Mentoring and Trust in High-Risk Scientific Professions

Abstract

Mentoring is an essential step in the learning process for many professions. In medicine, mentoring and working as an apprentice is vital to the education of future physicians. In other vocations, such as field biology, mentors help trainees learn how to navigate potentially dangerous situations, such as obtaining data on deadly animals. When lives are potentially at stake, are special mentoring skills required? The qualities of a good mentor and the benefits of mentoring have been explored by others. The question for this chapter is whether there are certain qualities that mentors bring to potentially life-threatening situations that help build trust and ensure the safety of all involved. The authors will explore this topic through the lens of their experiences and literature review. They each work in a field where trust in mentoring is vital. How does trust work in these situations and what can happen if a trainee and mentor do not trust or overly trust each other? As mentors and mentees walk the tightrope of these high-risk situations, how do they keep everyone safe?

1. Introduction

In the fields of medicine and science, most learning occurs through apprenticeship [1, 2, 3, 4]. First, beginners observe their experienced mentors and learn the skills of the profession. They are then gradually given more and more responsibility–first under observation, and then with more independence. This is a learning strategy that occurs in many professions but in certain areas, such as some scientific endeavors and medicine, there are potentially dangerous consequences if the learner has not understood or gained the necessary skills. For scientists who are headed into the field to study dangerous animals, such as venomous snakes, the danger is typically to themselves. However, as we will discuss, risk can be present for others if a learner overestimates their experience– such as misidentifying a venomous animal–and puts others at risk. As we consider the learner/mentor relationship it is important to consider its bidirectional nature. The learner has to trust that the mentor is teaching them the necessary skills. The mentor has to trust that the learner has listened and understands these skills as they practice with more and more autonomy.

In medicine, the risk is often not to the learner. There are situations, such as dealing with infectious disease, where if the learner does not follow the necessary guidelines they can be at risk. However, typically the risk is to the patient. This can complicate trust. In this situation, there is not only the bidirectional nature of trust, but the added element of whether the patient trusts the care that they will receive. In recent years, additional teaching strategies have been employed in medicine that can change the role of the apprenticeship. As new technology is developed, trainees often practice skills in a simulated setting before attempting them in a real-life situation. This can increase a patient’s trust in the system because they know that the trainees are receiving more practice in a low-stress environment. However even in these teaching situations, mentoring is vital. A trainee still needs their mentor to teach them the appropriate technical skills and ensure that they are practicing them properly. As Vince Lombardi, a famous American football coach, once said, “Practice does not make perfect. Only perfect practice makes perfect.” Whether in the field, the simulation lab, or the operating room, learners need to use precise skills. They need mentors who will ensure that they have perfectly understood and learned the skills so that when the learners practice independently, those involved in the situation can trust that they will be kept safe.

There are many terms that are used in the literature [5, 6, 7] and daily discussions of education—teacher, supervisor, mentor, advisor, or coach. Often mentors are senior individuals who are chosen by the mentee as a role-model. Within their discussions, mentors can provide advice and help the mentee as they navigate a professional path. Mentors often do not need to be in the same field. As a psychiatrist, I have mentored pediatricians in the more general perspective of medicine as a profession: how to juggle research, academics, clinical work and be able to have a homelife with one’s family. Advisors are often individuals in educational settings that can ensure that students are completing their requirements. They are often in the field of the students choosing and help guide their journey, discussing current classes and future opportunities. The advisors do not necessarily provide advice outside of immediate educational questions and are not often teaching skills to their advisees. Coaches are often seen in athletic situations; they provide advice about skills and also encouragement so that trainees can perform at their highest level. Teachers provide education in the classroom and lab, instructing others through lectures, demonstrations, etc. Supervisors are often in the workplace, monitoring their subordinate’s work.

