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David Pfister and Yungpo Bernard Su
David Pfister (left) and Yungpo Bernard Su are medical oncologists specializing in the treatment of head and neck cancers.

Mentoring Relationships Are Cornerstones of Excellence at Memorial Sloan-Kettering Cancer Center

The fulfillment of Memorial Sloan-Kettering Cancer Center's mission depends in great measure upon its ability to attract and retain the most talented people in their fields. Nurturing junior faculty members is an institutional priority -- with a formal program in place in Memorial Hospital and one recently implemented in the Sloan-Kettering Institute.

When Yungpo Bernard Su joined the Memorial Sloan-Kettering Cancer Center faculty in 2004, after a two-year medical oncology fellowship in the Center's Department of Medicine, he turned to his mentor, David G. Pfister, Chief of the Head and Neck Medical Oncology Service, for career advice. Dr. Su, a former chief resident at Memorial Sloan-Kettering Cancer Center, had decided to specialize in head and neck cancers and wanted to sharpen the focus of his research efforts. Promising advances in drug therapies for thyroid cancer had caught his attention, and he'd become intrigued with the challenges of treating the disease.

Dr. Pfister encouraged Dr. Su to follow his instincts and put him in touch with thyroid experts both within and outside Memorial Sloan-Kettering Cancer Center. "Part of my responsibility as a mentor is to help junior colleagues make satisfying career choices," Dr. Pfister said. "I felt thyroid cancer would be an interesting and rewarding field for Bernie to pursue."

In 2004, Dr. Su helped open the first investigational drug trial at Memorial Sloan-Kettering Cancer Center designed specifically for thyroid cancer patients, testing a compound for people with advanced disease that failed to respond to radioactive iodine, a standard treatment for many thyroid cancers.

At Memorial Hospital, junior faculty members are matched with senior physicians for one-on-one mentoring. The aim of the relationship is simple: to help the junior colleague prosper professionally and personally. Senior faculty advise junior physicians on how to balance their clinical, research, and institutional obligations. They help their junior colleagues set and meet goals and keep on track for promotion. They direct them to potential collaborators.

"There is no single formula for good mentoring. Mentoring styles are as varied as human relationships," said Memorial Sloan-Kettering Cancer Center President Harold Varmus. "Having a formal mentoring program in place is an effective way to retain talented young faculty and helps ensure that Memorial Sloan-Kettering Cancer Center will continue to lead as both a clinical and research facility."

"I don't think the value of mentoring can be overstated," Dr. Su said. "It was wonderful having a resource for advice and feedback." For example, Dr. Pfister's office door has always been open for weekly progress meetings -- access the young physician found particularly helpful as he began planning his first clinical trial. "David's guidance was invaluable during the process of prioritizing research questions and working to design a trial to most effectively answer them," he explained.

Dr. Pfister credits his own mentor, George J. Bosl, Chairman of the Department of Medicine, with teaching him, when he was a fellow and junior faculty member, to seek the advice of other specialists -- something he has impressed on Dr. Su. And, Dr. Pfister added, Dr. Bosl frequently relayed "pearls" of clinical wisdom he picked up from Robert E. Wittes, now Memorial Sloan-Kettering Cancer Center's Physician-In-Chief, who was a medical oncologist at Memorial Hospital when Dr. Bosl was a junior faculty member.

Head and neck oncology is among the most interdisciplinary areas of cancer care. Memorial Sloan-Kettering Cancer Center patients with head and neck tumors often see Dr. Pfister and Dr. Su, along with radiation oncologists, endocrinologists, surgeons, and other specialists. Head and neck medical oncologists at Memorial Sloan-Kettering Cancer Center consult experts in these related disciplines, who also can act as mentors. Similarly, Dr. Pfister often finds himself advising junior physicians in other services who treat cancers of the head and neck. "Mentorship here goes in many different directions and is not limited to one's own discipline," he said.

