3/05/2022 Neurosurgical Reflections: Mentorship Through Common Devotion

Dr. Michael Catalino presented his work on Harvey Cushing and mentorship to the Boston Society of Neurology, Neurosurgery, and Psychiatry last year. I asked Catalino and his neurosurgical mentor, Dr. Ed Laws, to submit their thoughts on the cornerstone of our profession's education: mentorship.

Dr. Michael CatalinoDr Ed Laws and Harvey Cushing

[Left: Dr. Michael Catalino. Center: The Harvey Cushing Cabinet. Right: Dr. Ed Laws, mentor to Michael Catalino and curator of the Cushing Cabinet] Nota Bene: The brass hand is a mold of Harvey Cushing's own hand!

Mentorship Through Common Devotion

Mentorship plays a key role in both education and medicine. The origins of the word “mentor” come from Homer’s Odyssey, in which Athena takes on the role of Mentor to guide Telemachus through a challenging life transition.1 A mentor has since been defined as a “close, trusted, and experienced counselor or guide.”2 The intangible and often unscripted value of passing on scientific and medical wisdom is observed in the traditional trivium of classical education, in which knowledge precedes understanding and understanding precedes wisdom.

The impact of exemplary mentorship on the progress of scientific, medical, and surgical advances in the early 20th century was typified by the mentorship Harvey Cushing during the Great War.3 This dedication to educating and sending trainees into the world continued throughout Cushing’s career.4 Today, we face new challenges that require a continued adaptation of our approach.5 There appears to be a shift of the mentorship paradigm - a shift from passive to active, from unstructured to structured, from generic to personalized, from the following of footsteps to following a trainee’s vision, and from unidirectional to multidirectional. While this framework is certainly of value to the modern learner, there is one key aspect of mentorship which is missing from this important line of historical commentary. That is the passing on of mentorship philosophy. The best teachers don’t just make great students, they make great teachers, for “the measure of a teacher’s success lies not in [his or her] own ideas but in those which radiate from [his or her] pupils;” and this dictum, according to Cushing, calls us to arouse curiosity, not to satisfy it, for our students.6

Unfortunately, earlier informative accounts of mentorship in neurosurgery lack a clear published corpus outlining the philosophy and principles of mentorship, such that they can be shared, built upon, and customized as we mentor in a modern world. Just like the records of scientific progress, we benefit from a concise philosophical thread which can be woven into the fabric of our own education and the mentorship of the next generation – for nothing can replace the impact that a mentor can have on the life and work of a young doctor.

The greatest mentors make sacrifices for their trainees, pass on timeless wisdom and understanding, and stir up all kinds of excitement, all the while fostering values of common devotion, sound work-ethic, and scientific integrity. In Consecretio Medici, Harvey Cushing emphasizes how a common devotion is what binds us together. 7 He says, “[while] interest separates [us]… common devotion, more than any other possible influence, serves to overcome the self-depravities and conceits inherent in us which, uncontrolled, represent the chief defeat of our natures.” Now, what if the learner is a true novice and the mentor a master of the craft? What common devotion in medicine do they share? Herein lies a tension in which many of us find ourselves. How we handle this tension might dictate the direction of the relationship and our own mentorship philosophy.

There are two ways, I believe, in which we might approach this lack of obvious shared devotion. First, the mentor could impart guidance based on his or her own priorities and hope that the student adopts a similar perspective and passions for the science and art of the craft. This might result in a productive short term academic relationship if the student is hard-working and the mentor has adequate experience. The problem is that the student might not take ownership of the work and thus the relationship is shallow and lacks the life-long impact one might desire. Many mentors and student will be satisfied with this alone, but I would argue there is more depth to be sought. The other way in which the mentor might approach this situation is through strategically identifying the promising passions and devotions of the student and cultivating those with his or her own mastery and experience.

I have reflected on my personal experience as a trainee from 2019 to 2020 when I trained under Dr. Edward Laws, Jr., Professor of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, in pituitary surgery and neuroendoscopy. To shed light on the mentor-trainee relationship, I asked Dr. Laws some poignant questions about his own philosophy, and I offer a brief reflection on my experience.

The first question I asked Dr. Laws, was who his greatest mentor was. It was his father, Edward Raymond Laus,* MD. His father mentored by “encouragement and support, facilitating opportunities, acting as a role model physician.” It is also notable that he cared about both the how and the why of medical decision-making, which can oftentimes be lost in a highly structured protocolize treatment process. The legacy of mentorship philosophy is obvious, as Dr. Laws, Jr., shares many of the same encouraging supportive qualities and mentorship approaches as his father. This, combined with expectations of excellence, challenged me, and provided growth potential very early on.