In this chapter, we have selected the words trainee and mentor despite the fact that this use of mentor is slightly different than the definition provided above. We have done this to emphasize the intense relationship between the trainee and his/her educator, teacher, supervisor. Those terms do not capture the significant relationship between the trainee/mentor that we will be exploring in this chapter. In the apprenticeship model, especially when lives are at stake, trust becomes more vital than one typically sees in a teacher or supervisor relationship. The term “mentoring umbrella” can be used to describe this relationship. The more-well trained individual (mentor) will be acting in all of the roles described above: they will teach new skills, advise and coach as the trainee learns the skills, supervise as the trainee begins to practice these skills independently, and nurture the formation of the trainee’s professional identity [8]. Everyone involved or affected by these relationships trust that while under the mentoring umbrella, they will be kept safe.

Trust is an integral part of any relationship: organizational, personal, and professional [9, 10, 11, 12]. The main framework of trust involves one party accepting vulnerability and depending on another party [9, 10, 11, 12, 13]. Trust can be split into two main groups: generalized and particularized. Generalized trust involves a larger collection of unfamiliar individuals or organizations–such as medical institutions– and relates to trust on a societal level [11]. In comparison, particularized trust is on a smaller and more familiar level–such as a single mentor and trainee relationship [11]. For medical trainees and scientists, both types of trust are involved in the mentoring relationship. First, the trainee trusts that the mentors hired by the institution will be competent clinicians/scientists and educators. This can be seen as generalized trust. As the trainee begins to work with mentors, they develop an awareness of how much they can trust each person individually (particularized trust). This trust typically forms when the trainee feels that the mentor is invested in them and their training [14]. This type of trust is vital in these relationships because when trainees trust their mentors, they are more authentic, willing to acknowledge any lack in their skills and ask questions without fear of a negative response [14]. If they cannot trust their mentor, the trainee will not want to demonstrate any deficits for fear of criticism rather than education.

Both generalized and particularized trust inherently means that one is always completing a risk assessment of another person or institution [9, 11]. The risk of trust becomes exceedingly more evident as the stakes become higher [10]. In medicine and other scientific endeavors, both types of trust are important. Organizational trust is often the initial consideration. Not only for the trainees but also so that patients trust that the medical organization will provide the necessary care. Trainees want to work at an institution that they trust will provide them with the necessary mentoring so that they can become competent professionals when they exit their training. Trainees need to trust their mentors, who they may not have worked for before–two people who are essentially strangers need to start the challenging task of building a trusting relationship (Figure 1) [15].

Figure 1.

A mentor and trainee working together with a King Cobra (Ophiophagus hannah). Photographed by Samantha Smith.

2. Qualities of a good mentor and trainee

What makes a good mentor, especially in the fields of medicine and biological research? As discussed, an example of particularized trust with high potential risk is in scientific fieldwork. Fieldwork is the portion of scientific research where data is observed or collected in uncontrolled surroundings [16]. Often fieldwork begins early in a student’s scientific education and is seen as an integral part of a young scientist’s training [17, 18, 19]. Fieldwork can be an excellent tool to train young scientists problem-solving and quick thinking in stressful situations [20]. However, unlike laboratory work, which is contained and highly regulated, fieldwork can involve traveling to new places, with procedures that often need to be modified in the moment based on the project’s need. In biology, as well as other scientific fields, fieldwork comes with inherent risk: potentially dangerous wildlife, weather, or people [20]. It can range from simple tasks, like habitat samples, to more extreme research, such as handling venomous snakes or diving into an ice-covered Antarctic Lake [17].

Medicine comes with inherent risks for the trainees but also for the patients. Future sections will look at what can help ensure a patient’s trust in the organization and individual. For now, we will consider the qualities of individuals who provide this essential mentorship before sending a young scientist out into the field or allowing a trainee to take over the independent assessment and treatment of a patient. Trainees will typically participate in essentially three apprenticeships, as described by Noone [21]. There is cognitive or intellectual apprenticeship, which focuses on applied knowledge (understanding clinical presentations or animal behaviors); skill-based apprenticeship, in which one develops clinical (or field) skills and judgment; and ethical apprenticeship, which focuses on ethical behavior and responsibilities of the profession (treating patients and the environment respectfully as tasks are completed). Ramirez [6] also emphasized that instruction from a mentor helps develop competence in three areas: intellectual, physical/manual, and interpersonal; “the mentor has an important task of guiding their mentees by word and deed” (p.A57).

