Evolution of mentorship in medicine

By Ruth Carol, Contributing Writer, July 1, 2023

What are your core values? It’s not the typical question mentees would have been asked years ago but one they may be asked now as mentorships have evolved almost as much as medicine itself.

In recent years, mentorships have undergone a paradigm shift. They have shed their hierarchical approach to embrace a more collaborative one. Simultaneously, they have broadened from a clinical and career focus to address all aspects involved in practicing medicine from managing administrative tasks to striking a work/life balance. The number of niche mentorships has also grown. Mentorship programs now engage individuals who are underrepresented in medicine (URIM), promote advocacy efforts, and hone leadership skills. There is even a JAAD Editorial Mentorship Program designed for young physicians who are interested in developing critical appraisal and editorial skills. 

Value of mentorship

When Mary Maloney, MD, FAAD, professor of medicine (dermatology) at the University of Vermont Medical Center in Burlington and professor emeritus at UMass Memorial Health, was a resident, formal mentorships did not exist. By the time she was a faculty member, mentorships started to grow, but they were more informal. “The Academy’s Leadership Institute was a driver for formal mentorships,” said Dr. Maloney, who is one of its founders. “We began to notice that people who had mentors were more likely to move up in leadership positions in their practices, institutions, or societies,” she added.

Mentorships can offer professional growth and personal satisfaction for mentees and mentors alike. “If one enters a mentoring relationship with a growth mindset, everyone benefits, often in unexpected ways,” said Kelly Cordoro, MD, FAAD, chair of the Academy’s Leadership Development Steering Committee. “Mentoring is both enriching and educational. It lends itself to creativity, idea sharing, and mutual growth,” she added.

“We began to notice that people who had mentors were more likely to move up in leadership positions in their practices, institutions, or societies.”

For Kimberly Butterwick, MD, FAAD, a cosmetic dermatologist in San Diego, mentorships are about helping mentees believe in themselves, see the possibilities, and get excited about their careers. As a mentor, Dr. Butterwick gets so much energy from working with mentees and has so much fun, she views mentoring as an antidote for burnout. “They are a breath of fresh air with their curiosity and delight,” said Dr. Butterwick, who earned the Women’s Dermatologic Society’s Mentor of the Year Award in 2022. Over time, many of her mentorships have developed into friendships.

Similarly, several of Dr. Maloney’s dearest friends were mentees at one point. “It really is a bond,” she said. Meeting up with mentees at various dermatologic meetings throughout the year and over the years serves to strengthen that bond. “I have mentees call me 10 years after our official mentorship has wrapped up seeking advice on an issue,” said Dr. Maloney, who has similarly sought advice from former mentees. She rejoices in her mentees’ successes as several of them have moved on to leadership positions. “You feel so proud; it’s like watching one of your kids graduate,” she said.

The main value of mentorship comes from the relationships that are forged, said Andrea Tesvich Murina, MD, FAAD, chair of the Academy’s Mentoring Workgroup. Mentees can get a lot of advice and opportunities through mentorships, which is especially helpful at the start of their career when they are faced with different career choices and paths. As dermatologists progress in their career, they deal with many difficult situations, conflicts, and ethical dilemmas. “Medicine is a high-stakes career, and we work in high-stress environments. Having a mentor can help deal with stressors and career decisions along the way,” she said.

The Mentoring Workgroup’s mission is to nurture dermatologists at all stages of their career. Born out of the Leadership Development Committee, the workgroup fosters mostly informal mentorship opportunities within the AAD, such as mentoring sessions at the Leadership Forum and the Legislative Conference. These sessions, which tackle such topics as advocacy, time management, and career goals, grow into interest groups. The workgroup also hosts a mentoring session at the AAD Annual Meeting, but the big event is the networking reception that brings together all the mentors and mentees from these informal efforts and the more formal Leadership Forum, Academic Dermatology Leadership Program, Diversity Mentorship Program, and Legislative Conference Mentorship Program. In addition, the workgroup promotes the William D. James, MD, Mentor of the Year Award and offers a searchable database to connect mentees with mentors.

Key shifts

Meanwhile, mentorships have adopted a more collaborative approach. Previously, mentorships maintained a one-directional dynamic with mentors passing on their wisdom to mentees, who absorb the mentor’s knowledge and beliefs, and then imitate their characteristics and behaviors. Mentees tended to observe, rather than engage with, mentors. Today, mentors collaborate with mentees to generate research projects, apply for grant funding, write journal manuscripts/articles, develop presentations, present cases, and participate in quality improvement efforts.

