Effects of Mentorship on Graduating Vascular Surgery Trainees

Mentorship in surgical training; a systematic scoping review to inform a mentorship framework for ophthalmology trainees

BACKGROUND

Mentorship plays a vital role in surgical training. In the field of ophthalmology, effective mentorship is particularly critical due to the specialised nature of surgeries and the need for comprehensive skill development. However, the landscape of mentorship remains underexplored. Understanding key characteristics and components of effective mentorship is essential for optimising training and ensuring the success of future generations of surgeons. This scoping review aims to analyse existing literature on mentorship in surgical training and to employ Levac et al.'s enhanced methodological framework to construct a conceptual framework for a bespoke mentorship programme tailored to the needs of ophthalmology trainees.

METHODS

The search strategy adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and included relevant databases such as MEDLINE, Scopus, CINAHL Complete, ERIC, EMBASE, and the Cochrane Library. Selection criteria encompassed studies exploring mentorship experiences, perceptions, and outcomes across all surgical training domains. A two-step screening process was employed, followed by thematic analysis using Braun and Clarke's approach. The Medical Education Research Study Quality Instrument (MERSQI) assessed study quality.

RESULTS

Of the 81 identified articles, 24 were included in the review, with an average MERSQI score of 11.65. Studies comprised randomised controlled trials, systematic reviews, cohort, cross-sectional studies, and reviews. The thematic analysis identified five domains: (1) mentorship and burnout; (2) surgical skill and performance; (3) career paths and professional development; (4) diversity promotion; and (5) work-life balance.

CONCLUSIONS

This review underscores the significance of mentorship in surgical training and proposes a conceptual framework tailored to ophthalmology trainees. By synthesising existing literature and through author engagement with relevant training bodies, the study contributes to the development of an imminent mentoring programme, aiming to enhance surgical training outcomes and foster trainee well-being and professional growth.

Educational challenges and opportunities for the future generation of surgeons: a scoping review

PURPOSE

Surgery offers exciting opportunities but comes with demanding challenges that require attention from both surgical program administrators and aspiring surgeons. The hashtag #NoTrainingTodayNoSurgeonsTomorrow on 𝕏 (previously Twitter) underscores the importance of ongoing training. Our scoping review identifies educational challenges and opportunities for the next generation of surgeons, analyzing existing studies and filling gaps in the literature.

METHODS

Following the PRISMA guidelines, MEDLINE/PubMed was searched in February 2022, using the MeSH terms "surgeons/education," for articles in English or German on general, abdominal, thoracic, vascular, and hand surgery and traumatology targeting medical students, surgical residents, future surgeons, and fellows.

RESULTS

The initial search yielded 1448 results. After a step-by-step evaluation process, 32 publications remained for complete review. Three main topics emerged: surgical innovations and training (n = 7), surgical culture and environment (n = 19), and mentoring (n = 6). The articles focusing on surgical innovations and training mainly described the incorporation of structured surgical training methods and program initiatives. Articles on surgical culture examined residents' burnout, well-being, and gender issues. Challenges faced by women, including implicit bias and sexual harassment, were highlighted. Regarding mentoring, mentees' needs, training challenges, and the qualities expected of both mentors and mentees were addressed.

CONCLUSION

At a time of COVID-19-driven surgical innovations, the educational and working environment of the new generation of surgeons is changing. Robotic technology and other innovations require future surgeons to acquire additional technological and digital expertise. With regard to the cultural aspects of training, surgery needs to adapt curricula to meet the demands of the new generation of surgeons, but even more it has to transform its culture.

Surgical revascularization for pediatric moyamoya: the role of surgical mentorship in sustaining and developing a neurovascular service

OBJECTIVE

Obtaining operative experience for the treatment of rare conditions in children represents a challenge for pediatric neurosurgeons. Starting in November 2017, a surgeon was mentored in surgical revascularization (SR) for pediatric moyamoya with a view to service development and sustainability. The aim of this audit was to evaluate early outcomes of SR for pediatric moyamoya during and following a surgical mentorship.

