https://orcid.org/0000-0002-2397-0566
A career in academic medicine will entail a number of challenges to an individual’s development.1-4 Some of these obstacles stem from a lack of content expertise (eg, a learner still developing clinical competency or a researcher with a project requiring unfamiliar methodology). Other times, the challenge requires broad-based guidance (eg, how to establish an academic niche) or facilitating access (eg, getting onto a steering committee or grant team). Still other times, the need is developmental (eg, a residency director establishing their own leadership philosophy or a midcareer faculty member considering an advanced degree or a new career direction). Though professional development guidance was recently provided by the Accreditation Council for Graduate Medical Education (ACGME) Clinician Educator Milestones,5 there is rarely an objective “right” approach to any of these conundrums. Instead, each individual must weigh preferences, needs, and immediate circumstances to make a decision. Often, learners and faculty turn to others for advice within the community of medicine in the form of a developmental interaction.
A developmental interaction is a bidirectional exchange between 2 or more people causing an intentional change in behavior toward a specific outcome.6 These interactions come in many familiar forms: teaching, advising, mentoring, coaching, sponsoring, etc. At its best, a developmental interaction can be deeply satisfying, empowering, and career-propelling. All too often, though, physician developmental interactions are approached as a passive process that “happens to you” rather than something one can proactively shape. In this article, we review common developmental interactions within medicine and provide some guidance on how a physician can deliberately and proactively leverage them to address future career challenges in a “personal board of directors” model as described in the Harvard Business Review.7
Flavors of Developmental Interactions
A unifying quality of a developmental interaction is that it is “a distinguishing characteristic of training professionals.”8 Teaching is undoubtedly familiar to most readers and will not be covered further. Advising is a hierarchical, content-focused relationship wherein a knowledgeable advisor gives direct guidance on how best to satisfy a challenge or overcome an obstacle.9 Mentoring involves a longitudinal, senior-junior dynamic wherein the senior mentor uses accrued wisdom and experience to guide the junior mentee along a (typically similar) career path.10 Sponsorship involves using one’s position or power to vouch for another or direct opportunities their way. Coaching, a nondirective partnership, helps the coachee develop new insights and take action to address a specific goal.11,12 Coaching uniquely can occur across backgrounds, with no content expertise required.13 Each of these interactions have value, but none are a panacea; the key is to choose the right developmental interaction based on its indications for use (see Table 1).
Ask Yourself: What Do I Need From This Interaction?
A common mistake when engaging in a developmental interaction is to conflate the need for assistance with the need to be deferential. This passivity often leads to a mismatch between the developmental need and the specific developmental interaction format—something that can be frustrating, time-consuming, and unproductive. For example, a resident may become frustrated with a faculty member who is using a nondirective coaching approach when the resident is actually seeking definitive answers for how to perform better on a clinical rotation. Here, an advisor could best serve the resident. When deciding on the optimal type of relationship to pursue, spend time considering your desired outcome. Is it a structured space in which to reflect, give clarity to thoughts, and set goals? If so, a coach may provide the needed accountability. Is it to take advantage of the other’s knowledge and expertise? Perhaps an advising relationship is in order. A mentor can add a layer of personal investment in the mentee’s success over the long term. Table 2 can be used as a worksheet to identify the core issue for which support is desired and can assist the reader in identifying the type of relationship needed (the online supplementary data contains examples of completed worksheets for both a hypothetical learner and a faculty member).
The Arc of a Developmental Interaction
Much of the benefit of a developmental interaction stems from the quality of the interpersonal relationship that forms within the dyad—regardless of the actual format of the relationship. Psychological safety, a concept that amounts to trust and consistency, is central to the formation of any high-quality relationship, especially where sensitive personal thoughts, goals, and challenges are revealed.14 Table 1 provides an overview of ideal uses for each type of role and what each of these conversations might look like, as well as potential questions you might ask as you consider them for your personal board of directors. Though some roles may involve a difference in seniority or expertise, each participant should feel empowered to co-create the relationship by clearly stating what they will contribute and what they need. Agreeing on goals of the relationship, which may seem contrived at the outset, will help structure your interactions and create a shared mental model to avoid misunderstandings. This transactional agreement amounts to a social contract each party understands and will strive to fulfill. Furthermore, these goals of the relationship can be revisited over time to meet evolving needs.
As Shakespeare said, “All the world’s a stage, and all the men and women merely players; they have their exits and their entrances.” So too is the developmental relationship circle. Though creating your personal board of directors is a long-term endeavor that requires curation, needs and people evolve. It is important to be attentive to signs a relationship has run its course. Have the advising questions been answered? Does the other person’s position no longer bring the necessary support? Has the coaching goal been met? Has the relationship been sullied through other factors? If so, it may be time to let that person move to another role—perhaps a treasured peer, perhaps an ex-colleague. Laying the groundwork early for goals of the relationship will facilitate a more comfortable closing conversation when the time comes.
Conclusion
Developmental interactions are foundational to physician professional development. However, they are not one-size-fits-all; each has specific strengths that can be leveraged for personal growth. The keys to maximizing their effectiveness are to (1) understand differences between the various developmental interactions; (2) be proactive in seeking out the right one; (3) clearly articulate your needs up front; and (4) be mindful of cultivating—and maintaining—the relationship. Each factor requires proactive intent from the person seeking assistance; simply showing up and participating passively will yield fewer satisfying results. By crafting this personal board of developmental directors in advance of any specific need, one can have a go-to cadre of professional aides to address any career challenge.
References
Editor’s Note
The online supplementary data contains a guided worksheet exercise with completed examples.
