So yesterday during the resume talk, like there was a talk on the resumes and the cover letters, I was thinking how your resume or your CV kind of makes your career look like this great arc, you know, this great upward trajectory. But that's not really how your career is. I mean, that's how you make it look on your CV or your resume because you want to look good when you apply for a job. But in real life, your career is going to be a lot of ups and downs and you don't really know where stuff is going to go, right? So it kind of reminds me of the Zen master joke and then I'll tell the Zen master joke and we'll kind of get down to the business. But the Zen master joke is very illustrative and I think about it all the time. So this boy is given a horse and it's a big deal and everybody in the village says, oh my God, what a great gift for this young boy to get this horse and the Zen master says, we'll see. And then like a year or two later, the boy falls off the horse and his leg is mangled and he's never going to walk again and everybody in the village is like, what a terrible thing, he's messed up for life and the Zen master goes, we'll see. And then a couple years later, the village gets into an armed conflict with the neighboring village and all the young men have to go off to war and everybody in the village says, oh, what a great thing because his leg is hurt, he doesn't have to go fight in the war and the Zen master goes, we'll see, right? So what it really gets at is like, you don't know where things are going to go, your life is going to go in unexpected directions, right? And that brings us to mentorship, right? This is why you guys, you know, you need to have mentorship really your whole life, like at all phases in your career, not just when you're a fellow, like at all phases in your career and for different aspects of your life. So, you know, ideally it looks something like this, right? And humans have a long history of mentorship going back literally thousands of years. The word mentor comes from Homer's Odyssey, right? And in the old days, right, if you wanted to learn to be a baker, right, your parents shipped you off to work with the baker for a couple of years and learn sort of next to them or if you wanted to learn to be a, like a woodsmith or a woodworker, right, they shipped you off and you worked next to this guy for a couple of years, right? If you wanted to fight the heavyweight champion of the world, right, you need a mentor, right? If you want to get into a fight with your father who happens to be a dark lord of the Sith and, you know, ruling the galaxy, like you need a mentor to guide you through this, right? This guy too has somebody to help him along the way, right? I had to put in Harry Potter for these guys. But you also have to explain this to Star Wars. Right, no, they got that one. I hope, I hope. And, you know, medical schools, right, before formal med schools existed, most people were trained to be physicians just through mentorship, right? But in medicine, there's lots and lots of different forms of mentorship and the three most common are clinical mentorship, research mentorship, and career mentorship. And we'll talk a little bit about all of these. And you need different people to help you with all of these different roles, right? And, like, your career mentor may not be your research mentor and that may not be your, you know, your clinical mentor. Like, these are all different things and there's different people around you that you can reach out to to help you learn different things or solve different problems in your life. You know, I've kind of developed a reputation as somebody who is open to mentoring people and people that I know and people that I don't know call me all the time with all sorts of questions. And I really enjoy doing it, but sometimes I need mentorship too. And, for example, I'm reminded of about 10 years ago, I found myself at a real career crossroads and I wasn't sure what to do and I called Bill Tierney. I don't even know if Bill remembers that, but I called Bill and I just talked to Bill for about an hour and it was extremely helpful and it guided the decision that I made at that time. So, like, you know, like you always need to have that person to go to, even if you are often in the mentor role. So, clinical mentorship is pretty much the easiest thing to accomplish, right? Like, everything in our work day and our work environment is kind of structured to facilitate clinical mentorship, right? You know, you're assigned an attending, right? When you're a med student, you have your intern. When you're an intern, you have your resident, right? There's always somebody above you in the clinical hierarchy to help you out, right? And, you know, your interaction all day, taking histories, doing physicals, writing orders, like, very, very quickly this model is shown to be very, very effective and you learn very, very efficiently, right, clinically in this setting. It also builds clinical rapport, kind of greases the social wheels in the hospital. You're all on the same team working for the patient's best interest. And endoscopy is particularly well suited to clinical mentorship because the mentor and the mentee physically stand next to each other and they can pass the scope back and forth, you know, all day long, right? So, over time, ideally, and for example, like in an advanced fellowship, right, there is a gradual shift, right? In the beginning of the year, like with our advanced fellow, I'm doing 80% of the work. By the end of the year, I'm doing practically nothing, right, as the advanced fellow takes on all the sort of technical responsibilities of the procedure and there's a sort of gradual transition there. Research mentorship, which most of you will probably have at some point in your training, is potentially more challenging and results often in a lot more sort of emotional stake. Both parties have more at stake in research mentorship. There is the goal of creating a product, right, a paper, a publication, right, a discovery or something. And there are often hard timelines or deadlines that have to be adhered to. It's much more structured