Everything seems to be extreme nowadays – “Extreme Makeover: Home Edition,” “Extreme Weight Loss,” even “Extreme Fishing” and “Extreme Couponing” – so it was only a matter of time that extreme came to cardiothoracic surgery.

Dr. Michael K. Pasque of Washington University in St. Louis explored “Extreme Mentoring in Cardiothoracic Surgery” in his commentary published online ahead of print for the October issue of the Journal of Thoracic and Cardiovascular Surgery (J Thorac Cardiovasc Surg. 2015 doi: 10.1016/j.jtcvs.2015.04.056).

Meaningful mentoring “carries with it considerable responsibility. Extreme mentoring comes only at a price – it is going to cost us,” Dr. Pasque wrote, calling on academic cardiothoracic surgical mentors to perform a self-appraisal of their commitment and mentoring skills. He even developed a self-appraisal checklist that involves 37 different markers in four different categories: general; goals, pathways, and meetings; milestone timelines and taking action; and clinical assistance.

The first step in extreme mentoring for the academic cardiothoracic surgeon is to focus exclusively on the mentee. “As cardiothoracic surgeons, we are used to having the attention focused on us,” Dr. Pasque noted, but mentoring is different: the “energy of our relationship” must focus on the mentee.

The next step involves an objective assessment of the mentee. “If we are to throw our support wholeheartedly behind our mentee, we must genuinely believe in them,” he said. This assessment leads to setting goals for the mentee. “My formula is to honestly estimate the surgical, research, teaching and academic life goals that are both desired by and within reach of our mentee – and then double them,” he said. “We must set very aggressive goals for our mentee.”

Achieving those goals involves directing mentees to the right pathway and then helping them stay on that pathway despite obstacles. “When their progress through these barriers is discussed – and that should be often – then ours should be the voice that reminds them that despite the momentary setbacks, the goals we have set are going to happen,” Dr. Pasque said.

The process involves frequent “and substantive” meetings between mentor and mentee and establishing timelines for achieving milestones and goals. The mentor must back up what happens in those meetings with action – both overt, like assisting them in surgery or introducing them to influential colleagues, and covert in ways the mentee may never know about.

One “clandestine” operation involves the mentor keeping an updated list of 10 individuals who have the most to offer the mentee, “especially in areas in which we have limited or no influence,” and habitually following up with them. The mentor must be willing to “pick a fight” so the mentee doesn’t get left behind on call while senior colleagues attend meetings.

“We must be the senior voice that speaks up for them,” Dr. Pasque wrote. “They need to attend these meetings, even if it is we who must stay behind in their place.”

The mentoring process involves being across the operating room table from them at key milestones in their surgical development and being on-call 24/7 for the mentee. That may seem like extreme handholding to some critics, but Dr. Pasque said that letting a patient suffer or die is inexcusable. “Our first priority is always the patient’s well-being.”

The mentor must show respect to the mentee and practice “extreme encouragement,” especially in the operating room. “There is something magical about being told you are a good surgeon,” he said. “You become one.” This isn’t about falsely building up the mentee, but instilling the confidence to act on the patient’s behalf. The mentee will face enough doubters. “We must be the voice that assures them otherwise,” he said.

Teaching leadership also is key for the mentor. Mentors teach leadership by modeling it. “The best leaders are always those who place the needs of others above their own,” Dr. Pasque pointed out, harkening back to putting the focus on the mentee. “We can’t teach them to put the needs of others above their own without putting their needs about ours.”

Ultimately, the mentor’s greatest desire should be that the mentee exceeds them, “that they make everyone forget about us,” Dr. Pasque said. That would be the “crowning achievement” that would make the mentor “most unforgettable.”

Dr. Pasque had no disclosures.


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