It takes two to make a thing go right: maximizing the mentor/mentee relationship

Buddy Creech: [00:00:12] Hey, everybody. I'm Buddy Creech, and this is Let's Talk ID. Today we're going to talk about mentorship. And there's no one better to help us think about how we mentor students, residents, fellows and faculty than Dr. Kathy Edwards. Kathy is in the pediatric ID pantheon. Her career in vaccinology, clinical research and immunology has led to over 650 research publications. Election to the National Academy of Medicine, the Maxwell Finland Award and the American Pediatric Society Howland Award. She recently retired as the Carousel and Cornelius Vanderbilt, Endowed Chair in pediatrics at Vanderbilt, where she spent her entire 42 year career. And she's now professor emerita. And maybe most important to today's conversation is that she's considered a real mentor of mentors. In 2006, she received the IDSA Mentor Award, and in 2014, she received the Maureen Andrews Mentoring Award from the Society of Pediatric Research. Full disclosure, this year marks the 20th anniversary of me joining Kathy's team as a fellow. So I thought it would be a good opportunity for us to hear from one of the best in the business about how we can mentor our trainees in the best way possible. Kathy, thanks for joining us this morning. I want to jump right in and ask you the origin story. We think about it in superhero movies and in other narratives. Who were your first mentors? What did they do well and maybe what did they do that made you think, gosh, I'm never going to do that again when I start mentoring folks. Tell us how this all started.

Kathryn Edwards: [00:01:38] Well, first of all, thank you so much for this opportunity. And as I look back over my years, probably the most important thing that I've done is mentorship. So it really means a lot to me. My initial mentors really were subject matter experts. My love of microbiology began in my microbiology class. In medical school, my love of infectious disease began with a subspecialist that joined my residency program, an infectious disease doctor, Todd Davis, and then my laboratory mentor in Chicago, where I worked for two years in doing basic immunology. Henry George was a wonderful mentor and then came to Vanderbilt and Peter Wright, who was a division leader, and David Carson, who was the chair, were also very involved in infectious disease and stimulated my interest and excitement. So I've had a number of mentors all along. And guess the common theme is that they have been interesting. They have piqued my interest, they have stimulated me. My talks that we used to do with Dr. Carson and Dr. Wright and Barney Graham, who was a fellow, and Kathy Neuzil and Bill Gruber that were all at Vanderbilt. That interest was stimulated by always asking questions of why. And when I answered sort of perhaps incompletely or without the lack of knowledge, I was chastised in a very nice way. So always continuing to stimulate me, to ask more questions, to do better work and to perform better. So I've really been blessed with a number of really great mentors.

Buddy Creech: [00:03:14] You know I've known you now for over two decades, and I don't know that I've heard it put as succinctly as that from your story, and I'm just laughing at the number of times early on when I first started with you where you did that exact same thing with me and I saw you do it with the other fellows, which was asking the next question and not being satisfied when things didn't make sense or things weren't clear. And if I had a nickel for every time in a manuscript or in a presentation that you wrote, this isn't clear, we would have no compensation problems in infectious diseases, I can tell you that. So let me ask you this. What did it look like when you first started mentoring? I mean, you had these mentors that kind of showed you to be interested and to ask questions. They piqued your interest in those subject matters. What did mentoring look like when you first started taking on trainees? Honestly, how did you know what you were doing?

Kathryn Edwards: [00:04:09] As an infectious disease doctor who likes clinical medicine, I think I've always loved to teach. I think mentorship is really teaching, but it also is a two way street, and that's really important as a common thread that you have to understand that you're giving but you're receiving. So that relationship has to be very reciprocal, has to be interesting for the mentee and has to be stimulating and not boring and something that you don't look forward to. So I began to mentor very shortly after I became a resident and a fellow, you know, mentored in in terms of questions about patients, about looking into the literature, about case reports, that I began to stimulate people and students to write. When I came to Vanderbilt, there was this opportunity to work with medical students in a research rotation. And for every year I would have several medical students. They would mostly do surveillance or they would do laboratory work. And I was always very intent that this work would result in a manuscript, because I think that is also is very exciting for young people to see their names. And as I often tell people, that unless it's written down, it didn't happen. Stimulating that at all levels. And then as time went on, I wasn't initially the one that was allowed to to mentor the fellows. But then as I became more capable, I did that. And then I began to mentor faculty. And it was a maturation process, but certainly one that enhanced my work enormously. The mentees would bring questions and bring ideas and thoughts that I would never have had myself. So it's really a two way street. The better mentee that you are, the better mentor your mentor will be.

