Views of Radiology Program Directors on the Role of Mentorship in the Training of Radiology Residents

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1 Health Care Policy and Quality Original Research Donovan Health Care Policy and Quality Original Research Andrea Donovan 1 Donovan A Keywords: mentoring, mentorship, professionalism, program directors, radiology education, radiology residents DOI: /AJR Received July 30, 2009; accepted after revision September 9, This study was supported by a grant from the Canadian Medical Association. 1 Department of Radiology, Sunnybrook Health Sciences Centre, Rm. AG 278, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada. Address correspondence to A. Donovan (andrea.donovan@sunnybrook.ca). AJR 2010; 194: X/10/ American Roentgen Ray Society Views of Radiology Program Directors on the Role of Mentorship in the Training of Radiology Residents OBJECTIVE. The successful mentoring of resident physicians has been linked to several beneficial outcomes for trainees including increased research productivity, improved career satisfaction, and retention in academics. Female residents may have greater difficulty establishing mentoring relationships than male residents. The purpose of this study was to assess the attitudes of radiology residency program directors toward the subject of mentorship, to determine the prevalence of formal mentoring programs, and to evaluate several issues specifically pertaining to the mentoring of female residents. MATERIALS AND METHODS. An anonymous, voluntary survey was sent to 156 members of the Association of Program Directors in Radiology. The survey assessed views on mentorship during residency training, the potential role of mentorship in resident career development, and the prevalence of mentorship programs in residency programs. Subanalyses evaluated survey responses according to program director sex. RESULTS. Seventy program directors (45%) responded to the survey. The majority of respondents (85%) agreed it is important for residents to have mentors, but only 52% thought that current residents had identified mentors. Compared with male program directors, female program directors differed in their views on the role of mentorship and of the importance of female resident access to female mentors. CONCLUSION. Program directors consider mentoring relationships to be an important resource for resident professional development and a potential resource to increase the proportion of residents pursuing academic careers and positions of leadership. Female residents may have specific mentoring needs that should be explored with further study. M entoring has an important role during the professional development of physicians and differs from role modeling and teaching. In a mentoring relationship, a more experienced individual (mentor) provides active one-on-one guidance and support to help a less experienced individual (mentee) enhance his or her professional development to achieve one or more career goals. Role modeling, unlike mentoring, is a passive process whereby an individual attempts to emulate his or her role model s desirable behaviors or qualities. Role models may or may not be aware of the effect their behavior has on others. In radiology, the mentoring of residents may lead to increased research productivity and the retention of outstanding graduates in academic radiology [1]. Many successfully mentored residents have received guidance with career development and have developed skills to function independently, reduce stress, and practice with greater confidence. Mentoring of junior faculty by senior radiologists has been suggested to be an important tool for maintaining the visibility and success of the profession [2]. There are several potential barriers to successful mentoring including increasing time demands related to clinical workload, lack of recognition for mentoring efforts, and lack of a working environment that fosters mentorship [1]. Furthermore, it may be more challenging for women in radiology to find mentors [3, 4]. These are important topics to explore to assist all radiology residents to maximize their professional potential [5]. Directors of radiology residency programs have an important role to create an environment that encourages the mentoring of residents [6]. Recently there has been increased interest in formal, structured mentoring programs whereby a resident is paired with a faculty mentor [7, 8]. The goals of the current study were to, first, assess the radiology program directors attitudes toward mentoring in residency; second, 704 AJR:194, March 2010

2 determine the prevalence of formal mentoring of categoric data. A p value of < 0.05 was considered statistically significant for all analyses. portant (26.9%) or very important role (26.9%) programs in radiology residency training programs; and, third, evaluate specific issues pertaining to mentoring female residents. Materials and Methods Institutional review board approval was granted for this retrospective HIPAA-compliant study. After extensive review of the mentoring literature, a questionnaire was designed to determine the views of program directors about the role of mentorship and the prevalence of mentorship programs in radiology residency training programs in the United States. An anonymous and voluntary survey was ed to 156 radiology program directors with membership in the Association of Program Directors in Radiology (APDR). The survey was performed via an online survey ( com). Program directors were ed an additional reminder 1 month after the initial . In this study, a mentor was defined as a faculty radiologist who takes an interest in a radiology resident s career development and provides support and guidance to help the resident achieve one or more set goals. A mentorship program was defined as a formal (resident assigned to a faculty mentor) or informal (resident selects a faculty mentor) program in the radiology residency training program that provided opportunities for residents to establish resident faculty mentoring relationships. The survey collected basic demographic information about program directors including sex, age, years of practice, and years as a program