Learning from Mentors – and the reverse
This is the modified text of the last Grand Rounds lecture I gave August 30th, 2017 at the Minneapolis Veteran’s Hospital while still teaching as a Professor of Orthopaedics at the University of Minnesota
Good Morning
As I left for deployment to Afghanistan in 2016 I had no thoughts of speaking to you today to say thank you. But, life intervened.
From the outset of my career, I understood that medicine has the potential value to other humans equal to other service careers. But, sometimes I got sidetracked. Some distractions were the result of factors that I could not control – spouses and children more than deserve a portion of our focus. Many “baubles” distract us from our chosen focus and some – especially in academics - appear to carry the shine of gold when compared to the repetitive and mundane aspects of clinical care and recurring teaching conferences. Speaking only about myself, I often succumbed to the podium’s attraction. There is something about applause that is addictive.
I did have modest success teaching in the realm of clinical medicine and, to a degree, in the lab as well. Now, at this edge of my career, I find it interesting that in the end I came back to my own academic beginnings. Specifically, the work at the University of Minnesota that I co-started 10 years ago with my colleague Ann Van Heest enabled me to return to interests sparked at Dartmouth College. That work focused on measuring acquisition and retention of learning in Sprague-Dawley rats. Here I will focus most on how I was guided and what tools you will need to define your path forward.
One of the first “semi-good” papers I wrote served as the platform for me to approach Professor Thomas Roos (dec) in my college’s Biology Department and describe to him my crazy idea that I could build a model to simulate learning --- Artificial Intelligence.
Since that moment, complex computing has become so ubiquitous that some of you might think this not unreasonable. However, seasoned colleagues know the moment I’m describing is exactly the moment for which mentors are made. You cannot control when you will get your own “hair-brained” idea or know if the person you present it to will be a mentor, a naysayer, an uncritical cheerleader, or even a thief. Specifically, finding a mentor is – and should be – your hard work. I do not think it is your school’s or employer’s job to assign or find you a mentor. Actually they can’t.
Every teacher is not your mentor. It simply is not possible to mentor all the students we teach. Often this is a simple function of time available. But, sometimes it is a function of personality. That we are not forced to be mentored by all of our teachers is a good thing. We may not enjoy them as much as we need the grade. This is not to say that you and I shouldn’t carry lessons learned from our teachers forward our whole life – rather it is to say that you should not confuse favorite and/or effective teachers with having a mentor.
Also, many potentially great mentors are, by the systems design, overcommitted. My first surgical chief, W A Wichern, Jr. MD, was such a person.[1] He was responsible for turning a whole gaggle of newly graduated medical students into young surgeons and was our go-to-resource for trauma, day and night. One thing he taught us all was the simple – yet often forgotten – concept – “do you have control of the bleeding?”. If our answer was less than YES!, then his instruction was consistent – “Get Control!, I’m on my way”. But despite his great teaching, it is not fair for me to call Dr. Wichern a mentor.
Image 1. The “troops” with W. A. Wichern, Jr. MD – aka “the Wick”. 1978. Location – NY, NY. Source – The Roosevelt Hospital
Mentors are not common. If you are lucky you will have a few in your lifetime.
Mentors do not need to be older than you. They do need to be more expert than you in the subject to be learned. The sex and gender of your mentor is of no consequence.
Mentors should not be your boss. They should not be able to determine your fate.
Parents and spouses are not mentors. Their job is hard enough.
You should not need to pay your mentor. A paid “mentor” is a coach. They work for you. In this situation do you actually think you will be told what you need to hear? Not to say a mentor cannot be a Coach but I will mention that momentarily.
The best mentor is not going to be asking you out for beer to discuss your progress. Mentors are not your best friend or confident. Mentors should challenge you to the point of making you uncomfortable.
Mentors may give you a wise saying to make easier your remembering an important principle. Dr. Robert E. Carroll gave those of us who trained in Hand Surgery at New York Orthopaedic Hospital (NYOH) – “good, better, best; never let them rest; ‘til your good is better; and your better best”.[2] Pithy, but true. Possibly St. Jerome (347 – 420 CE) said it first over 1500 years ago, but this is debated.[3],[4] Whatever. Dr. Carroll impressed on us the need to find something more than money by which to measure our success.
Image 2. Operating at NYOH. RN, author, W Gomez, MD, R E Carroll, MD, L Weeks, MD. Location – NYC. Taken by W H Seitz, MD. Source author’s image files.