than clinical mentorship, which sort of just takes place all day, every day, and is sort of open-ended and never really wraps up. The mentor and the mentee often have different goals, right? You may find yourself in a research mentor or mentee relationship that's mandatory, right? You may not be interested in this, but you might be in a fellowship where there is a research expectation of you, right? You may find yourself having to find somebody and do a paper and get a project and it's not really something you're interested in, right? Paradoxically, the mentor may not be interested. They may be more interested in promoting their own career, but they may have a division chief or a department chair saying to them, hey, it's time for you to take on a mentee and they may not want to do that, right? So recognize that people can sometimes enter research relationships not under the best of terms, right? And these research mentorship relationships can last months or even years. There are different expectations on the mentor or the mentee, right? So the mentor is there to identify and define a project. Like sometimes people come to me and say, hey, like a med student come to me and say, hey, I have an idea for a project and I'm like, yeah, it's kind of my role to think of the project for you. Like usually if the med student brings me a project, it's not a good one, right? It's just true. Like it's just true. Like they don't know, right? So you've got to have a project that is appropriate for the mentee. Like I've had med students who want to do a prospective randomized trial. Like they're not going to do that as a third year medical student, right? Maybe a review article perhaps might be more appropriate for a medical student, right? So med students, residents, fellows, and faculty all need different types of research projects, right? And I've mentored a lot of faculty at different stages in their career, right? The mentor has to be willing to meet regularly, which sounds easy, but it's actually very, very hard. And sometimes people will attach themselves to the super duper world famous doctor and they're so excited only to discover that he or she has no time for them because they're busy running around the world giving talks, right? They're just, they never see them, right? The mentor has to be willing to give honest feedback to the mentee and support the research and independent growth of the mentee, which sounds easy, but is sometimes hard, right? You have to create opportunities for your mentee, not just for yourself, right? So again, not everybody is really ideal to be a mentor because it means you've got to not always think about yourself first and you've got to really acknowledge the contribution of the mentee in the work, right? And again, you can see how, right, it's not just, sometimes the mentee feels like everything's on them, but actually the mentor has significant obligations and responsibility in this relationship. On the mentee side, the mentee has to be honest about their ability to commit time and effort, right, to a project. And all of the attendings in this room have had people come up to us and promise that, oh, I'm going to work on this project. I'm so excited. It's going to be great. And then six months later, we're like, whatever happened to that person? Never heard from them again. They just disappeared, right? So again, just recognize that, you know, if you go to somebody and say, could you mentor me, like, that means you can't disappear and you have to hold up your end, right? I also encourage my mentees to be really open with me about their goals, right? Like, do you want to be a researcher? Do you really want to have a career, right, where you are writing and speaking and publishing and helping to set the dialogue, right, about a disease or a procedure that you care for for the nation or the world? Or do you just want a paper so you can look good when you apply to fellowship, right? And those are both fair answers, but just tell me, like, do you just want a paper so you can get a residency or a fellowship? Either one is fine, but I need to know what your goal is, right? Are you doing this because you have to? Like, are you here because your residency director said, go talk to Adler and he'll find you a project, right? So again, all of those are fine, but we need to kind of understand where we are. The mentee needs to respond to constructive criticism. And there are people in this room that I'm working with on research projects right now. And, you know, like, when people send me a paper, like, they're often shocked to discover that I read every single word. And I make very, very detailed comments on the paper. And, like, when I make a comment, that means I want you to address this point. Like, I don't just say, looks great, submit it. Like, I go through every single word, right? So they've got to be willing to be like, oh, all this red on the paper doesn't mean that I'm bad. It means that he really went through it and wants to make it better, right? The trainee also has, or the mentee, has to be willing to see the project to completion, right? So when I work with people, I always sit them down at the very, very first meeting and we talk about expectations. And I have a list of rules that I go through with them. Like, I've given this speech more times than I can count. But one of the rules is if we start a project, we have to finish it on the timeline that we agree. It is not my job to chase you, right? Whatever happened, where's the next draft? Where's the data? What's going on? Like, I shouldn't be emailing you, like, what happened, right? So again, projects sometimes take longer than you think, right? And you often get into what I call the pi squared rule, right? The project sometimes takes about pi squared as much time as you think it's going to take to do, which is roughly about 10 times as long. And that's sometimes true. Sometimes it's not. But, like, maybe the analysis is tougher. Or maybe you spend three months doing a systematic review and meta-analysis and then when you're about to submit it, a new prospective randomized trial gets published and you have to redo