director. Program directors were surveyed about whether mentorship played a role in their careers and whether they participated in a mentorship program during their training. Program directors were asked to indicate their views regarding the potential of a mentorship program to increase the proportion of graduating residents pursuing academic careers as well as leadership positions in radiology. Specific details pertaining to the residency program included the number of residents in the program, sex distribution among residents, and the presence and duration of any mentorship program that existed at the program director s institution. In addition, program directors were asked to rank a series of statements pertaining to mentorship using a 5-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). These statements included their opinions about the importance of having mentors for residents during residency, whether current residents had identified mentors, and the need for more structured mentorship in their radiology residency program. The scores from all program directors responses were averaged to produce a mean score. Details about the survey components are provided in the Results section. Statistical analysis was performed using SAS software (version 8.2, SAS Institute). Chi-square and Fisher s exact tests were used for the analysis Results Demographics of Surveyed Program Directors and Residency Programs Seventy of the 156 surveyed radiology residency program directors completed the online survey for a response rate of 45%. The demographics of the respondents are presented in Table 1. Fortyone of the program directors were male (59%) and 29 were female (41%). Respondents were in practice for varying lengths of time, with the largest proportion practicing radiology for years. The median number of years serving as a program director was 5 years. Residency programs varied in size, with a median number of 22 residents per program. In the majority of surveyed programs (87%), male radiology residents outnumbered female residents (Table 1). Role of Mentoring in Program Directors Career Development The majority of the surveyed radiology program directors indicated that mentorship had an important role in their career development (Table 2). Specifically, 53.8% of respondents stated that mentorship played a somewhat im- TABLE 1: Demographic Data on Radiology Program Directors and Residency Programs Sex Demographic Factor No. % Male Female Years in practice < > Years as program director < > No. of radiology residents < > Proportion of female radiology residents in training program in their career development. Only six program directors (8.6%) had participated in a mentorship program during their residency training. Of these six respondents, two stated that mentorship played a very important role in their career development and four indicated that mentorship had a somewhat important role. Role of Mentoring on Resident Career Choices It has been suggested that the successful mentoring of radiology residents has the potential to increase recruitment of residents to careers in academic radiology and to encourage them to pursue leadership roles in the radiology community [1, 9]. In this survey, 50 program directors (71.4%) indicated they would like to see more of their residents pursue academic radiology tracks (Table 2). A majority of program directors (60%) stated they would like to see more residents assume leadership roles in radiology. Forty-seven respondents (67.1%) indicated they would like to see more of their female residents pursue academic positions. A majority of respondents (83.6%) agreed that a mentorship program had the potential to increase the number of residents pursuing academic careers or positions of leadership (Table 2). < 25% % Approximately 50% % > 75% Note All respondents did not answer all the questions, so fewer than 70 responses are available for some questions. AJR:194, March

3 Donovan Program Directors Views on Mentorship A 5-point Likert scale was used to evaluate program directors opinions about mentoring issues in general as well as opinions pertaining to their radiology training program (Table 3). The majority of program directors (85%) agreed or strongly agreed that it is important for residents to have mentors. However, only one half of program directors (51.5%) agreed or strongly agreed that many of their current radiology residents had identified a mentor. Although 58.7% of program directors agreed or strongly agreed that they (58.7%) or their colleagues (65.2%) currently acted as a mentor to one or more residents, 41.5% of program directors agreed or strongly agreed that there is a need for a more structured mentorship program in their residency program. Mentoring Issues Pertaining to Female Radiologists Currently, approximately 22% of radiology residents in the United States are female [10]. In a previous study, the availability of mentors was of greater concern to female residents than to male residents [11]. Evaluation of differences in the views of male and female program directors may offer insight into specific mentoring issues pertaining to female residents. A subanalysis of program director survey responses showed that male and female program directors had significantly different opinions on three survey questions. First, a greater proportion of female program directors indicated that mentorship played an important or very important role in their careers (68% female, 35% male; p = 0.04). Second, a greater proportion of female program directors agreed or strongly agreed with the statement that it is important for residents to have mentors (97% female, 76% male; p = 0.005). Third, a greater proportion of female program directors than male program directors agreed or strongly agreed that it was important for female radiology residents to have access to female mentors (69% female, 44% male; p = 0.01). Characteristics of Established Mentorship Programs in Radiology Residency Program directors were surveyed whether their residency program currently had a mentorship program (Table 4). Forty respondents (57%) had a mentorship program for residents at their TABLE 2: Program Directors Previous Mentoring Experience