Facilitated peer-mentorship: thechallenges faced byfacilitator mentorsJanis E Blair, Anita P Mayer, Marcia G Ko and Julia A Files, Mayo Clinic, Scottsdale,Arizona, USA

INTRODUCTION

Women doctors who wish toadvance academicallyface many challenges.

The important role of mentorshipfor female teaching staff who arepursuing such career developmenthas been previously described.1,2

However, the current environmentin health care has negativelyaffected the pool of qualified andwilling mentors.3 Confronted withincreased demands for clinicalproductivity, many senior teach-ing staff do not have the time orresources to commit to this

activity.4 The resultant paucity ofwomen in the upper ranks ofacademia precludes the develop-ment of sufficient dyadic men-toring partnerships.

A few years ago, Mayo Clinicwas in a similar quandary: manyfemale teaching staff wanted tohave a senior female mentor, butthe few female teaching staffqualified to serve as mentorslacked time, resources and suffi-cient numbers to meet the statedneed of the surveyed juniorteaching staff.5 This situationprompted the development of a

model for a facilitated peer-mentorship project. Our goal wasto use the few female mentorsavailable in a way that amplifiedtheir efforts and maximised theircontributions to the academicadvancement of junior femaleteaching staff.

This peer-mentorship modelhas allowed us to define the rolesof facilitator mentors and peermentors and to apply them todifferent groups of women doctorswho have expressed interest inacademic advancement. We reportthe 3-year experience of

Many femaleteaching staffwanted to havea senior femalementor

Faculty

development

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facilitator mentors in three peer-mentorship groups formed withina busy clinical practice of a large,multispeciality, academic prac-tice.

BACKGROUND ANDRESULTS

Mayo Clinic started a programmeof facilitated peer-mentorship, inwhich three or four women on thejunior teaching staff who wantedacademic advancement but lackedthe tools and training to create anacademic paper for publicationand to develop an area for aca-demic study and expertise formeda peer-mentorship group. Througha series of small group classes andtutorials, the peer group acquiredskills in writing, internet searchesof medical literature and refer-ence management. Each memberserved as the lead author on awriting project, while the otherpeer mentors assisted with papersaccording to task assignment bythe lead author. Each subsequentwriting project was led by adifferent lead author, with thegoal of publication of three orfour scientific papers within eachgroup by the end of its first year.The papers were brief scientificreviews of topics that the grouphad identified as key areas ofresearch interest. Efforts in thesecond and later years centred onlaunching a career focus forresearch and study. The group wasmentored by the authors of thispaper, hereafter referred to asfacilitator mentors – womendoctors who held an academicrank of assistant or associateprofessor.

The ideal peer-mentorshipgroupAs our project started, we delin-eated the characteristics andrequirements of the peer-mentorship group. The commit-ment of the peers to the projectand the group’s members wasimportant for keeping the grouptogether. Every member signed acommitment of at least 1 year,

with the option to leave the groupthereafter.

Ideally, group members shouldhave had similar academic inter-ests, so that each publicationcontributed to their career pro-gress. To allow equality in peerinteractions, the academic rank(that is, instructor or assistantprofessor) among the peers ineach group should have been thesame. (However, despite this idealplan, we later formed groups inwhich a difference of no morethan one rank existed amongmembers).

We also believed that an idealmentoring group should havecertain attributes. First, given thetime constraints of doctors inclinical practice and the limits ofcyber communication, the idealwas to have proximity (that is,working in the same building oron the same floor) among thepeers. In addition, they needed tobe willing to maintain a positiveattitude, work collaboratively andretain a sense of humour, andhave the ability to be tenaciousand focus on the task at hand inpursuit of their goals. We asked allpeers to request help and guid-ance when needed from the facil-itator mentors. Finally, peermentors needed always to main-tain personal and group account-ability in meeting establishedtimelines.

The actual peer-mentorshipgroupsThe first peer-mentorship groupwas the closest to our vision ofwhat this project should ideallylook like. It consisted of four busyfemale internists specialising inwomen’s health and academicallyinterested in the health-relatedissues of women. The peers wereranked academically at theinstructor level and were locatedin the same building. Althoughthe initial year was fraught withdeadline stress and health issues,three papers had been written andaccepted for publication within

1 year of the group’s initiation,and research ideas were beingformulated, with realistic plansoutlined to pursue those ideas.

After the success of the firstgroup, a second peer-mentorshipgroup was launched. This secondgroup had already formed and itsmembers were bonded by similarresearch interests; however, ithad not been productive beforebecoming a part of our mentoringcircle. This group was formed bytwo internists and one medicalsubspecialist, of whom two wereinstructors and one an assistantprofessor. The women doctorsworked in the same building buton different floors. Since thelaunch this group has written twomanuscripts and designed aneducational curriculum.

