Mentorship: Who benefits?

Mentorship is one of the professional relationships that fascinates me the most. We've all had those people in our lives that help us advance our careers, gain more insight to our practice, guide us to a more work/life balance. Some might call these people mentors, while other call them coaches or guides. Even after completion of training or schooling, people make use of these coaches/mentors as is the case in sports or medicine. For example Atul Gawande writes how a mentor helped him improve his practice as a surgeon years after completing his training.

This relationship is very complex, but at the same time vital for a successful career. In its complexities we must find what makes it functional and nonfunctional in order to benefit from this interaction. When this relationship is successful there are four winners:

• The mentee
• The mentor
• The institution to which they belong
• Patients 

Mentees and mentors end up with better career satisfaction, career advancement, and better pay, but the relationship has to “click” in order for it to work. The institutions can benefit from improved morale, enhanced productivity, external recognition, and more. When these relationships become dysfunction, and it’s not remedied, it can be harmful to the parties involved. The study below published this past November in Academic Medicine, explores the characteristics that make these relationships a success or or a failure.

 

Fifty-four faculty members from different career streams were interviewed via telephone. Although this qualitative study has its limitations, it contains salient points that are worth considering in this complex relationship.

Characteristics of an effective MENTOR

Altruistic Honest Trustworthy Active listener Previous mentorship experience Enriched network Accessibility Understands the potential and limitations of the mentee Helps promote the mentee’s career

Characteristics  of an  effective MENTEE

Open to feedback Active listener Respectful to mentor’s input and time Responsible Pays attention to timeline Takes responsibility for “driving the relationship” Prepared for meetings

Actions  of  effective mentors

Act as guides rather than supervisors Offers: advice, advocacy, network, goal setting, opportunities, how to navigate the system Provides emotional support focusing on work/life balance Warn mentee of potential pitfalls Protects mentee from harsh interactions Helps mentee have a clear vision of the career path and how interrelates with their personal and social life

Characteristics of a successful  mentor-mentee relationship

Reciprocity Mutual respect Clear expectations Personal connection Shared values

Characteristics and consequences of a failed mentorship

Poor communication Lack of open communication Lack of commitment Lack of time or waning interest over time Personality differences Different personalities have different ways of approaching the world Perceived (or real) competition How much credit does the mentee get as opposed to the mentor? When working together, it is important for the mentor to step back and let the mentee have the spotlight. Conflicts of interest The mentor should not be in a position of authority over the mentee Mentor’s lack of experience Lack of knowledge to provide advice

Tactics for a successful mentoring relationship

Start in the mentor’s office (a safe environment) Establish a communication network (“reiterate and review”) May use a checklist to address: career, education, administration, and personal issues Schedule regular appointments

When the mentor-mentee relationship did not work, participants still felt that these were good life lessons. Interestingly, people in more junior positions found it more difficult to approach more senior members about the failed relationship because of the potential for bad career repercussions. Two useful podcast from the Get-It-Done Guy:

• How to pick a mentor 
• How to leave a mentorship relationship

Since this is a vital process which takes part under institutions, it is being looked at more closely these days. This is a great study and gives a lot of insight into quite an interesting relationship. Although I had participated in mentorships, I was not aware or mindful of all of the characteristics mentioned here. One should be cognizant on how to continually improve the relationship. Rather than waiting until the relationship ends poorly, it is important to have a mechanism to leave the relationship under amicable terms. I hope this post motivates you to become a mentor or gives you some important points to consider when searching for that mentor or coach.

Additional reading on blog about mentorship

1. Blog post: CJEM 2010 review article (Pubmed) on Mentorship in EM
2. Blog post: Acad Emerg Med 2004 article (Pubmed) on Mentorship for Clinician-Educators

References

1. Straus S, et al. Characteristics of Successful and Failed Mentoring Relationships: A Qualitative Study Across Two Academic Health Centers. Acad Med. 2013 Jan;88(1):82-89.
2. Atul Gawande. Personal Best The New Yorker, October 3, 2011.
3. Coates W. Being a Mentor; what’s in it for me? Acad Emerg Med. 2012 Jan;19(1):92-7.
4. Get-It-Done Guy: Choosing a mentor Episode 245: November 26, 2012, Moving on from your mentor Episode 208: February 6, 2012
5. Tobin MJ. Mentoring: seven roles and some specifics Am J Respir Crit Care Med. 2004 Jul 15;170(2):114-7.

