Mentoring and Geriatric Mental Health Research Careers

Abstract:

Mentoring, a traditional part of a student's progress in the academic environment, is beneficial in particular to the furthering of a research career. In the area of geriatric mental health research, there are unique challenges that make mentoring a valuable tool in the development of the skilled and effective researcher.

What Is a Mentor?

The term "mentor" comes from the Greek story of Odysseus, the hero of The Odyssey. The tutor of Odysseus's son Telemachus, Mentor acted as protective friend, advisor, and teacher when Odysseus was away during the Trojan War. The modern-day definition of mentor can be defined in much the same terms. In fact, the title of a book on mentoring published by the National Academy of Sciences describes the role of the mentor as: "advisor, teacher, role model, friend." [1] Mentors encourage and nurture their proteges or "mentees" and work to guide them toward independent and successful careers.

The Mentoring Relationship

The traditional view of the mentoring relationship is that of a mentor working closely with one mentee through the course of the mentee's academic career. However, increased clinical, research, and administrative demands in the academic research environment have led to adaptations in the mentoring framework. Mentors may have more than one mentee and sometimes may not even be at the same institution as their mentee, causing the relationship to be almost entirely conducted by e-mail — a practice known as distance mentoring or "e-mentoring." Mentees may also have more than one mentor, or even an entire mentoring team. There may be a formal mentoring program at the institution or department, or informal mentoring relationships may occur. Regardless of the mechanics of mentoring, the essential components of the mentoring relationship remain the same. As described by Rodenhauser et al, [2] they are "a commitment to mutually agreed-upon objectives, a willingness to learn under the mentor's supervision, devotion of the necessary time and energy to the agreed-upon goals, and an expectation that the protégé become increasingly independent."

Reynolds et al [3] have described the roles played by mentors in the NIMH-funded Junior Faculty Scholars training program at the University of Pittsburgh, which is designed to ease the transition from research postdoctoral fellowships to extramural grant support. At its heart is the fundamental role of the mentor as advisor, helping the mentee to decide on his or her individual goals and providing advice on how to achieve those goals. Other roles include:

With this wide array of responsibilities, it is unsurprising that many mentees look to more than one mentor to fulfill these obligations.

Importance of Mentoring in Academic Advancement

In the academic environment, mentoring is a critical component of successful career development and satisfaction.[4] More specifically, mentoring has been correlated with improvement in research participation, an increase in mentees' self-confidence in the research environment, increased time spent in research, and greater research-related productivity as shown by number of publications and grants. Studies in biomedical and behavioral research and mental health and psychiatry, specifically, have demonstrated that individuals who become successful independent investigators are more likely to have had an extended mentoring experience. [3] In a survey of over 3000 doctoral level faculty in psychiatry at US medical schools, time spent with a mentor was ranked as the most important factor of research training programs in psychiatry. [5]

Conversely, not having a mentor is seen as a hindrance in the completion of both research projects and publication. [6] In Jackson et al's [7] survey of faculty members about their experience with mentorship, respondents who did not have mentors reported that they felt lost, lacking the guidance of someone to teach them "the rules of the game" of academic advancement. They believed they had lower salaries and less success as a result of not having a mentor to advise them.

Mentoring in Geriatric Mental Health Research

One of the most critical issues in geriatric mental health research is the ongoing decline in numbers of researchers in the field. According to Reynolds and Gatz [8] the number of scientific opportunities (the rapid growth of the US population over age 65, the increased rates of mental illnesses and suicide in later life, etc.) is far greater than the number of researchers available to do the work. There are several barriers to establishing a sufficient number of investigators in the area of geriatric mental health, including pressures on individuals (eg, student loan indebtedness, salary differences between academic and private sector careers), lack of substantial emphasis on government policy for appropriate funding, and a pronounced lag time in R01 grant funding after having won an award. [9] Other factors include lack of introduction to the field early in the investigator's career and departmental responsibilities that compete for the senior colleague's time (clinical work and teaching).[10]

Because of the role mentors play in supporting and furthering their mentees' career paths, mentoring has been cited as an important factor in growing and maintaining the geriatric mental health researcher pipeline.[10-12] Mentoring can help provide grant preparation skills, time management skills, and the type of collaboration and consultation needed to know how and when to make what kind of transitions. [9, 13] In fact, mentoring can be instrumental in developing and encouraging the initial choice of geriatric mental health research as a field of study[14,15] Lieff et al [14]reported that almost 75% of a study group of residents cited mentoring as stimulating an interest in the field of geriatric psychiatry, while in the study conducted by Halpain and colleagues [15], medical students who participated in the START-MH program, which has a strong mentoring emphasis, indicated that the program heightened their interest in a career in geriatric mental health research.