Buddy Creech: [00:05:54] I want to sit on that just for a little bit about the better mentee you are, the better mentor you will be. This is this idea, I guess, of managing up and giving your mentor the tools to be successful. So what does that look like? What are the things that you're going to look at or look for in someone who maybe wants to work with you or wants to lock arms for a while, maybe during fellowship? What are the things that you're looking for that give you a sense, okay, this might work.

Kathryn Edwards: [00:06:20] Well, first of all, there has to be a common understanding of what the expectations are, and I have pretty high expectations. I never have expectations that are higher for others than I have for myself, but those are pretty high. So people have to understand that if I'm going to take this on, that I mean business, that I really want this relationship to be one that is meaningful, that is reflected in commitment and hard work. So I think that's the first thing. Are we on the same page? Is it clear that you what you want, and it's clear what I want. If it's clear that, you know, this just doesn't seem like our commitments are the same, then that really isn't going to work. So we need to decide that from the very beginning and make sure exactly what you expect. The second is that there has to be a very organized and structured kind of environment to communicate. So for me and my mentors, that was weekly meetings. There was an hour every week that was set aside for the mentees and it came with an agenda. I needed to know what you wanted to talk about.

Kathryn Edwards: [00:07:29] I needed to know if there was a big issue that you're going to explode about that I could be ready for your comments. I also needed to have if you had a manuscript that you wanted me to look at, I needed to see that and probably not the night before the meeting that was going to be at seven in the morning, because that wasn't totally fair for me. But it also came with the understanding that I would be prepared for these meetings. I would get back with you with comments. And then finally, there also has to be an understanding that ultimately what you want to do, very much like you want to do with your biologic children, is you want to give your mentees wings so that they can fly away, so that they can be independent of you and that they can have their own careers that will not be constantly butting up against yours, that you give them something that really can be there. So those are the main ideas and concepts, or ten commandments, maybe only three commandments.

Buddy Creech: [00:08:31] Ten are hard to follow sometimes. If we can trim those down, maybe it makes it easier. You know, one of the things I'm struck by is that I was utterly clueless coming to you as a resident, saying, Will you consider mentoring me? I appreciate the idea of of setting up expectations and knowing that we agree upon things and maybe the trainee being able to articulate what it is they want to get out of the experience. But I experienced this now as a mentor. I certainly experienced it back then where I don't know that I knew enough to know where I wanted to go. And I think one of the things that you did is you acknowledged that you saw, I guess, some traits that would work in me, but more importantly, I think you painted a picture for me that said, if this is something you think you would like to do, here's how we can get there together. I guess I'm saying that I didn't have to come to you with a well crafted business plan or already the plans to build the house instead. It's as if you looked at me and said, okay, if this is the type of house you want to live in, I know how to make that kind of house. How do you do that? Like I imagine that you get and you've gotten over the years, people who are fully aware of what they want to do and people who aren't quite clear what they want to do. How do you start to mold them? How do you start to get them to where they need to be?

Kathryn Edwards: [00:09:56] First of all, you listen to them. You listen to what it is that they they want. You also observe them, you know, and this is one of the strengths that if you are going to mentor somebody as a fellowship, one of the strengths of having those people from your own residency. Program is that you know them, you've worked with them. You know that when you see patients together that they're going to be excited about the pathogenesis and you know that they're going to follow through and they're going. So I think that the more that you understand and know people, it's important and certainly people that come from other places. I will often call and and talk with the people that they worked at at the other places, you know, is are very small and very, very collegial group. So I think understanding and knowing the mentee, listening to what the mentee sees, understanding what their strengths and weaknesses are and then presenting options. I mean, certainly for some people, you know, to to do bench research is not what they want, whereas others it is I think it's a little bit intuitive, but I think you get better as mentorship with everything. The more that you practice anything, the better you get and you learn from your mistakes. I mean, certainly I have made plenty and so then you just try and not repeat those. So I think those are those are things that you just the relationship grows and you understand each other better.

Buddy Creech: [00:11:20] Well, gosh, you've given us the things to do. You've told us to listen and have meetings that are structured. One of the other things I think about with you in particular, and recently we had a symposium here in Nashville and a lot of your former trainees came in and one of the words that nearly everyone used was advocacy. That advocacy was such a huge part of mentorship. And I still remember some of those early meetings of IDSA and going to meetings with you. And I had what, looking back, were terrible posters. I mean, they were not rocket science, but they were, they were my contribution at the time. But you introduced me. You made sure that people were coming to my poster. You worked the ropes in order for people to know who I was. And that advocacy is so critical for those of us who are junior and just getting started. Do you want to say a little bit about what that looks like and what we need to be doing for our students and our residents, especially at meetings but but also in other areas, where we can really advocate for them.