Since mentors will be teaching clinical/scientific knowledge, skills, and professional behavior, they need to be approachable, available, experienced, supportive and demonstrate non-humiliating behavior [22, 23]. Trainees need to be able to readily reach the mentor to ask questions if unique experiences arise. They need to feel supported so that they can voice their uncertainty. When this psychological safety is not available, it can damage this relationship, affect future trust, and put patients at risk; at Boston Children’s Hospital in 2001, a 5-year-old boy died after a prolonged seizure, when two postgraduate medical trainees did not call a senior physician for assistance until an hour into the episode [24]. Mentors provide wisdom, shape skills, and pass on lessons learned [22]. Trainees need to be willing to learn, be proactive, communicative, and open-minded [22]. They need to know their limits and be willing to reach out if they feel out of their depth, to trust and understand that they have limited knowledge. They need to be flexible as they work with different mentors to learn new skills and be willing to ask questions and confirm details before making decisions.

Trust needs to be mutual between mentor and trainee, although there can be conflicts of interest if the mentor has overlapping roles [25]. These conflicts can affect trust in the relationship but can, hopefully, be navigated if the relationship is supportive and there is open communication. For example, if a mentor is involved in the research and under a deadline to get an article published, there still needs to be assurance that the trainee will not be sent out ill-prepared to collect the data. Mentors need to not only provide the technical know-how but also have a larger situational awareness. This would include the ability to recognize when a situation is no longer routine and has the potential for complications.

These skills are important for the safety of those completing fieldwork. Trainees must be able to trust that their mentor has adequately prepared them for unknown scenarios and the mentor must trust that the trainee understands the protocol if those situations occur [20]. The possible risks, and the plans if these circumstances happen, can help prevent or mitigate accidents [20, 26]. These mitigation plans can assess the risk of incidence and help prevent them: wearing protective legwear if venomous snakes are present, communicating about hazardous weather, and first aid kits are a few methods of ensuring safety [20]. The role of a mentor in fieldwork is to maintain the safety of their student and ensure that by the end the student leaves without severe bodily or mental harm [26]. As fieldwork is unpredictable and can lead to hazardous circumstances, the mentor also has the role of creating a suitable plan if an accident were to occur [26]. For safe fieldwork to occur, trainees must be willing and able to trust that their safety is the primary goal of their mentor: that if the scenario were to occur, their mentor would rather stop fieldwork to ensure safety–and that their mentor is competent enough to know when work has become too unsafe [[26], Dr. Max D. Jones personal correspondence]. Unfortunately, even seasoned professionals can make mistakes and in the field those mistakes can be deadly [20, 27].

Another important aspect of a mentor’s role is verifying the trainee’s work, as trainees are inexperienced and will always make errors at some point in the learning experience. This is true in field work and medicine. Environmental aspects of fieldwork can cause exhaustion or otherwise create situations where judgment is impaired. In addition, even when trainees believe they have learned the skills that they are being taught, they still may not understand the intricate details. Mentors need to remember that they have developed their expertise over many years. Verifying a trainee’s work may prevent a harmful situation. For example, Joe Slowinski–a leader in the field of herpetology–was bitten by a many-banded krait (Bungarus multicinctus) in Myanmar during a comprehensive wildlife survey. Kraits, a venomous snake with a potent neurotoxic venom, were present in his study area, as were many non-venomous look-alikes, such as the white-banded wolfsnake (Lycodon septentrionalis). On September 11th 2001, his assistant, Htun Win—a young Burmese herpetologist—gave him a bag containing two snakes, which Win believed were both white-banded wolfsnakes. Slowinski reached his hand in without verifying and one of the snakes within bit him. As he pulled it out, Slowinski realized that this snake was actually a many-banded krait, while the other was the harmless wolfsnake. He died the next day. Htun Win says that he was confused, as both snakes he brought in looked the same [27]. This is a tragic example of the possible outcomes that can occur when a mentor is too trusting of an inexperienced trainee’s work without verifying themselves. Trainee’s do not have the years of hard-earned experience that a mentor benefits from and can easily make a mistake that could cost lives.