The Sloan-Kettering Institute, which in the past has relied on its small and collegial atmosphere to nurture the career development of junior faculty, has recently implemented a more structured mentoring program. Because obtaining grant funding is integral to supporting basic science research, a major focus of the SKI initiative is coaching junior scientists on grant writing. "The competition for federal funding is fierce and becoming increasingly so," said Thomas J. Kelly, Director of Sloan-Kettering Institute. "Learning how to write a convincing grant application is crucial for any young researcher. This is one of the many areas in which our senior scientists offer career guidance to our junior faculty."

After more than 20 years of writing successful grants, Kathryn V. Anderson, Chairman of SKI's Developmental Biology program, has a good sense of what reviewers want to see. "There's a whole skill of 'grantsmanship' that you cannot intuit and aren't taught as a graduate student," she said.

A grant proposal to the National Institutes of Health (NIH) can easily run to 50 pages and includes lengthy passages about science, curricula vitae, and budget justifications. Clarity, if not necessarily brevity, is key. "When she read my grants Dr. Anderson would say, 'Tighten this up. Don't waste words to make your point,'" said Mary K. Baylies, a developmental biologist who is an SKI laboratory head and Dr. Anderson's junior colleague. "The value of that advice is clear to me when I read someone else's grant and think, 'You've got to tighten this up.'"

Dr. Baylies' latest proposal, which was to renew a previous NIH grant, received an extremely favorable review. "I took some pride in that," Dr. Anderson said. "Mary really learned to pull it all together." For the two women, Dr. Baylies' recent success neatly sums up the best aspects of mentoring: good advice given freely, useful habits formed and passed along.

"Junior faculty know how to do science. But most don't know how to teach, run a lab, manage people, get papers published, or write grants," Dr. Anderson said. "You need someone to go to for help, and it's essential that senior faculty take the time to provide that help."

Women in science confront special challenges. Among them are the relative scarcity of women in senior positions who can serve as role models and, for many, combining work and family in a way that neither suffers. For Dr. Baylies, who has two young children, juggling work and family has been particularly important. "I'm committed to what I do, but sometimes I just have to be at that school play," she said. "Fortunately, the culture of Sloan-Kettering Institute is supportive, as is Kathryn."

SKI developmental biologists Mary Baylies, Nicholas Tolwinski, and Kathryn Anderson
SKI developmental biologists (from left) Mary Baylies, Nicholas Tolwinski, and Kathryn Anderson study how simple cells grow into complex organisms.

In addition to her keen editor's eye, Dr. Anderson is revered in her department for her ability to size up prospective new lab personnel. "She's dead-on accurate every time. We all wish we knew the magic of her insight," Dr. Baylies said. Lately, Dr. Anderson has been guiding the department's newest faculty member, Nicholas Tolwinski. Dr. Tolwinski is Sloan-Kettering Institute's first Frank A. Howard Scholar, a multiyear position created to provide gifted young scientists with an opportunity to establish independent research programs and run their own laboratories.

"When I first got here I realized that my only experience with hiring was being hired," said Dr. Tolwinski, who received his doctoral degree from Princeton University in 2004. But he needed two staff members immediately -- a research assistant and a postdoctoral fellow. Dr. Anderson intervened, identifying a postdoctoral candidate whose academic background was outstanding but who had a baby and wanted to work part-time -- a stipulation that might have discouraged some lab heads. Meanwhile, Dr. Tolwinski's inexperience might have deterred candidates looking for a position with a more established researcher. Said Dr. Anderson, "I thought, 'Aha! This is a marriage.'"

Although mentoring takes time, Drs. Anderson and Baylies believe Sloan-Kettering Institute faculty will welcome the invigorated focus on junior researchers. "You're going to have a livelier environment and more productive researchers," Dr. Baylies explained.

Murray Brennan and Peter Allen
Surgery Chairman Murray Brennan (left) is one of several physicians at MSKCC who have mentored Peter Allen (right).

