Being the best mentor

A practical guide to the mentoring relationship.

By Bree Montana, DVM, VIN Foundation Vets4Vets® Program Leader

Everyone has a first day at work, and if this is your first mentoring experience you may be feeling similar jitters. Remember you don’t need to be board-certified in anything to be a great mentor. The only requirement is a willingness to communicate.

Being a good mentor is like being a good dancer; it’s difficult to dance well without a cooperative partner. Those of us who have seen the first couple of episodes of each season’s “Dancing with the Stars” can appreciate this. We’ll see a gifted dancer shoving a load of elbows and knees around the dance floor. As the season unfolds, the “star” will learn to collaborate and the dancing will be less cringe-inducing.

Both members of the ‘dance team’ will likely be a bit nervous starting out. Starting the relationship with some common ground can help ease your initial interactions.

BASIC GUIDELINES

When you are inviting a new associate into your practice, provide a handout with your basic guidelines such as:

Hospital rules and routines
Vaccine protocols
Infectious disease protocols
Laws of finance (estimates, deposits, payments).

Working through this list can help you to get to know each other’s practice and communication styles. You may find there are areas needing negotiation, and in all cases working through these questions will help your medical team figure out where you are flexible and where you aren’t.

COMMON SCENARIOS

You don’t have to tell your colleague how to practice medicine, but it’s helpful for them to know how you approach common scenarios. It’s also helpful for your support team to have a feel for the way you both handle frequently seen problems.

For example, if my schedule shows a pet with urinary problems, my team will have the ultrasound fired up before the appointment and our client will be advised to prevent the animal from urinating for a couple of hours prior to the appointment. I prefer to always try to perform an ultrasound guided cysto-centesis and in-house urinalysis (and culture if appropriate) with these cases. Now, if my new associate feels the urine needs to be sent out to the lab, we can chat about that option. The key is discussing these basic presentations in a low-stress environment, before the situation arises. This provides great practice for future discussions during more challenging situations.

These early discussions are most profitable when both parties come to these discussions ready to really discuss topics that are important to them. It wasn’t until I was setting up for my first anesthetized procedure in my newly purchased hospital that I learned the previous owner’s induction agent was “Ricardo.” I josh you not! Ricardo, a very willing and fairly strapping kennel assistant, was tasked with holding down the animals while they were masked down with isoflurane. If only I’d thought to have an introductory mentoring discussion with Dr Hospital-For-Sale before we traded keys!

Do you feel dental radiographs are important for every mouth, or do you only take them when you’re looking for a tooth root abscess?

COMMON PROTOCOLS

What about IV catheters; do you want one in every anesthesia patient? Do you use them for cat orchiectomies?

What common protocols might you discuss with your new associate? Take a moment and think through some of the questions you had as a newly-employed veterinarian, and maybe update them for today’s practice setup. Topics such as IV catheters and pain meds for animals undergoing procedures, full-mouth dental rads, and appointment duration are some of the most contentious issues that each of us has to negotiate when we start a new job.

While working through your mental list, remember there are one billion ways to “skin” a cat. Both the boss and the associate need to be ready to negotiate these topics. Remember, each of us believes our position is a good one, maybe the best… We need to realize the person ACROSS the table feels that way as well. It’s the conversation you don’t have that’s going to cause the most distress!

Whether you are an owner, associate, or hospital manager, remember you work full time in your field of expertise — you are the expert at practicing medicine and surgery in your hospital!

QUALIFICATIONS

What qualifies you to mentor a new associate?

You spend every day working in your area of expertise. You make intuitive leaps that are all but impossible without the experiences you’ve had! Your accumulated knowledge is of incredible value to a new associate. Think of the simple things, the obvious “pearls” and share those insights. Common sense is not common — it is earned and has great value. Anyone who has “been there, done that, and has the T-shirt” can be a mentor. Doctors with years of medicine under their belts aren’t the only folks who make great mentors. Consider having your Golden Tech work with your mentee for the first few weeks or months.

