Intentional mentorship and pushing beyond representation

Chicago medical student Maria Paz, BS, discusses intentional mentorship—and why she believes it matters.

When I started medical school, I never imagined that the most difficult part would be convincing myself that I deserved to be there. I remember at my first interview being separated at lunch to hear a presentation about diversity efforts at the institution. When I rejoined the rest of the students, I remember being asked where I went and one of my fellow interviewees telling me how lucky I was to be a minority. Suddenly, it felt like no one believed I was worthy of being there, least of all myself. I wish I could say this was an isolated experience. From that day forward, I felt as though I had to prove to everyone around me that I deserved the opportunities I had actually earned. Even my advisors at the time would make comments about how much easier it was for me as a Hispanic woman—how my MCAT could be lower, my application less impressive. They even went so far as to say that scholarships would be given to me, and residency spots handed over easily. It didn’t matter that I had worked for five years building a resume worth accepting. My grades, efforts, and dedication were diminished to a singular box I had to check when I applied. While my other classmates were able to start their medical school journey with the joy and excitement of finally achieving their dream, I was left with self-doubt and imposter syndrome that would take me years to unlearn, or at the very least develop effective coping mechanisms for.

The first time I met with my research mentor, she offered me the opportunity to help write a chapter for a textbook about disparities in surgery. I remember immediately feeling like I had to warn her that I would probably underperform. I wanted to set the expectations low for when I inevitably disappointed her. Years of striving to please advisors and admissions committees left me paralyzed with the fear of failure. She stopped me in the middle of yet another self-deprecating comment and said, “Stop worrying, you will be great.” Her singular vote of confidence was a startling contrast to the comments I had received in the past. This was my first experience with what I now consider intentional mentorship. Intentional mentorship goes beyond representation. Instead of simply serving as an example, these mentors use their lived experiences and backgrounds to relate to their students and actively foster a meaningful relationship. The actions that differentiate intentional mentors from the rest often require little effort, like the words of affirmation I received during that first research meeting. As medical students, we crave praise because we are so deprived of it. Words of affirmation are often so sparingly handed out but can have a lasting impact. Luckily, my mentors were not only intentionally telling me when they were impressed, but also did it vocally in front of other physicians and members of the team. Over time, their positive encouragement started to be louder than the negative self-talk to which I was so accustomed to listening. I stopped the self-deprecating comments and my mindset shifted from a fear of disappointment to an excitement about my untapped potential.

Despite the confidence boost from my mentors, the realities of academic surgery continued to reveal themselves, including the significant financial investment required to progress in your training and, ultimately, your career. I never expected my vascular research mentors to recognize these barriers because they were so far removed from the life and budget of a student. Yet again, they all exceeded my expectations in their understanding and compassion for my circumstances when it came to presenting our research at a national conference. Whenever they could, they allocated funds from their own section budgets to help offset the cost of travel or help with registration fees. When this wasn’t possible, they were intentional about helping me look for travel grants, reminding me about scholarship application deadlines, and writing me recommendation letters for financial aid. They sought out every opportunity they could to help me, even nominating me for awards that not only added to my resume but gave me very real financial stability. I had underestimated the difference it could make to have people looking out for me professionally. All these small acts not only provided me with tangible aid but also helped me believe in myself. Then came my clinical rotations. I was immediately filled with anxiety about performing well on my vascular rotation. It was one of the only opportunities I would get to impress the section during my surgery clerkship. It would also be the first time I would interact with my mentors clinically, and again I was struck with the fear that I would disappoint. After two years of working with them in a research capacity, I was terrified they would regret investing in me if I didn’t “perform” well in the operating room. The night before I started on the service, I was cc’d on the weekly section email that included the faculty and trainees. At the very end of the email, it read “Perhaps everyone is already aware, but we have a medical student joining the team tomorrow, Maria Paz. She is interested in Vascular Surgery so let’s show her a good time.” Those few lines probably took her less than five minutes to write, but it made all the difference in my experience on the rotation. People knew to expect me, and that someone they all admired believed in me. I truly think this led to opportunities that I wouldn’t have received otherwise. The fellow trusted me to assist with a chart review project he had been too busy to start, the attendings gave me extra learning opportunities during the procedures, and I began to really picture myself as a vascular surgeon. So many of my peers felt like they could never admit to their mentors when they were struggling. Especially given that those same physicians would be the ones reviewing their residency applications or writing their recommendations, it wasn’t an option to openly discuss issues like mental health or burnout. I had so many questions about a career in surgery. How do I balance this dream and all the other things I want out of life? What kind of mother will I be? How do I stay healthy during this journey? The only thing I never had to question was that I could turn to the mentors in my life for help finding answers. Women in medicine who agreed to mentor me truly meant it, and would never judge me for struggling. Maybe without realizing it, these relationcontinued on page 4 continued from page 1 cancer, trauma, bariatric surgery, pediatric surgery, to name a few. All these programs use the same structure used in the new Vascular-VP. This structure is based on four pillars:

