의사를 위한 멘토링 프로그램(Mentoring Programs for Physicians in Academic Medicine)

(출처 : http://www.massgeneral.org/education/internship.aspx?id=38)

“My mentor has been a great role model for a career in research as a physician-scientist. The match process worked so well for me that I selected her to serve on my PhD thesis committee. I greatly appreciate the URM mentorship program’s guidance and networking opportunities, which have contributed to my success as a medical student.”—José Alemán, HMS Class of 2009

멘토쉽은 의학(의료)전문가를 양성하는데 있어서 매우 중요하다.

Mentorship is a key component of professional development in the field of academic medicine

비공식적(informal)멘토링이 있고, 공식적(formal) 멘토링이 있다.

Informal mentoring occurs spontaneously, as mentors and mentees form a successful relationship built on shared interests and interpersonal chemistry.1 Formal mentoring develops around a systematic infrastructure that aims to replicate the effect of informal mentoring.1

멘토링을 활용하는 정도는 사람마다, 기관마다 차이가 있어서 19%와 84%까지로 다양하다. 1966년부터 2002년까지의 연구를 분석한 리뷰 논문에서 의과대학생과 의사들을 위한 멘토링 프로그램은 수련 기간이 종료되고부터는 점차 줄어든다고 보고된 바 있다.

The prevalence of mentoring in academic medicine varies: Between 19% and 84% of clinical faculty members reported currently working with a mentor in a recent review.2 A review of the literature from 1966 through 2002 that describes mentoring programs for medical students and doctors suggests that mentoring becomes less common once formal training is complete.3

이 논문의 목적은 (1)지난 리뷰논문 이후로 발표된 논문을 찾고 (2)그 논문들에서 다룬 멘토링 프로그램의 목적과 핵심 요소들을 정리하고 (3)각 모델과 요소에 따른 장점을 요약하고자 하는 것이다.

Specifically, our aims were (1) to identify articles published since the last review on this topic (i.e., articles published between 2000 and 2010) that describe models for mentoring programs for physicians in practice, (2) to describe the objectives and core components of these programs, and (3) to summarize the relative benefits of each model and their elements

Mentoring models

일곱가지 멘토링 모델이 있다.

Dyad : 1대1. 가장 전통적인 형식

Peer : 동료. 비슷한 나이, 경험, 등수(rank)의 멘토.

Facilitated Peer : 시니어 멘토에 의해서 관리되는 Peer cohort

Speed : 멘토와 멘티가 멘토링 관계를 맺기에 앞서서 10분간의 짧은 시간동안 하는 것

Functional : 특정 프로젝트에 대한 멘토링

Group : 그룹

Distance mentoring : 원거리

Seven mentoring models were described in the reviewed articles: dyad, peer, facilitated peer, speed, functional, group, and distance mentoring. The traditional dyad, pairing a mentee with a more senior or more experienced mentor, was most common and was the only model in place for nine programs.5–7,9,10,17,18

Dyad 모델의 변형으로 functional mentoring과 speed mentoring이 있다.

Variations of the dyad model, functional mentoring and speed mentoring, were also described. 

The functional mentor was paired with a mentee to provide guidance for a specific project.15

Speed mentoring was a one-time event with mentees and mentors paired for 10-minute periodsto initiate mentoring relationships.14

피어 멘토링 모델만을 사용한 논문도 있다. 이 중 한 연구에 참여했던 멘티들은 Top-down형식의 멘토링이 아니어서 좋았다고 응답했으며, 다른 연구에서는 피어 멘토링에는 투자해야 할 것은 시간과 헌신적인 자세 뿐이라는 사실에 만족해했다.

Two articles described the use of only the peer mentor model, through which groups of individuals similar in age, experience, and rank mentor one another.11,19 Mentees in one of these studies favored that program development did not occur in a topdown fashion.19 The other group felt that peer mentoring is especially beneficial in areas with fewer resources because peer support requires nothing more than time and commitment.11

로컬 멘토가 부족한 점을 다른 기관의 시니어 멘토와의 협조를 통해서, 즉 피어 멘토링과 원거리 멘토링을 활용하여 극복한 사례도 있다. 또 다른 연구에서는 일대일, 피어, 원거리 멘토링을 혼합한 방법을 사용하기도 한다.