METHODS

A retrospective cohort study with chart/database review of consecutive moyamoya surgeries performed by a new attending surgeon (between November 2017 and March 2020) was compared to a previously published cohort from the authors' institution in terms of clinical and angiographic outcomes, complications, operating time, and length of stay. A standardized technique of encephaloduroarteriomyosynangiosis with the superficial temporal artery was used.

RESULTS

Twenty-two children underwent 36 indirect SRs during the study period. Patient demographics were similar between cohorts. The first group of 6 patients had 11 SRs performed jointly by the new attending surgeon mentored by an established senior surgeon (group A), followed by 10 patients with 16 SRs performed independently by the new attending surgeon (group B). The last 6 patients had 9 SRs with the new attending surgeon mentoring a senior fellow (group C) in performing SR. Good angiographic collateralization (Matsushima grades A and B) was observed in 80% of patients, with similar proportions across all 3 groups. A total of 18/19 symptomatic patients (95%) derived symptomatic benefit. There was no perioperative death and, compared to the historical cohort, a similar proportion had a recurrent arterial ischemic event (i.e., acute ischemic stroke) necessitating a second SR (1/22 vs 3/73). Operative times were longest in group C, with no difference in length of hospital stay among the 3 groups.

CONCLUSIONS

Early outcomes demonstrate the feasibility of mentorship for safely incorporating new neurosurgeons in sustaining and developing a tertiary-level surgical service.

The Art and Science of Mentorship in Cardiothoracic Surgery: A Systematic Review of the Literature

BACKGROUND

As academic cardiothoracic surgeons focus on producing a new generation of successful surgeon leaders, mentorship has emerged as one of the most important variables influencing professional and personal success and satisfaction. This review explores the literature to determine the benefits, qualities, and features of the mentor relationship.

METHODS

A comprehensive review was performed in February 2020 of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and the SCOPUS Database using "'mentor"' as a primary search term. The titles and abstracts of these publications were then reviewed by 2 of the authors to identify relevant sources addressing topics related to mentorship in cardiothoracic surgery and also to identify 4 specific areas of focus: (1) the value of mentorship, (2) the skills needed to be an effective mentor, (3) effective approaches for identifying and receiving mentorship, and (4) the unique considerations associated with mentorship for traditionally underrepresented populations in surgery.

RESULTS

Of 16,469 articles reviewed, 167 relevant manuscripts were identified, and 62 were included.

CONCLUSIONS

There is undeniable value in mentorship when navigating a career in cardiothoracic surgery. By sharing the most significant features and skills of both ideal mentors and mentees, this review hoped to provide a framework to improve the quality of mentorship from both sides.

Formal Mentorship as an Opportunity to Expand the Urology Pipeline: Under Represented Trainees Entering Residency (UReTER) Program Evaluation 2020-2021

OBJECTIVE

To rank percentages of underrepresented residents in surgical subspecialties and understand the experience of mentees and mentors who participated in the inaugural University of California, San Francisco Urology UnderRepresented Trainees Entering Residency (UReTER) Mentorship Program for Black, Indigenous, and/or LatinX medical students applying into urology.

METHODS

Medical student mentees across the country were recruited via social media and email listservs. Demographic information and photos of mentors were presented on the UReTER website. Medical students could choose a mentor, and once matched, both parties were notified. A survey was emailed to all participants on Urology Match Day 2021.

RESULT

The 2018 -2019 ACGME Databook showed underrepresented minority residents made up 7.6% of urology residents, lagging behind neurosurgery, vascular surgery, general surgery, and obstetrics and gynecology. 71 mentees and 101 mentors volunteered for the UReTER Mentorship Program (71 mentor-mentee couplets). Overall response rate was 51% [33 mentors and 32 mentees]. Of mentees who completed the survey, 16 (47%) participated in the 2021 Urology Match; 15 (94%) matched and 6 (38%) felt that UReTER helped them match.

CONCLUSION

Feedback on this pilot program was very positive including a high match rate among those who participated. Future changes to the program include expanded student outreach, increased structure, broadened mentor network. The implementation of a low-cost program to increase underrepresented applicants into Urology has great potential to increase representation and improve the field. This program can and should be replicated in all subspecialties.

