge the gap between the trainee and the educational supervisor role. This is a simple but very effective concept that can be easily replicated across specialties as well as different level of trainees.
With thanks to Dr Muram El-Nayir and Dr Ahmed Chilmeran for their assistance in this article.