Mentors without Borders

Mentors without Borders is a proposed international mentoring network that allows trainee geneticists to identify mentors from a list of volunteers who are not at one's own institution. It is an experiment, a matchmaker between a junior and a senior professional. These mentors do not replace the mentors at the home institution but allow the mentee, if desired, to identify mentors outside of their own institution. We envision that different ways of communicating and/or different mentor‐mentee relationships may prove beneficial to the trainee and the mentor.


Definition of Mentor
The word "mentor" originally comes from ancient Greek literature. In Homer's Odyssey, during his two decades' absence from home, Odysseus entrusted the upbringing and education of his son Telemachus to a loyal friend by the name of Mentor. Interestingly, at times the goddess Athena took the shape of Mentor, thus imparting a spiritual element to the Mentor character. The first known use of the Greek word mentor in Latin was in 1616 (Merriam-Webster).
Today, definitions of "mentor" (the word can be used as a noun or a verb) include: an experienced and trusted advisor (Google); a trusted counselor or guide; a tutor, a coach (Merriam-Webster); someone who teaches or gives help and advice to a less experienced and often younger person (Merriam-Webster's Learner's Dictionary); a wise and trusted counselor or teacher; an influential senior sponsor (www.dictionary.com); an experienced and trusted person who gives another person advice over a period of time (Cambridge Dictionary).
Even though "mentoring" and mentoring relationships in different settings have been described for millennia, formal research on this topic has been published since the early 1980s including the seminal work by Kathy E. Kram entitled Mentoring at Work: Developmental Relationships on Organizational Life (1985). Searching "mentor", "mentee", and "mentoring" in PubMed (August 1, 2016) resulted in retrieval over 10,000 articles, many of them in the nursing literature (Chen et al. 2016;Gruber-Page 2016;Sood et al. 2016) and in articles of higher education (Fleming et al. 2013) including physicians during residency training (Fig. 1).

My Personal Experience
Over the years I have sought out and have had many mentors. Growing up in rural northern Germany in a resource-poor family, I remember fondly the impact of teachers and how they mentored me: a piano teacher during grade school, a middle school math teacher, a Catholic Priest, a high school biology teacher, and several professors in medical school.
I remember vividly the childhood story of the famous German mathematician, Johann Carl Friedrich Gauss . According to my 7th and 8th grade math teacher, the young Gauss and his classmates were left alone in their one-classroom school. The assignment during the teacher's absence was to add up all numbers from 1 to 100 (i.e., 1+2+3+4+5+. . .. . .+100). When Gauss came up with the answer in an unexpectedly short time, his teacher accused him of cheating. My teacher presented us with the same problem. The praise that I received after having come up with a way toward solving this problem was enough for me to enjoy math even more than before and to want to become a mathematician. I remember equally vividly a different situation when I was a junior faculty. During a particularly challenging time, a senior colleague was willing to listen and help me with a difficult decision that had a major impact on my professional career. Mentors along the way have made a lasting impression on me and on my career. Sometimes the significant influence was simply a short conversation after a presentation, while other times long-term professional relationships were made such as those with my thesis advisor during medical school, clinical attendings during my pediatric residency and medical genetics fellowship training, two postdoctoral advisors, and senior faculty colleagues.

Mentors in Literature and History
There is a Japanese expression "hearing a mentor's coughing". It means that a student can learn a lot by just being with his/her mentor in person even if there is no or little verbal communication (this saying was provided by Yoichi Matsubara). Literature provides many examples of mentors, usually in a setting where an older, more experienced person takes a younger, less experienced person under his/her wings. In his 1931 novel (published in 1943) "The Glass Bead Game" (Das Glasperlenspiel), which is set several centuries in the future, Herman Hesse details a number of teacher-student relationships. The main protagonist, Joseph Knecht, is both a mentee and eventually a mentor to several who are under his care. In Umberto Eco's 1986 novel: "The Name of the Rose" (Il nome della rosa), set in 1327 Northern Italy, an older Franciscan monk, William of Baskerville, teaches by example his travel companion, the Benedictine novice Adso of Melk. Examples from 20th and 21st century pop culture include Obi-Wan Kenobi and Luke Skywalker in Star Wars, and, of course Dumbledore and Harry Potter in the Harry Potter series. Mentoring in history comes in different flavors. The passing down of knowledge from one generation to the next has been practiced for millennia and is known as the concept of guru-parampara or disciplic succession.

