January 01, 2014
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Mentors positively impact the new ideas and innovations in orthopedics

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We introduce a new column called Pioneers of Orthopedics in this issue of Orthopedics Today. This first chosen Pioneer and all future featured Pioneers have distinguished themselves in the pursuit of new ideas and innovations that have changed the practice of orthopedics. Their innovations come in many areas, including clinical evaluation, surgical techniques, orthopedic implants, basic science research, clinical outcomes research, society leadership, practice management and advances in education.

A common characteristic of all these influential orthopedic surgeons is their role as mentors. The pioneers have legacies that continue beyond their careers. Through their mentorship, they continue to help shape the future of orthopedics.

 

Anthony A. Romeo

I have been blessed with many amazing orthopedic mentors during my training, including but not limited to: Robert E. Burdge, MD, as a medical student at St. Louis University; John J. Brems, MD; John A. Bergfeld, MD; Alan H. Wilde, MD; and Thomas E. Anderson, MD, as a resident at the Cleveland Clinic; and Frederick A. Matsen III, MD, and Douglas T. Harryman II, MD, at the University of Washington. Mentorship also continued after my fellowship training. Many of these leaders will be featured in upcoming Pioneers in Orthopedics columns.

Value of mentorship

Mentorship comes in many forms and places, and everyone has the ability to mentor someone. To be a mentor does not require a formal program of study. In fact, mentorship is often most effective in an informal setting, where knowledge can be shared through open and candid discussion, critical analysis using a Socratic method and compassionate empathy for the “mentee.” Informal settings provide valuable teaching moments where the stress of patient care or operating room activities are dissociated from the opportunity for the mentee to be in the presence of their mentor and reflect on the multifaceted life of a successful orthopedic surgeon.

Ideally, mentors invest in mentees to help shape their futures and provide support and guidance to accomplish personal goals. This requires a whole person approach to every facet of the mentee’s life and goes far beyond just remembering facts and simulating surgical techniques. One challenge for mentors is to constructively and positively affect the development of those mentored without destroying who they are as people. This requires a more intimate understanding of the mentee, which is usually not possible while fulfilling the responsibilities of a normal workday.

While the obvious mentorship role for those involved in teaching programs is for fellows, residents and medical students, this role should be extended to members of the health care team, including nurses, physician assistants, surgical technicians, physical therapists and the primary care physicians. This mentality promotes a team approach to provide patients with the best possible experience.

Understand goals, weaknesses

Mentorship is enhanced by a better understanding of mentees’ strengths, weaknesses and goals. Mentees may not have developed good self-examination skills, so this is the starting point. Learn more about mentees’ abilities and passions, what could be perceived as “gifts” to help them find success and separate from the competition. Conversely, improve mentees’ understanding of weaknesses that interfere with their goals. Help them realize what those goals are and refine them to what is possible. Once goals are more clearly defined, help mentees create plans to achieve their goals while highlighting strengths and improving deficiencies. Mentorship should also include sponsorship at activities that further mentees’ goals and provide accomplishments to measure success.

It is important to remember that when one begins the mentorship process, mentees are often sharing their hopes and dreams. Be positive and focus on what can happen — both the possible and seemingly impossible. Try to find everything “right” with their visions of the future. But also be compassionately critical, trying to align dreams better with what “fits” their gifts and deficiencies.

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When we are confronted by a new idea or concept, we have three levels of response: reactionary, critical and complimentary. When we are not invested, we react quickly and efficiently, even if it is not effective. However, most of us spend most of our time in the critical response mode, thinking about why something is not right or not going to work. It is a step above a reflex and may be filled with truth, but it is too often more about being efficient than effective. It cuts off further thought and discourages mentees from moving forward. The complimentary response pattern first looks at what is possible to make the idea become a reality. Embrace the thought, validate mentees and provide an encouraging path forward. This type of relationship and response is valuable for both mentees and mentors. Both learn and are more likely to contribute to the growing body of knowledge.

Practical example

There is a growing concern that orthopedic residents are not prepared for fellowship or the practice of orthopedics after residency. Many potential causes have been proposed, but one that receives little attention is the deficiency of mentorship. In the past, senior-level residents frequently were the mentors for the junior-level residents. They worked together in the same hospitals, clinics and operating rooms. However, with changes in health care delivery and the perceived need to expand the breadth of residency education, as well as the limitations in the hours allowed to work per week, residents are often not paired up with effective mentors.

A second-year resident who is working with a subspecialized orthopedic surgeon who focuses on complex cases will not gain as much knowledge and value from that relationship compared to a senior-level resident on the same service. Furthermore, this resident only gets to see what happens and does not get to truly participate in the orthopedic care. The less opportunity for residents to make decisions and act on decisions, including the actions necessary in the operating room, the less effective they will be when they matriculate to the next level. Flint and colleagues found that 96% of residents thought mentors were critical to their education, and they anticipated that an effective mentor would help in their education, research and career decisions. However, when surveyed, 17% were highly satisfied with their mentoring experience during their residency.

Adaption of the mentorship model

Traditionally, mentorship is a one-on-one relationship. But as the complexity of orthopedics increases with the expansive growth of information as well as more involvement in practice management and business issues, the mentorship model needs to adapt. In the future, mentorship needs to continue the transference of knowledge and opportunity to mentees, but also requires better exposure to collaborative efforts and team building, ways of organizing and collectively using talents from multiple sources to continue the advancement of the profession.

For example, the Sport Medicine research group at Rush meets bi-monthly to discuss current projects and future plans. The meeting includes multiple practicing surgeons, basic science researchers, fellows, residents, medical students and college students. Each person benefits from the collective effort, and multiple levels of mentorship occur at each meeting and after meetings end. The leadership and vision is provided at the top, but the mentorship is provided at many different levels. This multifaceted mentorship model has led to an academically prolific program, that is consistently influencing the practice of orthopedics.

In the past, mentorship has been about focusing on an individual’s skill and talents. However, the future will require a more sophisticated approach to self-awareness, empowerment, leadership, building personal networks and stimulating a life-long desire to learn and develop multidisciplinary collaborations. The complexity of ideas and goals may seem overwhelming and one approach may be to just focus on limited goals. However, the surgeons highlighted in the Pioneers in Orthopedics columns clearly did not have limited goals and dreams.

In my 20 years of practice, I have seen many concepts once thought to be impossible become part of daily practice for orthopedic surgeons. Mentors will continue to positively impact the ideas and innovations for the next 20 years. Their dreams will be our future. It is an incredible opportunity and responsibility to keep our profession moving forward, just like the dreams of our pioneers, which have led to the accomplishments we benefit from every day.

Reference:
Flint JH. J Bone Joint Surg Am. 2009;doi:10.2106/JBJS.H.00934.
For more information:
Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Rd., Thorofare, NJ 08086; email: orthopedics@healio.com.
Disclosures: Romeo receives royalties, is on the speakers bureau and is a consultant for Arthrex Inc.; does contracted research for Arthrex Inc. and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex Inc., Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed.