Hello everyone, my name is Andrea Sikora, and today I'm looking forward to presenting as part of the in-training sessions 2021 year in review. The specific topics we're going to be focusing on are going to be mentorship as well as burnout. Burnout is a syndrome that has three dimensions that results from chronic workplace stress that has not been successfully managed. These feelings include energy depletion or exhaustion, as well as increased mental distance or cynicism related to one's job. Now it's interesting to realize that burnout has components that are related to healthcare, so we think of distance from patients and patient care, but also is noted in education, so distance from students and so forth. So any profession that has some degree of caring or teaching another, you might see this. Additionally, it has reduced professional efficacy. The healthcare profession right now is really facing a pandemic of burnout, and this burnout was present even before COVID-19 came on the scene, and COVID-19 has really just served to fan those flames. So some good numbers to see are that over 75% of U.S. healthcare workers claim self-reported burnout, with 90% experiencing stress, 80 plus percent experiencing anxiety, and 77% reporting increased frustration and feelings of being overwhelmed. The rates of burnout are greater than 50% that have been reported across professions, so physicians, nurses, pharmacists, and this is specifically true in critical care and emergency medicine, especially, again, in the COVID-19 pandemic, but has also seemed to be inherent to these disciplines. When we think about burnout, we generally think of organizational factors as well as personal characteristics that are coming together to create this syndrome, but when we think about the specific intersection of burnout and critical care, we also have to bring in the unique factors of an ICU environment, which is going to have elements of compassion fatigue from dealing with critically ill patients, moral distress from difficult decisions that are being made under very stressful situations, perceived delivery of inappropriate care, and so forth. That already creates a unique setting for feelings of burnout. Then, on top of that, you bring in the fact that critical care is an academic discipline, and so many of the people that are taking care of those patients also have faculty and teaching-type roles, doing research, doing service, giving SCCM talks, and so forth, and that's another independent factor that comes in and can relate to burnout syndrome. All of this comes into these issues that we're facing, including post-traumatic stress disorder and psychological symptoms faced by critical care healthcare workers, decreased patient satisfaction and quality of care that's being delivered at the bedside, and also increased rates of job turnover and even attrition from the field, which is not only unfortunate for the individuals that are leaving the field after years of training and so forth, but this also increased costs to the institutions. This brings us to the first article that we want to highlight, called Igniting Change, Supporting the Well-Being of Academicians Who Practice and Teach Critical Care. It was published in the Critical Care Nursing Clinics of North America journal. You can see here the key points that they're highlighting, which is that there are unique challenges and stressors that can threaten well-being when you have someone who works at the healthcare bedside, in this case, nursing was the highlight, but also as a faculty member. You have someone who's taking care of both patients, but then also serving students and likely has a research and service component as well. This article is unique in that it discusses the environment specific to those that are teaching, learning, and practicing within the critical care domain and what is going to be useful for overall well-being, and then also discusses some of the strategies. Although this article was focused on critical care nurses, I think that many of the lessons can translate among all the fields and professions that we have within critical care. The two key highlights of this article focus on wellness and the models that are going to improve wellness. It discusses the synergy model to improve well-being of these academicians who are practicing and teaching critical care, and highlights the use of this structured wellness program that's designed for those teaching, practicing, and advising colleagues and students in the critical care environment. This brings me to yet another aspect of caring for others, which is so a part of what critical care is, which is, again, not only that we're taking care of a critically ill patient, but then you may be teaching. You're going to have learners and trainees. You're also going to be potentially mentoring colleagues and people that are in various phases of their career. This is on top of if you hold a leadership position or a supervisory position where you're going to be in those roles as well. Overall, this asks a lot of each individual when it comes to empathy and caring and feeling like you're making a difference. It has been really wonderful to see that there is much more awareness of burnout and burnout's effect on the individuals as well as on patient care. It's also been great to see this increasing promotion of wellness and just awareness of burnout. But you will also hear at times critiques of different programs in discussions where essentially a frayed ICU worker comes out of their 12-plus hour shift where they felt like they didn't have the resources that they needed. They didn't have the staff that they needed. Their point is, the pizza party didn't really