Image 1 source: http://ltownteacher.blogspot.com/2011/05/message-to-mentors.html
Image 2 source: http://madisonmusicfoundry.com/education/lessons/

The secret to patient presentations

So there’s a patient, and umm...  they are in the hallway, they came to the ED today for breathing problems, I mean dyspnea.  They also don’t speak any English.  So, uh the respiratory rate is normal, and they had a blood clot, er... I mean PE, in the past, but not on coumadin anymore.  Shoot, I forgot to tell you my exam...they had pitting edema for 3 months.  By the way, the labs came back on that other anemic patient in the other hallway, and they are really anemic...

Sounds familiar? Perhaps a medical student or intern-level presentation of a patient in the ED?  Imagine working in a hectic ED while listening to this chaotic presentation. 

What's the secret to presenting patients?

We, as attendings or senior residents, often assume that increasing knowledge will lead to improved presentations, and so focus on broadening their medical knowledge. That's only part of the solution.

What's the other part? Polishing the trainee's public speaking skills.  This is just like recommending to a lecturer that to improve their lectures, they should develop public speaking skills. In this case, the lecturer (trainee) is lecturing to an audience of one (attending).

Think of presentations as mini-impromptu speeches.  

Important qualities in public speaking:

• Lack of fillers (um, so, uh, really, like)
• Knowledge of content
• Brevity
• Organized structure
• Eye contact
• Subject matter of pertinence to the audience
• Practice (go over the presentation in your head once before giving it)

As a senior resident or attending taking patient presentations, imagine a presentation that is succinct (less than 1-2 minutes), where the trainee avoids filler words, with an organized history, physical, assessment, and plan.  Imagine a presentation that does not deviate but remains true to the topic and tells a coherent story.  This type of presentation would almost be like a gentle relief in an over-stimulated ED environment.

Just as how you probably would not interrupt a good public speaker in the middle of his/her speech,  you should hold your questions until the end of their presentation. Remember this, and try to allow the trainees to finish speaking.  It may help them to keep their train of thought and structure.

For the senior resident or attending:

• I challenge you to consider these aspects of public speaking the next time you listen to a patient presentation from a student or resident. See if you can make recommendations to improve his/her presentation style as well as the content.

For the trainee:

• Work on being a better public speaker. 
• As a side note, I was a part of Toastmasters International which is a nonprofit public speaking organization while in college.  Although I am no longer with the organization, I credit them with significantly improving my confidence and public speaking skills in both prepared and impromptu styles. Plus it was a lot of fun!  This is definitely something to consider if you are looking for a way to improve your public speaking skills.

Top 10 reasons why Yoda would be a terrible mentor and teacher in medicine

This is based on an article from GeekWire that lists the top ten reasons why Yoda would make a terrible teacher. Let’s see if I can make a derivation and convert these reasons as to why Yoda would make a terrible mentor/teacher in medicine.

10. Micro-manage much? 

Yoda never took into consideration the mentee’s motivations, desires, and mental states, which made for a very inefficient relationship. It also looks bad when Yoda is on Luke’s back and directing all of his moves. That level of micromanagement does not lend itself to the best situation for communication, which is a very complicated process and of essence in a learning environment.

9. Lack of transparency

It’s always important to tell your mentee what your reasoning is behind your decisions as an attending. They should learn how you go through the process of formulating answers so that they can do the same when challenged with similar problems or questions. If your reasoning is not explained, the student will never know why you arrive at a particular conclusion. Transparency also makes you more approachable.

8. The importance of goals

“Because I said so” should not really be an answer. Explain why and how the exercise/ activity/ challenge will make them better doctors. Jointly come to a decision as to what the goals of the shift are; be it seeing more patients, managing more critical care patients, working on procedures, or teaching medical students. The ultimate goal is to make of them a better doctors, take better care of patients, and be more proficient at skills. There should not be a hidden agenda. All cards should be on the table. Yoda was so secretive, and for some reason things needed to be figured out as riddles.

7. Communicate clearly

This has to overemphasized. Communication is everything. Everybody needs to be on the same page. The Geekwire article states “finding a way to minimize information friction should be job one for all mentors.” As you remember, Yoda did not communicate clearly, I mean really, who talks like that?

