Framework for Mentorship of Spine Surgeons in Early Practice

Mentorship in surgical specialties has a long history that predates the modern medical era. Prior to the advent of formal medical training programs in the 1890s, surgeons who were not self-taught spent time as apprentices under an experienced surgeon. The first formal surgical fellowship program is attributed to Dr. William Stewart Halsted of Johns Hopkins Hospital. In 1889, Halsted introduced a residency training system that included a structured approach to surgical education, and that system evolved into what we recognize today as fellowship programs.[1]

Training programs foster an ideal environment for mentorship as residents and fellows typically spend several months with one or more senior surgeons in the office and in the operating room. The long hours spent in cases, teaching conferences, and seeing patients are inherently ripe for relationship building. Ironically, it is upon graduation, after many years of intensive training, that young surgeons find themselves more in need of mentorship than at any other point in their career.[2,3] As young surgeons enter independent practice, decision-making responsibility becomes all their own, without the safety net of a structured program. While newly minted spine surgeons may succeed without mentorship, the complex, high-risk nature of the field makes this challenging. Spine surgeons are frequently faced with clinical and non-clinical dilemmas they have not encountered during training. In many of these scenarios, textbooks and the literature do not provide clear guidance. Thus, quality mentorship can dramatically improve a young spine surgeon’s procedural comfort, complication management, and confidence during these formative years. In addition, mentors can offer valuable insights into the business and administrative aspects of running a practice, which often are not covered in formal training programs.

Responsibilities of Mentors and Mentees

Mentorship is distinct from serving as a role model. Many surgeons have role models after which they pattern their clinical and non-clinical professional endeavors. Relationships between young surgeons and a role model are typically passive and observational, whereas mentorship involves an active, two-way exchange of information. This requires both mentor and mentee to assume certain duties in order to maximize the value of the relationship.

The best mentors take an active interest in the personal and professional success of the mentee. Mentors should make an early effort to establish an open, honest line of communication with the mentee and to make their preferences about mode and timing of discussions clear. An aspiring mentee may be hesitant to pursue mentorship with accomplished senior surgeons whom they perceive to have little or no availability in their schedule. Mentors are encouraged to share their personal stories of development early in the relationship. This both sets the stage for transparent discussion and provides an opportunity for mentor and mentee to find common ground. Seeking out open-ended discussion about the mentee’s goals and challenges further enhances rapport.[4] Lastly, mentors should consider their proficiency in providing constructive feedback, as this is a critical component of professional development for mentees. Models that help facilitate this often-challenging responsibility have been well studied in medicine.[5]

Mentees also have obligations to ensure successful mentorship. Mentees benefit from being proactive in the process of seeking a mentor to ensure their values and personality type are a good fit. Ideally, mentees would seek out mentors with whom they share common clinical or research interests. Mentees should give careful thought as to what specific information or guidance they are seeking and be capable of communicating these needs clearly. Mentees must understand that desirable mentors typically have demanding schedules that must be planned well in advance. Along these lines, it is essential that mentees are reliable with regard to deadlines and attending planned meetings. Mentees must also seek and be receptive to constructive feedback in order to maximize their personal and professional growth.

Benefits of Mentorship

Mentorship in spine surgery provides significant benefits for both mentors and mentees. Mentees receive valuable career guidance and support while navigating the challenges of a demanding field. They gain access to the mentor's thought process in the face of clinical uncertainty, refine specialized surgical techniques, and gain business knowledge. Additionally, mentees may receive exposure to leadership positions in specialty societies and may be given opportunities to advance their academic career or become involved with industry.

For mentors, the experience of teaching and guiding younger surgeons brings personal fulfillment and satisfaction. Mentorship helps them keep up to date with the latest advancements, reinforces their own knowledge, and improves leadership and communication skills. By mentoring, they leave a lasting legacy, shaping the future standards of care in spine surgery. Mentorship also opens opportunities for collaborative

research, enhancing the mentor's impact on the field and contributing to the overall advancement of spine surgery practices.[6]

Finding Opportunities for Mentorship

Practical opportunities for mentorship in spine surgery are numerous and can range from a simple email thread for case discussion to participation in formal multicenter research study groups. In some practice environments, regular weekly collaboration in the operating room with a senior partner is the norm and can serve as a tremendous opportunity for professional development. Those without an opportunity to scrub with senior partners might seek out traveling fellowships or live case observation facilitated by industry, as most instructors involved in these programs are enthusiastic about teaching. The majority of spine specialty societies are eager to involve young surgeons in committee work, which is often led by senior surgeons with a proclivity toward mentorship. Alumni networks from residency or fellowship programs also serve as phenomenal resources for identifying mentors in practice. On a local level, hospital peer review or medical executive committee

involvement is likely to help young surgeons meet and interact with mentors in their communities. As social media’s role continues to grow in our profession, even online platforms such as LinkedIn can provide exposure to potential mentors that would otherwise not be possible.

Conclusion

Mentorship in spine surgery goes far beyond simply teaching surgical technique; it serves as a guide to the potentially turbulent transition to independent practice and helps mold high quality clinicians ready to meet the spine care needs of their community. Mentorship is a dynamic process that requires commitment and engagement by both parties. This exchange benefits the mentor, the mentee, and patients, ensuring that valuable knowledge is passed down and applied in new ways. Fortunately, ample and varied opportunities for mentorship exist on the local, national, and even international level for those willing to seek them out. As spine surgery continues to evolve in the context of a challenging healthcare landscape, mentorship of young surgeons will remain critical to the ongoing advancement of our field.

References

1. Kerr B, O’Leary JP. The training of the surgeon: Dr. Halsted’s greatest legacy. Am Surg. 1999;65:1101–1102.

2. Dvorak MF, Collins JB, Murnaghan L, et al. Confidence in spine training among senior neurosurgical and orthopedic residents. Spine (Phila Pa 1976). 2006;31:831–837.

3. Bateman AH, Larouche J, Goldstein CL, et al. The importance of determining trainee perspectives on procedural competencies during spine surgery clinical fellowship. Global Spine J. 2019;9(1):18–24.

4. Mulcahey MK, Waterman BR, Hart R, Daniels AH. The role of mentoring in the development of successful orthopaedic surgeons. J Am Acad Orthop Surg. 2018;26(13):463–471.

5. Sargeant J, Lockyer JM, Mann K, et al. The R2C2 model in residency education: how does it foster coaching and promote feedback use? Acad Med. 2018;93(7):1055–1063.

6. Sundar SJ, Whiting BB, Lubelski D, et al. Key factors for enhancing academic productivity and fostering mentorship in spine research: the Cleveland Clinic Center for Spine Health approach to sustaining success. Spine J. 2024;24:14–20.

Contributor:

Brandon Hirsch, MD

From DISC Sports and Spine Center in Newport Beach, California.