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Clinicians as Mentors: Why Mentorship Matters
Dra. Krystal Chan, QI/PS Chief Resident
Clint Brayfield, MSIII
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Learning Objectives
1. Review data on student outcomes at UNM
2. Understand one intricacy of mentoring an
underrepresented minority
3. Implement one change to your mentorship practice
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Background
For 3yrs, I have worked with the SOM to mentor students “struggling academically.”
Unfortunately, 85% have been underrepresented minorities (URMs)
15% were dismissed
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100% said they had never heard
of an MD “failing”So…
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What does failure mean to you?
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What previous attendings have said…
65% “not meeting an expectation or goal”
25% “an opportunity to improve”
10% said “feeling inadequate”
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What is failure to those we mentor?
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● > 75% Disappointing my family/community
● 10% Letting myself down
● 10% Not achieving the American Dream
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Let’s take a side by side look
• 65% “not meeting an expectation or goal”
• 25% “an opportunity to improve”
• 10% said “feeling inadequate”
•> 75% Disappointing my family/community
• 10% Letting myself down
• 10% Not achieving the American Dream
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Why should we talk about failure?
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“Medical students on average, begin medical school with better mental health
than age-similar college graduates in the general population.”
Cathryn J. Lapedis, MD, MPH, “Murky Water.” Ann Intern Med. 2018; 169(6):415-416. doi: 10.7326/M18-13981
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“Throughout medical school, students’ mental health worsens and an
incredibly high percentage suffer from burnout and depression.”
Cathryn J. Lapedis, MD, MPH, “Murky Water.” Ann Intern Med. 2018; 169(6):415-416. doi: 10.7326/M18-13981
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“Rates of burnout, depression, and suicide are significantly higher in medical students than in an age-
matched population.”
Cathryn J. Lapedis, MD, MPH, “Murky Water.” Ann Intern Med. 2018; 169(6):415-416. doi: 10.7326/M18-13981
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Why does #MentorshipMatter?
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Mentors can enhance the implicit knowledge or “hidden curriculum” of professionalism, ethics, and the art of medicine not learned from books.
Students with physician mentors experienced less academic difficulty.
It matters because…
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The wisdom and guidance of experienced mentors not only help mentees ascend the academic ladder, but may also prevent burnout.
The relationship benefits mentors as well, through greater productivity, career satisfaction, and personal gratification.
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Why does Diversity Matter?
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2008 LCME “Roadmap to Diversity”
“An institution that offers a medical education program MUSThave policies and practices to achieve appropriate diversity among its students, faculty, staff, and other members of its academic community, and MUST engage in ongoing, systematic, and focused efforts to attract and retain students, faculty, staff, and others from demographically diverse backgrounds.”
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ACGME 2019 Program Requirements
“The program, in partnership with its Sponsoring Institution, MUST engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows (if present), faculty members, senior administrative staff members, and other relevant members of its academic community.”
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Policies and Standards Aside
Individuals who are educated in diverse settings have a higher level of critical analysis and are more likely to work in diverse environments.
(Sommers, 2006 and Hurtado, 2003)2
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What benefits do I generate by assembling and training a diverse class of aspiring doctors?
How can a diverse class enhance the delivery of medical services to underserved populations?
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Why MUST we mentor Underrepresented Minorities?
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Over 3yrs, I have worked with the SOM to mentor students “struggling academically.”
Unfortunately, 85% have been underrepresented minorities (URMs)
15% were dismissed
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20
40
60
80
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Matched 1st Choice Staying at UNM
#MentorshipMatters
2019 Residency Match Data
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Numerous studies have reported that
URMs typically receive less
mentoring than their nonminority
peers.
Mentoring programs designed to address unique challenges faced by URM faculty
are critically needed.
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Mentoring Minorities poses a special challenge because most institutions have few Minority faculty and many non-URM faculty hesitate to become mentors for them.
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What obstacles do we face when we mentor Underrepresented Minorities?
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Case #1
Vietnamese female fails her 1st year of medical school. During her 2nd year of medical school, she fails her last final by one point and is subject to dismissal. This causes tension with her father, who feels that she is a failure, and shuns her for not being able to achieve the “American Dream.” She eventually appeals and is allowed back into medical school. She passes second year successfully and will being 3rd year clerkships on medicine.
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How can I support someone through something I have never experienced?
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Case Highlights
The cost of failure and repeating a single year of medical education can be upwards to $100,000.
There can be additional psychological ramifications for students after failing a year of medical school.
Student feels as though she has lost her support system (in her father), causing a strained home situation.
