The Role of Mentoring in the Surviving Sepsis Campaign

Emmanuel P. Rivers, MD, MPHMarie T. Mullen, MD

Ryan O’Gowan, MBA, PA-C, FCCM

Faculty & Credentials

Emmanuel P. Rivers, MD, MPH

Marie T. Mullen, MD

Ryan O’Gowan, MBA, PA-C, FCCM

Disclosures

• Dr. Rivers

• Dr. Mullen- No disclosures

• Mr. O’Gowan does not have any conflicts of interest to disclose.

Objectives

• 1. Describe the role of mentor and mentee in a healthcare setting.

• 2. Explain the benefits of serving as a mentor.

• 3. Write goals for a mentoring relationship that uses the Surviving Sepsis Campaign as a basis.

Historical Framework and Overview of Ideas surrounding EGDT

• Initially started as cold vs. warm shock in the ‘60’s.• More research was done in physiology and the

advent of the Swan Ganz catheter made it possible to differentiate between different types of shock.

• Lab measurement of lactate, CVP, and mixed venous O2 sats made targeted therapy a possibility.

Mentors of Dr. Rivers

• Dr Shoemaker

What Are Mentors?

• Odysseus secured the aid of his friend, Mentor, to counsel and guide his son, Telemachus (Hamilton, 1942).

• A mentoring relationship is formed between two individuals who are committed to improving their professional environment and the advancement of the protégé’s career.

• In reciprocation, this offers enhancement of the Mentor’s sense of worth and self- esteem.

Mentors in Unlikely Places

Abraham- Harvard Business Review • June 2006

Mentors in Unlikely Places

• Even in crime-mentoring pays.• Younger criminals with lower self control

attract mentors, which resulted in a more structured approach after the benefit of guidance.

• These young protégé criminals have fewer incarcerations and manage more profitable criminal enterprises.

Abraham- Harvard Business Review • June 2006

Marie Mullen and Manny Rivers

Concepts about Networking & Ideas

• Ideas are generated through individuals who are information brokers. An information broker may also be a superconnector.

• Network nodes have more branching when information brokers keep likeminded individuals in their company who then serve as interconnectors.

• Networks that lack interconnectors may have nodes that fold back on themselves- ideas or information may not propagate in this instance.

Uzzi & Dunlap- Harvard Business Review • December 2005

How Networks Influence the Spread of Ideas

Uzzi & Dunlap- Harvard Business Review • December 2005

Parallels-The American Revolution and Revolution of EGDT

• Paul Revere served as an information broker, and began to branch outside of his own network, while Dawes did not.

• Here the information brokers are Drs. Shoemaker and Rivers. Through publication and academic networks, EGDT was able gain a successful foothold.

• Because it is a truly multidisciplinary type of therapy, it has lent itself to study and implementation into other disciplines like anesthesia and cardiac surgery.

How Ideas Gain Footing Vis-à-vis Networks

Uzzi and Dunlap- Harvard Business Review • December 2005

Mentoring Definitions

http://blogs.hbr.org/johnson/2011/10/get-the-mentoring-equation-rig.html

Qualities of a Mentor and Protégé

• Mentor– Tacit knowledge– Expertise in a given field– Credibility– Gives candid &

constructive feedback

• Protégé– Semantic Knowledge– Drive & Ambition– Talent– Incorporates feedback

readily

DeLong, Gabarro, & Lees- Harvard Business Review • January 2008

My Experience of Being a Mentor-Emmanuel Rivers

My Experience of Being a Protégé-Marie Mullen

• Semantic Knowledge• Drive & Ambition• Talent• Incorporates feedback readily

The Introduction of EGDT at Henry Ford

The Introduction of EGDT at UMass

• Arrived at UMass July 2000

• EGDT on shift basis 2000-2003

• Taking call for all ED patients 2004

Got Sepsis? Get SET! Sepsis Evaluation Team

• 2 SIRS Criteria with Hypotension• 2 SIRS Criteria and a Lactate of 4• Offering Early Goal Directed Therapy Call Beeper 8058 for Availability

The Introduction of EGDT at UMass

• Critical Care Operations Committee Coordination (CCOC) and Support 2005

• Sepsis Clinical Practice Guideline 2006• SLAM Sepsis Protocol• Strategies to Limit Adverse outcome and Mortality in sepsis

The Introduction of EGDT at UMass

• Sepsis Packet• Ongoing Education Across Disciplines• On-Line Education• Family Education Packet• Ongoing CCOC Support and Evolution• Acute Care floor algorithm• “Lactate of 4 does not go to the floor”

The Introduction of EGDT at UMass

• Reduced mortality• Reduced length of stay despite higher volume• Reduced cost per case• Community affiliate participation

Reinforcing Mutual Accountabilities of Mentors and Protégés

•Periodic assessment of the mentoring relationship ensures it is on the right track.

•Expect “Bumps in the Road” – examine causes, listen to concerns of the mentee, define a joint agreement to move forward, provide empathy & discuss alternatives.

•Periodically review & renew the “action plan”.•Provide mutual constructive feedback – not letting emotions prevent

honesty.•Discuss how disagreement will be handled.•Acknowledge the mentor may wear different hats in a professional

setting.

EGDT-Introducing the framework into novel environments

• Overcoming Inertia-Explain what’s changing.• Finding likeminded information brokers who

subscribe to the science that underpins EGDT-Explain why.

• Indentifying and leveraging interconnectors and superconnectors in novel environments-Look for pitfalls and elicit ideas.

• Generate institutional support for concepts and uncover reasons behind past failures.

Ford, J. & Ford, L. Decoding Resistance to Change. Harvard Business Review, April 2009.

Teaching-Using the Microskills Framework

Neher, JO, Gordon, KC, Meyer, B, and Stevens, N. A Five-step "Microskills" Model of Clinical Teaching. Journal of the American Board of Family Practice. 5:419-424, 1992.

Teaching-Using the Microskills Framework

• Get a commitment• Probe for supporting evidence• Teach general rules• Reinforce what was right• Correct mistakes

Neher, JO, Gordon, KC, Meyer, B, and Stevens, N.A Five-step "Microskills" Model of Clinical Teaching. Journal of the American Board ofFamily Practice. 5:419-424, 1992.

Refining your Research, Teaching, and Medical Practices

• requires thinking in the midst of action • requires preparedness often without apparent

preparation • involves multiple levels of learners • includes multiple roles/agenda for the teacher • occurs with limited time • occurs in multiple sites (bedside, hallway, conference

room) • occurs often in a setting of little control.

Irby, D. How Attending Physicians Make Instructional Decisions When Conducting Teaching Rounds. Academic Medicine. 67 (10): 630-638, 1992.

Bibliography• Why Mentoring Matters in a Hypercompetitive World. Delong, T.; Gabarro, J.; Lees, R.:

Harvard Business Review, January 2008.• Mentoring Millenials. Meister, J. & Willyerd, K.: Harvard Business Review, May 2010.• Knudson et al. Analysis of Resident and Attending Physician Interactions in Family Medicine.

Journal of Family Practice. 28 (6): 705-709,1989.• Irby, D. How Attending Physicians Make Instructional Decisions When Conducting Teaching

Rounds. Academic Medicine. 67 (10): 630-638, 1992.• Neher, JO, Gordon, KC, Meyer, B, and Stevens, N. A Five-step "Microskills" Model of Clinical

Teaching. Journal of the American Board of Family Practice. 5:419-424, 1992.• Ford, J. & Ford, L. Decoding Resistance to Change. Harvard Business Review, April 2009.

Forum Questions

• Opportunities to respond to the presented materials and pose specific questions to the presenters.