A third group was made up ofclinicians: one in emergencymedicine, two in internal medi-cine and one in family practice.The clinicians were located inthree buildings up to 30 milesapart, shared no common aca-demic interests, but were allbonded by the same motivation:publish or lose their jobs. Thispeer group was also geographi-cally separated from the facilita-tor mentors; the peer mentorswere located several States away.Twelve months after the project’sinitiation, two papers had beenaccepted for publication andanother manuscript submitted.

More peer-mentorship groupsare in their infancy at our insti-tution, some with geographicallyseparated peer members, otherswith peer members separatedfrom the facilitator mentors.All members are women doctorsand busy clinicians, and most aremothers with active families.Every group has encounteredobstacles, such as personal orfamily, physical or mental health,challenges with group dynamicsor changes in employment, thathave threatened the group’sprojects.

Each memberserved as the

lead author on awriting project

The first peer-mentorship

group was theclosest to our

vision

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Facilitator mentorsA facilitator is ‘responsible forleading or coordinating the workof a group’.6 In our peer-mentor-ship project, the facilitator men-tors do more than facilitate thework of the peer mentors; theyalso act as counsellors and projectsupervisors. As mentors, theyfunction as wise and trustedcounsellors and, as facilitators,they ensure that the group pro-duces academic results (forexample, manuscripts, grant pro-posals and educational curricula)in a timely and efficient manner(Box 1).

The decision to use a group offacilitator mentors, rather than anindividual facilitator mentor,arose from the results of a surveyof the female teaching staff atMayo Clinic.5 The results showedthat facilitator mentors who wereinitially involved in this projectwere willing to work as part of ateam, but felt that they did nothave the time to function as thesole mentor to a number of juniorteaching staff.

Of the four facilitator mentorsin the project, three were assis-tant professors and one an asso-ciate professor, all in theDepartment of Internal Medicine.We found that each facilitatormentor had a shared interest inthe career advancement of femaleteaching staff, but each also haddifferent clinical and research

interests. The peer-mentorshipgroup was effective because eachfacilitator mentor brought differ-ent and complementary skills tothe project. As the project gainedmomentum and more peer groupswere formed, the facilitator men-tors had difficulty achieving thehands-on approach that had beenso successful when mentoring thefirst group. The time commitmentwas significant; each mentorcontributed at least 4 hours perweek to the project.

The positive group dynamicsof the facilitator mentors allowedthe development of deep collegialbonds. One of the unanticipatedoutcomes of the project was thehigh degree of satisfaction andoverall enjoyment experienced bythe facilitator mentors. Our expe-rience with long-distance men-toring by facilitator mentors islimited, but we believe that ahands-on approach and face-to-face contact with the groups ofpeer mentors create the idealsituation. Assessment of the dif-ferences in outcomes betweenvirtual groups and on-site groupswill be pursued.

On occasion, the groups ofpeer mentors experienced con-flicts and stress, requiring inputfrom the facilitator-mentor group.These issues were usually associ-ated with interpersonal conflicts,illnesses or family crises. In thesesituations, some facilitator men-

tors did not feel adequatelytrained to deal with such issues.They also struggled with conflict-ing responsibilities and timeconstraints, because each hadother positions of leadership orother academic and researchresponsibilities at our institution.

The peer-mentorship projecthas been noticed by the leader-ship at Mayo Clinic, and interestin the project is expanding. Theinstitution has responded favour-ably to the initial results of theproject and has pledged supportfor the next phase, offeringsecretarial services, schedulingmanagement and minimal pro-tected time for the facilitatormentors.

RECOMMENDATIONS

We have discovered that mentor-ship of peer groups can success-fully amplify the efforts ofmentoring for the benefit ofmany. After initiating severalpeer-mentorship groups, we rec-ommend 10 criteria (Box 2) toanyone contemplating such atask:

1. Process expertise: the groupof facilitator mentors focuseson the processes that arecommon to all academicprojects. At least one facili-tator mentor in the groupshould have experience andinsight into: the process ofacademic advancement; theinstitution’s research struc-ture; the process of publish-ing scientific articles; andboth an understanding ofand connections with theadministrative hierarchy. Inother words, someone in thegroup should know whatneeds to be done in anygiven situation and, if theprocess is not known, who toapproach in the institutionfor help.

2. Topic expertise: the diversityof subjects studied withineach peer-mentorship group

Box 1. Functions of the facilitator mentor

Accountability

Coordination of group work

Conflict resolution

Timeline development and supervision

Initial edit of manuscript

Writing support

Liaison between editors and authors

Journal queries

Help with protocol development

Career planning

The positivegroup dynamicof thefacilitatormentorsallowed thedevelopment ofdeep collegialbonds

A hands-onapproach andface-to-facecontact with thegroups of peer-mentors createthe idealsituation

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can be great and, in somesituations, the peer mentorsmay know more about theindividual topic than thefacilitator mentors. This sit-

uation should not discouragethe process. As peer mentorsprogress in their expertiseand launch research projects,topic mentors will need to

be identified to give peermentors advice andassistance.

