JACC: CARDIOVASCULAR IMAGING
VOL. 7, NO. 4, 2014
ª 2014 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 1936-878X/$36.00
PUBLISHED BY ELSEVIER INC.
http://dx.doi.org/10.1016/j.jcmg.2014.03.003
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EDITOR’S PAGE
Mentees, Mentors, and the Mentorship.
Y. Chandrashekhar, MD,* Jagat Narula, MD, PHDy
Minneapolis, Minnesota; and New York, New York
T
he past many months have been emotionally
hard, and this Editor’s Page is unlike most
others we have written for iJACC. It is more
of a personal epistle, mostly anecdotal, not
connected to the science we have published in the
current issue. It is, rather, the emotional equivalent
of a mourning period; many of our mentors have
started to retire, most often for health-related issues.
Some have been incapacitated, and worse, some have
passed on. This is a time to reflect on their legacy
and how they shaped us.
Both of us have been blessed with an unusually
generous bounty of mentors, and we fondly remember
interactions long bygone. On deep introspection,
most of our lives seem to be the sum of a patchwork
of gifts from generous wayfarers on our journey.
Mentors taught us many things, but the best memories we have are those that were given unassumingly;
we learned what magnificent gifts they were only
long after they were given, and they have shaped our
view of the world. Some mentors were fleeting
companions parting with their wisdom, while others
remained ongoing, reliable buttresses for our future.
The mentoring tradition is a long one, even
longer than the story of its namesake in the Odyssey.
Many cultures have had teacher-student traditions
far older than that between Mentor and Odysseus’
son Telemachus. It is a feature of Talmudic lore (1)
as well as the guru-shishya tradition, in which a
pupil spent more than a dozen years in his guru’s
home for tutelage. In fact, a large vein of Sanskrit
philosophy, the Upanishads, is dedicated to “sitting
down near” an enlightened teacher to receive supreme instruction (2). Some of the oldest Vedic
literature mentions this in 3 powerful words:
“Aacaaryavaan purusho veda,” “Only the one with a
From the *University of Minnesota, Minneapolis, Minnesota; and the
yIcahn School of Medicine at Mount Sinai, New York, New York. The
authors have reported that they have no relationships relevant to the
contents of this paper to disclose.
true preceptor or mentor gains true knowledge.”
Although some of this enthusiasm is quite obviously
built on faith and homage, and we do not know how
well this worked as it was not formally evaluated as
we understand testing today, this concept is common to the ancient literature of many faiths.
More recently, mentoring has become a must-do
feature at educational institutions and granting
agencies (3), and high-powered journals are actively
encouraging it (e.g., the Nature awards for mentoring in science). Some of these efforts are being
incorporated into faculty development (4) and are
being considered for credit as academic achievement.
Formal evaluation metrics are being used to gauge
the success of mentoring and have involved easily
measureable endpoints (such as success in obtaining
peer-reviewed funding, number of publications,
H indices, etc.). However, one cannot help but get a
sense that although everybody recognizes the
importance of mentoring, many of the programmatic efforts are more pro forma in nature. Interestingly, despite the overwhelming enthusiasm for
standardized approaches to mentoring, their implementation has been spotty at best (5), and the fervor
possibly decays predictably over time (6). It appears
that mentoring has had an inauspicious beginning
since the time of Mentor, who was charged with
teaching and nurturing Odysseus’ son, arguably the
first mentor with strong documentation, who may
not in fact have been that successful after all despite
giving name to this august tradition. The efficacy
of formal mentorship programs, when considered
using objective criteria, remains unproven at best;
there is evidence both in favor (7) and less so (5)
of the usefulness of such programs as currently
implemented.
In our simplistic view, we can consider mentorship in 2 broad categories (which might overlap to
some extent). The traditional approach is what may
be considered as a “transactional” or “facilitatory”
mentorship, in which the promise is that one sticks
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with a mentor, working hard with integrity, and the
mentor will grease one’s path toward academic
success (first papers, then grants and networking,
and finally an independent career or laboratory).