6. Authentic assessments

The mentor/teacher should be aware of the learner's knowledge and where that falls within the standard for that level of training. If the student hasn't met these expectations, a plan should be laid out to delineate how to get there. There should also be benchmarks to let the student know whether s/he was successful. These assessments and benchmarks were not made clear by Yoda, which I would imagine made Luke more frustrated. 

5. Authority problems
The mentee/mentor relationship is a delicate one, and all the authority should not fall on just the mentor. The relationship should be seen as a respectful collaboration going both ways. Without respect, the relationship suffers and the communication fails. Yoda was very frustrated at what appeared to be Luke’s lack of respect, but the respect did not come from Yoda either. Mutual respect leads to better communication and a conducive learning environment.  

4. Constructed learning from existing contexts
Basically Yoda did not know how to motivate Luke to learn. Criticism needs to be well directed, specific, constructive, and connected to experiences that the mentee can relate to. Sometimes criticism are more welcomed when they come from a person that the mentee can relate to culturally, chronologically, etc. The point is that there has to be some common ground beyond the mentor/mentee relationship.

3. Dispel cult auras
Mentors might be too detached from the students. When the mentee or the mentor cannot relate to each other, the learning is more difficult. I’ve heard great podcasts where the attendings sound very down to earth, and this in turn makes the students feel more comfortable to learn from them. I went to a conference where Amal Mattu was lecturing, after lecture I approached him and called him Dr. Mattu, the first thing he told was to call him Amal. After that my conversation with him felt more like I was talking to a friend even though I knew how well renown he was.   

2. Accessibility in all ways
The mentor creates a better learning environment when the mentee sees him/her as being approachable. This is much easier with technology in the present time. When we have a question, we can just go ahead and text or email someone. In contrast, Yoda was pretty inaccessible.

1. There is nothing magical about learning new things
All students should know that learning is hard, and that they need to put in a lot of work. No matter how stellar a mentor is, if the mentee does not put in the time, s/he will not get to master the skills necessary to be successful. The name of the game is repetition, there are no shortcuts. 

The mentor-mentee relationship is a very complicated one. If basic principles are followed, however, the process of learning and mentorship can be a mutually beneficial and joyful experience. Clear communication and mutual respect are the foundation in this relationship, which both parties should strive for. 

Basically, don't be Yoda.
Javier Benítez, M.D.

Article Review: Generational differences in academic EM

Men are from Mars. 

Women are from Venus.

By learning about our differences, we can learn to appreciate and better communicate with those who are different from us.

The same falls true for working with residents and faculty from different "generations", as defined as traditionalists, baby boomers, generation Xers, and millennials.

This literature review and consensus document is quite extensive and even comes in 2 parts in Academic Emergency Medicine. There is a great summary table of the generational differences in personal, work, and educational characteristics, communication styles, and technology.

Think of faculty who fit in these age groups. Do they fit their generational stereotype?

Traditionalists (born 1925-1945)

• Personal characteristics: Loyal, reluctant to change, dedicated, value honor and duty, patriotic
• Work characteristics: Value hierarchy, loyal "company man",  job security
• Education characteristics: Process oriented
• Communication style: Formal
• Technology: Tend not to understand

Baby Boomers (born 1945-1964) 

• Personal characteristics: Optimistic, desire for personal gratification, highly competitive 
• Work characteristics: Workaholic, competitive, consensus builder, mentor 
• Education characteristics: Learner depends on educator, lecture format, process-oriented 
• Communication style: Diplomatic 
• Technology: Not particularly techno-saavy 

Generation Xers (born 1964-1980) 

• Personal characteristics: Independent, self-directed, skeptical, resilient, more accepting of diversity, self-reliant 
• Work characteristics: Value work-life balance, comfortable with change, question authority 
• Education characteristics: Independent learners, problem-solvers, desire to learn on the job, outcome-oriented 
• Communication style: Blunt 
• Technology: Interested and facile

Millennials (born 1980-1999)

• Personal characteristics: Optimistic, need for praise, collaborative, global outlook 
• Work characteristics: Team-oriented, follows rules and likes having structured time, career changes 
• Education characteristics: Team-based learning environment, turn to Internet for answers, outcome-oriented 
• Communication style: Polite 
• Technology: Very saavy, technology is a necessity 

The authors give multiple examples where generational differences come to light but none more so than in mentorship within the academic department.

