Resident – Faculty Advisor & Mentorship Systems

1. Resident – Faculty Advisor & Mentorship Systems Brian V. Reamy, MD Colonel(ret),USAF,MC Associate Dean for Faculty Professor of Family Medicine Uniformed Services University

2. Introduction/Objectives • Identify the different types of resident – faculty advisor & mentorship systems • Explain the key developmental tasks of residents in training • Identify positive and negative qualities in faculty advisors • Describe the features of an “optimum” resident-faculty advisor system

3. Historical Context - 1982 • Borus & Groves: “Training Supervision as a Separate Faculty Role” Am J Psychiatry 1982;139(10):1339-42.

4. Historical Context • “Training supervision is a longitudinal, nonclinically focused personal relationship between a faculty member and a resident for exploring the latter’s professional development. They … meet monthly over the 3-year residency.” • “The training supervisor’s role is that of a non-evaluative senior colleague who orients and advises the resident and systematically reviews training progress and problems”

5. Who has a resident-faculty advisor system? - How is it structured? Who assigns residents? Who makes changes when problems emerge? Is it based on advising and evaluation or just advising?

6. Types of Advisor Systems • Based on Clinical Care Teams • Self-selection • Proportional to faculty numbers • Random assignment • Assigned by PG year group • One faculty for each PG year group • Stay with year group thru residency program • Stay with their specific PG year group

7. Types: Clinical Care Teams • Most common system • Example: 3 year PEDS Residency • 6-6-6 resident structure • 6 faculty + 1 PD + 1 Dept Chair • Faculty physician + PG-3 + PG-2 + PG-1= care team • They cover each others patients during TDY’s/LV • This is also the academic advisor group

8. Types: Self-Selection • Residents are told to select their advisor within 3 months of arrival • Can not select the PD • Rare in M.D. training • Common in Ph.D. programs

9. Types: Proportional • If you have 24 residents and 8 faculty then each faculty member will get 3 advisees • Random/lottery or, • Each faculty takes one resident from each PGY or, • Assigned by PD based on research or clinical interests, gender, request etc.

10. Types: Assigned to PG year groups • Example: 3 year Internal Medicine Program • 8-8-8 resident complement; 16 faculty • One faculty (LTC Bezoar) has ALL PGY-1 • One has ALL PGY-2…one has all PGY-3 • 2 variations: • LTC Bezoar stays with his year group x 3 years or, • LTC Bezoar is always the PG-1 faculty advisor

11. Advantages/Disadvantages

12. Key Issues w/each system • Who does OER’s/OPR’s/FitReps? • Evaluation sabotages advising & mentoring!! It must exist – but, separate from the advisor system. Many cites: Davis OC, Nakamura J. A proposed model for an optimal mentoring environment for medical residents: a literature review. Acad Med. 2010;85:1060-1066 Sambunjak D et al. What makes a good mentor-mentee relationship? JCOM. 2010;17:152-154 • Distributing Faculty workload • Who manages change requests? • Chief resident? Prog Dir?

13. Key Issues • Who gives out discipline? • Should not be the advisor • Advisor should always wear a “white hat” • The Prog Director or Dept Chair should wear the “black hat”

14. Key Developmental Tasks of Residents in Training • Martin & O’Donnell. Resident Developmental Issues. Fam Med 1999;31:614-615. • 10 Common Developmental Issues for Faculty advisors to facilitate

15. 10 Developmental Issues

16. Advisor/Mentor Qualities • We have all experienced good & bad faculty advisors and mentors? • You can get better at this! • Many of the skills are those that serve you well in your clinical work with patients. • Reference: Sambunjak D et al. A Systematic Review of Qualitative Research on the Meaning and Characteristics of Mentoring in Academic Medicine. J Gen Intern Med. 2009;25:72-78.

17. Positive Qualities in a Faculty Advisor

18. Positive Qualities in a Faculty Advisor

19. Negative Qualities

20. Optimum System • Six core interactional foundations • Emotional safety • Responsiveness • Support • Protégé-centeredness • Respect • Informality

21. How would an optimum system appear? • Evaluation is NOT confused with advising & mentoring • Advisors who embrace the positive qualities • Equal distribution of faculty workload • Resident buy-in • Structure • Fits w/ your institution & training environment • Thoughtfully selected

22. Optimum System • Meeting Frequency & Guidelines • Informal “chats”: at least monthly • Formal faculty:advisee meetings every 3-4 mths • Need pre-planning ( initial vs. follow-up mtgs.) • Advisors need to get FULL faculty input • Avoid gossip sessions • Faculty need to keep records

23. Records • Without records a faculty forgets or confuses • Confusion sabotages the faculty-advisee relationship • Focus of the records is fourfold: • Includes review of rotations & areas of concern • Includes faculty expectations & resident goals • Includes a Resident summative self-assessment • Ends with an Educational Rx

24. ADVISEMENT RECORD EXAMPLE Name: Date: RESIDENT ADVISEMENT ROTATIONS: (1) (2) (3) (4) AREAS OF CONSIDERATION Comments regarding above topics:

25. FACULTY EXPECTATIONS RESIDENT GOALS ____________ RESIDENT SELF-EVALUATION: Educational Rx: Advisor & Resident Signatures

26. Potential Quicksand • Social • Friendship • Being a Clinician for advisee • Acting as a disciplinarian • Not involving the PD • Not proactively making time for meetings

27. Take Home Points • 5 primary structures of faculty-resident advisor systems exist and you should thoughtfully select one. • Evaluation sabotages advising & mentoring!! It must exist – but, separate from the advisor system. • All residents work through 10 major developmental tasks at their own individual pace. • There are advisor qualities to emulate and those to avoid. You can improve your skills as an advisor. • An optimum system can be designed and put in place

28. Thanks & Questions