3. Potential challenges in the mentoring relationship

Part of what can erode the mentoring process are behaviors that impact the bidirectional trust. Overly critical mentors can inhibit trust in the relationship [28]. Trainees become afraid to ask questions or clarify the reasons behind a certain decision and that can impair their cognitive development as a physician/scientist. They may hide their mistakes in fear of being chastised. This can impact not only the current situation but also future situations if the trainee has not developed the necessary understanding or skills. When trainees in Pakistan were surveyed, they identified two important qualities of a mentor: good communication skills (44.5%), and calm and non-humiliating demeanor (44.5%) [23]. Interestingly, those training in surgical fields considered generating competition among trainees as the best teaching method, as opposed to the views of trainees in other specialties (p = 0.001) [23].

In 2022, Gianakos et al. [29] looked at bullying, harassment, and fear of retaliation in surgical training. In the study, 63% of the trainees experienced bullying, 43% discrimination, 29% harassment, and 27% sexual harassment–with female residents reporting all of these experiences more often. Who was responsible for these behaviors? The study found that attending surgeons, followed by senior co-residents, were the most common perpetrators. What was the outcome? Of the trainees surveyed, 71% did not report the behavior to their institution and 51% stated this was due to fear of retaliation. They had good reason to worry. Of those who reported their experiences, 56% had a negative experience based on the report [29]. These negative experiences can also occur in undergraduate/graduate school. One study found seven major ways that students experienced negative mentoring: absenteeism (their mentors where not available when they needed help), abuse of power, interpersonal mismatch, lack of career support, lack of psychosocial support, misaligned expectations, and unequal treatment [30]. Some of these behaviors meant that positive mentoring was not provided, such as limited career support, but others were harmful mentoring experiences, such as abuse of power. In many cases, a “culture of intimidation” was established, and students had limited options to try and improve their situations [30]. Students have described the negative experiences with mentors as feeling like a cog in a machine, one that could easily be replaced, rather than a student looking for guidance to develop scientific skills [31]. This was often felt by students being funded by grants, putting them in a conflicted role where researchers/faculty saw them more as employees rather than trainees. In this study, more than half of the doctoral students cited instances in which mentors undermined their standing in their research groups, departments, and institutions [31]. Students felt that their negative experiences had detrimental career and psychosocial effects [30, 31]. The residents surveyed by Gianakos et al. [29] experienced burnout, anxiety, and depression related to the negative treatment. Clearly, negative mentoring can have both immediate and long-term adverse effects.

Medicine and scientific labs operate in a hierarchical nature. This can work well when those in the hierarchy treat those below them with respect. Yet, as seen in Gianakos et al. [29], that is not always the case. This has been identified as part of the hidden curriculum in medicine. In the hidden curriculum, what is taught and demonstrated is probably not listed in the goals or lessons in the overt curriculum [32]. Many students describe learning in the first years of medical school about communication and ways to interact with patients and their families. They then enter the clinical realm and see that professionalism and compassionate interactions are not always the norm. There is a conflict between what they have been taught in the classroom and what they see on the clinical wards. Since medicine operates as an apprenticeship, seeing those higher in the hierarchy demonstrate negative behaviors gives others permission to model that behavior. This was clearly displayed in Gianakos et al. [29], when senior residents modeled the negative behaviors of their attendings.

In addition to learning technical skills, educators need to model respect for the trainees and provide a sphere of psychological safety. Mentors need to acknowledge feelings and emotions triggered by encounters with patients or experienced in the field. Since mentors have worked in their fields for years, they may not recognize the emotional toll that certain situations can have on their trainees. Trainees need mentors that provide acceptance and support. Scientific discourse should be encouraged, and trainees should feel safe to admit when they do not know something without fear of ridicule [33, 34].