• Traditionalists view mentorship as a more formal process, where feedback is necessary only to provide criticism or suggestions for improvement.
• Baby boomers also view mentorship as a "top down" process. They are ok with infrequent interactions.
• Generation Xers and Millennials prefer mentorship as a more "peer to peer" process with more frequent interactions. They value the personal relationships and the opportunity to collaborate in creative solutions. Because of their stereotypical distrust of authority, however, they may inadvertently sabotage their relationship with their mentors. Distrust sometimes is misinterpreted as a general lack of respect. 

To overcome these differences, mentor-mentee pairings should take into consideration gender and shared views about goals, work/life balance, and experiences. Early discussions in a mentorship relationship should discuss generational differences and how each envisions the ideal mentor-mentee relationship to be. The pair should agree upon and adopt a collaborative, shared communication approach with frequent feedback.

So much more in this article... Take a read.

Reference Mohr NM, Moreno-Walton L, Mills AM, et al. Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I). Acad Emerg Med. 2011, 18:190-9, 10.1111/j.1553-2712.2010.00985.x
.

Article Review: Formative experiences during medical school

What were your most impactful experiences during medical school?

This study surveyed 216 medical students from Johns Hopkins about a wide spectrum of formative experiences and the impact on their lives.

The goal of this study was to determine which experiences are the most commonly shared and most impactful. Because these experiences contribute to each student's emotional development and early professional competence, faculty mentors should be cognizant of these events when advising medical students.

Methodology

An online survey instrument was developed using various focus groups, which included students, residents, and faculty advisors. A list of 34 distinct events/experiences were determined. In the study, students were were asked:

1. Did you experience this event during medical school?
2. What magnitude of impact did it have on you?

A Relative Impact Score was calculated for each item based on the numeric values for verbal descriptors:

• 0 = Experienced event but no impact
• 1 = Little impact
• 2 = Some impact
• 3 = A lot of impact
• 4 = Tremendous impact

The numerical values for each item were summed across all of the student responses, divided by the total number of events experienced, and scaled to 100.

Results

Of the 216 graduating residents, 181 completed the questionnaire (84%). Anything over 70% is generally considered a "reasonable" response rate for surveys. Obviously the higher the better.

Look at this table from the article, which lists the 34 "events". For each event, there is a corresponding exposure rate (% of students who experienced the event), Relative Impact Score, % of students who ranked the event as moderate impact, and % of students who ranked the event as high impact. The list is presented in descending order, based on the percentage of students who list the event as high impact.

I highlighted the 10 events with the highest Relative Impact Score in yellow. Click table to enlarge the size.

In general, impactful experiences were grouped into one of three categories (in descending order of "impactfulness"):

1. Inspiring experiences

• Being inspired by a special patient-care related experience
• Encountering a truly exceptional role model in medicine
• Working well with a team
• Seeing a patient whose life was saved by medical intervention

2. Mortality-related experiences

• Seeing someone undergo resuscitation/intervention
• Seeing someone die
• Encountering a corpse in the anatomy lab

3. Negative experiences in the learning environment

• Seeing/experiencing mistreatment by colleagues, staff, or faculty
• Receiving genuinely inappropriate feedback
• Getting a grade very much below expectations

This list of formative experiences during medical school is extremely useful for both medical students and faculty advisors. First-year medical students can anticipate what experiences will come. And faculty advisors can be more attuned to and ask about the moderate-to-high impact experiences for their advisees.

References
Murinson BB, Klick B, Haythornthwaite JA, Shochet R, Levine RB, & Wright SM (2010). Formative Experiences of Emerging Physicians: Gauging the Impact of Events That Occur During Medical School. Academic medicine : journal of the Association of American Medical Colleges, 85 (8), 1331-1337 PMID: 20671460

*

Article review: Mentoring in EM

This article in the Canadian Journal of Emergency Medical Care reviews the EM literature on mentoring. The authors specifically do a great job summarizing practical tips.

What is a mentor?
It is a person who supports and guides a junior colleague (junior faculty member, residents, or medical student) in his/her professional development.

Many studies show that medical trainees value mentoring. Junior faculty, especially those in academics, also benefit from mentorship by senior faculty. Despite these known facts, less than 40% of medical students have mentors. Furthermore, 98% of academic physicians cite a lack of mentorship as a major factor hindering their career progress.

