Μένος: Power, life force, and purpose in mentoring
Authors: Kathleen E. Sullivan
Journal: Journal of Allergy and Clinical Immunology (2021)

In Greek mythology, Athena, as Mentor, gives μένος [menos] to Telemachus to inspire him to greatness. The Journal of Allergy and Clinical Immunology has instituted an editorial series on the topic of mentoring. I am honored to be the fourth writer in the series, following Drs Busse, Metcalf, and Austin, with an additional important Paradigms and Perspectives article focusing on the fellow perspective.1Busse W.W. Mentoring: a lifetime cycle and key to successful career development.J Allergy Clin Immunol. 2021; 147: 1634-1637Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 2Akenroye A.T. Keet C.A. Mentoring into productivity during fellowship: a working tripartite model.J Allergy Clin Immunol. 2021; 147: 1627-1628Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 3Austen K.F. Mentoring: an art and a responsibility.J Allergy Clin Immunol. 2018; 141: 880-881Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 4Metcalfe D.D. A personal perspective on mentoring.J Allergy Clin Immunol. 2019; 143: 548-549Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar The stated goal of this series is to guide effective mentoring to encourage a thriving academic allergy immunology community. I concur with Dr Busse that mentoring and promoting allergy immunology begins in medical school, but I will restrict my comments to fellows and junior faculty.1Busse W.W. Mentoring: a lifetime cycle and key to successful career development.J Allergy Clin Immunol. 2021; 147: 1634-1637Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Fellows and junior faculty have different needs but are equally eager to receive menos. I hope to convey some different ideas and a plan for the future. I am not only honored to be asked but enormously impressed that the Journal of Allergy and Clinical Immunology has recognized the need to address mentoring substantively and is working to improve the current landscape. I think that everyone would agree that effective mentoring has had a significant impact on their own careers. Multiple studies have demonstrated the value of mentoring in career development and success in academia, and there are even abundant data on what constitutes an effective mentor. Compatibility with mentee, patience, generosity, and trustworthiness are often cited.5Holmes Jr., D.R. Warnes C.A. O'Gara P.T. Nishimura R.A. Effective attributes of mentoring in the current era.Circulation. 2018; 138: 455-457Crossref PubMed Scopus (4) Google Scholar Specific roles required of a mentor include networking, writing skills, data analytic skills, support for personal development, and life concerns. Not only is the road map relatively clear, but the special circumstances of women and minorities have been recognized. Yet, mentoring has been squeezed into one more box on the to-do list, losing the essence of an apprentice-mentee relationship. Allergy immunology certainly has unique aspects compared with some specialties, but the concern about how to best foster careers in academia is not unique to our specialty. We even have an abundance of patient, generous, and trustworthy mentors and work in a specialty that is currently saving the world. Our specialty is implementing ever more nuanced therapies for immunologically mediated diseases with profuse success stories. So where has the system faltered? I will first take exception to the idea that the central goal of mentoring in allergy immunology is to produce an academic physician-scientist. My goal as a mentor is to help people find and thrive in the career that fits them best. I hope to expose mentees to a range of options and provide insights into the less obvious aspects of each option so that they can make an informed decision. Mentoring should be a 2-way dialog respecting the values of the mentee. Today, there are so many ways to contribute to the community; a metric measuring mentors' accomplishments as a list of former trainees in academia sends a message we should rethink. Thus, my first wish for the future is to embrace a diversity of careers and advocate for recognition of mentoring success by adopting a broad definition, not limiting it to mentees with academic appointments. We can inculcate in our mentees the desire to ask big questions, to take actions large and small, and to improve the world by using a wide-angle lens, not the narrow lens of academic success (Table I).Table IFour action items for improved mentoringGoalOutcomeAction itemRespect for trainee career valuesDiverse career opportunities respectedChange the recognition of successful mentoring to embrace all career choices (AAAAI and advocacy at NIH)Fostering of intellectual growth through research and quality improvement projectsEngagement in asking big questionsCommunal opportunities to engage in research (AAAAI research bank)Recognition of the value of mentoringSufficient time for meaningful mentoringFinancial support for mentoring (AAAAI and advocacy at NIH)Multimodal training options to ensure breadth of trainingExposure to a variety of career guidance strategiesProvision of online material for on-demand guidance (AAAAI)NIH, National Institutes of Health. Open table in a new tab NIH, National Institutes of Health. Nevertheless, I am an academician (and proudly, happily so) and have some insight into issues that may be specifically driving the decline of enthusiasm for the academic career choice. Both Dr Metcalf and Dr Austin talked about the importance of a fellow research project that is successful but still challenging to nurture that wonderful sense of intellectual ownership. Interestingly, mastery and competence have been identified as a key features associated with protection from burnout.6Panagioti M. Panagopoulou E. Bower P. Lewith G. Kontopantelis E. Chew-Graham C. et al.Controlled interventions to reduce burnout in physicians: a systematic review and meta-analysis.JAMA Intern Med. 2017; 177: 195-205Crossref PubMed Scopus (518) Google Scholar It is of interest that coaching, a focused form of mentoring, has a high success rate in reducing burnout.7Gazelle G. Liebschutz J.M. Riess H. Physician burnout: coaching a way out.J Gen Intern Med. 2015; 30: 508-513Crossref PubMed Scopus (99) Google Scholar We must find a substantive way to grapple with burnout to preserve academia, but that topic deserves its own editorial. With the dwindling population of physician-scientists, there are limited opportunities for fellows to do bench research, translational research, big data analytics, and even large cohort studies. The fellow research options are often limited to a case series, a chart review, or a survey study. These have value and are not ineffective as a crystallizing focus for mentoring. Engaging fellows in the first year with a clinical article prepares them to consider larger questions during their research months. Ideally, the major research