Another challenge within the mentoring process is the lack of formal education for mentors and future mentors [35, 36]. Informal training depends on the role models that one has trained under [5]. If they had a negative role model who used intimidation or ridicule as a teaching strategy, then those behaviors may get perpetuated. Culture is difficult to change. When author MPL works with medical students, we often discuss that they need to learn from their experiences to know what they do or do not want to model when they are the ones in power. They need to stop the perpetuation of harassment and intimidation, and be the future face of change. Yet that can be difficult if one is faced with faculty who are overly critical and believe that learning should transpire in a culture of fear. Residents need support and training in their mentoring skills as well as their technical skills as they move up in the hierarchy [7]. They need education about mentoring, how to develop positive skills and the detrimental nature of negative mentoring.

4. Others’ trust of the mentoring process

In medicine, there does not only need to be trust within the relationships of colleagues, teams, mentors, and trainees but–most importantly–between patients and their doctors. How is this trust affected by the system of medical apprenticeship? Patients are currently more informed about and engaged in medical decision making and this includes the involvement of residents in their medical care. Studies show that patients are willing to have residents involved in their treatment but want information about the roles that they will play. Without this transparency, patients’ trust in the medical establishment can decline. For example, in one study, 83% of patients would approve of a resident’s involvement in cataract surgery in some way, and 49% would approve of them performing the actual surgery but only if the request was made ahead of time. The majority said they would be upset if a resident performed the surgery without their prior consent [37]. This does not only have trust implications but potential legal implications. Courts have ruled that except in emergency situations, there is an implied contract between the patient and doctor. This means that the patient needs to understand the roles that trainees will play in the surgery if there is going to be “significant participation” [32, 38].

Can patients trust that they will be getting safe medical care during apprenticeship training? Many scholars in academic medicine talk about the “July” effect. The underlying assumption is that since new trainees start in July and those already in the system move up to the next year or graduate, care will not be as safe. The saying goes, “Do not get sick in July!” If that effect were really present or if the involvement of residents in one’s care did put them at significant risk, then patients’ trust in academic medical centers would decline. That would also affect their overall trust in medicine and their physicians. Luckily, research demonstrates that these risks do not seem to exist.

One study looked at appendicitis. Because this surgery is straightforward, often trainees serve as the primary surgeon. This can allow us to look at academic year and level of supervision. According to Yaghoubian et al. [39], complications and outcomes are similar no matter what time of the year they are performed, early in their training (July) or later in their training. Evidence is also available that appendectomies can be performed without increased complications by unsupervised senior trainees [40] and junior trainees with senior trainees supervising them [41]. As described before, this is part of the training model: as a trainee becomes more competent, they then perform the task themselves, and eventually teach or supervise others. A common quote is, “see one, do one, teach one”, but what is more accurate is: see the procedure performed correctly, be able to describe the procedure, receive ongoing supervision as you perform it multiple times and when you reach expertise, pass that training along to others [42].

The success of apprenticeship has been demonstrated in a 10-year study looking at the outcomes of hip and knee arthroplasty. There was no training initiation effect among fellows (no difference in complications at the beginning of their training or as they proceeded). Some of this is related to increased supervision when trainees are just beginning. They have to prove their competence before they are given increased responsibility. Graduated autonomy, the backbone of the apprenticeship method, can be safely employed without impacting patient outcomes [43]. Trainees within an apprenticeship can be involved in multiple procedures and settings without adverse outcomes, such as, pancreatic resectioning [44], intracranial resectioning [45], laser prostate surgery [46] and trauma [47]. In these studies, it was noted that cases are chosen by level of complexity so that trainees, who are being supervised by mentors, can gradually increase their level of skills. That is often the most important aspect of trust between trainees and mentors, and in medicine between patients and the organization. There needs to be an experienced mentor who is able to teach the trainee the appropriate techniques and then supervise that individual until they are confident that the trainee can safely complete the task on their own. This is also true in field work. As noted before, you cannot send an individual out into the field to study venomous animals in uncertain field situations, unless the mentor is satisfied that the trainee has the tools to deal with the potential dangers. Medical and fieldwork training is designed to ensure that the trainee is not given more responsibility than they are able to handle.