Types of mentorship

• Individual, one-on-one mentoring
• Group mentoring
• Distance mentoring

How to get started in a mentorship relationship

• Schedule 30 minutes for the first meeting
• Get acquainted, sharing backgrounds and interests
• Exchange contact information
• Discuss best mode for communication and available times
• View mentee's CV
• Define expectations of the mentee and mentor
• Identify the mentee's short and long-term goals
• Pick 3 areas to work on together
• Schedule regular meetings

Yeung M, Nuth J, & Stiell IG (2010). Mentoring in emergency medicine: the art and the evidence. CJEM : Canadian journal of emergency medical care = JCMU : journal canadien de soins medicaux d'urgence, 12 (2), 143-9 PMID: 20219162

Insights into mentorship for faculty

No matter where you are in your training and career, mentorship is important (even for faculty). How do you navigate the waters of medical school, residency, and the specialty of academic Emergency Medicine?

Finding a mentor is key. UCSF just released a videotaped panel session, where star mentors and leaders gave their perspectives and experiences around mentorship.

The video is around 86 minutes long. If pressed for time, you can skip through the first 13 minutes or so (housekeeping issues and introductions).Unfortunately, this Flash-based video doesn't have a timed scrubber at the bottom, which allows you to fast-forward exactly to particular time-points in the video. Just eye-ball it.

In the second half of the video, they focus on differentiating between a manager (who sets goals and expectations - more like a referee) and a mentor (who is more like a coach).

What lessons have you learned in your mentorship experiences (either as a mentee or mentor)? Feel free to comment.

Article review: Mentoring for clinician-educators

What is so important about mentorship in Medicine anyway?

Mentorship plays a critical role in the development of medical students, residents, and faculty. For instance, research-based faculty who are mentored have greater academic productivity (i.e. getting grants and writing publications). Also, junior faculty with mentors demonstrate greater career satisfaction. In a nutshell, mentors shed greater light towards where you are going and help you avoid common pitfalls along the way.

However, what about those of us who are more clinician-educators? Early evidence shows that clinician-educators receive less mentorship than the traditional clinician-researcher. Also, what if you are a budding clinician-educator and are looking for a mentor? How do you go about that process?

This review article, written by 4 Emergency Medicine academic faculty, addresses these questions and provides pearls towards a successful career in medical education.

Mentorship should be tailored towards the mentee's career development stage, as defined by Wilkerson and Irby (Acad Med 1998).

1. Entry-level educators learning basic teaching skills and how they fit into academics
2. Educators with more conceptual knowledge of learning theories
3. Leaders who direct educational programs (residency program, clerkship, medical school courses)
4. Teacher-scholars who look at education on the big-picture level on curricular change and educational outcomes
   

Where are you on this scale? I feel like I flux across all 4 stages. On a good day - 4. On a bad day - 1.

This article also provides key tips for aspiring clinician-educators when seeking out mentorship relationships in the academic EM world. These are based on guidelines from the family medicine literature (Rogers et al, Fam Med, 1990).

1. As a potential mentee, be self-reflective and critically appraise your short-term and long-term career goals. Know your department expects out of you, as a clinician-educator. Get familiar with your institution's academic promotion requirements.
2. Identify your academic niche. Determine what skills you need to work on to build this niche. Examples include: educational research, bedside teaching skills, curricular development, time management, and grant writing. You can find out what skills to target based on the success and failures of your prior educational projects.
   
3. Identify ideal mentors. Characteristics of good mentors are: self-confident, patient, inspirational, supportive, approachable, competent, tolerant of learners, and respected as educators in the academic world of EM. A mentor will need to be able to assist you in networking. You will often need to work with others outside of your institution.
4. Once you have found a mentor, remember that it's a two-way street. Don't just sit back and expect wisdom just to flow your way. Think about how the mentor can help you. Ask concrete, practical, and specific questions.

Below is a checklist of things to think about as a potential mentee (from Table 1 of the review article - may need to click to see enlarged version):


Now go find a mentor, or be a mentor. This blog is my little way to contribute a little virtual mentorship for all those, who are interested in the academic world of Emergency Medicine.


Reference
Farrell SE, Digioia DM, Broderick KB, Coates WC. Mentoring for clinician-educators. Acad Emerg Med. 2004; 11:1346-50.