all of your stats because you now have to incorporate that, right? So, like, whatever it takes, we're agreeing that we're going to get through this together and we're going to finish it. It's super important to talk about authorship. So how many of you guys have a paper yet? So a lot, right? How many of you talked about authorship at the outset? Fewer, like about a quarter of the hands went up. And people who work with me know, right? Like, one of the very first things I talk about is authorship. Where will you be on the paper? Where will I be on the paper? What is your role? What is my role? It's critical to work out these issues at the very outset. Because if you don't, often different people think that they have a different position on the paper. If the paper comes out and you're not where you thought, very quickly that will turn into an extremely negative and toxic relationship. One of my mentors to this day will not talk to his mentor because he switched authorship on a paper. A paper that no one remembers except these two, and no one cares about except these two. When they see each other at TDW, they turn their heads and they walk past each other. I'm not making this up, and they pretend the other person doesn't exist because they are pissed about this authorship thing. So again, you've got to really clarify who's doing what. So this doesn't apply so much to a medical paper more as a scientific paper. It's a little humorous, but there is a little bit of truth to this slide. So I always say to people, here's what I'm going to do, and here's where I'm going to be on the paper. If you guys look me up in PubMed, with rare exception on about 90 percent of the papers I've written in the last 20 years, I'm last author and corresponding author. That's the seat that I sit in. I don't need to be first author anymore. So usually, the fellow or the resident or the student who's taken the lead on the project, they are first. I tell them, if you do the work of the first author, you will be first author on the paper, so that they are secure in their position, and there's no bait and switch when the paper comes out. They're not upset about this thing. Career mentoring is super important. Again, this never ends. For example, when I was thinking of leaving University of Utah, I called Doug Pleskow, another Doug. There's a lot of Dougs. Doug's 10 years older than me, and when I needed career advice, I'm somebody who gives a lot of other people career advice, but when I needed it, I called Doug Pleskow and said, hey, I'm thinking of taking this job in Colorado, what do you think? For an hour, I went through my contract and the pros and cons of the job with Doug Pleskow. It wasn't a five-minute call, it was an hour call. He listened to everything I had to say, and he gave me a ton of feedback that I was able to take into my negotiations and into my thought process. So you'll need different types of career mentoring when you're in training, early, mid, and late phases of your career. Again, everybody needs somebody to talk to. It's just human nature. For fellows, it's never too early to think about your career arc. Where do you want to be in 10 years? Have you guys thought about a 10-year plan? Have you thought about a 20-year plan? Like start planning today for where you want to be in 2035, 2045. That sounds crazy, but that's actually how you should think about it. What kind of job do you want? How do you negotiate for that? What's your work-life balance? That's going to be different for everybody. You've seen that even among the faculty here. We all have different work-life balances. I'm a crazy person. I work crazy hours. I work insane hours, but I really like it. I love going in. I like working on a lot of projects. I have a whole side career that I haven't even mentioned to you guys today. I like to be busy. So my work-life balance maybe isn't the same as Doug Fishman's. Everybody's going to be different. You have to think about what your work-life balance is. What are your family or childcare issues? Do you have one kid? Do you have three kids? Do those children have special needs? Are you married? Are you divorced? All these things are going to come into play. You may need some help with conflict resolution. Some of you guys are going to have smooth careers. Some of you guys are going to have rocky careers. We were talking about this last night. Professionalism matters. A lot of docs get in real trouble because of professionalism issues. It's easy to say, of course, I would never do that. Docs get into trouble because of professionalism issues. So just recognize you may need all sorts of different types of mentoring at different points in your fellowship and thereafter. So it would be great if all these mentor-mentee relationships were perfect, but they're often not perfect, and sometimes they can lead to trouble. So sometimes these relationships fail, and that can be very, very stressful for both parties. It's usually due to both parties making some sort of error. Sort of I mentioned earlier, one of my mentees still doesn't talk to his mentor, and that's been a big stressor in their life. The fact that this person that they worked shoulder-to-shoulder with for a long period of time now has been excluded from their world. Again, poor communication, misunderstandings, inability of the relationship to adapt or adjust to changing circumstances. All these things can gang up and cause the relationship to fail. A classic one is failure to meet regularly. Again, this often happens if the mentor is super famous, over-committed, too busy, not really committed to the whole process on the part of the mentee. I really didn't want this person in my lap. I'm just going to treat them with some neglect. You have to commit to each other. So the mentor and the mentee have to not procrastinate, meet deadlines that they agreed on, balance competing responsibilities. Everybody has a lot of stuff on their plate. But again, if you agree to write this paper, you got to write this paper. Prioritize the mentor-mentee relationship. Make time for each other. I always say to both mentors and mentees, beware canceling an appointment. If