This kind of mentoring is extremely important to
attract students to the sciences (8) and help them
succeed. It also seems to be the thrust of major
mentoring programs (4), and expert advice about
how to implement and improve mentoring seems to
cater mainly to this type of mentoring (9,10); programs using or encouraging this approach are rightly
lauded (7).
We, however, were the beneficiaries of yet
another kind of mentoring, a more primordial form
that is difficult to quantify and probably rarer to
find. These mentors believe in their students,
ignite a searing desire to ask questions, and make
answering those questions a highly satisfying experience even if beset with dead ends. They truly
believe that it would be a shame if talent in young
students were wasted. Grants and papers, although
on the horizon, are not central to this effort. The
best gift to us, personally, was not primarily a ramp
for our careers but that someone noticed that we
were capable of something unique, lit the spark that
showed us a whole new way of thinking, and fired
us up to be investigators with “outside-the-box”
thought processes. This indirectly translated into
the philosophy that producing new knowledge is the
greatest of human endeavors for a physician. As
Theophrastus is said to have exclaimed, “Teaching
is not pouring water into a pot, but lighting a fire”
(11). These mentors changed us from our destiny as
clinicians who were highly proficient at gathering
facts and regurgitating them as needed to possible
generators or curators of knowledge. It is our belief
that such mentors are far fewer than experts in the
more conventional form of mentorship and rarely
are recognized using conventional metrics for evaluating their efforts. Recognizing them is even more
difficult in the clinical sciences as opposed to the
basic sciences, in which signposts for success are
more clearly defined.
So what do we remember of the best of these
luminaries? There are a number of well-studied indicators common to most excellent mentors (12,13),
and it appears that mentoring can be improved with
structured training. What we recollect here is a more
unscripted version, something we found uniquely
helpful in our mentors. There were many different
individuals at different stages of our careers, and each
provided us with a piece of generosity, their “je ne
sais quoi” that served as a brick for building our
futures. For one, they were very good at what they
Chandrashekhar and Narula
Editor’s Page
did and were confident in their convictions. We
remember one master clinician who, when told that
an echocardiogram had shown a small atrial septal
defect, refused to change his diagnosis of an intact
atrial septum, because he could not hear a soft systolic murmur at the upper sternal border or a fixed
split. He was proved correct later; false dropouts on
the apical 4-chamber view were a problem with early
2-dimensional echocardiographic machines. It was
quite similar to Proctor Harvey challenging someone
that he had never seen an atrial septal defect without
a soft systolic murmur at the upper sternal border.
These clinicians could stand by their findings and
often did so boldly in face of high-profile opposition.
Second, they were unsparingly generous with
their time. One of our most influential mentors
would show up in the evening to discuss a paper,
having just been on a long flight crossing more than
one continent. Their enthusiasm was infectious.
They communicated constantly and made demands
that seemed both inordinate in scope and inopportune in timing. Yet we later realized that this taught
us to stay focused on the end result and to be timely
in execution. We have realized since then that we
always paid a price every time we disregarded this
principle and procrastinated; that lesson was learned
very quickly. Another mentor would often take us to
the concerts of the best classical Indian vocalists or
instrumentalists; the focus always was an exposure to
excellence in any form.
Third, they instilled in us a sense of history, the
provenance of thought and ideas. One of the most
precious gifts we ever received was to understand
how a thought originated and how it progressed
over many decades to its present form. The result
was a delightful portal to understand something in
great depth, allowing one to delve extensively into
long-forgotten papers and the concepts that underlie what we do today (such as comparative
physiology: Peter Harris’s [14] paper on how blood
pressure is preserved across species and how preserving it at all costs could be the stimulus to induce
salt and water retention, à la clinical heart failure).
Fourth, primordial mentors made us ask questions outside our comfort zones and then related
those to issues we would face in our regular practice.