3. Writing support: the facilita-tor mentors must be experi-enced writers who are willingto provide constructivefeedback to the peer men-tors. They should be familiarwith the institutional sup-port services available toauthors. We observed thatthe peer mentors were oftendiscouraged by the com-ments and queries frommedical editors and review-ers. The facilitator mentorsprovided perspective,encouragement and guidancefor the junior teaching staffas they modified and clarifiedtheir manuscripts throughoutthe editing process. In addi-tion, the facilitator mentorshelped the authors to iden-tify appropriate journals forsubmission of their manu-scripts and to bridge thecommunication betweenthe authors and the journalsas queries or requests forrevisions and resubmissionsarose.

4. Timeline development andsupervision: the facilitatormentors provide guidance inthe development of outlinesand the construction of thenext steps towards the goal.Adherence to a timeline thatwas mutually agreed on isessential for most groups,and the facilitator mentorsare responsible for holdingthe groups accountable.A missed deadline can easilybecome a point of conflictbetween the facilitator men-tors and the peer mentors, aswell as among the individualpeer mentors.

5. Communication: communica-tion between the facilitatormentors and the peer men-tors needs to be scheduledand frequent. Email andtelephone communicationswere only adjuncts to face-

Box 2. Ten recommended skills and attributes forfacilitators of peer-mentorship groups

1. Expertise in all institutional, academic and research processes

2. Ability to provide or identify appropriate topic expertise

3. Writing skills and support

4. Timeline development and supervision

5. Skillful communication

6. Ability to garner and maintain institutional project support

7. Conflict resolution

8. Positive attitude

9. Insight and counselling in career development

10. Expertise in information technology

Communicationbetween the

facilitatormentors and the

peer mentorsneeds to be

scheduled andfrequent

136 � Blackwell Publishing Ltd 2008. THE CLINICAL TEACHER 2008; 5: 133–137

to-face meetings. Peer-men-torship groups expresseddissatisfaction with thecommunication process whenregular group meetings didnot occur. For groups thatoperated at a distance, con-ference calls were essentialto effective communicationbetween facilitator mentorsand peer mentors.

6. Project support: a projectsuch as facilitated peer men-toring requires its own secre-tarial support, as well asinstitutional support of pro-tected time for facilitatormentors and peer mentors.

7. Conflict resolution: the role ofthe facilitator mentors inconflict resolution is as theneutral party in disputes aris-ing from within the group ofpeer mentors. These disputesoften involve emotionallycharged issues. Respected bythe opposing parties, thefacilitator mentors work toresolve conflict issues throughconciliation, mediation andarbitration.

8. Ongoing positive approach:initially, the peer mentorswere easily intimidated bynew tasks, but they gainedconfidence with each incre-ment of success. Frequentencouragement is needed tocounteract discouragementand despair.

9. Career development: an ulti-mate purpose of the peer-mentorship project is to ad-vance the academic careers ofjunior female teaching staff.In keeping with this goal, thefacilitator mentors areresponsible for reviewing the

curriculum vitae ofparticipants and must befamiliar with the institutionalrequirements for academicadvancement. One of our aimswas the advancement of allpeer mentors at the instructorlevel to the assistant professorlevel in 12–18 months. Toachieve this advancement,clear goals need to be estab-lished, and an aggressiveagenda and brisk productionof papers are needed.

10. Expertise in information tech-nology: within Mayo Clinic, anintranet with multiple servicesis available by wireless andwired technology, and aninformation technologist isavailable by phone at alltimes. However, even withthis support, we often found ithelpful to have one facilitatormentor who could quickly dealwith computer issues. Weobserved that, among thefacilitator mentors, computerproblems quickly increased thetension and, the faster theseissues were resolved, the fas-ter they were able to return toa productive environment.

CONCLUSIONS

The US National Academy of Sci-ences and the US National Insti-tutes of Health have called for anationwide effort to realise thescholarly potential of women inacademic medicine.7 A 5-yearstudy is under way to evaluate theissues that underlie the dispari-ties in academic advancementbetween men and women. Inkeeping with this agenda, wehave developed a programme offacilitated peer-mentorship, using

a strategy of peer mentoring toencourage female teaching staffto develop and implement skillsthat produce academic advance-ment. In our experience, womendoctors working in same-sex peer-mentorship groups with gender-matched facilitator mentors haveshown important academic pro-ductivity and satisfaction withthe process.

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Frequentencouragementis needed tocounteractdiscouragementand despair

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