Racial disparities in vascular surgery: An analysis of race and ethnicity among U.S. medical students, general surgery residents, vascular surgery trainees, and the vascular surgery workforce

The ever-increasing diversity of the U.S. population has resulted in a challenge to a vascular surgery workforce that does not represent the national demographics. Educational institutions, medical organizations, and medical agencies, through initiatives and programs, have attempted to increase the number of underrepresented minorities, with, however, only modest changes during the past 30 years. Several obstacles have been identified, some of which include racism, issues of finances, lack of mentors and scholarly activities, and inequity in promotion. In the present study, we have reviewed the reported data addressing these concerns and provided guidance toward the amelioration of these issues with the hope of constructive change toward encouraging a diverse vascular surgery workforce.

Gender Trends of Authors Presenting at a Regional Vascular Surgery Meeting

OBJECTIVE

We hypothesized a potential gender disparity within a regional society like the Southern Association of Vascular Surgery (SAVS) when compared to vascular surgery demographics in the region. To assess this, we analyzed meeting and membership participation at SAVS compared to regional data from the Society of Vascular Surgery (SVS) as well as Board certification in Vascular Surgery published by the American Board of Surgery (ABS).

METHODS

The published programs from the SAVS Annual Meeting from 2012 to 2019 were analyzed for membership, presenter gender, type, topic, discussant gender, moderator gender, post graduate course presenter gender, as well as manuscript publication demographics. The ABS was petitioned and yearly Vascular Surgery diplomate (ABS-VS) gender from member states of the SAVS was examined for the same period. Fisher's Exact students t-test and Analysis of Covariance were utilized.

RESULTS

There were 257 total presentations (184 podium, 71.6%; 73 poster, 28.4%). 61.4% (n=43) of presentations by females were podium presentations, compared to 75.4% (n=141) for males (p=0.03). Females were less likely to be published when compared to their male counterparts (41.8% vs. 58.7%, p=0.02). Percentage of female gendered presenters statistically increased over the time period examined compared to a decrease in male presenters (R² = 0.61, m=1.27 vs. R² = 0.08, m=-0.35, p=0.02). Females presenters had a female discussant 10.5% of the time compared to male presenters who had a male discussant 95.1% of the time (p<0.0001). Females comprised 3.8 ± 1.1% of SAVS yearly membership compared to 12.0 ± 4.6% ABS-VS diplomates among SAVS member states (p<0.0001). SAVS female membership significantly lagged behind the increase in ABS-VS female diplomate rate (p=0.001). Only 39.1% of SAVS members were cross listed in SVS membership rolls, with a total of 464 potential SAVS members, 11.2% or 52 of which are female.

CONCLUSIONS

We found that female presenters at the SAVS annual meeting were less likely to be podium presenters, interface with other female discussants and publish manuscripts when compared to their male counterparts. Statistically, female members were underrepresented within the SAVS membership rolls when compared to known boarded female vascular surgeons among southern member states. This gender gap highlights a unique opportunity to enhance and potentially increase mentorship opportunities for female trainees who are presenting and/or attending this regional vascular surgery meeting.

Mentorship in pediatric surgery: A need for structure?

INTRODUCTION

Mentorship in surgical training is critical but differs greatly from the early apprenticeship model and often spans generations. This study evaluates the current state of and desire for structured mentorship in pediatric surgical training from the perspective of program directors (PDs) and trainees.

METHODS

A survey addressing demographics, presence of or desire for structured mentorship, and proposed mentoring topics was emailed to pediatric surgery PDs (n = 58) and trainees completing fellowship in 2018-2020 (n = 72).

RESULTS

The response rate was 38.5%. 50% of trainees were female versus 15% of PDs (p = 0.02). 19% of trainees reported having a structured mentorship program versus 26% of PDs (p = 0.72). The majority, 83%, of trainees felt a structured mentorship program is warranted versus 40% of PDs (p = 0.002). There were differing opinions between trainees and PDs regarding important components of a mentoring program. Trainees felt the following were more important: transition to practice, job negotiation, CV review, financial planning and performance review. PDs felt the following were more important: quality improvement projects and work/life balance. Both agreed academic development and job search were important.