effort during fellowship inculcates the culture of asking important questions and thinking mechanistically (or causally in the case of quality improvement work). But there are additional factors on top of limited opportunities for a research project that "stretches" a fellow. Fellows are generally more comfortable in areas in which they have expertise already, which by definition is not fostering intellectual growth. Thus, there is comfort in a chart review because it feels like that which they have already mastered, but the opportunity for growth is limited. Part of mentoring is to foster intellectual courage. My second wish is to ensure that fellows are pushed to stretch themselves through research. This is meant not to limit people to bench research but rather to ensure that there are adequate opportunities to experience the tremendous sense of accomplishment when something difficult is overcome along with the intellectual ownership of designing and completing a study. The American Academy of Allergy, Asthma & Immunology (AAAAI) could serve a critical role in this regard by offering a bank of faculty and research options that could be completed long distance. The critical bottleneck for effective mentoring is not anything related to philosophy or talent; it is time. I have been blessed with outstanding mentors, quirky mentors, profoundly generous mentors, and a mentor who subscribed to Darwin's theory. I took something useful from all of them, but the unexpected mentors who shared lunch and wisdom with me, the mentors who gently took me aside to correct me, and the phenomenal role models I have had in this amazing specialty—they are memorable and valued precisely because they shared their time. Today, the practice of medicine feels like a race. The pressure to get the work done and get home is extraordinarily high. Some of this pressure is self-imposed by our own expectations and desires, but much is built into the health care system that rewards only revenue. When was the last time you had a social lunch on a work day? If your work is primarily research, time is even more pressed. I am not alone in despairing of the treadmill of grant submissions. If every day feels like a race, a faculty member is less predisposed to just stop and converse with a trainee or a second-year faculty member (who in some ways is the most at-risk). Those casual interactions were where I gained much insight when I was younger. If a time-pressed faculty member is trying to help a trainee through his or her first paper, they are more likely to just send back corrections rather than sit down and talk about writing practices. My secondary mentor spent a very valuable hour teaching me how to write leanly. He did not have to, but it surely made me a better writer. The casual interactions and the dedicated meetings to develop a fellow or young faculty member take desire and time. Our pandemic nerves, fraying and jangled, may not be able to absorb 1 more thing on our to-do list. Our trainees, also frayed and jangled, need us all the more. The end of the pandemic is not the destination that we once imagined. We are in our own long haul and must adapt and help young people who have had less opportunity to hone their coping skills to adapt in a way that is positive and thriving, not just surviving. Before the pandemic, the attrition rate for junior faculty was in the range of 40%. The many additional stresses of the pandemic will surely make that figure worse. All medical personnel have been stressed; however, fellows and junior faculty have had to traverse the rockiest waters. My third wish is that individual institutions free up support not just for training program directors but for all who dedicate significant time to mentoring. We need to commit not just words but actual financial support for mentoring to be valued and adequately resourced. The AAAAI can provide small grants to support mentoring effort, and the National Institutes of Health can rejuvenate their grant program to support mentoring. With support to back our stated goals, we can ensure a thriving specialty. This crazy unprecedented time is also an opportunity to rethink our mentoring strategies. We have never had to be more nimble and flexible. The personal one-on-one mentorship has to be the bedrock of mentoring, but we can nurture a more engaged community by harnessing the strengths of the AAAAI to innovate new approaches as a community. I have been privileged to learn the importance of case-based content mentoring by codirecting the Clinical Immunology Society's summer school in primary immunodeficiencies with Charlotte Cunningham-Rundles. This 2.5-day course brings together motivated fellows to talk about the very hardest cases. One of the most common comments from attendees is how liberating it was to learn that there is not always a single solution. The AAAAI has offered a similar allergy course in some years. By using the digital platforms that we have all had to embrace during the pandemic, these courses could be less expensive and reach far more fellows. I also mentor high school students and college students in summer programs designed for students from underserved areas to engage in science and medicine. These programs have taught me how important it is to have a structured program for trainees. Historically, fellows and junior faculty learned management, career development, and networking by close observation of their mentor. Today however, their mentors have administrative, patient care, and other responsibilities that can creep into that time. In this regard, the Leadership Institute could be reconfigured for fellows to watch critical presentations on key career skills. These efforts in no way marginalize the critical personal mentoring within each institution; they serve as a complementary approach and should spark additional conversations at each site. My fourth wish is to see the overall allergy immunology community strengthened and more engaged. The next generation will have diverse interests, career goals, and backgrounds. We should meet them where they are and respond with diverse mentoring options with substantial structured one-on-one mentoring, augmented by virtual opportunities encompassing burnout, innovation, business models, and specialized knowledge (Fig 1). Fellowship is all too brief, and it is a special time in so many ways. We cannot, as a community, squander our opportunities to support the next leaders. Committing to the changes needed to empower the next generation requires some advocacy and some new approaches that will be challenging—and some approaches that will be easy. Finding time to support fellows and junior faculty requires a commitment from all of us. We can all pledge to this important service. Even now, with exhaustion and burnout high, we can remember the meaningful mentoring that each of us experienced and pay it forward. Every AAAAI member has expertise, insights, and opportunities to share.