The Unwritten Rules of Mentorship: Facilitators of and Barriers to Effective Mentorship in Pediatric Hospital Medicine

Demographic Characteristics and Mentorship Experiences

Participants were nearly equally distributed between male and female genders, with a wide range of ages and years of medical experience (Table 2). All participants worked full-time, holding formal leadership positions in multiple fields, including hospital administration, community medicine, medical education, quality improvement, and research. All participants endorsed currently having mentors, with a median of 3 mentors (interquartile range [IQR] 3–4), and most reported receiving mentorship in multiple areas, including leadership, academics/research, education, networking, navigation of hospital politics, quality improvement, and/or work-life balance. All participants also reported currently acting as a mentor to others, with a median of 6 mentees (IQR 5–9). Almost all participants (n = 15, 94%) stated that mentorship had contributed to their career success.

Emergent Themes

A total of 124 excerpts from interviews were coded and grouped into themes based on recurring content. These themes were then grouped into 3 categories: (1) facilitators of effective mentorship for mentors, (2) facilitators of effective mentorship for mentees, and (3) common barriers to effective mentorship. Table 3 illustrates these categories, themes, and representative quotations.

Facilitators of Effective Mentorship for Mentors

Three themes emerged regarding how mentors can optimize mentorship: (1) comprehensive focus on the mentee, (2) setting of clear expectations, and (3) acknowledgment of mentors’ limitations.

Participants reported that successful mentorship relationships maintain a comprehensive focus on the mentee (theme 1), stating that mentors must strive to get to know the mentee well on both a personal and professional level. One hospitalist described this by stating, “I think that when you mentor someone, you mentor that whole person.” Participants also stressed that mentors must strive to fully understand the mentees’ goals and needs, with 1 hospitalist describing a need to “… really understand that everybody’s coming from a different perspective and everybody has different goals of what they want.” Expanding on this, participants reported that mentors must avoid pushing their own agenda to keep the mentee the central focus of the relationship. One hospitalist described this by stating, “You want to have respect for someone…the mentor should not be trying to recreate themselves.” Some interviewed participants stressed the importance of this theme to the point of suggesting that a mentor’s dedication to the mentee should reach altruistic levels. They expressed that mentors must find a way to “be invested in the mentee as a person,” to “be supportive” and “available,” despite potential time limitations, differing interests, or other challenges.

Many participants stressed the importance of setting clear expectations (theme 2), preferably at the beginning of the mentorship relationship, for it to be successful. They reported that mentors and mentees often have very divergent expectations, and only if expectations are made transparent and “some parameters” clearly defined, can the relationship be better tailored to each individual’s style and made more effective. One hospitalist stressed this by stating, “I think setting expectations at the beginning is vitally important…not just the overall goal, but…specifics.”

Acknowledgment of mentors’ limitations (theme 3) was also identified by hospitalists as a key contributor to the success of mentorship relationships, recognizing that even the most capable mentor has limitations to his or her fund of knowledge or expertise. Multiple hospitalists suggested that to be an excellent mentor, you must “put egos aside,” acknowledge when “you’re out of your realm,” and know when to direct mentees toward another individual who may be better able advise them. One expressed this by stating, “I am not a mentor in research...if I’m someone’s primary mentor, one of the things I need to mentor them in is finding people who are good mentors in research.”

Facilitators of Effective Mentorship for Mentees

Five themes emerged regarding how mentees can optimize mentorship, with representative verbatim quotations presented in Table 3: (1) preparation, (2) proactivity, (3) continual reevaluation of relationships, (4) willingness to seek mentorship outside of common venues, and (5) building of a mentorship team.

Many participants identified robust preparation (theme 1) on the part of the mentee as a vital determinant of success in mentorship relationships. Many stressed the need for mentees to begin a mentorship relationship only after having thought intensely about their own lives and careers, allowing them to be “as specific as possible” with regard to “what they want to get out of the relationship.” This mindfulness was described as valuable to developing an organized approach from the onset. Participants reported that mentorship relationships were most effective when a mentee could know and share his or her needs, goals, and expectations, and have an agenda. One hospitalist expressed this by stating, “you have to put a lot of work into it…the mentor cannot give you good advice if you cannot really clearly explain what you’re doing and where you’re trying to go,” while another stated that mentees “…need to prepare. Mentorship is not a relationship where you show up and somebody tells you what to do.”

