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Implementing the First Mentoring Scheme for Foundation Doctors in
Psychiatry: The Norfolk Experience
Dr Yasir Hameed Specialist Registrar (ST6)
Adult and Older Adult PsychiatryGlaven ward. Hellesdon Hospital.
Outline
Background
The mentoring scheme
Conclusion
Pre-talk Quiz
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Background
I graduated from Baghdad Medical School in 2002.
I worked in Baghdad, Iraq from 2002-2005.
Then moved to Yemen and worked in rural areas from 2006-2009.
Moved to the UK in 2009 and trained as a psychiatrist since 2010.
I benefitted from mentoring throughout my career.
Al Karama hospital in Taiz, Yemen (2006-2009)
Royal Preston Hospital (2009-2010)
Mentoring helped me immensely
What is mentoring?
‘The process whereby an experienced, highly regarded, empathetic individual (the mentor) guides another individual (the mentee) in the development and re-examination of their own ideas, learning, and personal and professional development.’
Supporting doctors and dentists at work: an enquiry into mentoring, 1998, London : Standing Committee on Postgraduate Medical and Dental Education, 1998.
Why Foundation Doctors in Psychiatry? Most Foundation doctors, especially in their first year (FY1) will lack
experience and will need a substantial amount of support from their supervisors and their teams (RCPsych, 2015).
Foundation doctors face significant levels of stress following their graduation (Steele & Beattie, 2013)
Perceived difficulty in dealing with patients with severe and enduring mental illness (e.g., psychosis) and how to communicate with them.
Doubts about their ability to be” good enough”, wondering if their skills meet the expectations of their supervisors.
Anxiety about becoming “de-skilled”, not doing physical health procedures (e.g., arterial blood gases, insertion of difficult cannula).
Why Foundation Doctors (cont’d)
Despite the support from clinical supervisors and Balint group, the role of a mentor as an extra layer of support (sounding board) is absent from all psychiatric placement in East of England and perhaps nationally.
It was felt that introducing the mentoring scheme will help to address some of the above needs and provide the extra support needed for Foundation doctors to manage the expectations of their role and help them settling in their teams.
Mentoring for Foundation Doctors
Many authors recommend a “buddy system” or peer support models to maximise success in psychiatric placement for Foundation doctors (Goodyear et al, 2013).
A mentor can be seen as a friend, trusted peer, or a more experienced colleague.
Mentoring is an ideal support tool for doctors during role transition and it provides a positive role model experience and “scaffolding” that is tailored to the to the need of the Foundation doctor (Steele & Beattie, 2013)
Mentoring process (Alred et al, 1986)
ExplorationDeveloping
new understandi
ng
Action planning
Benefits of mentoringBenefits to the organisation Benefits to the mentee Benefits to the mentorImproving the job satisfaction and therefore the performance, recruitment and retention of employees.
Useful is an additional tool for early recognition and resolution of issues that face employees. Helpful for the organisations to gather feedback and improve working conditions (plan ahead).
Helpful to ensure that the mentee has clear aims and objectives (development outcomes) at the start of their mentorship.
Helping the mentee to be part of a wider professional network and avoiding isolation. Help the mentee to use reflective practice and improve their self-awareness.
Mentoring is also very useful for mentors as many will feel satisfied by the process of being a trusted mentor
Opportunity to add skills to their e-portofolio.
Publication/research.
Harms of mentoring? Mentoring can be perceived to “infantilise” junior employees rather
than empowering them.
It might hinder creativity in new employees and inhibit them from thinking “outside the box” as it re-enforce the message that “this is how we do things here, and you should fit into our existing model.
Some mentees may also become uncomfortable with the influence or authority of the mentor and this may hinder the progress of the mentoring relationship.
Toxic mentors (and mentees)
Challenges to good mentoring experience Time and resources constraints. Lack of continuity of mentoring (e.g. part time
mentors/mentees). Lack of time or willingness to provide feedback and reflection
on the mentees progress and development. Personality clashes can be a major barrier to an effective
mentoring relationship. Lack of motivated individuals to be mentors.
The Mentoring Scheme The first mentoring scheme for foundation doctors in
psychiatry in East of England.
Probably the only current mentoring scheme for foundation doctors during their psychiatric placement in England.
The idea is simple but innovative, using existing resources and without any additional funding/expenses involved.
Feedback collected during and after the mentorship.
Participants and methods The mentoring scheme was offered to the FY doctors who
joined the Trust in December 2015 (Norfolk only).
11 FY doctors were invited, only 5 took up this opportunity.
Mentors were psychiatric trainees (senior CTs and STs) who were already providing mentoring for junior psychiatric trainees.
Matching process.
An initial meeting followed by at least once monthly face to face meetings.
