One of my former residents, who I supervised regularly, recently graduated & now is an attending physician herself. Now no longer the student, but the teacher, she asked me to advise her on my approach to teaching and mentoring.

Here’s what I wrote to her:

My mentoring approach is to just be myself. You might call it an existential style of mentoring: just be.  I take my residents who I supervise to cafes that I frequent near my home, and we talk. If I have meetings, I take them along.   I let you just be with me, as I go about my business, watching me and tagging along, and talking to you as we go. Half the mentoring is in the being, the other half is in the talking. Most people think mentoring is all about what you say; in my approach, it’s about how you are or what you do.  It’s a lot like parenting: Kids don’t listen to what you say; they watch what you do. To be a good parent, you have to be a better person, to set an example for your kids. Telling them to be good doesn’t work; you have to show them how to be good. That’s one reason why parenting is so hard.  You’re constantly being watched and judged, unconsciously if not consciously, by your kids.

It’s similar with mentoring. Residents are watching and judging their teachers; they may listen to what the teachers say, but more importantly they watch what the teachers do.  I formalize that in a way in my mentoring; I let you watch what I do more extensively than other mentors you might have, because I know that’s what will make the most impression on you.

My approach to mentoring has one other advantage: It’s easy.  It’s easier to just go about your business and let your students watch than to stop what you’re doing and try to teach your students separately from what you do. That’s the origin in a way of the famous “rounding” approach to mentoring, instituted by William Osler a century ago in the circular wards of Johns Hopkins Hospital.

Osler also said a mentor is really just a  senior student, teaching junior students. That puts you at the same level. The worst kind of mentoring is the hierarchical style, so common in the world; the US has the advantage of an egalitarian culture, which allows more easily for this kind of mentoring, compared to other countries. In Latin American, the Middle East, and parts of Europe, the teacher is on a pedestal which he usually doesn’t deserve.

I don’t even really like the word mentor; I get an image in my mind of a mother bird feeding a baby bird. It’s not a one way street and both “mentor” and student are students all the time, one is just older and somewhat more experienced than the other. The concept of mentorship can produce a major long-term harm in that in later years students often outpace their “mentors” .  I often feel these days bothered by some of my old teachers and supervisors at Mass. General, with whom I now disagree almost totally on many things. They seem to want to preserve a power imbalance because there was a day when I was their student; as if they always will know more than me. If I’ve superseded them, it’s difficult to engage with them anymore because there’s an awkwardness based on the past mentorship hierarchy.  Nietzsche once said a student repays his teacher poorly by staying a student only. Good teachers need to be ready to acknowledge that their students exceed them; they rarely do.

I have had a few mentors who had that skill though, who, over time, were overjoyed to find me meet and exceed them in many respects.  Fred Goodwin, Athanasios Koukopoulos – both dead now – I hold them in such fervent esteem because, like good parents, they loved to see me progress, even beyond them.  As a parent, I understand how they felt; no good parent ever feels bothered when their child succeeds; it’s amazing how envy doesn’t exist in the parent-child relationship. That’s biological I suppose. Great mentors feel the same way with non-biological children, their students. Fred Goodwin always used that parental analogy. He said that his mentors were my scientific grandparents, because he was my mentor.  There’s something to that. He implied that he was my scientific father, and, like any father, he was overjoyed in seeing my success. I’ll never forget the last national conference lecture I gave where he sat in the audience, at the APA meeting in Toronto in 2018. He was grinning from ear to ear, listening to me talk about a central topic in our research, antidepressants in bipolar depression. He had heard me lecture on the topic for nearly two decades. Afterward, he told me I had nailed it; this time, I was at my most persuasive, completely logical, strongly based in data, objective, calm, composed. He was so happy.

So how should you approach becoming a new teacher or mentor to your students? I would start with the senior student/junior student concept. View yourself as equal to your students, just a little more experienced.  Then, take the existential mentoring approach: don’t worry about having to say all kinds of wise things; just let your students watch what you do, sit in on your interviews, observe how you talk to patients, see how you make decisions. Answer their questions in the process, and always be very alert to never hiding your ignorance. Jump to the statement – “I don’t know” or “We don’t know” or “We don’t really know with good research” – whenever you can. That is not only true, but it will enhance your credibility with your students when you say something that you do indeed know.

It’s a privilege to teach, but it’s a privilege that can be abused easily by teaching your beliefs, as opposed to your ignorance, by pretending to know more than you do, by imposing authority as opposed to opening minds.  View it as you would raising a child; it’s the same in many ways: the goal is not to impose your way of doing things, but rather to teach someone else how to make their own good decisions.

That’s not easy. And it can’t be done by simply listing facts.  My father always said that kids learn by example first, and then by stories, by telling them stories. Stories have a message, but by putting the message in the story, it’s indirect, which makes it less easily dismissed.  Also stories are more memorable than mere commands or facts. The parables of Jesus take this approach.  You could tell stories about your teachers, or about historical figures in psychiatry, or special patient cases in your experience. Stories have impact, and are remembered. Advice has no impact, and is forgotten.

So teach by example, first and foremost, then by stories, and only last and to a limited degree by advice or statements or edicts.

One last point, as important as the rest.  A famous saying of the Prophet Mohammad is to speak to the people to the level of their understanding.  Don’t try to teach a medical student what only a resident can understand, nor a resident what only a fully trained specialist can understand, nor a young specialist what only a more experienced person can understand. Don’t speak to a patient, like he or she is a doctor (unless he or she is a doctor). Speak to the level of your audience, not above it, and not below. You always will need to hold back some things you know, some knowledge or some insights you have, because the other person just won’t get it.  At best, the other person will just miss or ignore it; at worst, he or she will misunderstand it, and even hold it against you.  So hold back some of what you know; don’t say it all.  Judge what you say by what your hearer can appreciate.  You’ll be surprised how much people appreciate being taught a little, and how much they resent being taught too much.

Besides, you could be wrong.