A Critique of the 2023 AAHA Mentorship Guidelines

The new guidelines reflect a lack of scholarship and conviction, seemingly built to fulfill an agenda rather than accomplish a goal.

This resource is not a substitute for legal or other appropriate professional advice. AAHA is not responsible for any inaccuracies, omissions, or editorial errors, or for any consequence resulting therefrom…

2023 AAHA Mentoring Guidelines (p. 1)

You can approach the act of writing with nervousness, excitement, hopefulness, or even despair—the sense that you can never completely put on the page what’s in your mind and heart. You can come to the act with your fists clenched and your eyes narrowed, ready to kick ass and take down names. You can come to it because you want a girl to marry you or because you want to change the world. Come to it any way but lightly. Let me say it again: you must not come lightly to the blank page.

King, Stephen. On Writing: A Memoir Of The Craft (A Memoir of the Craft (Reissue)) (p. 106). Scribner. Kindle Edition.

I like writing. I believe the things we write matter. Maybe not to everyone, maybe not all the time, but the things we write should matter to us, to others. So when a set of guidelines opens with a disclaimer like that, I can’t help but become skeptical of the words that follow. “We’ll say this, but we don’t think enough of it to stand behind it,” seems to be the message. I understand the necessity of disclaimers like this in the world today, but it’s especially disappointing to see it in a professional publication like this. But as I dug into the 34 pages of the AAHA Mentoring Guidelines, I couldn’t help but feel that they didn’t believe their disclaimer was protection enough. Too often through the guidelines did I find language that was flimsy, ideas without structure or support, and an apparent lack of not just research, but resolve.

Let me say it this way: They came too lightly to the blank page.

These guidelines don’t feel like guidelines so much as a compilation of weakly supported ideas that suit a narrative that the authors find acceptable. This work doesn’t represent leadership, or even mentorship, as much as it seems to represent a way to probably not bother anybody. (Except, I suppose, the irascible and unrelenting author of this essay.) I’ve compiled some examples of what I believe to be representative examples of the flimsiness of the guidelines:

Critical mentoring provides a mentorship framework within the broader context of a person’s social identities related to race, ethnicity, class, gender identity, and sexual orientation. Critical mentoring takes into account the identity of the mentee and mentor in mentorship program design, structure, and relationships.

(Page 3).

Call me a cynic, but I work in private practice and own a small business. Any human resource expert I hired to advise me would advise me against having conversations about race, ethnicity, class, gender identity, and/or sexual orientation with any employee or mentee. As a middle class white guy with a doctorate I’m basically the poster child for the privileged patriarchy. But I’m not a selfish jerk so I make a considerable personal effort towards educating myself to be a progressive, empathetic, and compassionate person regarding the plight and challenges faced by others. And it would be insanely dangerous for someone in my position to have conversations like this with anyone in a subordinate role.

Absolutely no mention of the risks exist within the mentorship guidelines. People without experience in human resources or the laws that govern employment in the United States could be wading into a minefield of problems without knowing that they’re exposing themselves to tremendous liability and the wrong kind of “AAHA moments.” I would never engage one of my employees in a critical mentorship role described here because it would be too fraught to safely navigate, even more so without specialized education and training to that end. There’s no specific mention of such risks within the guidelines, a troubling oversight.

Local Versus Distance. Local mentorship simply means the mentor and mentee live or work with each other or in close geographic proximity. Distance, or virtual, mentorship uses technology to provide opportunities for direct observation of skills, timely feedback, and virtual interaction. Distance mentorship opens access to additional mentors otherwise not available locally. This greatly expands the mentee’s support network and outside perspective and advice.

(Page 4).

The next time you’re on a video call, pay attention to the faces of the other people. You’ll notice you have to make an effort. Research has shown that people mostly interact with their own image, rather than those of others, on video calls. (Maybe Narcissus’ pool was really a webcam?) As such, we are further limited from developing rapport on video calls.

There’s no mention of the limitations, of the risks, of advice on how to navigate the distance mentoring process espoused here.

Gender pay gaps

The study cited for gender pay gaps was a self-reported study of income sent to members of the ACVS. If you want to know what I think of self-reported studies on income, I’d invite you to ask 100 people their height, then subsequently measure their height. (An entertaining aside: When I asked my spouse to proofread this for me, she asked, “How would people not know their height?” I had to smile at this kind and trusting person for whom dishonesty is unfathomable, I had to remind her, “No, love, people lie about it.”) I’d wager you’d find considerable variation. What the study cited studied was not income, but how surgeons report their income. Representing not a gender pay gap, but a gender pay reporting gap.

Further, the study measured career success only by employment status, professional title, and income. I don’t think many of us believe those are the most meaningful measures of professional success, just the easiest to quantify.