Faculty highlight: Dr. Lisa Moreno-Walton

A large part of the reason why I love academics so much is that I get to meet really inspiring emergency physicians, who are passionate about their cause. I can't imagine a more dedicated person than my friend Dr. Lisa Moreno-Walton, who is the Associate Program Director at LSU in New Orleans.

Dr. Lisa Moreno-Walton
Associate Program Director, Emergency Medicine
Assistant Professor, Louisiana State Univ Health Sciences Ctr, New Orleans
Clinical Research Scholar, Tulane University

Lisa, I know that you have your hand in lots of areas within Emergency Medicine, but what would you call your niche?
My academic niche is translational research. When I started my residency in EM, I had no clue that I liked research; in fact, I thought it was boring. My mission and my passion was providing excellent clinical care to under-served populations. I knew that I wanted to do academics, because the opportunity to teach residents to deliver good clinical care with compassion and respect is a great way to serve even more patients, indirectly.


How did you decide on translational research?
In my last year of residency, one of my mentors, Dr. Yvette Calderon, used her great persuasive powers to get me involved in a research project. And suddenly, I saw the light. Not only did I love doing research, but I also realized that by doing research and establishing best practices through evidence based studies, I would be able to improve the care of hundreds of thousands of patients during the course of my career. That is both humbling and exciting. Also, I am the kind of person who is always asking questions. I want to know why we do things the way we do them in the ED. I always wonder if there is a better way. And I wonder why certain diseases or injuries evolve the way they do. Research is the way you get the answers to your questions. So, now, I have three professional passions!

What are some things that you have learned during your time in academics?
The most important thing I've learned from my mentors is to choose the right mentor. I got the best advice on the characteristics of a good mentor when I attended the AAMC Minority Faculty Development Seminar, and I would be happy to share what they taught me:

• You need a mentor who is successful in his or her own career, otherwise how can s/he guide you towards success?
  
• S/he should be powerful at your institution or in EM; someone who other people know and respect, so that when s/he recommends you for committees, speaking engagements, etc. people will listen and respect the recommendation.
  
• S/he should be influential. That is not the same as being powerful. There are powerful people who couldn't get anyone to follow them to a water cooler during a drought!
  
• You want someone who can open doors for you, whose intellectual and professional currency is reliable, someone who can make things happen. Your mentor does not need to be the same sex or the same race or of the same cultural background as you are, but s/he needs to be someone who is willing to understand your world and your perspective and who wants you to reach your career goals just as much as you want to reach them.

Now, that being said, the second most important thing I learned from my mentors is that you must be willing to work very hard and you must follow through. It does no good to have your mentor opening doors for you if you don't walk through them, or to have him get you a speaking opportunity and then you show up unprepared, or for him to get you on a national committee by saying that you are enthusiastic and a hard worker, and then you turn out to be a slacker. You discourage him, you ruin your reputation, and you ruin his credibility for recommending the next mentee who comes along.

Dr. Peter Deblieux on PBS

Who is your mentor?
My mentor is Dr. Peter DeBlieux, and he is an absolute rock star. He is not interested in research, but he has a real gift for moving a young faculty member through all the right steps to achieve her career goals and get her from one success to another. He knows when I am taking on too much, when I am not focusing on the right things, when I am not organizing my tasks and dividing my time appropriately. I may not always love everything he tells me, but he tells it to me straight and his advice is always on target.

I remember Peter being interviewed on TV multiple times post-Katrina. He is consistently so poised and well-spoken. You are lucky to have him as your mentor. I totally agree about Peter being a rock-star, although he's got a mischievous side to him...



You are the Chair of the SAEM Diversity Interest Group (DIG). What is this group all about?
Well, I'm the Chairman this year, and thanks to Dr. Michelle Lin, we have actually recently realized one of our goals. For a long time, we have wanted to be involved in a virtual advisor program where we could be available to students who come from under-represented minority groups, who are interested in EM but may not have doctors in their family group or among their friends who can advise them, or who may not have had opportunities to be exposed to research or science in school.

We are also in the midst of doing a study to look at how women and racial minorities are represented in academic EDs around the country. A similar study was done just over ten years ago, showing that women and URMs are under-represented at all levels, but especially at the higher academic ranks of Associate and full Professor. We wonder if the disparities have in any way changed. And we wonder how leaders in EM feel about these disparities and whether there is a motivation to change them.