you cancel an appointment, that sends the absolute worst message. If something comes up, instead of saying, hey, I need to cancel for today, you say, hey, I need to cancel for today, let's do the meeting tomorrow at the same time instead. That sends a very different message than I'm just canceling the meeting. Cloning is really common. I fell prey to a little bit of cloning from one of my mentors. It occurs when the mentor tries to shape the mentee into a version or a replica of themself. That actually happens a lot more than you think. It's much more likely to happen if the mentor is early in their career because they don't have enough experience to maybe recognize that they're doing it. It often results in a honeymoon period, where the mentee feels like, hey, I'm moving quickly, I'm getting a lot of papers, like things are really happening. But what you're really doing is, you're not really breaking any new ground, you're doing what the mentor has already done. Down the road, eventually, this will become apparent when the mentee starts to go out, and people start treating you like mini me. They're like, well, you're just like that other guy. Why wouldn't we just call that other person? Then they realize like, oh, I'm really now only really trained to compete with my mentor, and that's a competition that I will lose. Why would they pick me over my mentor who's just like me? That can often result in a lot of ill will and bad feelings down the road, when eventually the mentee feels like, hey, I got cheated. Talking and not listening is a big one. The mentor has got to listen to the mentee. The mentee has to listen to the mentor. Part of these relationships is you have to be able to say things that aren't so comfortable or aren't so pleasant. In The Empire Strikes Back, Yoda spends the whole movie criticizing Luke. Luke goes off to Cloud City to fight Darth Vader, and Yoda's like, you're not ready, and Luke doesn't listen. What happens? He loses. He didn't listen to his mentor. You got to listen to each other. Got to be the mentor, can't be intimidating, but you've got to be helpful. The mentee can't be intimidated, but the mentee also can't be disrespectful. A lot of times mentors, if the mentor feels like the mentee is being disrespectful, it doesn't go very far. So again, communication is really, really important. Again, it's very easy for me to say that, but it is hard in real life. Beware being the first mentee. If there's the young, hip, cool attending, maybe that's not the best person to be your mentor, because they're probably really inexperienced. They're probably still figuring out their career, who they are, what they want to do. They may not be ready to take on somebody, and you might be better off with somebody who's less hip, less cool. You can't call them by their first name, but they've had 10 mentees who've gone on to be successful. That's a lot better, or maybe a better deal, or a more appealing situation. Sometimes if the mentor is not willing to share credit, again, this is part of the danger of having a mentor who's too young. They're building their own reputation. They're really just thinking about themselves. They're not ready to put the mentee first. They're just thinking, me, me, me. And then a very dangerous situation is if the mentor is threatened by the mentee. Oh, this person's actually better at this than me, or they're picking it up faster than I did. That can be very, very threatening. It's not validating to the mentor, and then they may find themselves consciously or unconsciously sabotaging the mentee, not mentioning them when opportunities come up, or not mentioning their contribution to a particular project when they're speaking at a national meeting. It's very easy for the mentor to sabotage the mentee if they decide consciously or unconsciously that they want to do that. Sometimes it just doesn't work out. Sometimes, right? You can have conflicts that can't be resolved. Your personalities just don't mesh, right? Your work ethic is not the same. One person really, really, really wants to move fast. Let's get this paper done and submit it in 90 days. And the other person was thinking maybe a year. Those aren't gonna mesh, right? You're not gonna be able to work that out. Sometimes there are social or cultural conflicts that just can't be bridged, and sometimes there are generational conflicts that just can't be bridged, like the worldview of the mentor and the mentee are so far apart that there's not enough to really sort of bind them together. And in rare cases, you're better off to just dissolve the relationship and move on because sometimes you just can't fix things. That sounds bad, but there's no value in fighting, and if it's obvious to all parties, you know that this isn't gonna work out. Let's just wish each other well and part ways. So, again, mentorship is part of medicine. I've been very lucky in that I've benefited from a lot of very, very good mentors, really starting in residency. I didn't have a mentor at all in medical school, and I really suffered for it. But in residency, I had somebody who agreed to sort of take me on late in the game. And then in fellowship, I had real structured, formal mentorship, and it made an enormous difference in my career. So just recognize that it's a part of medical training and it's really gonna be a part of your whole career. So always sort of think about people you could reach out to for help at different phases of your career. And most of the time, if you reach out to somebody, they're gonna say that they're happy to help you. It's unusual that people aren't, but recognize casual mentorship is different than structured, formal mentorship, so those relationships have to be entered into with a lot more care. Again, I'm not trying to spook you guys. Most of these relationships work out really well, but just recognize that there are pitfalls and you wanna be careful to avoid them, because if you do wind up in one of these pitfalls, you may find yourself in a very difficult situation that you can't get out of easily. Thank you, guys.

career progression

mentorship

uncertainty

communication

medicine

expectations