If a mentor is not very self-aware, using the unidirectional approach can be very biased and may lead mentees down a pathway that is in service to, or in the best interest of, the mentor rather than the mentee, Dr. Cordoro warned. Disillusionment, burnout, and role confusion may result. A more mentee-focused approach is one of active listening, idea sharing, and shared decision making around best next steps. “Sometimes the best I can offer is an active ear and asking the right questions to help my mentees work things out for themselves without the bias of what I think may be right for them. Guiding people to their own success is my idea of success as a mentor,” Dr. Cordoro said.

Dr. Murina agrees. “Putting the mentees in the drivers’ seat is the way to see them achieve their personal goals,” she said. “It’s better than giving my advice on what they need to work on. The latter could cause shame and resistance, which could harm the relationship.” As a mentor, Dr. Murina asks for self-reflection from mentees. “Most times, mentees come to me with the plan or solutions already worked out. That removes some of the hierarchy from the relationship and allows me to be the support system but not the architect,” she said.

“Today’s mentorships are all about working together,” said Dr. Murina, who also serves as a mentor through the Leadership Forum. Mentees are encouraged to take an active role in committees or conduct research projects with their mentors. Through active mentoring and engagement, mentors can learn the mentee’s skill sets, which can help focus their advice. That way, goal setting is more directed to what the individual is seeking and to build skills in a particular area.

The shift from passive to active mentorships reflects today’s society, said Dr. Butterwick, who in 2007 began offering a week-long fellowship in cosmetic dermatology in her office. Fifteen years ago, mentees would sit in the corner passively and observe; they would ask questions at the end of the day. “After that week, we probably wouldn’t talk again,” she said. “The younger generation is bolder and more empowered; they ask a lot of questions.” Additionally, Dr. Butterwick or a colleague collaborates with most mentees on a long-term project, such as a study and/or paper. They routinely have virtual meetings and correspond via email and text and meet in person at dermatology conferences. Some fellows get involved in skin cancer screenings while others may focus on becoming proficient in using the latest laser acquired by the practice. Gaining expertise in medical technology builds confidence and is a skill that they can use in the future, she said.

Broader focus

While clinical competence and career goals remain a focal point of today’s mentorships, they are much more comprehensive than in the past, Dr. Maloney said. Topics of interest include everything from time management and keeping current with medical knowledge and research to running a practice or department. All that entails dealing with technology from electronic health records and interoperability to telemedicine. Psychosocial support often focuses on creating a work/life balance and for mid-career mentees, managing burnout. Advocacy efforts can be broached on a local, state, or federal level and address such issues as scope of practice, truth in advertising, and skin cancer prevention.

Dr. Maloney has focused on all the above. “If you don’t touch on those things, you’ve missed a great opportunity,” she said. A discussion about time management in the practice could lead to a discussion about prioritizing family life around work. Dr. Maloney also talks with mentees about the importance of being flexible with their career goals as they do change over time. “Oftentimes, you don’t even recognize the career goals that you started with and that’s okay,” she said.

Mentorships taking a broader view has prompted Dr. Maloney to ask mentees about their core values. “I want to know what’s important to them,” she explained. Many mentees offer standard answers, such as family and helping patients, but others cite their passions, such as helping people in less affluent countries or treating homeless patients. Some mentees want to build a large private practice that affords them a lot of flexibility, while others want to focus on advocacy and maybe even seek political office. “Knowing these things allows me to guide mentees in the right direction, and maybe even challenge them,” she said. “I can introduce them to other dermatologists who share those core values and can help them along the way. I can help them set attainable goals and remind them to have fun and enjoy the journey.”

Likewise, Dr. Cordoro has addressed myriad topics as a mentor. They include providing career advice, navigating complex relationships or institutional politics, preparing a presentation or for negotiations, resolving conflicts, and navigating personal and professional crises. Other mentorships have focused on well-being and burnout prevention, work/life balance, and professional and personal identity. As of late, mentees are seeking more guidance around wellness and mental health, she said.

Niche mentorships

Specialized mentorships are also gaining in popularity. These can address a specific area of interest, such as research, a subspecialty, or skin of color; a target audience, such as the LGBTQIA community or individuals who are URIM; advocacy for patients or the specialty; and leadership skills. “There are innumerable models of mentorship and ways to build a mentoring relationship,” Dr. Cordoro noted.