We all need Mentors
It is worth noting that even smart and famous people need mentors. Einstein was mentored by Max Talmey beginning at age 15.[5] Kareem Abdul Jabar and Bill Walton recognized John Wooden as the key mentor in their lives.[6] Had Wooden been simply a great basketball coach I doubt that this would have been true. But his teaching was more about life than basketball.[7]
In Homer’s Odyssey Telemachus is guided by Mentor. That Mentor was - when not possessed by Athena (the Goddess of wisdom) - a mostly ineffective older man seems not the point except it is in-so-far as we associate age with experience and the need (for the mentor) to pass on wisdom to us in times of need.[8], [9] What goes unsaid in the Odyssey is that not only does the mentor need to be available but the mentee needs to listen.
Maybe I should really be talking about this single trait – listening – as it relates to your future success. For sure, I was given the opportunity many times in my lifetime to become a better listener, but being open and honest I have to admit that it was actually the US Army that improved my listening. They teach leaders how to use the Johari Window – helping one to become more authentic to others and oneself.[10],[11] This quality of knowing and revealing yourself is seriously studied in business today as it is part of being emotionally intelligent which turns out to be as important as IQ.[12] When you combine authenticity with listening you are in a position to benefit from a mentor.
A mentor does…what exactly?
So what does a mentor actually do? Chopra and Saint answer this specific question in a recent issue of Harvard Business Review.[13] Although their article can fit many fields, they are actually writing related to medicine. Based upon my experience my restatement of their rules is:
1. Choose mentee’s – and mentors - carefully. Neither party benefits from lack of commitment. Unless both sides are fully committed, both sides are wasting their time. Although this rule seems obvious it is the one I’ve observed to be often overlooked.
2. As with many things, it helps to think of the relationship as a team. Both sides have work to do. This does not mean that the mentor is not in charge. She is. But, if the mentee is to gain from the team, the mentor needs to be more that an instructor.
3. Trains and mentee meetings should be frequent and on time. Goals must be set and monitored. A method to reschedule meetings should be established. Providing adequate time is allowed for rescheduling – neither mentee or mentor should find fault. However, frequent rescheduling may indicate a need to reconsider the relationship. Be professional.
4. If either party feels dissatisfied – see above – be professional. Basically, head off disagreements or resolve them quickly. If this is not possible, terminate the mentor to mentee relationship and maintain your professional relationship.
5. Don’t treat or expect to be treated as an employee. Mentoring is not the same as taking on apprentice. A mentee should never accept having their mentor take credit for work that they have done. This goes both ways. Similarly, do not be mentored into becoming the mentor’s doppelganger – that is not the point. The mentor is supposed to help the mentee find their apex – not to become the mentor’s mirror.
6. If you ask to be mentored, you must prepare for doing the same for another in the future. I believe that I have successfully mentored a few others. I hope I met many of their needs. I have no illusion that I met them all.
Learning and Hope
Earlier I noted that I set out in college to build a machine model of learning. Ultimately, this became a model that could learn a new maze quickly - if it had seen the general maze before. This research and programming spanned the course of my college career. The chance I could have completed this work without my mentor is zero. Similar research now occurs attempting to determine the best way to teach and re-prepare for any activity – even flying and surgery. In fact, research the U of MN team continues regarding surgical skill acquisition resembles the advantage we observed where preparation for an activity increases the chance of success.[14], Maybe this should be disheartening – but, I don’t think so.
Anders Ericsson, whose research Malcolm Gladwell cites in formulating his famous 10,000 hours’ rule in his book Outliers[15], strongly disagrees that time – or repetition – alone will result in improved performance.[16] Ericsson believes that without “deliberate practice”, this includes doing what is hard for you and honestly measuring your success, you have no hope of improvement.
How does this work out? All this mentoring and being mentored. Well, we cannot know. So we hope instead of knowing for sure. I think for some the idea of hope sounds foolish, like Pollyanna.[17] Not active enough. Not a sure thing. But, good or bad, that is often how mentoring is – especially as one ages, or when one is young and one’s mentor is older – neither side can be sure of being there at the moment of success. For me, no one has ever captured this sort of hope better than Vaclav Havel. He wrote – “Hope is definitely not the same as optimism. It’s not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out”.[18]
Pay it Forward
When I was at the University of Pittsburgh I was taught by Albert Ferguson, Jr. MD.[19] Some of us would ask him why he taught surgery as compared to work in the community. His recurring answer to this question was to explain how thru teaching he could help more patients than he would have otherwise. Only at this edge of my career do I fully understand what he meant. As I previously said, sometimes the best potential mentors are so busy that they cannot give themselves fully to each student. Still they hope that some of their hard-won knowledge will stick and go forward with you. Effectively, our best teachers are paying it forward never certain how it will turn out. Image 3. Paying it forward in Afghanistan. Teaching a fixation trick while “getting control of the bleeding”.
SPC J-M, author 61M, MAJ. George 61J, SGT M (not seen, but essential – CPT Dodd(Anesthesia). Surgery is the “Ultimate Team Sport”. Location Deployed. Source author’s image files.