Remember that first week or two of your first job? It’s hard to know which tests can be run during an outpatient visit, and which ones work better with a drop-off. Did you have to ask for three different kinds of ophthalmic examination toys before you lit on the ones the hospital actually had available? I’d bet you a vanilla soy latte that your more experienced techs or veterinary assistants know what’s handy for corneal anesthetic, dilation, staining, examining, and pressure reading. Encouraging your support team to help mentor your new associate will allow your newbie to maximize efficiency.

New grads can be great mentors as well. I always think of a new associate as a chance to freshen my treatment protocols and learn new techniques. Hopefully, while I’m guiding them in my classical favorites, they’ll share something new and cool that they picked up. Additionally, new grads frequently mentor each other successfully through those dark nights of the soul known as “internship.” Anyone who has reached out in support of a colleague, answering questions on message boards or in person, has dabbled with mentoring. A formal mentor-mentee relationship is just a more structured version of that support system.

PERKS OF MENTORING

I waited a bit too long before hiring my first associate. When she came on board, I was overwhelmed by my practice load. One of the unexpected pleasures she brought was a wonderful level of enthusiasm; she was like a breath of fresh air for our practice! Take a moment to dream about some of the cool new qualities, skills, and enthusiasms that you hope your new mentee/associate will bring to your practice.

TIME CONSTRAINTS

There are many ways of mentoring — from intensive one-on-one training regimens to more casual remote mentoring relationships. You and your associate can design a relationship that suits both of you. For associates who are newer grads, a few days of shadowing will give a comfortable introduction to your practice’s style of communication.

During the first few days with a new associate, I generally introduce my new colleague to my clients, giving a ten second intro; basically “selling” the new associate’s awesomeness to the client. Then I perform the exam, make the recommendations as per usual. Once the pet is in the treatment area, I’ll invite the shadowing associate to perform their own exam and make recommendations. We generally chat about each of the cases, sharing ideas for diagnostics and treatments. My goal during the shadowing period is to get the team comfortable working together. As soon as the new associated feels ready to go solo, we’ll start booking them appointments. I try to schedule juvenile exams and easier cases for my new colleague during the first month or so. I schedule longer appointment times to begin with, then decrease them as my new colleague becomes more efficient.

With more experienced DVMs I still provide longer appointment times initially. I’ll always schedule the new doctor with my most experienced technician for the first few weeks. My tech team knows the clients well, and will help the doctor create estimates that make sense with our hospital’s style of medicine.

Take a moment to consider the kinds of scheduling modifications you are thinking of making during your new associate's first few months.

I prefer to start new grads with longer appointments and only do anesthetic procedures on days we are together. We’ll adjust that over time. My practice uses intensive scheduling – 30 minute appointments with 15-min add ins. This means our first appointment starts at 9am and runs to 9:30 am, our second appointment starts at 9:15 am and runs till 9:45 am. I don’t expect newer grads (even with internship training) to “go there” for quite awhile. Of course, this is my style as the culture of our practice is pretty information-intensive. We like to educate clients and develop the best bond we can. Some doctors have great success while being less chatty than I am, and there is nothing wrong with that! Every hospital, and every doctor, will develop the practice style best suited to their communication style and comfort level. Clients will settle in with the culture of practice that best suits their needs as well.

New associates need to be comfortable with the kinds of sedation your hospital offers; either you or an experienced support team member may need to provide support during sedated procedures for the first few months. For the first few weeks, I’ll invite the new associate to scrub in with me on surgeries. I’ll usually do the first ovarian pedicle on the first OVH, then invite them to do the next. During these experiences, I’ll be sure to discuss good surgery habits.