do anything for my wellness or my feelings of burnout. I think that's a very fair complaint or critique of some of these programs. One of the things that I like the best about this article is that it has institutional components for improving this environment as well as individual components. Individual components are very important and this is on the individual to take responsibility in that way in terms of sleeping, exercising, nutrition. There's a lot of good things to be said for taking that time for yourself and promoting wellness on that level. However, those things can be very difficult if you don't have institutional support or feel that you have institutional support to do that. One of the things I liked about this was that you can see that they're equally balanced concepts here where they're discussing having a wellness committee, developing curriculum, having events, and investing in professional development. The reason why these things are important is when you start talking about feelings of personal inefficacy and so forth, professional development can be very useful for this. I also think these type of committees, when done well, can identify problems that can be fixed on a structural or institutional level. I think that's one of the most important parts of this article and why it's worth reading and thinking about how it can be applied to your setting. The next article that I want to discuss is called Kindling the Fire, the Power of Mentorship. It was published in the American Journal of Health System Pharmacy. This article discusses mentorship within the profession of pharmacy, but I think the concepts go well into any profession within critical care. I also think that this article goes well with our discussion of burnout. You can notice in the previous, it was discussing seek high-quality feedback and connection. I think one of the best things about mentorship when it's done well is that not only does it provide you practical hands-on advice of, hey, you have too much on your plate, don't take that on, which can eventually lead to burnout, but I also think it provides you these really high-quality connections. One of the most important things for preventing burnout and for feeling efficacy in the field and so forth is these feelings of connection and loyalty over time. This article defines mentorship as a deliberate, effortful, and evolving relationship characterized by mutual growth and shared altruism with a primary goal of the personal and professional development of the mentee. I want to break down this definition for you all because I think it's a very meaningful definition. The first is that it's deliberate. This is not a happenstance experience of you happen to see someone in the hallway and you provide them a little bit of advice. This is something where you're seeking an individual out, you're following up with someone, you're making time to meet, both people are reaching out, both the mentor and the mentee are reaching out to each other, investing in the relationship. This gets to the effortful side of things. This is something that you're going to expend effort into, so if a mentor says, I think you should go look into this fellowship program, you're going to go spend the time and look into that program, or if a mentee asks you a question and you don't have a good answer for it, you're going to spend time looking up the answer or finding people that can help them answer that question. You're willing to put in that time and that effort. Finally, it's evolving. This means that you may have a mentor-mentee relationship with a third-year pharmacy student that has a certain dynamic, and then five and ten years later as they graduate from pharmacy school or residency, take on their first or second job, it can evolve into a much more collegial type relationship. Second, this characterization of mutual growth. Mutual growth means that both individuals are there in a give-and-take type dynamic. You're both giving to each other and providing something, but you're also taking something from the other in that you're becoming, hopefully, your best self through the process of mentoring or being mentored. It's also shared altruism. At the end of the day, what you guys are doing in this dynamic is trying to do what's best for the other. It's important to realize that the primary goal is the personal and professional development of the mentee, but again, it's important to realize that mentors are taking just as much from this relationship at times as the mentee is. You will sometimes hear mentorship, advising, coaching, precepting used in similar ways, but they are very distinct concepts. A coach is someone who's helping you with a specific skill set. They're saying, I'm going to coach you on how to become better at doing a literature search in this way. An advisor is a formal program. They may also be a mentor, and this relationship may extend beyond the formalities, but this could be you start your first year as a faculty, and you have an advisor for the first year that you're required to meet with every month to discuss your progress. That's wonderful, and that person may grow into being a mentor, but the idea of mentorship is that it transcends some of these more structural aspects. Thinking of the evolution of mentorship, I think it's really important to realize how much was grounded in healthcare and even how healthcare mentorship has evolved over time. One of the things to think about is that the odyssey, that's where the word mentor comes from, is when Athena, the goddess Athena, takes on the role of mentor to help a young telemachus through his difficult journey. It's interesting to note that the Hippocratic Oath begins with