Mentoring A Proposed Model for an Optimal Mentoring Environment for Medical Residents: A Literature Review

Purpose To develop a model of the optimal mentoring environment for medical residents. The authors propose that such an environment is a function of a relationship that rests upon a set of interactional foundations that allow a protégé to capitalize on the strengths of the mentor, and it facilitates behaviors that will enable the protégé to develop and internalize the requisite knowledge, skills, and attitudes (KSAs) as fully as possible. Method The authors searched the literature using Web of Science and Google Scholar in 2007–2008 to identify articles addressing the mentoring process and the context in which it occurs (mentoring environment), and the effect both have on KSA development. The authors distilled the attributes of a good mentor that were consistent across the 20 papers that met inclusion criteria and described good mentoring of residents or curricula for training mentors or residents. Results The authors identified six interactional foundations that underlie the optimal mentoring relationship: emotional safety, support, protégé-centeredness, informality, responsiveness, and respect. These foundations enable protégés to engage in four key developmental behaviors: exercising independence, reflecting, extrapolating, and synthesizing. Conclusions This model identifies mentoring practices that empower protégés to engage in developmental behaviors that will help them become the best physicians possible. Educators may use this model to develop training tools to teach attendings how to create an optimal mentoring environment. Researchers can use the model to help guide their future investigations of mentoring in medicine. Acad Med. 2010; 85:1060–1066. One of the key recommendations of the American Medical Association’s 2007 Initiative to Transform Medical Education1 was to “ensure that the learning environment throughout the medical education continuum is conducive to the development of appropriate attitudes, behaviors and values, as well as knowledge and skills.” During residency, a crucial period in the “educational continuum,” the development process is largely facilitated by an outcome-driven mentoring relationship between an attending physician and a resident. Although the literature addresses residency training in general, researchers have not identified the characteristics that distinguish a good mentor, who effects a positive outcome in a resident, from a good mentoring environment, the atmosphere in which the mentoring process activates the resident’s development and internalization of the requisite knowledge, skills, and attitudes (KSAs) to the fullest extent possible (i.e., the maximal outcome). Although it seems likely that a good mentor would create a good mentoring environment, there is an important distinction between a relationship that is good for a protégé and one that is optimal. In a good mentoring relationship, a protégé might not be able to capitalize on all of the mentor’s strengths and, consequently, might not achieve the maximal outcome. Thus, we propose that the optimal mentoring environment is a function of a relationship that (1) rests on a set of interactional foundations (the fundamental elements of the mentor– protégé relationship that inform their interactions) that allow a protégé to capitalize on his or her mentor’s strengths and (2) enables a protégé to engage in behaviors that foster the development and growth that will yield a maximal outcome. This raises two questions: Which aspects of the relationship allow a protégé to capitalize fully on the mentoring relationship? Which developmental behaviors should the mentoring relationship enable the protégé to perform in order to achieve a