CONCLUSIONS

The majority of pediatric surgery trainees desire structured mentorship programs; however, few institutions have them. Training programs and program directors warrant a response to this gap.

LEVEL OF EVIDENCE

IV.

Mentorship Effectiveness in Cardiothoracic Surgical Training

BACKGROUND

Mentoring is an essential component of cardiothoracic surgery training, yet trainees report varied experiences despite substantial efforts to enhance mentorship opportunities. This study aimed to evaluate mentorship effectiveness and identify gaps in mentorship education.

METHODS

A survey was distributed to cardiothoracic surgical trainees in Accreditation Council for Graduate Medical Education-accredited programs (n = 531). Responses to 16 questions concerning trainee experiences, expectations, and perspectives on mentorship were collected. An 11-component mentorship effectiveness tool generated a composite score (0 to 55), with a score of 44 or lower indicating less effective mentorship.

RESULTS

Sixty-seven residents completed the survey (12.6%), with most (83.6%) reporting a current mentor. Trainees with mentors cited "easy to work with and approachable" (44 of 58; 75.9%) as the major criterion for mentor selection, whereas trainees without a mentor reported an inability to identify one who truly reflected the resident's needs (6 of 11; 45.5%). Resident age, gender, race or ethnicity, marital status, family status, postgraduate year, and training program type or size were not associated with having a mentor (P = .15 to .73). The median mentorship effectiveness score was 51 (interquartile range, 44, 55). More than one-third of residents (25 of 67) had either no mentor (n = 6) or less effective mentorship (n = 16), or both (n = 3). Resident and program characteristics were not associated with mentorship effectiveness (P = .39 to .99). Finally, 61.2% of residents had not received education on effective mentorship, and 53.8% did not currently serve as a mentor.

CONCLUSIONS

Many resident respondents have either no mentor or less effective mentorship, and most reported not having received education on mentorship. Addressing these gaps in mentorship training and delivery should be prioritized.

The State of Mentorship and Pancreatic Research Among Trainees in Pancreatology: A Multinational Survey Study

OBJECTIVES

The recent decrease seen in pancreatic research and young investigator involvement may reflect inadequate mentorship. This study aimed to describe the current state of mentorship in pancreatic research and evaluate how mentorship is associated with research productivity.

METHODS

In this prospective study, a survey addressing mentorship and research was distributed to trainees worldwide. Survey responses were analyzed using descriptive statistics and logistic regression was used to describe the association between mentorship and trainee research productivity.

RESULTS

A total of 137 trainees from 16 countries participated. Although two-thirds of trainees expressed interest in pancreatic research and had identified a mentor in the field, only 34.8% had published a manuscript. Barriers to pancreatic research included lack of research opportunities (58.3%), limited mentorship (23.3%), and inadequate institutional support (15%). Although having a single mentor was not associated with research productivity (odds ratio, 1.43; 95% confidence interval, 0.74-2.76), having a local mentor was significantly associated with publishing (odds ratio, 4.57; 95% confidence interval, 1.95-10.74).

CONCLUSIONS

Although many trainees interested in pancreatology have access to a mentor, barriers including lack of research opportunities, mentorship, and institutional support hinder trainee productivity. Opportunities for mentorship, collaboration, and networking are needed.

Faculty mentorship during residency and professional development among practising emergency physicians

What is known about the topic?

Mentorship is perceived to be an important component of residency education; however, evidence on its influence in emergency medicine is lacking.

What did this study ask?

We surveyed emergency physicians in Canada to identify the association between mentorship during residency and professional development and attitudes regarding mentorship.

What did this study find?

While many participants consulted their mentor regarding their first job, fewer contacted their mentor regarding subspecialty training or research.

Why does this study matter to clinicians?

Mentorship during residency may have a greater association with the location of practice than with academic scholarship or subspecialty training.