Kathryn Edwards: [00:12:26] Advocacy was shown really, really clearly when I came to Vanderbilt, the first week I came to Vanderbilt, in 1980, there was a meeting at the NIH with the Vaccine Group and Dr. Sarah Sell, who's my chair was named after her, was was an infectious disease person who worked on Haemophilus. So Sarah said, Kathy, I think you need to come to this meeting. There was no hotel room for me. So Sarah said, You'll stay with me in my room, you'll go to the meeting and I will introduce you. And she did, with amazing scope and warmth, she introduced me to the head of NIAID. She introduced to me to all of these additional people and she said, You know, this is Kathy. She's going to be coming to take my position as I retire to the Board of Health. And so that warmth and graciousness of of the Southern hospitality, which only Sally would had was was very apparent. That became a role model. I mean, why not? I mean, that's really what you need to do. You need to introduce people because that's how they become excited. If they at a meeting can meet the person who decided that mRNA vaccines were the cat's meow, then they can really see, well, look, this looks like me.

Kathryn Edwards: [00:13:48] I could be this person, I could do this. So that's really important to to introduce people and to help them so that their posters are good. To also be very careful about, you know, presentations that your mentees have that you practice and you make sure that you're going to be proud of them, that they're not going to be embarrassed. They're going to be able to answer the questions. Preparation. So that's advocacy is really important because, you know, today I'm not doing the vaccine studies, Buddy Creech is doing the vaccine studies. Natasha Halasa is doing the surveillance studies. Kalpana Manthiram is figuring out the genetic basis of periodic fever syndromes. All of those things my mentees are doing because I cannot or no longer have the energy to do. So advocate for people to grow your people, to make them understand how exciting this life is, to show them the experts and to make it possible. Make it very clear that this life is really one that's fun and you can do it well.

Buddy Creech: [00:14:51] And you've done a masterful job of creating this enduring legacy where I don't know how you did all these things. You did it, you didn't sleep, but whatever. And then you created these little mini me's that could take on these aspects of your career. So one person doing vaccines, one doing surveillance, one doing FERPA. One doing pneumonia. Someone else doing vaccine safety. I mean, it's this remarkable legacy building. And I think one of the ways that you've done this is embodying this sort of see one and then do one and then teach one model where we would see you give a presentation, you'd empower us to give grand rounds, but you'd sit with us and go through slide by slide to make sure it was as tight and as clear and as perfect as it could be. And then you gave us the tools so that when we have trainees, we can do the exact same thing with them, and it becomes this sort of academic multiplication where exponentially there's now a team, there's a group. So one of the things that I think you and I have done and you and others have done is this idea of a junior senior mentor where I didn't know what I was doing when I took on my first fellow, we had practiced a little bit with students and summer students and residents where maybe the stakes aren't as high right? If I make a few boneheaded mistakes early on, that medical student is still going to get a paper. They're still going to get a good residency. I haven't messed anything up, but gosh, taking on a fellow is a much different effort because you mess that up now you've sidelined a career potentially. Can you talk a little bit about that strategy of having someone like me early on mentoring a fellow, but you standing in it and above it and around it to make sure I didn't mess things up?

Kathryn Edwards: [00:16:39] That has been something that is also a fun experience and that is seeing your mentees begin to mentor. It's a little bit like being a grandparent, which is really fun, and what you can do is that often the junior mentor and mentee can meet once a week and then you can meet or the senior mentor can meet either every other week or every month that works well. In addition, I think that that fellowship mentor committees are important because they include the junior and the senior mentor, but they also include people from your department that is maybe not involved in the research or other subject matter experts. So think a fellowship committee mentorship committee is helpful in doing that. To be a senior mentor, you have to be making sure that you fulfill your commitments to the junior mentor so that if the mentee has a paper that needs to be edited, then then the junior mentor takes the first crack at it so that you can see and then the senior mentor does so that it shows then you know that you what you might have added or what you didn't add or what you thought of that the senior mentor didn't. So I think that kind of relationship is very important. I also think it's really exciting if you can create a legacy. So an example is that Mary Beth Nicholson is a GI, was a GI fellow, she's a GI faculty now, and we began to work on C diff. She wrote a Thrasher Junior Investigator Award, which she got.