Modern Mentoring in Medicine and Science
Inspiring and guiding the next generation is influenced by many factors, including the mentor and the setting. As an academic physician-scientist, Nobel Laureate Robert Lefkowitz considers, "one of the most important things we do is mentor young trainee-scientists" (Lefkowitz 2015). He lists key ingredients of a successful mentormentee relationship: providing a strong role model, leading by example, sharing a sense of wonder and curiosity, spreading enthusiasm, a passion for knowledge, and "liberal doses of humor to encourage out of the box thinking" (Lefkowitz 2015). Sambunjak et al. (2006Sambunjak et al. ( , 2009) present a comprehensive overview and review of research of the "meaning and characteristics of mentoring in academic medicine." They summarize desired qualities and actions of good mentors, barriers to mentoring and dysfunctional mentoring, and lastly strategies to improve mentoring. Characteristics of good mentors have been divided into three categories: personal, relational, and professional. Personal characteristics of a good mentor include: being altruistic, understanding, patient, honest, responsive, trustworthy, nonjudgmental, reliable, an active listener, and a motivator. Relational mentor qualities are: being accessible, dedicated to the mentee's best interest, able to identify potential strength, "a good match" in terms of practice style, vision and personality. A professional mentor is senior, well-respected in his/her field, knowledgeable and experienced (summarized in Sambunjak et al. 2009). The authors conclude: "successful mentoring requires commitment and interpersonal skills of the mentor and mentee, but also a facilitating environment at academic medicine's institutions." Levinson et al. (1991) reported on the specific challenges for women to identify female mentors and/or role models in leadership positions in academic medicine.
In addition to individual physicians or scientists who mentor, there are many institutionalized mentorship programs, like the Summer Internship Program in Biomedical Research (SIP) at the National Institutes of Health (https://www.training.nih.gov/programs/sip), prestigious internships in large companies like Ernest and Young (http://www.exceptionaley.com), Google (https:// www.google.com/about/careers/students/), Apple (https:// www.apple.com/jobs/us/students.html); Epic (https://careers. epic.com/Home/ViewPosition?id=270), Facebook (https:// www.facebook.com/careers/university/internships/engineer ing), and many others. When discussing my experience with my fellow program directors, there are common themes throughout all of our practice as mentors. Mentoring is as individual as the respective mentor and mentee. Leading by example can be very influential. Most trainees in our programs are advanced in their training, highly motivated, and need little supervision and guidance. However, we found that regular interactions through weekly clinic conferences or lab meetings and the giving of immediate feedback to trainee presentations or resident-patient interactions can be instrumental. More formal one-onone meetings between trainee and mentor including documentation of previous goals and progress as required by the American Board of Medical Genetics and Genomics (ABMGG) have shown to be beneficial for both mentor and mentee.

Mentoring in Medical Genetics and Genomic Medicine
Mentoring requires dedication and concerted effort to periodically and honestly review progress made by the trainee, obstacles encountered and assessment of performance in order to adjust and align goals with developing knowledge and skills. This process can be rewarding, time-consuming and exhausting especially when performance, personal issues or even personalities impede progress. On occasion, there can be an urgency to mentoring and the need to be more directive and to help out at moment's notice in a challenging situation. At other times, the mentee may benefit from the experienced mentor who leads by example in taking the high road, by having a sounding board, and/or by injecting some sense of reality into a difficult situation. Ideally, the mentee should sense an environment of trust and sincerity in order for the most challenging issues to be unveiled and explored. However, in practice, the desired mentor-mentee relationship is not always achievable. In cases where the match may not be ideal, efforts should be made to help the trainee identify other mentors who can establish a relationship that allows exploration of challenging issues, self-limiting habits or behaviors that threaten the trainee's professional development.

Proposal of Mentoring Through Mentors Without Borders
Ideally, every trainee has at his/her institution one primary, long-term mentor, for example, the thesis advisor, the head of the laboratory, the director of the residency or fellowship program, or others. There may be additional secondary mentors, like the members of a thesis committee, clinical attendings, an assigned mentoring committee for tenure track faculty, etc. Lastly, trainees may seek yet additional advice from other students or faculty from the same institution who are outside their own training program. This system can work well at colleges, universities and other institutions of higher learning that are large enough to have a graduate or medical/dental school, several residency and fellowship programs, but less well at institutions with a small number of faculty and/or faculty with limited expertise relevant to a particular trainee. In addition to the potential lack of mentors at one's home institution, trainees may want to have different mentors for different aspects of their professional career. Lastly, every trainee is unique and may benefit from a mentor that works well with a particular trainee.
The concept of mentoring from afar is neither new nor simply theoretical, and has been practiced in different settings even without experiencing direct one-to-one mentoring on an ongoing basis. I am aware of a number of senior human and medical geneticists who have mentored trainees by phone, email, or occasional planned in-person meetings at the annual conferences of professional societies, such as the American Society of Human Genetics, the European Society of Human Genetics, or the Japanese Society of Human Genetics. Furthermore, E-mentoring is an actual term for mentoring through the use of online software and/or email. Mentoring databases exist, for example, one for medical students on how to identify a mentor from the American College of Physicians (ACP) (https://www.acponline.org/membership/medical-students/ find-a-mentor).
We propose an international mentoring network that allows trainee geneticists to identify mentors from a list of volunteers who are not at one's own institution. Mentors without Borders (www.MentorsWithoutBorders.com) is an experiment, a matchmaker between a junior and a senior professional. These mentors do not replace the mentors at the home institution but allow the mentee, if desired, to identify mentors outside of their own institution. We envision that different ways of communicating and/or different mentor-mentee relationships may prove beneficial to the trainee and the mentor. Similar to the ACP website for medical students (above), the Mentors without Borders website will start with a Find a Mentor section. Other features may include a list server to allow networking and email exchanges between trainees and trainees and mentors and possibly online lectures and/training modules on issues important to a wide of trainees.

Conclusion
Genetics and genomics continues to be a rapidly evolving area. The changes and the potential in this area of medicine and science, while exciting, can also be overwhelming. It will also take hard work to make sure that new techniques and discoveries can spread to benefit many, rather than being concentrated in a few select institutions. We sincerely hope that our program can contribute to the field by investing and believing in the next generation of mentors.