Participants also reported that the mentee’s degree of proactivity (theme 2) was paramount in the establishment and maintenance of effective mentorship relationships. Participants described the benefit of having a mentee who is willing to “take a lead” and “reach out” to the mentor. They reported that this quality not only increases the likelihood of finding mentors, but it also keeps the mentorship relationship current and active. One participant expressed this by stating, “mentorship is something that really depends on the mentee a great deal to seek out.” Another hospitalist expanded on this, stating that it is the mentee’s “…job to reach out to the mentor, because the mentor does have a lot of other things going on.”

Many participants stated that to maintain successful, functional mentorship relationships, continual reevaluation of relationships (theme 3) must occur. A recurring topic throughout many interviews was the fluid nature of mentorship, with many hospitalists reporting that the relationship must evolve and grow along with the individual participants to be successful. Many hospitalists acknowledged that during this evolution, some mentorship relationships lose their utility, and stated this should be recognized so as to appropriately discontinue those relationships, allowing the mentee to “regroup” and “find another mentor” who can contribute to a more functional relationship. One hospitalist described this by stating, “there’ve been people who I’ve needed at certain points in time, and then my utility for that part of the relationship went away as I moved on.” In response to these situations, another participant suggested, “if [the mentees] are not getting what they need, they need to be able to…find someone else to be a mentor.”

All interviewed hospitalists expressed a belief that mentorship is important to career success, with many suggesting that to achieve adequate and effective mentorship, it is helpful for mentees to have a willingness to seek mentorship outside of common venues (theme 4), potentially “beyond [their] institution,” at “national meetings,” or with peers. One hospitalist expressed this by stating, “I don’t think you should limit yourself to just those people in your own department or in your pediatric hospital…you want to be looking for…the type of physician that [you] would like to be ideally.” Some hospitalists expanded on the significance of this theme, stating it’s “really important, especially in our subspecialty (PHM),” as the relative youth of the field may not allow for a great number of senior mentors at any one institution.

Many interviewed hospitalists expressed that the building of a mentorship team (theme 5) could increase the likelihood of achieving effective mentorship, given that “there may not be 1 mentor that fits all [the mentee’s] needs.” They suggested approaching this in a deliberate fashion, acquiring different mentors to address specific needs and interests, effectively forming an individualized mentorship team. One hospitalist expressed this by stating, “you may need to work with more people on specific things, and that’s ok.”

Common Barriers to Effective Mentorship

Although interview questions probed barriers to effective mentorship from both the mentor and mentee perspectives, the same themes arose from both perspectives. Four common barriers to effective mentorship were identified and are represented with verbatim quotations in Table 3: (1) mismatched expectations between mentor and mentee, (2) lack of available mentors in PHM, (3) lack of time/compensation for PHM mentors, and (4) geographic separation between mentor and mentee.

Many participants described a detriment to the mentorship relationship when there are mismatched expectations between mentor and mentee (theme 1). One hospitalist stated, “I can think of times when the relationship was strained, probably because boundaries weren’t clear,” and another expressed, “it’s frustrating for the mentee and the mentor when you can’t even agree on what the issues are.” Some hospitalists offered personality or generational differences as potential sources of recurring difficulty. Shared projects and authorship were also cited as being particularly troublesome to a relationship if expectations were misaligned. One mentor stated, “I’ve had some mentees that really don’t follow through, and that gets frustrating,” and 1 hospitalist stated from the mentee perspective, “…sometimes, you know, you’ll do research, and then your mentor takes the credit.”

Multiple participants expressed that mentorship within pediatric hospital medicine may pose an even greater challenge, given the youth of the field and resultant relative paucity of senior faculty, causing a lack of available mentors in PHM (theme 2). One hospitalist described, “it’s a young field overall, so sometimes…you don’t feel like there’s anybody else to ask these questions of, especially if you’re at a community hospital….” Another participant stated, “I think locally it’s rare to have somebody senior in hospital medicine that has the experience needed to be a mentor.”

Many hospitalists reported that despite mentors’ best intentions to participate in mentorship relationships, lack of time/compensation for PHM mentors (theme 3) interfered with their ability to do so effectively. One hospitalist offered, “there are so many demands for your time, providing clinical service and…supervised education….” Another added, “it’s hard because we usually don’t get compensated for this.”

Seeking mentorship from nontraditional venues was acknowledged as being an important facilitator of mentorship, and some hospitalists provided options of e-mentoring or mentorship across institutional boundaries to accomplish this. However, these hospitalists also recognized that the inherent geographic separation between mentor and mentee (theme 4) in these types of relationships could be challenging. One hospitalist stated, “just not physically being around each other…it’s more difficult to get to know somebody…then it’s really hard to provide mentorship to them at a personal level.”