The point of my snark is simply that the study chosen isn’t very good. And it didn’t take me very long to find that out. I decided to read the guidelines at 11am, I was done writing this essay by 6pm the same day. Hanging an assertion on a study like that makes me doubt the validity of the rest of the work that cited such a study.

The authors of these guidelines contend that mentorship offers the potential to mend the fabric of the profession.

(Page 5).

You don’t get to claim credit for the success if you’ve already abstained from responsibility for the outcomes. There’s no honor in asserting your belief for the benefits while disowning any side effects. Sounds a bit like the faith healer, collecting credit and coin for those whose ailments dispelled by nature’s good luck while simultaneously ostracizing the persistent invalid for not believing hard enough. I imagine Kim Scott (more on her later) would have no such problem with this dichotomy.

Suicide Risks. Compared with the general population, male veterinarians were 1.6 times more likely and female veterinarians were 2.4 times more likely to die by suicide.

(Page 5).

Suicide is a real danger for us as veterinary professionals. Failing to note that, among the general population, men are three to five times more likely to be victims of suicide is an irresponsible omission.

Breaking Down Stigmas. If all members of the veterinary profession openly discuss these shared challenges and support each other, this may result in decreased mental health stigma and increased help-seeking via mentoring and other modalities. Positive mentorship thus potentially leads to positive impacts on mental health and wellbeing in the profession.

(Page 6).

We are not mental health professionals. Mentorship is an aspect of mental health support, but does not replace the work of a mental health professional in the same way that a gym buddy can support physical fitness but doesn’t replace the work of a physician.

This sort of language doesn’t hold up under scrutiny. It’s flimsy. It’s shallow. It’s a nice idea, but it’s not supported by citation or explanation. It’s just casually presented and then we speed away from it. The problems we face merit more words, more work, more focus, not less.

What I want is what I think we need. So I want the AAHA Mentorship Guidelines to have the weight of credible research and study. I want the explanations and justifications to be robust and thorough. I want this work to have the same gravity and seriousness as the work on endocrine disease and surgical protocols. We need it and deserve it in the profession.

Cultivate Open Two-Way Communication and Encourage Radical Candor (see Glossary). Mentoring functions as a collaborative endeavor, so communicate goals, boundaries, and expectations early in the mentoring relationship. If using a structured mentoring program, ensure relevancy and match between the mentee’s goals and purpose and focus of the mentoring program. Acknowledge the value of different cultures, learning styles, communication styles, personality types, and conflict resolution styles. Together, find common ways to communicate while acknowledging and celebrating individual differences in learning and thinking. Radical candor is a form of feedback that is done in a kind, humble, and direct manner and focuses on helping the other person.50 Encouraging radical candor can help mentors and mentees communicate effectively.

(Page 10).

I read, a lot it seems, and a fair number of the books I read are business books. There are a few business books I don’t think are very good, and one of them is “Radical Candor” by Kim Scott. (While the phrase is used in the guidelines, it isn’t defined in the glossary.) The phrase is defined by the book’s author as “saying what you think while also giving a damn about the person you’re saying it to.” My trouble with this one isn’t its ending sentences with prepositions so much as the fact that it consistently equates good outcomes with correct action. Correct action results in good outcomes, and incorrect action results in bad action by the reasoning expressed within the book. If you get a bad outcome, you didn’t do it right. But for those of us out here in the trenches and wicked systems of practical medicine, we know that you can do all the right things and still have the outcome go south, sour, or sideways. Reality isn’t often, if ever, that neat and clean.

None of that is explained or defended within the guidelines. Using this phrase, without explanation or citation, that has a well-defined meaning within the literature of leadership, is sloppy scholarship. It’s tossed out as an addition, an “oh by the way,” without the robustness and impact being imparted. It’s too wimpy for the AAHA guidelines. We must come stronger to the blank page.

Homophily, defined as the tendency to seek out those similar to oneself, often leaves women and individuals from underrepresented and marginalized communities with limited access to mentors within their desired professional fields.

(Page 12).

Perhaps, for an example of homophily, one might look to guidelines on mentorship in a profession that is 65.7% female written by a cohort of authors, consultants, and reviewers comprised of ten women and two men.

Communicate Openly and Clearly. Share your preferred communication methods—such as email, text messages, or social media platforms—and your learning style with your mentor. However, make adjustments if your mentor cannot accommodate your preferred communication method.

(Page 12).

Do the things. Unless you can’t do the things. Then do something else.

Forgive my sarcasm, but the delivery of these messages isn’t strong or specific enough to have the weight of the professionals who wrote it or the professional organization that commissioned it. This kind of soft and insubstantial delivery is almost certainly why the notions of soft skills and mentorship are so often met with scoffing and rolled eyes. We’re serious professionals, we deserve a message that respects that accomplishment and status by delivering it with precision, specificity, and validation.

