Table of Contents  
Year : 2019  |  Volume : 6  |  Issue : 2  |  Page : 63-64

Paradigm shift in mentoring

Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat, Oman

Date of Web Publication6-Jun-2019

Correspondence Address:
Edwin Stephen
Department of Vascular Surgery, Sultan Qaboos University Hospital, Muscat
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijves.ijves_26_19

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How to cite this article:
Stephen E. Paradigm shift in mentoring. Indian J Vasc Endovasc Surg 2019;6:63-4

How to cite this URL:
Stephen E. Paradigm shift in mentoring. Indian J Vasc Endovasc Surg [serial online] 2019 [cited 2022 Aug 16];6:63-4. Available from:

  Introduction Top

Sportspersons have been known to be mentored and later become coaches for several years. The aim is to enable an individual or a team to improve on their potential and therefore achieve better results.

Over the recent past, there have been discussions, publications, and lectures available online that encourage surgeons to change the way that they mentor and more so the need to be coached and achieve one's true potential.

The role of mentors has been seen in Indian and Greek history, with the word “Mentor” being taken from a Greek myth, where the character of Mentor took under his wing Telemachus, while his father Odysseus was away. Indian mythology too has stories of princess being left in “Gurukuls” to be imparted education, skills of battle, and general principles of being a good administrator and human being.

In the surgical world, mentoring began as “apprenticeship,” whereas surgeon in training was under the watchful eye of the master. It was he who decided when a trainee would be ready to be certified to practice. In the late 19th century, William Halsted brought in the concept of “surgical residency,” where the mentee was under a tutor over a period of 5 years or more. This soon became the standard of training.

  Be a Better Mentor Top

Anyone reading this write-up would agree that he or she has been a mentor to someone and has helped that a person become better both professionally and as a person.

N. A. Healy et al. in an article published in the American Journal of Surgery in 2012 defined mentorship as “a process whereby an experienced, highly regarded, empathetic person (the mentor) guides another (usually younger) individual (the mentee) in the development and re-examination of their own ideas, learning, and personal and professional development.”[1]

The Socratic methodology of a dictatorial form of behavior by the mentor wherein the mentee is subjected to questioning, critical thinking had a strong influence on Halstead and soon became known as the “Halstedian” methodology. It was through this technique the mantra of “See one, do one, teach one,” came to be. This has been for long the method of mentoring and continues to be so in some centers.

Mentors have to be person/s who have a sense of professionalism; focus on integrity and honesty; are approachable and aim for excellence; are a role model and a good listener, and are compassionate, kind, and supportive.

There have been rather rapid changes in the health-care system with duty-hour restrictions, emphasis on a work–life balance, development of subspecialties, and innovations in the education and technical fields. This has therefore posed challenges to the mentor and needed a change in mentoring style.

Dr. John Rambeau (Former President of the American College of Surgeons [ACS]) in his 2014 address mentioned four styles and structure of mentorship.

The first is where the senior-most surgeons take on under their wing a trainee and impart experience, wisdom, and give off their time in honing clinical, technical, and life skills. This method frees up the middle- and junior-level faculty to focus on patient care and their own professional development.

The second option is to let mentors, with different interests and strengths, such as clinical assessment, technical skill, research, and administrative prowess, build the mentee separately on each of these aspects.

Simulation laboratories form the third option. One has to agree that the laboratory provides an environment, unlike the operating room (OR), where there is no time constraint or fear of creating complications due to an error in technique. The atmosphere gives the mentee one to one time with the mentor, and once a proper assessment tool of skills is in place, it would prepare trainee mentally and technically for the OR.

The fourth and final option that was mentioned is one where the mentor and mentee meet up the scrub sink and discuss the patient to be operated. Discussions would range from the history, findings, anatomy, pathology, management options, operative steps, and technique as relevant to the patient on the table. Perhaps, adding video recordings of the mentee performing the procedure would make for good discussions and learning, postoperative.[2]

Readers would agree that mentoring continues beyond the wards, OR, and outpatient clinics into journal clubs and informal gatherings. Mentee's blossom is a nonhierarchical and nonjudgmental environment.