Telling you something about how mentoring benefited me and led me down a path I could not have predicted was my goal today. Knowing that this is an ask, I recommend you read Sir William Osler’s treatise titled Aequanimitas.[20] It will introduce you to the concept of “keep your cool” in a whole different light. We all need to do this. It was originally published in 1904 and is often cited today.
The Mentor as Mentee
The last thing I want to say about Mentors is perhaps the most important. Each of your patients who comes before you will mentor you. I admit to having been so taken with the concept of the doctor as teacher that I did not hear my patients teaching me at the beginning of my career. I am fortunate that I finally caught on. So, if I could give one thing and one thing only to everyone reading this essay it is the gift of listening to and hearing your patients – and their families. Ultimately, I truly started to love and learn from my practice when I heard my patients speak.
An odd thing about coming to the far edge of any career is actually realizing that you are “over the edge”. That to go back is impossible. A friend and I often joke that we thought this process of passing the baton would be more celebratory. Maybe – dancing on the tables! But, it is not like that as much as it is like The Old Man and The Sea.[21] That I was fortunate to be able to celebrate with friends the 25 year Anniversary of the Twin Cities Hand Fellowship which I helped to start and put my whole self into without guarantee of success is a recognition event for which I will be forever grateful. That such a thing requires other’s help while in the process and still others to carry on is less obvious in the middle of keeping it going – but every lasting good is built with the support of colleagues.
Image 4. The 25th year of the Twin Cities Hand Fellowship. James House (co-founder), Christina Ward, MD (current Lead), author. Location – St Paul, MN 2017. Source author’s image files.
I read poems. Some are famous written by famous people. This poem is known but it’s author is not.
Trifles
The massive gates of Circumstance
Are turned upon the smallest hinge.
And thus seeming some pettiest chance
Oft gives our life it’s after tinge.
The trifles of our daily lives,
The commonest things scarce worth recall,
Whereof no visible trace survives,
These are the mainsprings after all.
“And in the end…” is a famous line and song from the Beatles.[22] For me it captures what I have been trying to do since before college. I know that I have not always succeeded. But, I have always tried to succeed. My hope for you is that your future is always bright and sunny. I am grateful that I was able to work with all of you.
References:
[1] https://www.legacy.com/obituaries/nytimes/obituary.aspx?pid=184794880
[2] https://www.legacy.com/obituaries/nytimes/obituary.aspx?pid=131518907
[3] https://www.brainyquote.com/quotes/st_jerome_389605
[4] https://fauxtations.wordpress.com/2016/09/26/good-better-best-st-jerome/
[5] Ravin, JG. Albert Einstein and his mentor Max Talmey. The seventh Charles B. Snyder Lecture; Doc Ophthalmol. 1997;94(1-2):1-17.
[6] James, M. Kareem Abdul-Jabbar memorializes the great John Wooden in ‘Coach Wooden and Me’. LA Times, June 22nd, 2017.
[7] John Wooden, Jack Tobin, Bill Walton. They Call Me Coach. McGraw Hill. 2004
[8] https://en.wikipedia.org/wiki/Mentor_(Odyssey)
[9] O’Donnel, BRJ. The Odyssey’s Millennial Old Model of Mentorship. The Atlantic, October 13th 2017
[10] https://en.wikipedia.org/wiki/Johari_window
[11] Luft, J.; Ingham, H. (1955). "The Johari window, a graphic model of interpersonal awareness". Proceedings of the western training laboratory in group development. Los Angeles: University of California, Los Angeles.
[12] Goleman, D. Emotional Intelligence. Bantam Books. 1995.
[13] Chopra V, Saint S. 6 Things Every Mentor Should Do. Harvard Business Review, March 29th, 2017
[14] Putnam M, Kinnucan E, Adams J, Van Heest A, Nuckley D, Shanedling J; On orthopedic surgical skill prediction – the limited value of traditional testing. J Surg Educ. 72 (3), 458 – 470. 2015
[15] Galdwell, M. Outliers: The story of success. Little, Brown, and Company; NY, NY. 2008.
[16] Ericsson, K. The danger of delegating education to journalists: Why the APS Observer needs peer review when summarizing new scientific developments. Internal Letters. Florida State University. 2012. https://psy.fsu.edu/faculty/ericsson/ericsson.hp.html
[17] https://en.wikipedia.org/wiki/Pollyanna
[18] Havel - https://www.traumaministry.org/resources/havel-on-hope
[19] https://www.legacy.com/obituaries/postgazette/obituary.aspx?pid=172228724
[20] Sokol D. Aequanimitas. BMJ. 2007 Nov 17; 335(7628): 1049.
[21] Hemingway E. The Old Man and the Sea. Charles Scribner's Sons. Ny, NY. 1952
[22] https://en.wikipedia.org/wiki/The_End_(Beatles_song)