Ethics of Teaching

Mentors Wanted

A Stitch in Time

Ethics of Teaching

Mentors Wanted

The Accreditation Council for Graduate Medical Education (ACGME) has mandated that all residency programs implement measures to teach and assess six new competencies including 1) patient care, 2) medical knowledge, 3) professionalism, 4) interpersonal and communication skills, 5) practice-based learning and 6) systems-based learning.

The American Board of Ophthalmology has added surgical competence as a seventh mandate. A proven and effective means for teaching these competencies has been the mentorship relationship. These role models are often cited as a major reason for selecting a career or subspecialty in ophthalmology.

My mentors possessed outstanding patient care skills, an amazing fund of medical knowledge, impeccable professionalism and ethics, excellent communication and interpersonal skills and an incredible command of evidence-based and practice-based medicine. They were experts at maneuvering the sometimes byzantine system of medical care and were surgeons extraordinaire.

The critical factors for a successful mentorship relationship are 1) the process must be completely voluntary, 2) the communication must be two-way, honest, timely and open, 3) the dialogue must be based upon trust and mutual respect, 4) all information should be discreet and confidential, 5) both parties must be committed to the process with interest, enthusiasm and passion and 6) mentoring must be given sufficient time to grow and be sustained. Mentorship programs that are involuntary, mismatched in personality or interest, “closed-door” or too brief are doomed to fail. A bad mentor is worse than no mentor.

The point is that good mentorship works. It improves job satisfaction, reduces turnover and career uncertainty, and provides tangible and intangible rewards to both mentor and protégé alike. We need mentorship now more than ever.

The ACGME mandate demands that we measure in our trainees that which we implicitly believe to be present, but which can probably be merely inferred, namely professional competence. Who better to assess these competencies than those best suited to teach them?

I urge all academic programs to reexamine, reinvigorate and renew the mentorship process and modify their individual mentorship programs to allow us to teach and assess the new ACGME competencies. We owe it to our future trainees, to ourselves and to our former mentors to meet the spirit as well as the letter of the ACGME mandate.

Andrew G. Lee, MD
Iowa City, Iowa

A Stitch in Time

I read with interest the excellent article “Detecting the Ocular Ischemic Syndrome,” by Gary C. Brown, MD, MBA, and Melissa M. Brown, MD, MN, MBA, in the February issue of EyeNet (Ophthalmic Pearls). They correctly pointed out that some patients with this disorder will have normal or low IOP in spite of iris neovascularization and synechial angle closure because of poor ciliary body perfusion.

It is important to realize that if such a patient undergoes carotid endarterectomy, ciliary body reperfusion may result in a dramatic rapid rise in IOP, necessitating emergency glaucoma shunt surgery to save the eye.¹ Therefore, one should consider the possibility of placing a glaucoma drainage shunt prior to or in conjunction with the endarterectomy. Hypotony can be avoided by placing a suture ligature or tube stent, to be released in the office or clinic postoperatively, as required.

James R. Brinkley Jr., MD
Laguna Hills, Calif.

_______________________________
1 Wagner, W. H. et al. J Vasc Surg 1988;8:551.

_____________________
Write to Us

Here's how:
You can write to us at:
     Editors, EyeNet Magazine
     American Academy of Ophthalmology
     665 Beach Street
     San Francisco, CA 94109
     FAX 415-561-8533
     E-mail:eyenet@aao.org

EyeNet reserves the right to edit letters.