Expanding the Horizon of Resident Development

Scholarly activity is an integral part of graduate medical education for anesthesiology residents. Among the scholarly work products, publications in peer-reviewed journals are desirable for both residents and for residency program accreditation.

There are numerous challenges to a successful resident publication, including access to suitable opportunities, residents’ academic skills, time availability, and the need for continual project support. It is often tempting to offer projects to residents with prior experience, as they may function with more independence. Ford et al. reported that in anesthesiology, despite there being almost as many resident publications as there were graduating residents, only 30% of residents graduate with publications, publishing on average 2.7 manuscripts each (Anesth Analg 2019;128:796-801).

Programmatic characteristics are cited as one of the central aspects of resident scholarship (BMC Med Educ 2021;21:567). To address this apparent clustering of scholarly opportunity and engage all residents in academic development, the author’s (ZJ) institution developed a formal academic mentorship program. The infrastructure of the program includes:

• Involvement of senior academic faculty for scientific oversight and project acquisition.
• Close work with the residency program leadership and clinical leadership to ensure the ongoing provision of project support.
• Centralized organization of project distribution to ensure that prospective projects are screened and distributed to a team with the necessary skills and experience, while maximizing the inclusion of residents with limited prior experience.
• A library of supporting documents, including sample writing, correspondence templates, and technical guides.

Each supported project is assigned a subspecialty advisor and an administrative mentor. The subspecialty advisors are faculty members experienced in the relevant field (often fellowship trained) who can provide expert guidance on the clinical topic and relevant scientific evidence. The administrative mentor may be an experienced senior resident or a faculty member. They are responsible for overseeing the team organization, timekeeping, and providing assistance with the submission and revision process.

Having a formal academic mentorship infrastructure creates a mechanism for mobilizing institutional resources in support of active, high-yield projects. Since the program’s inception in October 2022, more than 70% of the residents have been involved in at least one publishable project. It has supported 26 publications, with more submitted for peer review. This contrasts with the historical average of 3.5 resident publications per year. Additionally, the mentorship program also facilitated new collaborations with other departments and promoted active medical student engagement with the department of anesthesiology.

It is common practice for senior residents to take on clinical mentorship or administrative roles within a residency program (Anesth Analg 2023;136:270-81). In contrast, the value of senior residents as academic mentors is largely unexplored territory (Fam Med 2014;46:288-90). As part of the academic mentorship program at the author’s (ZJ) institution, interested residents are given the training and necessary experience to develop as academic mentors to their peers. A senior resident is selected each year to help organize the academic mentorship program. The opportunity for academically active residents to become mentors serves to benefit both the individual’s professional development and the residency program.

For the individual, the mentorship role is an opportunity to develop skills in nonclinical teaching, team organization, and project management. In contrast to being a primary author, being an academic mentor enables interested individuals to provide academic expertise to multiple projects, while also learning from the decision-making process. At the author’s (ZJ) institution, five residents have mentored 49 projects. This level of scholarly exposure is extremely rare for residents who don’t have protected research time.

The development of successive resident mentors each year also creates a mechanism for academic skill to be passed down from each graduating class, which facilitates skill retention within the institution. Resident mentors could also assist faculty with the organization and administration of individual projects, which indirectly contributes to faculty professional development.

As in mentorship, a sponsor-protégé relationship is also built on the ideas of career advancement, professional development, and mutually beneficial goals; however, there are some key distinctions. On a fundamental level, mentorship focuses on advising through sharing knowledge and experience, with “time” being the major investment. Sponsorship focuses on sharing power and leverage to support and advance the protégé, with “reputational capital” being the major investment. In contrast to the traditionally private relationship between a mentor and mentee, a more public relationship is part of sponsorship (asamonitor.pub/3vE0fK1). While initially developed in the business setting, the concept of sponsorship is increasingly gaining traction, especially in women and other underrepresented in medicine, or UIM, individuals (Acad Med 2013;88:1414-7). Recognizing that with an increasingly diverse residency program and varying needs of the trainees, in addition to an expanding department, it is unlikely residency program leadership can match a specific faculty to a resident that meets all their precise mentorship needs, the author’s (MH) institution created a Sponsorship Program. All willing faculty can serve as sponsors to facilitate opportunities for residents and connect them to the rest of the department and profession for focused mentorship or other needs. Specifically, faculty sponsors share or disseminate work or accomplishments of the resident to:

1. improve visibility (amplification)
2. provide insider knowledge to the workings of a system to help the resident advance (strategize)
3. expand the resident’s network, including identification and facilitation of specific mentors both within and outside the department (connect)
4. create opportunities for clinical, professional, or academic work that advances the resident’s career
5. write letters of recommendation and less tangible offers of support like “talking up” the resident (boost)
6. advocate for the resident against someone’s negative perception, being a vocal source of support (defend) (asamonitor.pub/3vE0fK1). Ideally, rising CA-1s in the department (MH) will be able to build an “umbrella of mentors,” each addressing different needs due to their access to faculty sponsors, residency program leadership, and other departmental education leadership.

It is important to recognize that residents not only need advice and counsel from a designated mentor but also expert guidance in their areas of professional interest. They also need advocacy from sponsors to be placed into networks and opportunities. Residents should be proactive with connecting with potential mentors and sponsors, conveying interests and needs, asking for specific opportunities (working on a hospital committee, giving a talk, working on a particular skill, etc.), and not hesitating to share kudos about their mentors or sponsors with residency program leadership. As the field of anesthesiology expands and faces new challenges, residents must be supported in their development as the next generation of innovators, leaders, and educators.