◆ Standards based on peer-reviewed published data and expert consensus

◆ Appropriate infrastructure based on the standards designed for the program

◆ Data for monitoring outcomes and quality improvement support, using reliable, clinically relevant, benchmark data

◆ External peer-review team to verify compliance with the standards

“It was a win-win to work with the College for the vascular program,” said Anton Sidawy, MD, who, as the vascular regent serving on the Board of Regents of the ACS and past president of the SVS, led the effort to create the Vascular-VP. This is not the first time that the SVS sought such a program to ensure vascular centers are reviewed for quality.

“With the ongoing shift in reimbursement for our services from volume to value, who best to define quality and value than us—vascular surgeons—and the professional organization representing us, the Society for Vascular Surgery?” Sidawy said.

Vascular diseases and issues covered in the program include, but are not limited to, thoracic-aortic, abdominal aortic, carotid disease, peripheral arterial disease (PAD), arteriovenous hemodialysis access, and superficial and deep venous disease.

Those centers that meet the current inpatient standards will be “Verified” at one of two levels: a “comprehensive inpatient vascular center,” or “verified inpatient vascular center.” Eight pilot programs—four inpatient and four outpatient—have already gone through the pilot phase of the verification process, including both the inpatient and outpatient components of Albany Medical Center in Albany, New York, under the direction of R. Clement Darling III, MD, chief of vascular surgery at the institution, himself an SVS past president. He called the process “invaluable.” That includes ascertaining that

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Albany Medical Center “had the components we always thought we did. We found out we need to do better in some areas, and actually begin implementing procedures in other areas.”

Administrators at Albany Medical Center found it eye-opening to see how much work goes into a successful vascular program, Darling said, including “how comprehensive the infrastructure needs to be to care for these incredibly complex patients. It showed them what infrastructure we need from the hospital to provide the best care for our patients.”

Going through the process “made us better and helped us take better care of our patients,” Darling said, and urged other vascular centers to undertake the verification process. The process also ensures the longitudinal care for which vascular surgeons are known. “Our care doesn’t end in the OR [operating room],” said Darling. “Every move has to be documented and evaluated; this process lets us follow our patients to make sure we’re providing the best care for them.”

“As the program launches, more institutions are waiting in the wings, including my own in Indianapolis, Indiana,” added Dalsing. He believes the new initiative will provide several benefits, including improvement in quality of care for patients, enhanced learning throughout the institution, and external credibility to regulators. “We set the

Intentional Mentorship And Pushing Beyond Representation

continued from page 2 ships gave me a framework for how I want to be once I finally achieve all my dreams. I know that when a medical student comes to me one day, I will be intentional about every interaction. I will remember the small things that made all the difference, and strive to show them exactly how to treat their future students. The cycle will continue, and all these small acts will add up to real and significant changes in medicine.

I now realize the power of someone believing in me, which is multiplied when it originates from mentors that you look up to. I hope that sharing more of these experiences will provide physicians with real and actionable examples of ways to be more intentional about mentorship. Improving representation in the surgical workforce must begin with helping students believe they can succeed in this field. I believe that intentional mentorship could make all the difference in recruiting diverse students into a field they historically felt simply wasn’t for them.

MARIA PAZ is a medical student at the University of Chicago Pritzker School of Medicine.