Because of its importance in choosing and remaining in geriatric mental health research careers, several short-term and longer-term research training programs have made mentoring an integral part of the curriculum (Figure). The following are a few examples:

The American Association for Geriatric Psychiatry lists various suggestions for senior investigators/academics/clinicians in the field to implement mentoring-related activities, including the development of a clinician-shadowing program in which medical students have the opportunity to observe the clinician's experiences with geriatric patients; delivering neuroscience-based lectures to first- and second-year medical students to address possible stereotypes of working with elderly patients; and creating a geriatric psychiatry elective for fourth-year medical students.[16]

In the late '90s, the National Institutes of Health recognized the importance of mentoring to a research career with the K series mentored career development awards (K01 and K23). These grants are intended to assist postdocs and early career scientists in becoming independent investigators with the guidance of a mentor or mentors. Because the transition to R01 funding is considered proof of attaining independent investigator status, K awards take on a special importance in maintaining the "pipeline" of geriatric mental health researchers.[3,9] Bruce [9] found that among recipients of K01, K07, K08, K23, and R29 grants in geriatric psychiatry, a relatively small number (14%) received R01 funding within 1 year of completing the earlier grant. Similarly, an NIH working group found that only half of K08 award recipients who applied for a subsequent R01 or R29 were successful, but the likelihood of success was less for those without a prior mentored award. [17]

Barriers to Mentoring

Mentoring is a labor-intensive process. It requires time, energy, and commitment on the part of both the mentor and mentee, and as such, may be pushed aside by the research and administrative demands of the academic life.[18] Williams [19] found that lack of time was cited as the number one barrier to mentorship among psychiatry residents and faculty. In fact, the time costs of formal mentoring programs are usually underestimated.[20] For less formal mentoring, a busy researcher may not have the time available to spend with a mentee. Mentees may also be reluctant to ask directly for a mentor's help or may have difficulty identifying a potential mentor.[19,21] There was also a perception among some residents surveyed by Williams [19] that mentors were more focused on research than on being effective advisors. Since there are so many rewards to be gained, it is important for both mentors and mentees to be open to the possibilities of a mentoring relationship.

Issues of Gender and Diversity in Mentoring

Although mentoring is important for all researchers, it may be especially vital for women and minorities, who face special issues in building a research career. In fiscal year 2002, only 5.5% of principal investigators who received NIH training grants were African-American, Hispanic, or Native American (minority groups historically underrepresented in medicine and the sciences, or URMs); the numbers for URMs who received research program grants (RPGs) and NIH fellowships were 3.2% and 10.7%, respectively.[22] Faculty members from underrepresented minority groups are also promoted to associate or full professor levels at lower rates compared with white faculty [23] and are less satisfied with their careers.[24] They may be more likely to have economic and emotional pressures that discourage them from pursuing research careers. [25,26]

While women are close to parity with men in predoctoral and postdoctoral research training and K awards, they comprise 24% of PIs on R01s and other traditional research grants.[27] According to the most recent Association of American Medical Colleges figures, more than 70% of women faculty members are concentrated at the lowest academic ranks.[28] Women may be less likely to put themselves forward for higher positions than men and are likely to have less extensive networks that are limited to colleagues at their current institution.[29] Women of color may also feel particularly isolated; they may be the first or only woman or member of a URM in their program and may experience intense pressure to succeed as a result.[30]

One problem may simply be a lack of mentors. Since both women and URMs may be less likely to have mentors, this decreases the odds that they will go on to become mentors themselves. [18,31,32] In Williams' [19] survey, female and minority residents and faculty were more likely to agree that shared gender and ethnicity were essential to the mentoring relationship, whereas male faculty members and residents believed that race and gender made little difference. On the other hand, Palepu [33] found in a survey of 1800 faculty members that most of the women faculty (80%) and the minority faculty (86%) who had had mentors reported that it was not important to have a mentor of the same gender or minority group.Mentoring across cultural/ethnic lines has challenges, but may be a rewarding experience for both mentor and mentee. Perhaps more importantly, it may be unavoidable; as Crutcher [34] states, "Because few mentors, especially in the higher ranks of academe, come from nonmajority backgrounds, we especially need to focus on strategies to make cross-cultural mentoring work." Several academic institutions/departments have come up with their own solutions to the problem of mentor shortage. Peer mentoring, in which the mentor and mentee are similar in rank, is one of these.[32,35] Several published reports have found that peer mentoring groups lead to positive climate change within departments and an increased sense of community and involvement among participants.[32,35] One institution has combined peer, onsite, and distance mentoring to create an entirely new multilevel mentoring model for URM faculty members. Known as the POD (for Peer, Onsite, Distance), this model provides mentees with guidance and support from peers, targeted assistance with professional questions from onsite senior faculty, and information from an outside network of distance mentors. [18]

Mentoring is also a major component of several research training programs in psychiatry focused on increasing URM participation and retention in psychiatry. These include the Program for Minority Research Training in Psychiatry (PMRTP), a joint program of the NIMH and the APA, and the Institute for Research Minority Training on Mental Health and Aging (IRMMA), funded by the NIA and sponsored by the AAGP and the Medical University of South Carolina in Charleston. [36,37]

Conclusion

The importance of mentoring to the geriatric mental health research career cannot be overstated. Mentoring is vital not only in order to keep the pipeline of investigators going, but to prepare the next generation of mentors in this field. To do so, it must continue to be a priority on both the individual and institutional level. The online mentoring education and reference source MedEdMentoring.org is an essential part of this goal. Developed with the support of the National Institute of Mental Health (under contract/grant HHSN278200444084C), the site offers valuable career development tools for both mentees and mentors, as well as up-to-date resources on relevant publications, funding announcements, and career development. The Career Autobiography section, in which investigators describe their individual career paths, is testimony to the positive impact mentors have on their mentees. Accessible to all, MedEdMentoring is an important response to the impending need for more geriatric mental health researchers.

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