Should mentoring be mandatory for trainees? No

There are many potential advantages of being involved in mentoring relationships. Reported benefits for those who have had an effective mentor include increased confidence and leadership skills, personal and professional development, opportunities to develop networks and work through issues in a non-threatening environment. There are also said to be many benefits for mentors, and for organisations that have effective mentoring programmes. There is certainly an appetite for mentoring, and arguably a need. A recent ACEM report highlighted many respondents’ support for mentoring programmes and networks. This survey, and a recent New Zealand survey by the union for senior medical staff reported a large degree of burnout. Mentoring may help address this. But this discussion is not about mentoring per se, it is about the role of mandatory mentoring. Although I believe that mentoring can be a very good thing, and believe we should have quality mentoring available to all staff, I do not believe that mandatory mentoring is a good idea. Is there anything more likely to induce the larrikin ANZAC ‘yeah right’ reflex in us than being told that we must do something? If the compeller is our spouse or significant other, the resistance will hopefully be short-lived, given under the breath. If it is the government, or worse, management, the abreaction can last years, fill entire departmental meeting agendas, even stimulate whole new genres of comedy. If it is ACEM, the reaction is likely to be somewhere between these two extremes. Being told by ACEM that we have to be involved with mandatory anything, including mentoring, is likely to upset a lot of diggers in ED trenches and battle zones across Australasia. We respect our patient’s autonomy to make informed decisions, why not our own autonomy, and that of our colleagues’? Mentoring is surely about empowering mentees and supporting them to safely explore topics that are important to them. An authoritarian climate of compulsion to partake in mentoring programmes is hardly conducive to these themes of empowering and supporting mentees. In contrast, while some antiauthoritarianism is to be tolerated, even applauded, some things that may not appeal are important to do. We sometimes have to put up with things we would rather not, for the good of ourselves, our colleagues, our department and our patients. So how do we decide whether mentoring should be mandatory? We need to know the likely cost, the evidentiary benefits and whether these balance towards the side of mentoring. If the benefits overwhelm the costs (beneficence, non-maleficence), and override the myriad competing demands on our limited resources (justice), then the case may be strong for mandatory mentoring. When evaluating any intervention, as scientists we like to refer to the ‘evidence’. Whatever your definition of science, the evidence for compulsory mentoring in Australasian emergency medicine is far from compelling. In preparation for a survey on local mentoring needs we conducted a literature review of mentoring in emergency medicine. We found essentially no empirical evidence to support mentoring in our setting. However, as clinicians we recognise that a lack of empirical evidence does not equate to a lack of benefit, nor discredit the need for something. Additional dilemmas evolve when considering the financial implications of instituting a mentoring programme with sufficient capacity to cater for all trainees. Such a programme would need to be costeffective and therefore able to demonstrate quantifiable outcomes. The qualitative and subjective nature of mentoring makes this a significant challenge. Furthermore, can we justify imposing extra demands on already stretched FACEMs by requiring them to be mentors? Mandatory programmes will not confer mandatory engagement, which is likely to result in disgruntled and counterproductive ‘mentoring’ relationships. The will and enthusiasm has to be voluntary for such a relationship to thrive. Options for data gathering among mentoring programmes do exist and will surely evolve, yet as clinicians trained to use quantitative methods, qualitative data can leave us wanting for evidenced-based information on which to change our practice. Professional satisfaction, personal wellbeing, workplace stress and resilience, meaningful employment and healthy workplace environments are all themes that are probably more meaningfully studied by employing qualitative research methods. These issues are heavily interlinked with career progress and longevity, hence should be explored in a mentoring setting. Correspondence: Dr Gordon Michael (Mike) Nicholls, Emergency Department, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand. Email: mnicholls@adhb.govt. nz