and Views on Potential Benefits of Mentoring for Residents Survey Question No. % What role did mentorship play in your own career development? Not a very important role Somewhat important role Very important role Did you participate in a mentorship program during your residency? Yes No Would you like to see more of your residents pursue academic radiology careers? Yes No female residents pursue academic positions? Yes No residents pursue leadership positions in radiology? Yes No Do you think that a mentorship program has the potential to increase the number of residents pursuing above careers? Yes No Note All respondents did not answer all the questions, so fewer than 70 responses are available for some questions. institution. Among those programs with a mentorship program, there were similar numbers having programs whereby residents were assigned to faculty mentors and programs whereby residents were encouraged to choose their faculty mentors (Table 4). Regardless of the method of mentor mentee pairing, most mentorship programs were newly established within the previous 5 years (62.5%). Discussion Radiology residency training provides residents with many experiences that can influence their career choices, their attitude toward balancing work and personal life, and their interest in research and teaching [2]. Mentoring has been shown to reduce resident stress, ease career decision making, and increase retention in academics [12]. For radiology faculty who serve as mentors, the benefits of seeing a resident succeed are frequently cited as the main reason for initially accepting the responsibility to mentor and in some cases for deciding to practice in an academic setting in the first place (Collins J, presented at the 2009 annual meeting of the Association of University Radiologists). During the President s Address at the 2006 annual meeting of the Radiological Society of North America, mentorship was highlighted as a strategy to promote the highest professional standards of residents in radiology departments [13]. The training environment of radiology residents is greatly influenced by the residency program director [6, 7]. In this study, the majority of surveyed radiology program directors placed great importance on the role of mentorship during residency. Many program directors agreed that effective mentorship had the potential to increase the number of residents pursuing academic career tracks and positions of leadership. These data support previous studies from other medical specialties suggesting that mentorship may increase resident retention in academic medicine [12]. It may be important to involve residents in a mentoring relationship early in their training. This may increase interest in many aspects of academic radiology, including fostering interest to pursue research during residency [1, 14]. Mentorship may also help residents broaden their communication and teaching skills [15]. Radiology residents likely consider it to be their responsibility to find mentors rather than the responsibility of their faculty. The majority (52%) of surveyed program directors indicated that their residents sought mentors on their own in the residency program. Frequently, program directors take on a mentoring role to as- 706 AJR:194, March 2010

4 TABLE 3: Program Directors Views on Mentorship General views on mentorship Survey Statement sist residents with professional development. Indeed, 59% of program directors in this study indicated that they serve as mentors to one or more of their residents. However, there are potential barriers that prevent some residents from receiving mentoring from a program director [1]. For example, residents may not be comfortable to freely discuss concerns and career dilemmas with the program director. Other commonly cited barriers to residents finding a mentor include the fear of approaching someone and the feeling that there is no one they can trust [16]. Thus, it may be advantageous to delegate mentoring roles to other faculty members. The choice of mentor is extremely important because not all faculty members may be good mentors. Specific skills and attributes may make someone a good mentor. Indeed, only 27% of surveyed program directors thought that any one of their colleagues would have the skills to be a good mentor. Program directors may be able to identify good faculty mentors in the department and encourage them to take on mentorship roles. Many professionals believe that informal mentoring relationships whereby a resident voluntarily searches for a faculty mentor are more effective than mentoring relationships in which a resident is assigned a mentor [17]. However, the rise in formal (assigned) mentoring programs in radiology training programs may be borne out of a need to create definable and readily measurable mentoring resources for residents. Academic institutions call on program directors to promote mentoring and, in this regard, a formal mentoring program may be easier to operate and to measure success than an informal one. Formal mentoring programs may help overcome many of the barriers to mentorship discussed earlier. Therefore, many program directors may work to establish a formal mentorship program despite holding the view that informal programs are superior. Formal mentorship programs are increasing in number in training programs [18]. In this study, 50% of the established mentorship programs used a formal method of assigning a resident to a faculty mentor. Further research is needed to establish the specific merits of formal and informal mentoring in radiology. Assigned, or formal, mentorship may serve as the first step in promoting mentorship. Certainly, it is challenging to encourage spontaneous mentoring in residency training programs when knowledge among residents and faculty about mentoring in general is limited. Initially organizing a formal mentorship program may be more feasible to generate a supportive mentoring environment. Informal mentoring relationships may follow. In addition to the barriers to mentoring discussed, female radiology residents may have more difficulty than male residents in finding mentors [19]. In general, female physicians report having less beneficial