Kathryn Edwards: [00:18:05] And then as time went on, when she began to be a junior mentor, then her mentee submitted a junior investigator Thrasher Award where she was the junior mentor and was the senior mentor. Well, fortunately, her mentee got this. Now funding agencies love this. I mean it's just like that that you know here you've raised a whole family of researchers. So again thinking about what the mentee and the junior mentor has done and sort of helping and advocating along that path is also important. But I want to stress that you have to be demanding. You have to not say, well, you know, everything's fine if it isn't. The other thing that you have to realize, and I think it's really important we're talking about my successes, but we're not talking about the times when I did something to a mentee or said something that really irritated them, that I asked them to do something they thought was stupid. I asked them to do something in a time frame they thought was unreasonable. Remember that your mentee mentor relationship is a little bit like a parent and an adolescent. Sometimes they love you, sometimes they hate you. So make sure that you understand that no mentor bats a thousand and we all make mistakes. But when we do make those mistakes, we try and understand them. We apologize if we have done something that's not good, but if someone else has done something that's not good either, we point it out to them.

Buddy Creech: [00:19:41] Some of the most wonderful things I've heard professionally and some of the hardest things I've heard professionally have both come from you. And I mean that in the most positive way. I mean, some of the the hardest corrections or some of the most craved for praise came out of the same person. And like you said, gosh, I almost think all of us need some sort of academic family tree or academic genealogy that we put together just to remind us of who those people are. Who our academic brothers and sisters are and what that family tree looks like, because it's it's truly remarkable. The adolescent thing really makes me get excited because one of the things that I'm experiencing with our with our own kids who are the older two are in college and the youngest is still in elementary school, is watching that dynamic where, yes, there are times I mess up and we have to kind of work through that. There are also times where we just do it differently because we're made differently and we have a different approach to the same problem. And and both are actually reasonable options. Finding that inflection point that made me feel so academically grown up. When you as my mentor, were able to to kind of highlight the fact that maybe that's not how you would have done it, but the way I was going was going to be just fine. And having that ability to own that and that I'd sort of graduated. I think that's really empowering for a trainee. And I wonder, I guess everyone is at a different stage in that, right? Some people are going to do that sooner or later. But could you talk as we kind of finish up here, could you talk a little bit about what it looks like to see a mentor mentee relationship evolve over time and how it takes on different just like adolescence takes on a different flair

Kathryn Edwards: [00:21:29] Certainly. And I've spent a lot of time thinking about this, thinking back now that I've retired over my career and thinking back about this whole mentorship process and realizing that it is clearly the most important thing that I've done. Because I think as time goes on, our scientific discoveries are rediscovered or undiscovered. They may not be correct. Science will go forward, and many of the things that we've discovered will be changed. But I think that what we have to understand is that each person is an individual. But also as we go forward, I certainly sometimes was excited and envied the fact that all these people were doing these wonderful trials with mRNA vaccine. And I was looking at safety, but I wasn't doing them because you go on, you realize that you change. People are different. I don't think that I could do the intricate genetics that's required for FAFA that's just beyond me. And so making sure that you understand how to let go, how to make sure that that you might want to do things differently, it's not all that different from being a grandparent. Sometimes I, I look at my kids and I say, I'm not sure I would do that, but my tongue, I just fight. And I really do a lot of tongue biting, both in my grand parenting and my mentoring. Everyone needs their own influence, their own way to do things that there are a lot of ways to do things and that you have to be gracious and and make sure that you allow people to do that. And you have to be sometimes be silent when you would like to not be silent.

Buddy Creech: [00:23:04] What a great word. Well, Kathy, you've been incredibly generous with your time, not just today, but, my goodness, the number of papers that you've turned around in less than 24 hours, the presentations you've reviewed that were in really rough shape, the first go around writing grants on my porch and helping really craft so many people's careers. It's a remarkable legacy and we want to keep learning from you. We want to keep learning what it looks like to mentor well, we want to have some grace with ourselves when we mess things up and yet at the same time hold ourselves and hold our trainees to a high standard. It's worth it for what we're called to do, which is to care for people at their most vulnerable and to advance science and to try to figure out how to to lead to human flourishing by the work that we do. So I can't thank you enough for giving us your wisdom on this. I think we could fill hours, but let's just keep learning and keep teaching and keep doing this for for the sake of those around us. So thank you for joining me today and thanks for this remarkable career and mentoring that you've had.

Kathryn Edwards: [00:24:15] Thank you. The pleasure is mine. And guess I couldn't think of a job that I would love more than being a pediatric infectious disease specialist. So I just think everyone should clamor to be that as well.

Buddy Creech: [00:24:27] That's a great word. So for all of our listeners who aren't yet PIDS physicians and scientists, we are open for business. We'll be happy to train you. You can find out more on the IDSA website and on the PIDS website. And until next time, this is Buddy Creech with Let's Talk ID.