By Doug Brunk, San Diego Bureau

On his application for medical school, Dr. Jeffrey A. Toretsky remembers writing that mentoring goes hand in hand with being a physician.

Maybe that's because during his undergraduate training at the University of Wisconsin, Madison, he was mentored by Dr. Jonathan Finlay, a pediatric oncologist who “had a contagious enthusiasm for his work,” recalled Dr. Toretsky, a pediatric oncologist at Georgetown University Medical Center in Washington, known for his research work in Ewing's sarcoma. “It was his enthusiasm that led me to where I am today.”

Two years ago, Dr. Toretsky followed Dr. Finlay's own example by mentoring students from a science, mathematics, and computer science magnet program at an area high school. Each year, two students from the program spend a summer with him in the research lab of Georgetown University's Lombardi Comprehensive Cancer Center.

Dr. Toretsky assigns the students a month's worth of reading before they set foot in the lab, to “get them up to speed on the background science,” he said. “They have to expand their knowledge of molecular biology. Then they have to learn specific details pertaining to the projects underway in my laboratory [including] lectures by me and my laboratory colleagues. From there, they meet individually with all the postdoctoral fellows and graduate students in my lab.”

The students' main goal is to generate a list of scientific hypotheses based on research going on in the lab. Then they choose one hypothesis, design experiments, and work shoulder to shoulder with members of the lab to learn the techniques necessary to address their hypothesis.

“Watching the students make choices and get excited about careers in science is rewarding,” Dr. Toretsky said. “So is thinking that they may have the opportunity to discover things that I won't have the opportunity to learn about.”

For example, he said, Audrey Kubetin, a student who spent the summer of 2006 in his lab, will graduate from Montgomery Blair High School in Silver Spring, Md., this spring; Dr. Toretsky graduated from high school in 1980. “She has a 27-year offset to my career,” he explained. “If I think about where technology has come in 27 years and where it's going to be 27 years from now when she is approaching the prime of her career, she's going to have opportunities that I can barely dream about today.”

Even though Ms. Kubetin's summer research project did not achieve results that addressed her hypothesis, Dr. Toretsky hopes that she remains enthused about pursuing a career in science. “The experiments Audrey pursued were never done before, so her getting a successful result was a total unknown,” he said. “For me, it was a little bit frustrating because I would have liked her to have more success in the results, but with research, there are always surprises.”

Physicians who aren't mentoring others in some way “are missing out on an opportunity for immense reward and immense contribution,” he said. “If you can incorporate some young minds in your work, they will see the joy that you get out of your career, giving you a chance to inspire somebody that could soar into the next generation of medicine.”

Immersion in 'Real-Life Medicine'

Last summer, Dr. Osama Aaflaq received the “mentor of the year” award from first-year medical students at Southern Illinois University in Carbondale. In their nomination letter, the students described him as “a family man who understands the stressors of being a physician and won't hesitate to share his mechanism for not only being the best doctor he can be, but how to stay true to your family and yourself.”

Each academic year since 1998, two medical students have “shadowed” Dr. Aaflaq during his shifts as an emergency department physician at Memorial Hospital of Carbondale. “It's more like immersing [themselves] in real-life medicine,” he said in an interview. “They see how the real things happen, rather than sitting in a classroom and learning about it.”

Usually he takes first-year students because he considers that the most challenging year of medical school. “It's a maze that they get into,” he said. “They need some guidance.”

Dr. Aaflaq likes being a mentor because he views learning as a two-way street, noting that he learns as much from medical students as they learn from him. Most medical students ask a lot of questions, “and you want to provide them with good, accurate answers,” he explained. “This is always an element that pushes you to strive more and read more to answer these questions. Sometimes, you're asked a question that you don't know the answer to. The simple thing to say is, 'I don't know. Let's look it up.' So we look it up together, and we both learn something new.”

He doesn't take the mentor role lightly, realizing that the time students spend with him will influence their views of medicine. “Whether they like what you do or they dislike it, it's going to affect the way they shape their personality and their career in the future,” he said.

His primary challenge in accommodating students is the emergency department's tight quarters. Often it gets crowded, “not for me but more for the nurses and other people in our office,” he said.

Dr. Aaflaq noted that opportunities for mentoring exist regardless of where you practice or what field you're in. “You can mentor medical students, PA students, or high school students,” he said. “Sometimes, we get students from law school who need to be introduced to medicine because it's part of their schooling.”

If you reach out to nearby schools to let them know of your interest in providing a mentoring experience, “it won't take long before they contact you and ask you to volunteer,” he said. “I've been enjoying it since I started, and I probably will continue [mentoring] for as long as I'm practicing.”

Promoting Public Sector Psychiatry

Being a mentor “goes way back,” for Dr. Mary Ellen Foti, a psychiatrist who has practiced in the field for more than 20 years. “There's a triumvirate of direct clinical care, research, and training that most of us adhere to,” said Dr. Foti, medical director of the Massachusetts Department of Mental Health, Boston. “You do some of all of these things all of the time wherever you are.”

Currently, Dr. Foti mentors postgraduate fourth-year psychiatry residents who have an interest in developing careers in the public sector and working with persons who have serious mental illness. Residents who are chosen for the position spend 8–12 hours per week in the department of mental health's central office for a year, learning about leadership in public sector psychiatry and shadowing Dr. Foti.

“I take them to committee meetings or board meetings, [and] other kinds of things that I normally would go to,” she said. The training focuses on inpatient public sector psychiatry, work “that can be very grueling,” she said. “It's a high energy output every day. You do get the gratification of seeing patients do well, but it's very tough. How do you feed yourself? Where are the wellsprings of refreshment? That's where a mentor can help, a mentor who allows the person to talk about it, to reflect on [his or her] own experience.”

Dr. Foti also mentors early career psychiatrists in the public sector who are out of training but are trying to figure out what they want their niche to be. “They're wondering, 'How can I make my work on a daily basis more interesting? I have so many clinical patients but I have so little time. I really want to teach. I want to do some research. I want to make it more multidimensional,'” she explained.

The way she sees it, mentors are people willing to take a special interest in someone who is “a little bit or a lot” farther behind them in their career development. “There may be anxieties, like 'should I take this rotation or that, or should I take this job or that job,' but it's not like they're coming to you with an anxiety disorder that needs treatment,” Dr. Foti said. “You're not treating them. You're not teaching them. You're helping to support them to try different things, make opportunities available to them that they would not have known about, and encourage them to see beyond the job that they're in.”

Mentoring means being supportive during professional setbacks as well. It's challenging to watch mentees, “fall … and fight back the urge to say, 'I told you that probably wasn't a great idea,'” Dr. Foti said. “You can't do that. You're there to hear what they're thinking about doing, suggest additional options in the menu, help them to choose if they ask you to, and then, it's information only, nothing about what you think would be better or not better for them personally.”

That's the kind of approach Dr. Aaron Lazare took with Dr. Foti when she was a third-year medical student at the University of Massachusetts, Worcester. Dr. Lazare, who chaired the medical school's department of psychiatry at the time and is now the school's chancellor and dean, spent an hour with Dr. Foti in his office, sharing his vision of the department and the medical center. “It was an extraordinary experience being the mentored one,” Dr. Foti recalled. “He gave me something that was very important. He modeled for me what mentoring is all about.”

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Dr. Jeffrey A. Toretsky, pictured with high school student Audrey Kubetin, has two students spend the summer in his laboratory making and testing research hypotheses. Sally Koch Kubetin/Elsevier Global Medical News

Mentoring: A Win-Win Learning Experience