It takes time to build a trusting relationship with someone new, so focus on creating a safe space for mentees to feel vulnerable and express honest sentiments.

(Page 15).

This is the line that broke me. This is the one that snapped my brittle patience.

Why? Time takes time. It doesn’t take space. It’s not the bad writing or even the bad physics that gets me, it’s the trite nonsense that was allowed to pass muster for publication in the scholarly work of the AAHA Mentorship Guidelines.

I’m all for allowing things to take time, I’ve written about it here. I believe in the importance of safe spaces, and in brave spaces, even if I don’t believe that every space must be a safe one. But the passage of time isn’t solved by the provision of space. The advice starts off in promising fashion, then dissolves into a weak excuse for a near aphorism. A sentence like this never should’ve been allowed to pass the editorial review of a dozen professionals.

Vulnerability demonstrated by the mentor through sharing personal lived experiences, previous errors, and solutions provides a judgment-free zone and ensures psychological safety.

(Page 15).

I like Amy Edmundson’s work. I think it’s pretty good reading. I think she’s got valuable things to say about psychological safety and we should employ those principles in our workplace and profession. I do not think that she would agree with the statement that “vulnerability demonstrated by the mentor…provides a judgment-free zone and ensures psychological safety.” There’s a bit more to it than that. There’s two books, half a dozen articles, and some YouTube videos about it being more than that. This doesn’t “ensure psychological safety.”

There’s no such thing as a judgment-free zone in the world of medicine. The practice of medicine requires tremendous diligence and effort. Our judgment in practice is a crucial skill, and evaluating it requires judgment. We can avoid being judgmental, with its connotations of excessive criticism, but not abstain from judgment.

Again, we see a fragile and shallow demonstration of scholarship. Perhaps it was an effort to simplify the concept, but we’ve cored the soul and impact out of a valuable area of study and development. We’ve damned with faint explanation. I think Dr. Edmundson would agree with me, but she’d probably be nicer about it.

Personality/Learning Styles: See DISC Assessment

When building a house, consider a hammer. The DISC Assessment isn’t bad. It’s a useful tool. But it’s a tool, and it should be used thoughtfully and carefully and intentionally rather than flatly recommended in a casual fashion.

When considering a mentor with a socially privileged identity, mentees with socially oppressed identities must ask questions that allow for exploration of shared attitudes, values, and the emotional intelligence of their potential mentors. If the prospective mentor agrees to it, mentees can request discussion of relevant topics related to social identity, such as systemic racism, discrimination, proactive pronoun use, and so on.

(Page 20).

How powerful it might be, to seek mentorship and advice from people who aren’t like us, who don’t share our worldview, our demographic values, but with whom we might connect and support through our shared and noble pursuit of the study and practice of medicine. Rather than seek those who merely look like us, who think like us, how much could we learn if we didn’t treat those who are different like opponents or enemies? A lack of certain kinds of diversity is demonstrable in veterinary medicine, but I have always enjoyed the way that love and care for animals can bring together people from all walks of life. I don’t think we should look to highlight the ways we are different. I think we would be better served by developing the ways in which we are alike, and that is what mentorship in medicine should be. We could use it to bring us together over what we share, rather than entrench that which divides.

Realistically, this invertebrate set of guidelines doesn’t reflect the degree of impact and research that goes into the doing of the day jobs of Dr. Reinhard and her co-authors. What this reflects is the lack of commitment - on the part of the American Animal Hospital Association - to produce a meaningful work. Corralling experts and offering them rigid timeline and a nominal honorarium is, apparently, not the way to produce a quality work. And let’s face it, you’d be hard-pressed to get a dozen veterinarians to come to consensus about what day of the week it is. A better outcome might be achieved by appointing a chair and then empowering them with both resources and authority, rather than merely responsibility, in pursuit of the mission. It’s a common question of the veterinary profession, “you love what you do, so why won’t you do it in your free time for less compensation to serve my needs?” Veterinarians should know better and treat each other better than that.

I don’t often write about leadership in veterinary medicine, it’s a noisy theater and I don’t know that my grouchy, impatient brand of hardassery suits the widespread demand for desperately cheery positivity. However, what these examples represent, I believe, is a failure of conviction. Worse, they are collectively representative of the failure of leadership that exists throughout the veterinary profession. We have more celebrities than leaders. We have more problems than solutions. Too many consultants and entrepreneurs while lacking enough clinicians and surgeons. And when we come upon a way of making the profession better for the more than 120,000 of us in the United States, we tremble and rush to publication. We lose our nerve and our composure. We put forth a work of flimsy scholarship and tepid opinion. We recoil from the danger that comes with the courage of our convictions. We have to be willing to be wrong, to be disliked, to be unpopular, if doing so serves the greater good of doing what’s right.

The blank page beckons. Let us not come lightly.