The RCOG does not provide a mentorship scheme. Doctors are advised to contact their Clinical Director or their Regional College Advisor for further information and/or support.
Nancy Redfern - Specialty Dean Director, Northern Deanery
This paper will review some of the reasons why doctors can find themselves in difficulty, and outline some observations from the NCAA and Deaneries about the problems that lead to doctors being reviewed, or seeming to 'fail'. Using this as background, some of the challenges these may present to a mentor and to a mentoring system will be presented. The speaker will also share some examples of the sorts of issues that mentees in such circumstances might wish to discuss.
What sort of difficulties do doctors find themselves in?
There are a host of reasons that may make a doctor in difficulty seek a mentor. Some identify the value of mentoring for themselves, whereas others may be encouraged to explore the possibility of using a mentor by someone in authority. For doctors in training this may happen when they 'fail' an assessment (e.g. examination or 'RITA' annual review) or their trainer or programme director considers that they have difficulties. These are sometimes personal or health problems. Independent practitioners may find themselves the subject of a National Clinical Assessment Authority (NCAA) review or a GMC assessment, or their behaviour or performance may have come to the attention of their Medical Director. Doctors may seek a mentor themselves to discuss issues such as work/life balance, career choice, difficult working relationships, or how best to manage Ill health or a personal crisis
What sorts of behaviours do the NCAA and Deaneries observe in doctors who get into difficulty?
Clinical concerns are more likely to lead to a full NCAA assessment. However, the NCAA and Deaneries have identified a number of patterns of behaviour, which may underlie the reported clinical problem. Issues identified often relate to leadership, team working and communication or decision-making.
Leadership and teamwork
Inconsistent leadership behaviour can leave colleagues feeling nervous and confused.A number are described as lacking self-awareness, not realising the impact they have on people. Others appear to be defensive, and not open to self-reflection or feedback. They may interpret negative feedback as personal rejection. Doctors who find it hard to be assertive can have difficulty in influencing or negotiating. Those who seem unconventional, with a love of new ideas, can be difficult to work with and are described as easily distracted and lacking in self-discipline.
Decision-making
Some appear to have very high and uncompromising standards, and put pressure on others and themselves to achieve these. If accompanied by an antagonistic style, this can be reported as bullying. Others are reported as inflexible when faced with uncertainty, and have difficulty recognising when corners must be cut. They may be cautious decision-makers, so anxious to avoid mistakes that they over-investigate, or have difficulty in prioritising.
Personal stress and organisation
Personal stress and poor personal organisation can result from difficulties in coping with a lack of structure and order in the work environment, or from being anxious to please and taking on too much. Some who are altruistic and trusting can feel let down and resentful of the system or colleagues.
Despite all these problems, the NCAA describes those assessed as highly motivated. They often struggle to understand what to do to improve, and are not helped by the fact that colleagues often isolate the individual. Indeed the NCAA indicates that there is need for recognition and inclusion in this group of doctors.
What challenges might these present for a mentor?
If a doctor has been advised to use a mentor, and 'referred' to the mentoring scheme, he or she may already be suspicious, regarding the mentor as likely to be an 'authority figure'. Beginning a mentoring relationship under such circumstances can be challenging, and careful thought is needed about how best to make contact and what to do if the person does not respond. My own experience is that many have a preconceived idea that mentorship involves giving unwelcome advice, rather than being an opportunity to deepen understanding of the situation and explore ways in which matters might be improved. A brief note explaining what a mentor would aim to do, indicating that there is a choice of mentor and offering to meet and have a first go at talking things through, sometimes break the ice. If this is successful, then the doctor many continue with the same mentor or prefer to move to someone he or she thinks might be more appropriate.
The pace of the mentoring process can be much slower when talking with doctors who are already in difficulties. People need time to build up trust and to tell their story. The mentor may spend a long time listening and reflecting, acting only as a sounding board. Some feel overwhelmed and find it hard to focus, and need the space to re-tell their story several times before being able to move on. It may take 3 — 6 sessions for the mentee to develop their understanding of the present situation.