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Recommendations:
to counseling/wellness servicesRefer
for scholarships geared toward this student
• Don’t just forward emails, but offer to help (CV/PS)Look out
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Case #2
African American female has “struggled academically” during her pre-clinical years and has fallen two years behind her original class. She is currently on medicine wards and the attendings note that she is timid and nervous while presenting her patients, and not interested in learning medicine. She has “poor” differentials and seemingly doesn’t take “ownership” of her patients. What do you do now?
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Case Highlights
Where do we assign value in determining how a student takes ownership in their patients?
Are the academic ways of grading a student’s medical knowledge the ultimate desired outcome? What other things might go unnoticed/ungraded?
Does an African American student look at ownership the way we do? Is “ownership” a troublesome term?
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Recommendations:
Do the work, don’t just
assume. Give feedback sooner.
Check in throughout her
rotation.
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Case #3
A Navajo male and 1st generation college graduate, is consistently in the ~80% range during his pre-clinical years. He then goes on to fail Step 1 three times, is dismissed from the SOM, appeals, and is reinstated. He passes Step 1 on the 4th attempt with a 218. All the while he is dealing with family issues, loses two full ride scholarships, and feels like he had to figure things out on his own. He believes he is a let down to all of the people who believed and invested in him.
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Case Highlights
How did someone who excelled through pre-clinical years get to this?
What might he struggle with in the future as he continues through medical school?
How does his background play a role here?
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Recommendations:
Get a sense of what needs to be done to match in to residency.
Help find resources to successfully pass the medicine shelf.
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Examples of Success!
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Latina female failed step 1, passed with a
194, honored one rotation. Passed step 2 on
first attempt. Received multiple interviews
is now a chief/chair/chancellor.
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An African American female who failed step 1, but passed with a 197 on her 2nd
attempt. Did well 3rd year but did not honor. Passed Step 2 on first attempt with a 237. Had >20 residency interviews and matched into her first choice pediatric residency.
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How Can We Do More?
Get informed! Get Trained!
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Support a Local/National Organization
● Latino Medical Student Association (LMSA)
● Student National Medical Association (SNMA)
● Asian Pacific American Student Association (APAMSA)
● White Coats for Black Lives (WC4BL) 4
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Attend a Talk or Workshop on Campus
● Subscribe to “HSC Office for Diversity Partners”
● Diversity workshops in the weekly “HSC Announcements”
● Walk into our Office of Diversity, Equity, and Inclusion
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Office for Diversity, Equity, & Inclusion
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But what can I do now?
Three main take-aways...
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3 Things I Can Do Today...
Don’t assume.
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Remember important
dates.
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Consult or refer when
needed!
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Learning Objectives
1. Review data on student outcomes at UNM
2. Understand one intricacy of mentoring an
underrepresented minority
3. Implement one change to your mentorship practice
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Resources
1. AAMC. Roadmap to Diversity: Key Legal and Educational Policy Foundations for Medical Schools. AAMC, 2008. https://members.aamc.org/eweb/upload/Roadmap%20to%20Diversity%20Key%20Lergal.pdf
2. Abernathy, A. (1999) A mentoring program for underrepresented minority students at the University of Rochester School of Medicine, Academic Medicine, 74, pp. 356–359.
3. Address burnout with a caring, nurturing environment. ED Manag. 2014;26(6):65-68.4. Beech, Bettina M. et al. “Mentoring Programs for Underrepresented Minority Faculty in Academic
Medical Centers: A Systematic Review of the Literature.” Journal of the Association of American Medical Colleges 88.4 (2013)
5. Christian Mateo Garcia, Amanda Bustamante-Provencio, Justin-James Roesch M.D., FACP “Good Intentions: A Novel Peer-to-Peer Tutoring Program Designed to Reduce Block Failure Rates.” ACP Abstracts, (2017)
6. Frei, Esther, Martina Stamm, and Barbara Buddeberg-Fischer. “Mentoring Programs for Medical Students - a Review of the PubMed Literature 2000 - 2008.” BMC Medical Education 10 (2010): 32.
7. Garibay, J “Diversity in the Classroom.” UCLA Diversity and Faculty Development 2014.8. Rose GL, Rukstalis MR, Schuckit MA. “Informal mentoring between faculty and medical students.” Acad
Med. 2005 Apr;80(4):344-8.9. Tekian, A., Jalovecky, M., and Hruska, L. (2001). The impact of mentoring and advising at-risk
underrepresented minority students on medical school performance. Journal of the Association of American Medical Colleges. 76(12):1264.
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