The above methods have their own pros and cons. A mix and match of this is more often seen in the Indian subcontinent over the past few years.

  Role of the Mentee Top

The mentor–mentee relationship cannot be one sided.

The mentee should have clear goals, complete assignments, be able to accept criticism and introspect, thereby refining goals, while being respectful of the mentor.

As the health sector continues to change, I am certain that there will be newer multifaceted styles of mentoring that will develop and would encourage our readers to share them with the journal.

  Mentors Need to Be Coached Top

A few months ago, I was performing a carotid endarterectomy, and at the end of the procedure, I felt that the procedure had been done with a finesse rarely seen and with a good outcome. Shortly after in the recovery room, my colleague called me aside and said, “If you don't mind, may I comment that there were a couple of steps that could be changed in your technique for an even better end result ……Ouch!!. How dare??!”

As my ego was still recovering, someone posted a TED talk by Atul Gawande on the vascular surgery-WhatsApp group, about why seasoned surgeons needed coaches.[3]

Further, in an article by him in the Annals of Medicine, 2011, he highlights that as surgeons we tend to peak in the mid-forties and as time passes by our judgment improves as we tend to get familiar with the case scenarios.[4] However, expertise is something that should not remain static but be built upon and sustained, he adds.

India as a nation loves sport and we are all aware that the cricketing greats such as Sachin Tendulkar and Virat Kholi and tennis legends such as Rafael Nadal and Roger Federer too have coaches. Then, why not us as surgeons?

Dunning and Kruger write about an illusionary superiority that one can suffer from and “suggests that poor performers are not in a position to recognize the shortcomings in their performance.” [5] Charles Darwin said, “Ignorance more frequently begets confidence than does knowledge.”

The two forms of surgical coaching described by Kara Vande Walle and Caprice Greenberg (ACS) are expert coaching and peer coaching. In the former, experts would impart a skill or knowledge, and in the later, it is more about introspection and change of practice in discussion with a colleague who has almost the same experience and know-how. [6,7]

Seasoned surgeons are attending workshops where newer techniques are being demonstrated and participating in open house discussions, especially about cases that have not gone well. This is a mix of the above techniques. Perhaps, it is time to add the role of a peer watching our teaching, mentoring, and surgical skills. This would be certainly a paradigm shift, coming from a standpoint where we have a “know it all” feeling.”

Having a coach and showing changes in mentoring styles would become part of continuing professional development and innovation in the years to come and could well lead to a time where a record would have to be maintained of “Coaching sessions” at appraisals of surgeons by societies and regulatory bodies.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Healy NA, Cantillon P, Malone C, Kerin MJ. Role models and mentors in surgery. Am J Surg 2012;204:256-61.  Back to cited text no. 1
Economopoulos KP, Sun R, Garvey E, Hogan J, Bazzarelli A. Coaching and mentoring modern surgeons. Bull Am Coll Surg 2014;99:30‑5.  Back to cited text no. 2
Available from: [Last accessed on 2019 Mar 28].  Back to cited text no. 3
Gawande A. Personal best. Top athletes and singers have coaches. Should you? [Annals of Medicine] The New Yorker. 2011. Oct 3, Available from: [Last Accessed 2019 May 10].  Back to cited text no. 4
Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one′s own incompetence lead to inflated self‑assessments. J Pers Soc Psychol 1999;77:1121‑34.  Back to cited text no. 5
Beasley HL, Ghousseini HN, Wiegmann DA, Brys NA, Pavuluri Quamme SR, Greenberg CC, et al. Strategies for building peer surgical coaching relationships. JAMA Surg 2017;152:e165540.  Back to cited text no. 6
Greenberg C, Walle KV. Surgical Coaching Offers an Innovative Approach to Continuous Professional Development. Available from:‑of‑education/publications/./surg‑coaching. [Last accessed on 2019 Mar 28].  Back to cited text no. 7


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