As an example, the Pediatric Dermatology Research Alliance offers a mentorship program for trainees, early-career, and mid-career clinician-scientists interested in developing their skill set and growing their network to advance their careers in pediatric dermatology research. The goal is to build the professional networks of burgeoning clinician scientists, while also providing career development training and advancing active and future research. The Skin of Color Society offers a mentorship program designed to help mentees acquire new knowledge and skills about skin of color as well as participate in relevant research opportunities. Mentees meet with their mentor at the Society’s annual Scientific Symposium and have three to four in-person or virtual professional development meetings a year to discuss goal-setting and practical ways to increase their knowledge.

“It is important to have a mentor who understands who you are and what you want to achieve.”

The Academy’s Diversity Mentorship Program offers hands-on exposure to students who are URIM interested in learning about the specialty. Through this one-on-one mentorship program, mentors provide medical students with hands-on exposure to the specialty and help stimulate interest in dermatology as an obtainable career choice. The Gay and Lesbian Dermatology Association (GALDA) Mentorship program seeks to connect residents and early career dermatologists with experienced board-certified dermatologists to provide advanced clinical training, promote leadership skills, and/or encourage research endeavors.

Howa Yeung, MD, FAAD, assistant professor of dermatology at the Emory University School of Medicine in Atlanta, participated in the GALDA Mentorship Program when he was the chief resident there. “It is important to have a mentor who understands who you are and what you want to achieve,” said Dr. Yeung, who wanted to incorporate LGBTQIA health into his research. “At that time, nobody was doing that,” he said. His GALDA mentors helped him extend his research project into the LGBQTIA world by sponsoring his work and introducing opportunities to present it to a wider audience, including writing a book chapter and a two-part continuing medical education article in JAAD. “They helped me frame why dermatologists should advocate for transgender patients,” he said.

Since then, Dr. Yeung has served as a mentor. Through mentoring others, he can teach the next generation of dermatologists, recruit diverse talent, and expand the pipeline of LGBTQIA dermatologists. Despite serving as a mentor, he continues to get mentored himself. Dr. Yeung maintains ongoing relationships with his mentors, with whom he still collaborates, most recently on securing a National Institutes of Health grant to build on his research about the epidemiology of acne in transgender persons.

Advocacy is another hot topic of niche mentorships. The mentorship program at the AADA’s annual Legislative Conference held in Washington, D.C., gives mentees the opportunity to work with dermatologists entrenched in advocacy efforts to gain insights about the Academy’s advocacy policy priorities and how to advocate for those priorities when meeting with members of Congress and their staffers. “It can be overwhelming to a first-year participant,” noted Sara Moghaddam, MD, FAAD, chair of the Academy’s Grassroots Advocacy Task Force.

After signing up for the mentorship, mentees are paired with a mentor from their state, enabling them to attend congressional meetings together, explained Dr. Moghaddam, who has been both a mentee and mentor. For the 2022 conference, she was assigned three mentees. As a mentor, she provided information about legislative priorities, shared talking points and other resources, and coached mentees on how to advocate on topics such as Medicare physician payment, prior authorization reform, and step therapy. Since 2013, 322 mentees and 260 mentors have participated in this program.

Mentees and mentors of all ages participate. Younger physicians or newly graduated residents tend to be focused on taking care of their patients, she said. But once they get more comfortable in practice and start learning about behind-the-scenes issues that negatively impact their patients and the specialty, they want to get involved. Dr. Moghaddam’s path to advocacy started when she became aware of the growing number of physician assistants, nurse practitioners, and non-dermatologist physicians practicing dermatology and the lack of state restrictions on who could call themselves a dermatologist. She also testified about the burden that step therapy requirements place on her patients, often delaying appropriate care.

In recent years, Dr. Moghaddam has seen more younger physicians get involved in advocacy because of an increased awareness of the political climate. Additionally, it’s getting more onerous, challenging, and stressful to be a physician whether it’s additional administrative requirements, documentation burdens, or Medicare cuts, she said. The Academy’s advocacy efforts are always bipartisan and issues that all dermatologists can support, such as improving access to medications, Dr. Moghaddam stressed.

Mentorships have clearly undergone a paradigm shift in recent years. “Mentoring as a concept has unlimited possibilities and takes many forms,” Dr. Cordoro said. But their purpose remains the same: to help nurture future generations of dermatologists. “That’s why so many people who have been mentees become mentors as soon as they are ready,” Dr. Maloney said.

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