One program overcame the scarcity of local mentors by collaborating with a senior mentor at another institution, a combination of peer and distance mentoring.16 Another employed dyadic, peer, and distance mentoring with the mentees supported by a peer mentor (i.e., a colleague close in academic rank to the mentee), a local mentor (i.e., a medical faculty mentor from the same institution as the mentee), and a distance mentor (i.e., a mentor from outside the mentee’s institution).12

Program objectives

멘토링 프로그램의 목적은 다양했는데, 특정한 목적에 따라 디자인 된 것도 있었고, 좀 더 종합적인 목적에 따라 디자인 된 것도 있었다. 가장 흔한 목적은 다음과 같다.

(1) 전문성과 직업 개발 professional or career development,5,7–9,11,12,16,17 

(2) 학문적 영역 academic success,6,8,10,13 

(3) 네트워킹 networking,6,7,10,14,16,19,20 and 

(4) 교수 잡아두기 faculty retention.10,12

Program objectives varied widely. Some programs were designed to meet specific needs, and others were designed to be more comprehensive. The most common global objectives of mentoring programs were (1) professional or career development,5,7–9,11,12,16,17 (2) academic success,6,8,10,13 (3) networking,6,7,10,14,16,19,20 and (4) faculty retention.10,12

Program components

이 리뷰는 성공적인 공식적 멘토링 프로그램의 요소들을 밝히기 위해서 수행되었다.

We undertook this review to determine the components that build successful, formal mentoring programs. The term “formal” in this context indicates that the articles described a recognized infrastructure for mentoring

일곱 개의 핵심 요소들은 아래와 같다.

Although the 16 articles varied in the degree to which they described systematic components, we identified seven key components across multiple programs as detailed below.

Mentor preparation. 

준비된 멘토

As an element of organizational readiness, several programs addressed mentor preparation.5,9,10,12,18 Llewellen-Williams and colleagues12 developed a Mentor Readiness Inventory and found that mentors desired both retraining to enhance their teaching skills and instruction on, specifically, how to mentor.

Planning committee. 

멘토링 설계 위원회

Several programs were overseen by a team or committee.10,15,17,18 Committee members included faculty15,17 and “senior department managers.”17 Committee responsibilities included pairing mentees and mentors,15,18 program oversight and design,17 program monitoring and intervention as needed,15 evaluation and data interpretation,17 and assurance of program effectiveness.17

Contracts. 

계약 및 계약서

Several programs drew on written mission statements or contracts.5–7,10,11,13,16

Pairing mentors and mentees.

멘토와 멘티 짝짓기

Of the 10 programs with paired mentee–mentor dyads, 4 allowed mentees to choose their mentors,6,9,10,17 rather than the more traditional pairing of mentors and mentees by an external party. Most mentees chose mentors within their own academic section or department.17

Mentoring activities.

멘토링 활동

A minority of reviewed programs were structured around a single activity, such as speed mentoring14 or group mentoring sessions during a national professional conference.20

정기적인 미팅이 가장 흔한 형태의 멘토링 활동이었다.

Regular meetings between mentors and mentees or among peer mentors were the most common mentoring activity.

Formal curricula for mentees.

멘티를 위한 공식적 커리큘럼

A formal training element for mentees was described as part of three programs.11,13,15 Curricula topics included career development,11,15 research,11,13,15 teaching,11,15 and clinical practice.15

Program funding and participant compensation.

참여에 대한 보상

The funding for mentoring programs came from both external5–10 and internal10–12,19sources.

Evaluation and outcomes

멘토링 결과를 평가한 프로그램을 보면, 대부분은 멘티로부터 자료를 수집했으며, 일부는 멘토에게 자료를 수집했다. 데이터 수집은 수로 설문조사로 이루어졌고 면접이나 포커스 그룹 인터뷰 등도 사용되었다.