Doctors who have found themselves in difficulty are often not used to talking about themselves and their difficulties, and feel that they have been isolated and not listened to by their colleagues. They can be very wary of sharing what really went on, or how they really feel. Some might be very emotional at first; others might find the emotion hard to express. They are often less skilled at realising the impact they have on others, and find reflective practice and realistic goal setting
A doctor in difficulty may feel very deep personal hurt at the way he or she has been treated. A challenge for the mentor in this circumstance is to get the balance between exploring and acknowledging feelings, and helping the mentee to find a positive way forward. Some find it hard to acknowledge their own feelings, something they feel medicine has not allowed them to do. It is important that the mentor gives them the affirmation that it is appropriate to be angry and upset while not leaving them in a morass of negative emotion.
Some have coped for years by placing blame on circumstances or on others. They may not be ready to acknowledge their own part in events and address their weaknesses, and may be described by others as 'lacking honesty'. Again, they may need several sessions to tell their story, to recognise their own emotions and behaviour. Getting the balance between remaining empathic but helping them recognise their own part in a situation can be challenging for the mentor. A good deal of energy might be needed to provide the mentee with enough support and affirmation to empower them with the bravery to change, and to be there if things don't go well. This can be difficult and complex work. A mentee, who is looking for a 'quick fix', may want to give up. The mentor is not there to push the mentee further than he or she wants to go, and it can be difficult to get the balance between respecting the mentee's position, and empathically challenging what might be a coping strategy. Having access to or knowledge of how to refer to therapeutic forms of help, such as counselling, cognitive behavioural or other psychotherapy is useful.
Doctors who make the decision to seek out a mentor may be nervous, but are less often hostile. They may feel very stuck with their situation and take time to identify the key issues. Some are overwhelmed by the enormity of what they face, and can't find an appropriate first step. Some are disempowered, and have been behaving as the victim rather than taking action. Even with the mentor, they may be apologetic of taking time. The mentor may spend several sessions listening summarising and reflecting feelings, before the mentee starts to have the confidence to believe there might be a way forward. Sometimes a mentee will ask what the mentor would do, wanting to hear someone else's solution to their problem. The mentor might be much more able to take action than the 'stuck, disempowered' mentee. Although offering a suggestion might seem kind, it can leave the mentee feeling even more less effective.
Facing illness, particularly stress related or psychological illness can be very challenging to doctors. Some have personal difficulties in accepting they might be ill (often psychological/stress related illness), perhaps because their core values are about caring for others, or because taking time away from work will place more stress on their already overstretched colleagues. Others are afraid of taking action because of worries about what others will think. It is important that such people get treatment for their illness and have the opportunity to review their situation with a Consultant Occupational Physician. Mentoring may be of more value in helping with a return to work, or reaching a decision to seek treatment, than during the illness itself. For some with longer-term illness, mentorship can be a useful way for the mentee to learn more about triggers for illness, and about how to manage the natural curiosity of others.
Conclusions
Working with doctors and dentists in difficulty as a mentor is challenging, and time- consuming work. It can also be very rewarding. Over time, nearly all of those who are motivated and robust enough to address their difficulties, do find an appropriate way back.
Challenges faced by mentees in difficulty
- suspicious of mentor 'authority figure'
- not used to talking about difficulties, or being listened to find it hard to focus
- find it hard to acknowledge own feelings
- place blame on circumstances or on others
- not ready to address their weaknesses
- want a 'quick fix' - may give up easily
- disempowered, overwhelmed
- feel personally hurt or undervalued (MBTI 'thinkers and feelers')
What challenges might these present for a mentor
Suspicious of mentor 'authority figure'
Challenge for mentor
- Making contact, explaining what mentoring is, agreeing who would be 'the right mentor'?
- Consider that 'authority' has not managed them well
- may not understand the impact of their own behaviour
- may have unrealistic expectations
- may lack 'self-awareness or self-control'
- may not understand/empathise with manager's responsibilities
- may feel great personal hurt
- may be working in isolation, or in dysfunctional teams
Not used to talking about difficulties, or being listened to
Find it hard to focus
Challenge for mentor
- May spend a long time listening and reflecting, as a sounding board
Find it hard to acknowledge own feelings
Challenge for mentor
- Giving them the affirmation that it's OK to be angry/upset etc
Not ready to address their weaknesses
Place blame on circumstances or on others
Challenge for mentor
- Giving enough time to tell their story. Getting the balance between remaining empathic and helping them recognise their own part in a situation. Providing enough support and affirmation to give them the bravery to change. Being there if things don't go well.