In high-risk fields, one needs to consider the costs and benefits of trust in a mentoring relationship. Biology is the study of living things, and as such, biological data is usually collected under a timeline outside of human control. The changing of a season, the movement of living organisms, or the death of a study animal can all cause the end to data collection, and adds urgency during the study period. Additionally, biological studies are often operating with limited funds, particularly in academic settings, which causes most fieldwork to be done by early career scientists that will accept lower wages [48]. Because of these factors, workers frequently enter field settings with little experience or time to fully understand the project or protocols [20]. It is the job of the mentor to ensure that a trainee has had adequate training and understands field protocol in a short timespan [[20, 26], Dr. Max D. Jones personal correspondence]. When the information can only be introduced in the field setting itself, a demonstration by the mentor is crucial to introduce techniques and to set expectations [20]. Trust in a mentor allows for quick and effective training, an invaluable asset in high-risk fields.

5. Additional training tools to increase skills and thereby increase trust

Apprenticeship is the main training model of medicine and has been effectively used for centuries [49]. Attendings (mentoring physicians) are clearly more knowledgeable, more skilled, and have more experience. This allows them to supervise their trainees and provide the apprenticeship needed to pass on the tools of the trade. Even though medicine has become more complicated, the tools to acquire these techniques have expanded as well. With advancements in medicine and technology, new training methods are being devised. Simulation centers, role play, computerized programs, and laboratory surgical training can allow trainees to practice manual skills, such as intubations and surgical techniques. and non-technical skills, such as running a team and situational awareness [50, 51, 52, 53, 54, 55, 56, 57, 58, 59]. They also allow trainees to practice tasks such as giving bad news, dealing with angry family members, or navigating individuals with various cultural and religious beliefs [60]. Although practice helps to hone these skills, it is only through observing their mentor with real patients–managing both the patients’ and their own emotions–that trainees can become truly compassionate physicians [60]. Simulations can expand on but cannot take the role of in-person experiences.

6. Conclusion

Medicine is a complicated field and physicians need to learn how to navigate life and death situations. Graduates from training programs need to leave with not only technical skills but also sound clinical decision making. They need to have developed a professional identity that allows them to become mentors themselves and provide compassionate care to their patients. Clearly, the expectations of mentors are substantial and their roles are vital. Over the years, medicine has demonstrated that apprenticeship is the best way to teach future physicians the necessary skills.

Fieldwork is extremely broad and used in so many aspects of science, there is little consensus on what it entails [61]. This leaves students who do not have an adequate mentor uninformed of what is necessary for fieldwork and under equipped to deal with challenges as they arise [61]. Without a mentor, students go through their fieldwork alone, spending valuable time and resources relearning methods that an experienced researcher may already know. They may make mistakes that experts could have warned against, and many have to learn through trial and error [61]; this cannot be a learning style in high-stake fieldwork or in medicine, when a person’s life depends on the trainee’s skills. In political science, 62% of surveyed graduate students in Comparative Politics and International Relations programs did not receive formal training for fieldwork and only 20% felt that they were very or mostly prepared for their fieldwork [62]. Of the students who did international fieldwork, half of them encountered safety issues–a majority of those students were women [62]. Student-run projects are especially susceptible to risk, as they often have less funding and support [63]. Most graduate schools lack formal safety courses and when training is provided it tends to be haphazard and subjective to the one teaching it [63]. This is more evidence of the need for formal instruction, to ensure mentors have the skills to adequately shepherd their trainees through difficult situations. As trainees learn safety from their mentors, trust in those mentors and that information is crucial in perpetuating safe practice, in both medicine and science. Conversely, mentors must trust that their trainees are absorbing the information needed to become capable professionals. Only through this bidirectional trust, can learning be passed from one generation to the next.

Acknowledgments

We would like to thank Dr. Max Dolton Jones for his correspondence on mentoring and venomous snake handling. We would like to thank Samantha Nicole Smith for the use of her photograph displaying Dr. Max D. Jones and author Dayna M. Levine during King Cobra handling training.

Conflict of interest

The authors have no conflict of interest.