Of the programs that evaluated results, most gathered data from mentees6–8,13–19; fewer also collected data from mentors.6,10,14,15,17,18,20 Data collection was predominantly by survey,7,8,10,13–18,20 though program leaders also used participant interviews6,8 and focus groups6,18,19 as means of collecting data

Barriers to program development

멘토링의 장애물에 대해서 언급한 논문의 저자들은 거의 없었다. 정해진 시간이 없는 멘토링 프로그램에서는 대부분의 멘티들이 멘토의 시간 여유 부족을 가장 큰 문제로 꼽았다. 정해진 시간이 없는 것은 프로그램 구성이나 멘토 모집에 장애물로 작용한다.

The authors of the articles we reviewed seldom mentioned barriers to developing mentoring programs. In a mentoring program with no protected time, most mentees felt that mentors’ lack of time was detrimental to the program.18 Lack of protected time was also identified as a barrier both to program organization6 and to mentor recruitment.20

Integration with previous research

Buddeberg-Fischer와 Herta의 리뷰에서는 학생 뿐만 아니라 의사를 대상으로 한 멘토링도 포함되어 있다. 의사에 대한 멘토링은 교수개발로부터 출발하였다. 우리가 밝힌 것은, 일부 멘토링 프로그램이 여전히 교수개발 프로그램에 속한 형태로 남아있긴 하지만, 지금은 독립적인 형태의 멘토링 프로그램을 지원하는 경우가 많다.

Buddeberg-Fischer and Herta’s3 review of the mentoring literature between 1966 and 2002 included programs for physicians—both in practice and in training—as well as medical students. They found that mentoring for physicians emerged from faculty development programs; our review revealed that, although some mentoring programs remain embedded in faculty development programs, institutions now support and implement independent mentoring programs as such

우리의 리뷰에 따르면 일대일 멘토링이 남아있고, 가장 흔히 사용된다. 전통적인 일대일 멘토링에서 멘티가 멘토를 고를수 있게 하는 것은 상당히 좋은데, 이같은 "윗사람 관리(managing up)"는 멘티를 더 주도적으로 만들어서 멘토링이 좀 더 성공적으로 이루어질 수 있게 한다.

In our review the dyad mentoring relationship remains, as it was in the last 35 years of the 20th century, the most frequently described model. Allowing mentees to choose mentors in the traditional dyad model is highly valued.15,21 In the business world, this practice of “managing up” has encouraged mentees to take control of the mentoring relationship which helps ensure mentee success.21

이 리뷰에 따르면 멘토는 멘토로서 역할을 훈련받게 된다. 지난 리뷰에는 이러한 훈련 프로그램이 거의 없었다. 하지만 지난 리뷰나, 이 리뷰의 한계점은 대부분 연구들이 기술적(descriptive)이고, 지역적(local)이며, 주관적(subjective)이고, 입증이 어렵고(unvalidated), 그리고 표준화된 평가 형식이 없다는 것이다. 이러한 문제로 인해서 개개의 프로그램에 따른 멘토링 프로그램의 성과를 평가하기가 어렵다.

Our review indicates that mentors are now trained to perform their role in some programs; such training was completely absent according to the last review. A weakness noted previously2,3 and persisting through the articles we reviewed is that reported results remain mostly descriptive, local, subjective, unvalidated, and without standardized evaluative metrics, such that no conclusions can be made regarding the effect of individual program components on mentoring outcomes.

Implications for medical practice

멘토의 수가 제한적인 상황에서는 전통적인 일대일 방식보다는 peer 또는 facilitated 모델이 효과적일 수 있다. 멘토링 프로그램에 대한 적절한 지원은 성공을 위해 필수적이며, 시간적으로 제한되거나 정해진 시간이 없는 상황은 멘토링 프로그램에 장애물로 작용한다. 멘토링 프로그램을 위한 정해진 시간이 있는 프로그램에 참여했을 때, 그 참가자들은 기관(조직)이 멘토링을 제대로 하고 있다고 받아들인다. 또한 계약서를 작성하는 것은 멘토링 관계를 좀더 확고하게 만들어서 mission statement를 사용하거나 signed agreement를 활용하는 것이 멘토링 관계에 책임감을 높이는데 도움이 된다.