How would Dr. Laws, Jr., describe his own mentorship philosophy? For him, it is to “[bring] out the best in [his trainees], encouraging [them to do] important work..[and] evaluating and striving for advances in science and practice.” He himself modeled this pursuit of excellence. He wanted me to accept and learn from opportunities and do sincere work with unwavering integrity, always doing what was right, never compromising patient care. Our primary interest was always the patient, and we never took short cuts in education or technically. Advancing the practice and science of pituitary surgery was an important part of my training. But, what about the role of scientific inquiry in mentorship? “Inquiry,” Laws said, “is a keystone [to the mentorship relationship], often needing perspective and guidance [from the mentor].” I would add that every persons needs are different, and it is the role of the mentor to challenge the trainee, and, as Cushing said, “arouse curiosity.”6 This, however, is not an easy task.

Anyone who has sincerely mentored, knows it is challenging. If the fruit in the mentor- trainee relationship is the progress of the trainee, the greatest challenge might be making “consistent progress” in knowledge, techniques, and personal behaviors, saws Laws, “aequinimitas”. Aequinimitas, as William Olser taught, calls us to rise above the “trials of life and to meet the little annoyances, as well as real sorrow, with serenity of mind.”8 This stability of heart and mind is, surely, a great gift to our patients and colleagues, and one that requires incredible endurance. Another challenge of mentoring is dealing with unmet expectations. If we maintain that the fruit of the mentoring is progress, struggles with performance which are discussed, understood, and overcome, are not meaningless. In fact, lack of progress could result from lack of critical oversight or too low expectations which secretly stalls progress under the veil of positivity.

Now, let us, briefly, discuss professional friendship. Over time, the bond formed between a mentor and his or her trainee is unique, especially if drawn together by a common devotion. This friendship is not among contemporaries, rather it, typically, spans a chasm in age, expertise, experience, wisdom, or perspective. Neither person can be unsuitably needy and mutual respect is critical, for it can be detrimental if boundaries are not established and there is loss of respect. If handled appropriately, this professional friendship can provide substantial ongoing encouragement and be very fulfilling.

In conclusion, mentorship is a unifying experience, in which the mentor and his or her trainee realize that together they are more than the sum of their individual abilities. This phenomenon is not unique to mentor- trainee relationships. It is seen in our families, and in our most meaningful friendships. As physician educators, we might say that mentorship, has the potential to cultivate a lifelong commitment to a shared cherished purpose, and this devotion we share becomes part of our own personal legacy.

A bit about the authors:

Laws and Catalino in front of the Cushing bookcase

[The authors in front of the Harvey Cushing bookcase at Brigham & Women's Hospital]

Dr. Catalino is a chief neurosurgery resident at UNC Health Care. Follow him @mpcatalino on Twitter.

Dr. Laws has served as President of the World Federation of Neurosurgical Societies, President of the Congress of Neurological Surgeons, Editor of Neurosurgery, President of the American Association of Neurological Surgeons, and President of the Pituitary Society. He has been the fifth neurosurgeon to become President of the American College of Surgeons and was elected to membership in the National Academy of Medicine. He remains actively involved in Brain and Pituitary tumor research and surgery. Of note, during his surgical career he has operated upon more than 8,000 brain tumors, of which over 6,000 have been pituitary lesions---more than Harvey Cushing himself! It is always an especial pleasure when Dr. Laws joins the neurology department's weekly neuropathological conference to enrich and enliven the discussion with his insight and experience.

 

*You may have noticed a change of spelling between the author's last name (Laws) and the author's father's last name (Laus). The family is of Italian origin, having come to America in the 19th Century with the name "Laus," meaning "Praise." When the author was in high school the family Anglicized his name to "Laws."  

References for this reflection

  1. Lattimore R. Homer: The Odyssey. New York: Harper & Row; 1965.
  2. Davis LL, Little MS, Thornton WL. The art and angst of the mentoring relationship. Acad Psychiatry. 1997;21(2):61-71.
  3. Catalino MP, Laws ER. Exemplary mentorship in action: Harvey Cushing's trainees from 1912 to 1919. J Neurosurg. 2020:1-8.
  4. Suero Molina E, Catalino MP, Laws ER. Harvey Cushing's international visitors. J Neurosurg. 2020:1-9.
  5. Ahmadmehrabi S, Farlow JL, Wamkpah NS, et al. New Age Mentoring and Disruptive Innovation—Navigating the Uncharted With Vision, Purpose, and Equity. JAMA Otolaryngology–Head & Neck Surgery. 2021;147(4):389-394.
  6. Cushing H. The Clinical Teacher and The Medical Curriculum. In: Consecratio Medici. New York: Little, Brown, and Company; 1928:18
  7. Cushing H. In: Consecratio Medici. New York: Little, Brown, and Company; 1928:3.
  8. Pratt JH. Aequanimitas. Arch Intern Med (Chic). 1949;84(1):86-92.