Surgical fellows at Memorial Sloan-Kettering Cancer Center might not have much time for novels, but one they all read is The Grapes of Wrath. Murray F. Brennan, Chairman of the Department of Surgery, asks his clinical fellows if they have read and remember chapter three of John Steinbeck's tale of the Joad family's migration west. He then tells them to identify themselves in the characters depicted in the brief passage, which describes a turtle's plodding and perilous journey across a road. This ritual is part of Dr. Brennan's mentoring technique, an effort to encourage his young trainees to better recognize their personality types, motivators, and ambitions. "This is a place where we provide fellows with tools to grow as people," Dr. Brennan said. "They are in a period of wonderful maturation, and choosing which tools they need is a real challenge for them."

Peter J. Allen joined Memorial Sloan-Kettering Cancer Center's Gastric and Mixed Tumor Service as a faculty member this year after serving as a staff surgeon at Walter Reed Army Medical Center, in Washington, DC -- a position that took him to the Iraq war as a surgeon. Dr. Allen's arrival was a return to Memorial Sloan-Kettering Cancer Center. In 1996, he had been a research fellow at Memorial Sloan-Kettering Cancer Center and spent time in the laboratory of Yuman Fong, Chief of the Gastric and Mixed Tumor Service. During that time he developed an interest in becoming a clinical investigator, and worked on translational research projects. And in 2001, after having spent two years as a general surgeon at West Point, he returned to Memorial Sloan-Kettering Cancer Center as a surgical oncology fellow (he was named chief administrative clinical fellow in 2002), and trained with surgical oncologists Daniel G. Coit, David P. Jaques, and Leslie H. Blumgart, along with Dr. Brennan and many other members of the clinical staff.

Whereas other teaching hospitals might have three or four surgical oncologists on the faculty, Memorial Sloan-Kettering Cancer Center has more than 70, including urologic surgeons. "Memorial's surgical oncology division is so much larger than that of other institutions, and the expertise of the faculty is so broad that you can have more than one mentor in more than one area," said Dr. Allen. "I cannot imagine a better place for a cancer surgeon to train."

"Peter's experience here is an example of a multifaceted kind of mentoring that extends over ten years," Dr. Brennan said. "That reflects incredibly well on both the environment and the people at this institution."

Surgical training, while always arduous, was not always nurturing. "When I started my career, the idea was, metaphorically speaking, that a senior professor would take a number of talented young physicians, put them in a pool, and say 'Swim,'" Dr. Brennan said. "You wouldn't teach them to swim, and to make it harder, you would poke them with a forked stick. If they surfaced, you would throw a shark in to see if they could swim faster! That's terribly inefficient, it's competitive, and it doesn't get the best out of young people."

With an eye toward more efficiency -- and humanity —Dr. Brennan has actively shepherded the department's seven clinical fellows and the surgical faculty as a whole during his 20 years as chairman. For example, he implemented a system of "priority" operating time, meaning all surgeons, regardless of seniority, have dedicated days when they know they will be in the operating room. Such scheduling was relatively straightforward to install at Memorial Sloan-Kettering Cancer Center, where surgeons do not treat trauma or transplant patients requiring unpredictable care. But even at similarly specialized institutions young surgeons often "go last" in the operating rooms, their calendars subject to chance, Dr. Brennan said. "It's hard to conduct research when you have to rush off to the operating room in the middle of an experiment," he added. "Giving surgeons more control over their days enables them to do more research and themselves be better mentors."

Last year, Dr. Brennan's fellows presented him with a rare first edition copy of The Grapes of Wrath, which he proudly displays in his office, one of several tokens of esteem from past trainees. Beset by obstacles, Steinbeck's dogged turtle finally makes it across the road, carrying with him wild oat seeds that drop into the soil, promising new shoots. That, said Dr. Allen, might symbolize Dr. Brennan. "If mentoring is like sowing seeds, he certainly has sown quite a few of them in his time here."

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