Mentorship in patient safety: Do we need a new approach?

I still remember the day the package arrived. As a young assistant professor at John Hopkins, I was happy to see it was from my mentor, Steve McPhee. Inside, was the draft of a manuscript I had started more than 5 years earlier, but never finished. In the accompanying letter, he exhorted me to resume work on the draft, which affirmed the ethical imperative to disclose errors to patients and their families, and explained how to do it. He said it was important. Oh, and he had found another collaborator, rewritten the draft, and filled out the forms for submission to JAMA – with me as the first author. ‘This is your paper’ he coaxed. ‘It just needs a bit more work – I’d be happy to help.’ Many drafts and many more hours of his time later, the paper was published, and was covered the same week in the New York Times. I continue to this day to work on the topic of disclosing adverse events to patient and families. Mentors are role models who help guide the personal and professional development of their students over time. At least as far back as when Odysseus asked the “wise and faithful” Mentor to educate his son, trusted and experienced people have taught, coached, sponsored and connected the young. One of my colleagues described a mentor as someone “who doesn’t rest until you have succeeded.” Mentorship has long played a critical role in the training and career development of physicians and scientists. A growing body of research has documented the impact of mentorship on outcomes including number of research papers published, grants received, and career satisfaction. But relatively little has been written about mentorship and patient safety. Harrison and colleagues suggested that providing mentors to newly appointed attending physicians could help enhance patient safety. The same authors suggested that having a mentor may contribute to reducing preventable harm to patients, perhaps through service as coaches to improve clinician performance. An exploratory study by Shepherd suggested that positive experiences with mentorship can help physicians learn from medical errors. We are not aware of a study suggesting beneficial outcomes of mentorship for research and careers in patient safety. However, Singh has written about the importance of mentorship in supporting patient safety researchers. My personal experience, and a study by Brancati and colleagues on predictors of success in academic medicine in general, suggest that early mentoring experiences could be important. I ventured into the field of patient safety at the start of my career in research. This was before patient safety could properly be called a field, at a time when the topic was still referred to as “medical error.” I attribute much of my early success to exceptionally good luck in finding mentors. In 1987, having completed a residency in internal medicine and a subsequent year working in an AIDS clinical trials unit, I applied to be a Clinical Scholar in a health service research and policy fellowship run by the Robert Wood Johnson Foundation. In my application, I described a vague idea to study errors committed by medical residents. I squeaked into the program, and went to the University of California, San Francisco. There, I was fortunate to assemble a dream team of mentors: Bernard Lo, director of the fellowship and UCSF’s program in medical ethics, Susan Folkman, pioneer in the field of psychological stress and coping, and Steve McPhee, one of the top internists in the US and author of multiple medical monographs. My team members were wise, knowledgeable, and very patient. They devoted their concentrated attention and dozens of meetings to the design and execution of a study and drafts of a paper. This effort ultimately propelled me to otherwise unachievable heights a plenary presentation at a national professional meeting, and a publication in JAMA. The science underlying patient safety, though, is young. This and related factors make the field a tough one for anyone looking for a mentor. Although patient safety is a priority for all health care organizations, expertise is safety science is not widely distributed, and research expertise is not universally available. In the US, although the situation is improving, expertise tends to be concentrated within a relatively small number of institutions. Globally, the distribution of expertise is still more uneven. Despite efforts of this Journal and others, there is a dearth of publications on patient safety from countries with developing economies. A second problem is that patient safety is a truly multidisciplinary field. Patient safety experts and practitioners come from many specialties in medicine, multiple professional groups, and several disciplines outside medicine such as human factors engineering and health information Editorial