The Role of Mentoring in the
Surviving Sepsis Campaign
Emmanuel P. Rivers, MD, MPH
Marie 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/getthe-mentoring-equation-rig.html
Qualities of a Mentor and Protégé
• Mentor
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• Protégé
Tacit knowledge
Expertise in a given field
Credibility
Gives candid &
constructive feedback
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Semantic Knowledge
Drive & Ambition
Talent
Incorporates feedback
readily
DeLong, Gabarro, & Lees- Harvard Business Review • January 2008
My Experience of Being a MentorEmmanuel Rivers
My Experience of Being a Protégé-Marie
Mullen
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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
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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
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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
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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 of
Family 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
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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.