Eliminating disparities for our patients and within our profession is what the DIG is all about. We are dedicated to the concept that EM is better for everyone when health care disparities are eliminated and when there is parity in the work place. And our success depends on the continuous influx of committed, effective young students and residents. Everyone of us needs to have one hand up, reaching for the next rung on the career ladder, and one hand down, pulling the other folks up behind us.

So what are you working on this week?
Well, my major project is the study of the effects of moderate alcohol intoxication on the secretion of epinephrine, norepinephrine, and arginine vasopressin in the trauma patient. This week, I will also start to work with one of the basic scientists at the Medical School who is studying the effects of alcohol on the regulation of mononuclear cell tumor necrosis factor production in the murine model. Tumor necrosis factor is a significant marker for sepsis. Should this relationship prove to be significant, we will be developing a study to quantify this relationship in trauma patients. We know that intoxicated trauma patients develop sepsis more frequently than unintoxicated patients, but we don't fully understand why or what can be done to prevent it.

This week, I will also attend classes at Tulane, where I am studying for a Masters Degree in Clinical Research, I will work a shift in the ED side by side with my excellent residents, I will moderate a didactic clinical conference for our residents, and I will work with a few residents on their clinical research projects. One resident will start a project with me this week looking at the effectiveness of an educational intervention designed to encourage patients admitted for ROMI/ACS to modify their cardiac risk factors.

Yesterday, I completed the writing of a manuscript and did some of my committee work for the SAEM Diversity Interest Group. Later in the week, I will start the research to put together a lecture that I'll be giving at AAEM in February.

Wow, is this an average week for you?
So, by looking at my work week, this is a pretty average week for me. You can really see that Emergency Medicine provides me with a very well rounded professional life. I can see patients, do bedside teaching, do didactic teaching, and do both clinical and translational research. I get to be a learner and a teacher. I have the stimulation of working with students and residents, and of interacting with basic scientists who do work that is substantially different from what I do in the ED. I am able to serve my patients and my colleagues with work in national EM organizations, and I am beginning to have opportunities to publish and to lecture nationally.

I work with a really outstanding group of dedicated and really smart EM faculty and residents in a really terrific city, where I enjoy living and spending time with my family. I have a mentor, a Medical School Dean, and my Masters program advisory faculty who really want to see my career progress. I can't imagine that anyone who does anything else for a living could be as happy as I am doing EM at LSU. I mean, my work is not work...it's a pleasure!

I'm living my dream.

Wow, Lisa. You are indeed living the dream. You are the epitome of a classy academician. Keep up the great work.

Sneak Peak: CDEM e-Advisor Program almost ready

The Clerkship Directors in Emergency Medicine (CDEM) group is about ready to officially launch the e-Advisor Program!

The e-Advisor program will be replacing the successful but unfortunately retired SAEM Virtual Advisor Program. The first phase of the program is to target medical schools, which do not have a home Emergency Medicine (EM) residency program. Students from such medical schools are traditionally thought to be at a slight disadvantage compared to students from other schools, because they do not have easy access to EM faculty who are intimately involved with the residency application, screening, interview, and rank-listing processes.


Each school will have a team of 2-5 geographically diverse CDEM faculty advisors who will be available to advise students potentially interested in EM. Students can think of them as their own personal "A-Team" (remember that great TV series?). They can help students figure out such questions as:

• How many residency programs should I apply for?
• How competitive am I, given my CV and application?
• Who should I get letters of recommendations from and what's a SLOR?
• How should I plan my 4th year?
• What is interview season like?
  

Here's a sneak peak at the first 10 medical schools, which were selected for the e-Advisor Program. The Emergency Medicine Interest Groups (EMIGs) from these schools have all expressed interest in being part of the pilot group.

• Baylor College of Medicine (Houston, TX)
  
• Dartmouth School of Medicine (Hanover, NH)
  
• Meharry Medical College (Nashville, TN)
  
• Rush Medical College (Chicago, IL)
• Sanford School of Medicine of Univ of South Dakota (Vermillion, SD)
  
• Touro University College of Osteopathic Medicine (New York, NY)
• Tufts University School of Medicine (Boston, MA)
• University of Miami School of Medicine (Miami, FL)
  
• University of Missouri School of Medicine (Columbia, MO)
• University of Vermont College of Medicine (Burlington, VT)
  

Phase 2 will provide e-Advisors to another 10 medical schools. This time, schools with or without home EM residency programs, will be eligible. Medical schools will be chosen based on those who request the CDEM e-Advisor service. For those schools with residency EM programs, out-of-state e-Advisors will be provided.