Objectives of the mentoring scheme To develop the confidence and motivation of foundation
doctors to work in psychiatric settings and enhance their active learning.
To support their transition from student to qualified doctor.
To reduce stigma associated with mental illness.
To encourage recruitment to psychiatry as a medical speciality.
Help the mentors to be able to build confidence in their mentees through coaching of the mentors.
Roles of the mentoring scheme coordinator
Establish a “mentors’ band”
Match mentors to mentees (through a clear matching pathway)
Provide written information and handout about the structure of the scheme, the beginning and end of the mentoring process, and other useful information
Keep a record of the mentoring meetings
Gather feedback from mentors and mentees at the conclusion of the mentorship
Topics discussed during mentoring meetings General guidance regarding job roles and responsibilities
Advice regarding difficult scenarios/patients
Assistance on completing the competencies on e-portfolio
Advice regarding personal health and wellbeing
Advice regarding bullying or harassment at work
Support regarding career choices and leadership opportunities.
The assessment processDifficult to objectively assess the impact of mentoring, but the majority of literature on mentoring considers satisfaction of the mentees and mentors as a very important measurement of success of any scheme.
The motivation of the foundation doctors, their views about mentoring, the support they got and likelihood of choosing psychiatry as a career was assessed through online questionnaire at the end of mentoring mentorship.
The motivation of the mentors, their experience and feedback to improve the scheme was also be assessed through their responses to the end of mentoring questionnaire.
Throughout the mentoring process, continuous feedback collected and acted upon as soon as possible to improve the mentorship experience.
Survey responses for the first cohort (April 2016) Response rate was 80% from mentees and 100% from mentors.
Results showed that most mentees had regular meetings and contact with their mentors.
Half of the mentors felt that their mentees were motivated to get the most of the mentorship. Four stated that they feel they helped their mentee to favourably change their attitudes to psychiatry and psychiatric patients. One mentor stated that she/he influenced the mentee to choose psychiatry as a future career.
Two of the mentees strongly agreed that the mentoring process was very helpful for their placement and that mentoring should be provided for every foundation doctor in every rotation (not only in psychiatry).
Comment from FY doctor (December 2015-April 2016 cohort)
By coming to work in a speciality that we havelittle experience in as an undergraduate, it isdifficult to try and get involved in teaching andperforming audits. With a mentor in psychiatry,I was able to identify some possible areas ofdevelopment, including leadership opportunities for foundation doctors. There were also opportunities to be involved in teaching as my mentor was involved in coordination ofstudents’ placement in the Trust.
The progress so far Nine foundation doctors in Norfolk benefitted from the mentoring
scheme so far.
Two foundation doctors received intensive support through mentoring when they faced challenging working conditions.
Two foundation doctors considered psychiatry as a career.
Appointment of Foundation Doctors Reps (in Norfolk and Suffolk)
Two foundation doctors presented a poster about their mentoring scheme.
The scheme now is running across Norfolk and Suffolk and support by all stakeholders.
Conclusion Mentoring provides a focused opportunity to target the holistic
needs of the trainee. This not only may help encourage trainees to pursue a career in psychiatry, but also provides the space for a trainee to learn how to incorporate psychiatry into whatever specialty they choose to pursue.
Setting up a mentoring scheme can seem a daunting task, especially at the current climate of limited resources and low morale. However, based on our experience, it is a very cost-efficient and rewarding project.
“Start small and grow”
References Alred, G., Gravey, B. and Smith, R, 1986, Mentoring pocketbook. Alresford:
Management Pocketbooks. "But What Exactly Is Mentoring? Invited Commentary On…Mentoring Scheme for
Child and Adolescent Psychiatry Consultants in Scotland." Psychiatric Bulletin: Journal of Trends in Psychiatric Practice 33.2 (2009): 47. Supplemental Index.
Goodyear, H, Bindal, N, Bindal, T, & Wall, D 2013, 'Foundation doctors' experience and views of mentoring', British Journal Of Hospital Medicine (London, England: 2005), vol. 74, no. 12, pp. 682-686.
Mentoring – CIPD Factsheet. Revised February 2009. Downloaded from: https://www.shef.ac.uk/polopoly_fs/1.110468!/file/cipd_mentoring_factsheet.pdf
Royal College of Psychiatrists (2015). A Guide to Psychiatry in the Foundation Programme for Supervisors. http://www.rcpsych.ac.uk/pdf/A%20Guide%20to%20Psychiatry%20in%20the%20Foundation%20Programme.pdf
Steele, R., & Beattie, S. (2013). Development of foundation year 1 psychiatry posts: implications for practice. Advances In Psychiatric Treatment, 19(6), 410.
Thank you for listening and special thanks to our mentors..
Jane StillJames Miller Dawn CollinsAbosede IghomerehoNigel GillSrinaveen AbkariEmma Bosier