One question posed to one of us while we were in
training whether all the causes of salt and water
retention, including heart failure, have a common
final pathway. This led us to read Baker’s (15) (as
well as Monge’s) classic paper on human adaptation
to high-altitude hypoxia, a seminal paper in Clinical
Science about hill walkers in England who develop
heart failure–like symptoms (16), and a report on
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the Hausa women of Nigeria who develop postpartum fluid overload when, per tradition, they sleep
on heated beds as a part of their recovery from
pregnancy (17). This then led to the unexpected but
now seemingly logical conclusion that such a
mechanism may be operating in fluid overload seen
with severe anemia or cor pulmonale. To another of
us, one question referred to the influence of mitral
stenosis on the hemodynamic profile of constrictive
pericarditis or in a scenario in which there was
anomalous pulmonary venous connection with an
intact atrial septum. The hemodynamic profiles of
constrictive pericarditis and mitral stenosis were
mutually exclusive, and that of the latter largely
incompatible with life (18,19). It was both fun and
challenging to solve these riddles. We were provoked as to why a failing heart with florid myocarditis in rheumatic fever would maintain normal
contractility (20,21). These kinds of intriguing
forays into the unexpected resulted in very
rewarding years of science (22,23). The idea was not
to smugly point out some minutiae but to get us
thinking.
Fifth, there was an unrelenting emphasis on
quality. Our mentors spent countless hours and late
evenings with us in our younger years, helping us
refine our slides and presentations before major
meetings, and they genuinely believed that a flub on
the stage reflected not on the presenting fellow but
on themselves. The essence was often that “nothing
comes from this laboratory, division, section, or
department that is not of the best of quality. If you
are criticized on stage, it is like I am being criticized.” This kind of attention to detail has been a
great asset in our subsequent careers.
Sixth, we found that they let us cope with triumph and failure with equanimity, reminding us
that once the mourning period is done, it is time to
get back to work and find out why something did
not work out as planned. It still comes in handy
when our papers are rejected or our grants declined.
Last, one of these mentors’ unique characteristics
is that when the time comes, they set their students
free, accepting them as peers and delighting in their
accomplishments. One of the most delicate yet
crucial rites of passage in an academic path is the
need to show academic independence, and there are
numerous examples of this going badly to the
detriment of mentees. We uniformly found that the
hallmark of great mentors is their ability to gracefully detach themselves from claiming credit for
their mentees’ achievements while maintaining a
steadying hand on their careers. The best mentors
fostered collaboration and networking with other
scientists around this time so that their absence was
replaced by the presence of other strong collaborators. Some of the most satisfying mentorship experiences we had were when our mentors later
became outside collaborators on our grants, a perfect
balance of letting go and helping out. Not surprisingly, their students stay in touch long after they
have moved on in life to other opportunities. Both
of us have regularly stayed in touch with our mentors past and present, to seek advice or to merely
chat; they continue to be invaluable resources, even
if the questions we now address are no longer within
their areas of expertise.
So what is it that results in this excellent pairing?
Although a lot depends on initiative on the part of
the mentee, we cannot deny that a large part of it is
the chance of crossing paths with such gifted
mentors. It is sad to see them recede from our lives,
for, as a Turkish proverb says, one is equally
indebted to one’s mentor and to God (24). Then
again, they left us with something deep, in the true,
time-honored tradition of the teacher-pupil relationship. We hope that we can pass on much of
what we so generously received from them.
While we were in the process of finalizing this
editorial, we received the sad news about the passing
of Professor Raj Tandon. We both mourn the loss
of our revered and beloved mentor: he exemplified
the original “primordial mentor” and was one of the
doyens of academic cardiology in India. Although
we are immensely sad at his passing, we truly celebrate what mentors such as Professor Tandon gave
so unselfishly to generations of students like us.
Address for correspondence: Dr. Jagat Narula, Icahn
School of Medicine at Mount Sinai, Mount Sinai Heart,
One Gustave L. Levy Place, Mailbox 1030, New York,
New York 10029. E-mail: [email protected].
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