In settings with limited mentors, peer and facilitated models help extend available resources and benefit more mentees than would be possible with the traditional dyad model. Adequate support for the mentoring program is a key ingredient to success because sustaining mentoring activities without support is difficult.10 Limited or unprotected time was often cited as a barrier to program development. Participants with protected time viewed this commitment from their institutions as a sign of acceptance for mentoring.15 Lastly, although other reviews have noted that contracts may make the mentoring relationship inflexible,22 the use of mission statements to set boundaries and of signed agreements to enforce accountability to mentoring relationships may be helpful.5–7,10,11,13,16

Going forward

멘토링 프로그램에서 가장 어려운 것은 평가이다. 대부분은 주관적이고, 특정한 주제에만 집중하고 있으며, 로컬 프로그램에 대해서 단기적 성과만 보고 있다. 기관간 연구를 촉진하고, 연구를 더 일반화 시키기 위해서는 표준화된 기준이 필요하다. 이러한 목적에서 Berk 등은 멘토링 관계를 평가하기 위한 설문지를 만들었다.

Program evaluation for the most part, however, remains largely subjective or focused on specific, local program aims and short-term results. Standardized metrics would facilitate cross-institution research and enhance generalizability. To this end, Berk and colleagues25 developed two questionnaires to comprehensively assess the mentoring relationship by evaluating behavioral characteristics of the mentor as well as the characteristics and outcomes of the mentoring relationship

또한 멘토링이 장기적으로 영향을 미친다는 점을 고려하면, 장기적 성과를 조사하고 보고하는 시스템이 필요하다.

Additionally, given the likely longitudinal effects of mentoring on individuals’ careers, examining and reporting longterm outcomes is essential.

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Acad Med. 2013 Jul;88(7):1029-37. doi: 10.1097/ACM.0b013e318294f368.

Mentoring programs for physicians in academic medicine: a systematic review.

Kashiwagi DT, Varkey P, Cook DA.

Source

Dr. Kashiwagi is assistant professor of medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Varkey is professor of medicine and preventive medicine, College ofMedicine, and associate chair, Department of Medicine, Mayo Clinic, Rochester, Minnesota. Dr. Cook is professor of medicine and medical education and director, Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota.

Abstract

PURPOSE:

Mentoring is vital to professional development in the field of medicine, influencing career choice and faculty retention; thus, the authors reviewed mentoring programs for physicians and aimed to identify key components that contribute to these programs' success.

METHOD:

The authors searched the MEDLINE, EMBASE, and Scopus databases for articles from January 2000 through May 2011 that describedmentoring programs for practicing physicians. The authors reviewed 16 articles, describing 18 programs, extracting program objectives, components, and outcomes. They synthesized findings to determine key elements of successful programs.

RESULTS:

All of the programs described in the articles focused on academic physicians. The authors identified seven mentoring models: dyad, peer, facilitated peer, speed, functional, group, and distance. The dyad model was most common. The authors identified seven potential components of a formal mentoring program: mentor preparation, planning committees, mentor-mentee contracts, mentor-mentee pairing, mentoring activities, formal curricula, and program funding. Of these, the formation of mentor-mentee pairs received the most attention in published reports. Mentees favored choosing their own mentors; mentors and mentees alike valued protected time. One barrier to program development was limited resources. Written agreements were important to set limits and encourage accountability to the mentoring relationship. Program evaluation was primarily subjective, using locally developed surveys. No programs reported long-term results.

CONCLUSIONS:

The authors identified key program elements that could contribute to successful physician mentoring. Future research might further clarify the use of these elements and employ standardized evaluation methods to determine the long-term effects of mentoring.