For me, this means:

Setting up the surgery tray in the same way each time (i.e., sharps to the left, clamps to the right, etc.)
Maintaining excellent posture
Breathing – I remind myself and my team that “when the going gets tough, the tough relax and breathe!”
Self-focusing and calming techniques

Conversation during surgery lets my new team member relax and chat about comfortable topics while they work through their first surgeries in our facility. The topics also remind all of us — support staff as well as veterinarians– to recognize high-quality performance is a habit which benefits from being practiced.

It's important to acknowledge the elephant living in the surgery suite - - fear.

Explaining I use self-focusing techniques whenever the blood squirts into the air allows less experienced doctors to accept they will experience some scary things in surgery and medicine, and that they will be able to face those challenges when they arise. When my body is tense, my mind is tense. I try to keep my body comfortable so I can make good decisions

What focusing and calming techniques do you use when cases get tricky? One of the best things we can give our new associates is confidence. Sometimes that means the confidence to boldly go forward alone with diagnostics and procedures, and sometimes that means they’ll boldly go forward and call for help!

We’ve all probably had an experience or two where we’d have appreciated an in-person mentor. Work with your new colleague to plan ahead for the procedures where they might need some support. Some are obvious, such as GDVs, bad HBC’s, DKAs…the classically tricky or scary stuff. However, I’ve also learned I need to sit with my newer grads many, many times through abdominal ultrasound. Sometimes they don’t see key changes, and since they don’t see it, they miss it. It’s a tricky toy, ultrasound is. Dental rads and surgical flap extractions may seem simple to you, but they also takemental and dexterous finesse. As you observe each others’ strengths and growth opportunities, set out a plan to support each other.

REMOTE MENTORING

Remote mentoring may be an option for more experienced veterinarians. I work remotely, on a very casual basis with several doctors. When they find themselves with a confusing case or difficult client, they email me and we chat through options. With my own associates, I’ve been generally pretty available in person or via text message whenever they’re at work for about the first year. If they have a critical case, I will come in from wherever I am and assist.

As the associates become more confident, I’ll swing by to review rads with them, or just be available for a quick question. Then, I’ll wean myself (ahem! I mean THEM) away and be available by email or cell phone for questions.

I try to wait at least a few months before leaving a new associate completely alone. Everyone is unique, so you’ll need to feel your way with this one. Practice owners all want our clients and patients to be in great hands, but we experience that “tension of the opposites” as we’d also like a week in Bimini.

Scheduling time once a week to work side-by-side with your team members facilitates good communication. I initially schedule all of my associates’ procedure days when I’m on-site running outpatient appointments. This way I’m readily available for unexpected crises and moral support.

CUSTOMIZE YOUR MENTORING

Customize your mentoring program to suit your own comfort level. Don’t let your mentoring become a chore!

Avoiding over-mentoring can be tricky, veterinarians tend to be driven folks who like to succeed and lead, so we are often tempted to “over train.” It can be hard letting the new associate make their own mistakes… and believe me, I have lost sleep over this one! Sometimes being a good mentor means allowing your associate to work their way through a case on their own.

Remember your goal is to push your new associate to work through problems on their own. Often, the problems that might occur with their cases haven’t even dawned on them yet. So tell them your stories about those tricky cases and clients, but don’t diagnose their cases for them.

How will you know when it’s the right time to step back?

What clues will you look for?

I typically hang around “doing paperwork” on days when I think I may be needed. And as I see my associate handling those tricky cases nicely, I ease myself out of the picture.

Let’s start in the surgery suite… I’ll be scrubbing in on those OVHs and splitting them until I see good tissue handling, good hemostasis, then I’ll just be “around” for a few. Then, I’ll maybe ask if my new associate is comfy and step out. I am a bit of a control freak — I’d rather lose some play time the first year than lose a patient. How will you know it’s okay to be off-site when your new associate is doing surgery? I focus on surgery because many practice owners are very possessive of the surgery suite — and this isn’t good for our business. We need to develop the ability to coach from the sidelines, then let them roll on their own once they have the skills.