mentoring relationships than male physicians [20]. In addition, the availability of mentors has been reported as being of greater concern to female than male residents [11]. Lack of effective mentorship has been consistently identified as one of the top reasons hindering career progress in medicine [20 22]. Compared with female physicians in other specialties, female radiologists report less career satisfaction and less work control and are more likely to feel overworked [4]. Several authors have suggested that female radiology residents and junior faculty may benefit from female mentors [5, 23]. In this study, the opinions of female and male program directors about mentorship differed TABLE 4: Radiology Residency Mentorship Program Characteristics Program Characteristic No. % Total no. of radiology residency mentorship programs Method of resident faculty pairing Resident assigned to a faculty mentor Resident selects a faculty mentor Duration of mentorship program No. (%) of Respondents Strongly Disagree Disagree Neutral Agree Strongly Agree It is important for residents to have mentors during residency 0 (0) 0 (0) 10 (14.9) 36 (53.7) 21 (31.3) 4.2 It would be important for female residents to have access to female mentors 0 (0) 10 (15.2) 19 (28.8) 32 (48.5) 5 (7.6) 3.8 Mentorship plays a more important role in early stages of residency training 4 (6.2) 21 (32.3) 22 (33.8) 17 (26.2) 1 (1.5) 2.9 Any of my colleagues would be a good mentor 10 (15.9) 26 (41.3) 10 (15.9) 16 (25.4) 1 (1.6) 2.6 Mentorship program may be used to a resident s or mentor s personal gain 8 (12.3) 35 (53.8) 19 (29.2) 3 (4.6) 0 (0) 2.1 Views on mentorship in current program I currently act as a mentor to one or more residents 2 (3.2) 11 (17.5) 13 (20.6) 21 (33.3) 16 (25.4) 3.6 Many of our current residents have identified mentors 3 (4.5) 16 (24.2) 13 (19.7) 22 (33.3) 12 (18.2) 3.4 Many of our current faculty act as a mentor to one or more residents 1 (1.5) 10 (15.2) 12 (18.2) 31 (47.0) 12 (18.2) 3.6 I believe our residents would be interested in a mentorship program 0 (0) 4 (6.3) 23 (36.5) 32 (50.8) 4 (6.3) 3.5 There is a need for more structured mentorship in our program 1 (1.5) 12 (18.5) 25 (38.5) 21 (32.3) 6 (9.2) 3.3 Note All respondents did not answer all the questions, so fewer than 70 responses are available for some questions. a Responses were made on a 5-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree. < 5 y y > 10 y Mean Score a AJR:194, March

5 Donovan significantly. A greater proportion of female program directors thought that mentorship played an important role in their careers, that it is important for residents to have mentors, and that it is important for female residents to have female mentors. Currently, nearly one third of radiologists in the United States are women, with an increasing proportion of female radiologists pursuing academic positions [4]. Residency programs and academic departments should continue to explore ways to help female residents develop beneficial mentoring relationships. There is a need to develop new mentoring strategies in radiology. Although 57% of surveyed program directors had a mentorship program in place, 42% of program directors agreed or strongly agreed that a more structured mentorship program in their residency program may be needed. Creating an environment that encourages mentorship initially may stem from a program director s efforts, but productive mentoring will likely flourish if similar views about the benefits of mentoring are shared by all members of the radiology department. Similar to teaching, mentorship is frequently undervalued. One strategy to increase awareness about the importance and value of mentoring would be for radiology programs to recognize and award outstanding faculty mentors in a manner that is similar to, yet separate from, the method used to recognize outstanding faculty teachers. There are several limitations to this study. First, there is a potential response bias from those program directors with an interest in mentorship, potentially overestimating the importance program directors place on the role of mentorship during radiology residency training. Second, only program directors with membership in the APDR were surveyed. It would be beneficial to determine how mentoring influences the decision to pursue community-based radiology practice in addition to academic radiology. The role of mentorship may differ in these two practice settings. Third, the purpose of the survey was to evaluate the prevalence of mentorship programs. It did not capture the full spectrum of informal, spontaneous mentorship relationships that currently exist between residents and radiology faculty. Finally, the term mentorship was used throughout the survey without a distinction between true mentorship and role modeling. This omission may have resulted in a falsely high prevalence of mentorship in cases in which role modeling, rather than mentoring, was taking place. Evaluation of the current state of mentoring in radiology residencies and of program directors views about mentorship is important to develop strategies to increase opportunities for mentorship in the future. In conclusion, program directors view mentorship as an important resource for resident professional development and as a potential resource to increase the proportion of residents pursuing academic careers and positions of leadership. Many residency programs have established mentorship programs for their residents. There is an expressed need for additional mentoring strategies in radiology. Promoting an environment that encourages mentorship may be an important first step to increasing faculty resident mentoring in radiology residency programs. Mentoring issues are extremely important to continue to study to help all residents maximize their professional potential. Acknowledgment The author would like to thank Marko Katic, biostatistician with the Institute for Clinical Evaluative Sciences, Toronto, for assistance with data analysis. References 1. Mainiero MB. Mentoring radiology residents: why, who, when, and how. J Am Coll Radiol 2007; 4: Barr LL, Shaffer K, Valley K, Hillman BJ. 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