saying mentorship and saying that he's part of a long line of individuals who is passing down tradition. It doesn't even start with medicine, and it certainly doesn't start with do no harm, which I think is very interesting. You move into the guild and apprenticeships of the Renaissance times, this is a very hierarchical standpoint. You have the senior person advising the more junior person with the flow of information and benefit going in one direction. Finally, I think as we've evolved in healthcare, we're seeing again these mutual growth, shared altruism based relationships that have the power to provide advocacy, enhance connection, but again is characterized by this give and take of both individuals. There was another really important article that came out this year focused on gender equity in pharmacy. It wasn't necessarily within critical care, and again it was focused within one profession, but what I loved about this article was how action oriented it was, and I think that many of the concepts that are discussed here would translate well into critical care as well as other professions. One aspect in particular I want to highlight within this kind of domain of mentorship is that one of the specific actions that was recommended was that diverse mentorship can promote diversity, equity, and inclusion in leadership, in recognition, and so forth. I think this is a really beautiful thing that this construct that we're going to use in so many other areas can also promote DEI concepts. It's really interesting to realize that mentorship, although it can have these touchy-feely words like mutual growth and shared altruism and so forth, has extremely practical benefits. The numbers are very supportive of the fact that having a mentor makes you more likely to get a promotion that you want, to be given awards and titles that you're interested in. It results in higher salary and pay overall, but it also decreases turnover, increases feelings of satisfaction and personal well-being. There's a lot of benefit that kind of shows that what you put into a mentoring relationship is likely what you're going to get back out, and I think that's really powerful to realize. This article proposes an ethical construct for mentorship that is based on healthcare ethics of autonomy, beneficience, non-maleficence, honesty, as well as justice. Autonomy can be thought of as the independent and successful functioning of the mentee. Alternative practices are identifying challenging and attainable activities, engaging the mentee in meaningful dialogue, having the mentee seek alternative viewpoints and provide follow-up on guidance that's taken. So again, what we're looking for here is that the mentee can have these really thoughtful experiences and reflection and self-development, but that they are going to be ultimately independent of the mentor. Benefits here is the act of doing good with personal and professional success of the mentee as the goal. So we're looking to identify new connections and individuals for the mentee based on their interests, generating new ideas and topic discussions, providing meaningful feedback and so forth. So the goal here is for the mentee to have the most benefit, and so it's good to think about what are the best uses of their time, not just what's most useful for the mentor and so forth. Justice is generally concerned with the fair and equitable treatment of others. Within a mentor-mentee relationship, to me this means providing appropriate authorship and credit on scholarly work products, prioritizing time together, so not cancelling meetings last second, putting the calendar invite on there, respecting each other's time and efforts, as well as making sure that everyone is gaining things from this relationship in the best ways possible. Non-maleficence has to do with not harming others. Obviously you will hear stories of egregious infractions of sexual harassment or coercion of other kinds, and this should never be tolerated, but also I think that there are moments where there are difficult ethical discussions between a mentor-mentee that are maybe in more of the gray areas, and so again, to me this has to do with making sure you're having the best use of your mentee's time, just because they can maybe help you with something doesn't mean that it's beneficial for them to do so. Again, providing appropriate level of credit and sponsorship for different published works and deliverable products, putting your mentee forward in the best possible way as opposed to basically using their work for your benefit only. Also I think globally being aware that both of you are professional reflections of the other is very important. The final construct is honesty, which is the truthful and authentic reflection and feedback, which is going to be core to mutual growth. So this is going to include scheduling time for open dialogue, asking difficult questions, providing detailed feedback at regular intervals that includes both positive and negative feedback, although I think all feedback can be delivered, you know, supportively. Reflecting on questions for discussion in future time, and basically just being honest regarding current struggles, feelings, and so forth, because if you're not honest, you're not going to get the most out of the relationship that you're looking for. I want to thank all of you for coming to this discussion today. I hope you will read these articles and take something from them. I found them both to be incredibly idea generating and thought generating in terms of how to apply to your own practice and your own institution. I wish you the best of luck.

mentorship

burnout

healthcare profession

COVID-19

critical care professionals