Kudos to Dr. Megan Fix (Maine Medical Center), who has been leading the charge to make the CDEM e-Advisor Program a reality.

Questions: Would you like for us to consider your medical school as part of Phase 2 of the e-Advisor program? If so, email me at Michelle.Lin@emergency.ucsf.edu.

USC 2008 medical student symposium videos

Over the years of advising medical students interested in Emergency Medicine as a career choice, I often point them to the SAEM website where there are many practical tips and FAQs written by EM faculty across the country. Recently, I discovered that the University of Southern California EM Medical Student Symposium from 2008 was videotaped and posted online. These free video clips are a great resource for those of you advising medical students.

Go to USC's EM Core Content website.

Finding the videos
Under the Conferences menu (blue bar in the upper right), select "USC EM Medical Student Symposium". There are 10 free lectures:

Introductions (Dr. Jorge Fernandez)
ACEP and AAEM (Dr. Billy Mallon, Dr. Stu Swadron)
Career Paths in EM (Dr. Scott Votey)
Careers in EM (Dr. Mark Morocco)
Choosing a Residency (Dr. Stu Swadron)
Optimizing Your Fourth Year (Dr. Michelle Lin)
Matching Your Strengths to a Program (Dr. Dustin Smith)
Toxicology Review (Dr. Aaron Schneir)
Ultrasound Review (Dr. Rusty Oshita)
History of EM (Dr. Mel Herbert)

Humorous distillation of specialty personalities

If only I had this flowchart when I was a first-year medical student! I too have always felt that emergency physicians have a little baseline crazy in them to be happy and successful in the specialty.

This diagram has been floating around the web for years now, and I wanted to share with you. It's a humorous (partly because there's some truth to it) decision tree on how to choose your medical specialty. Did you decide upon the right field?

I use this in some of my medical school/ EM Interest Group talks just to break the ice. We talk about stereotypes and how you don't necessary have to fit into them. For instance, I'd rather be a couch potato than scale mountains and swim with sharks. Feel free to use, if you advise medical students!

Everyone needs an advisor / mentor

Do you remember in college or medical school when you had to identify an advisor or mentor? It's hard, but finding a great advisor/mentor is the key to success.

Throughout residency and at the General, I've been lucky to have several. I came upon them by being at the right place at the right time. I randomly joined a medical education research project with Dr. Wendy Coates (Harbor-UCLA), and she got me immediately involved with SAEM. Little did I know that she's such a powerhouse and recognized name in EM education. She still has nuggets of wisdom to share with me to this day.

At the General, I've been lucky to have Dr. Ron Dieckmann, guru of pediatric EM, as my mentor. I've learned from him --

* You have to think big
* Surround yourself with great people, because you can't help but be successful around them.

His little office project, now called PEMSoft, quickly became an internationally-known decision support software for pediatric care. Now that he's retiring in July, it will be hard to keep up with all his big plans for our nonprofit organization, KidsCareEverywhere. His plan in a nutshell - world domination. See the logo? It's crazy- I came up with the preliminary idea on the back of a grocery receipt while cooking dinner one night.

In the hopes of improving advising for medical students interested in EM as a career choice, I have been working on behalf of CDEM (Clerkship Directors in EM) to revamp the now-defunct Virtual Advisors Program. I fully confess that I have been holding it hostage for a year, since I never quite built enough momentum to complete the project. It will be called E-Advisors. And yes, I know that it sounds a little too much like an online dating service.

I spoke today with an awesome EM clerkship director at Maine Medical Center, Dr. Megan Fix, who will be taking over and running with this project. I'm fully confident that with all her enthusiasm, we can resurrect the E-Advisor program from the dead. This will start by focusing on advising students from 10 pilot medical schools, which currently do not have a home EM residency program. There are interested medical students in need of advisors and CDEM faculty willing to advise. We just have to build that bridge.

Question to You: What's the best piece of advice that you've gotten from your mentor?