Building a Vertical Advisory System

Creating and using a Vertical Advisory system allows students and residents to obtain rapid and effective responses to questions or requests for advice. It also encourages this group to become active advisors, teachers, and mentors to those behind them, in the hopes of nurturing strong future academic role models and mentors.

As I first stuck my toes into advising students, residents, and match applicants, it became clear that one could easily drown in apparently shallow water. Students at every level ardently seek insight into how to choose a career, how to arrange their clinical years, how to become a competitive applicant, and how to wrestle with the various demons encountered as they transition from the sheltered cocoon of basic science to the harsh, exciting, rewarding, exhausting, invigorating roller coaster ride of the clinical years. They also may need or benefit from a sounding board for more personal, esoteric, or interpersonal issues. Dealing with current students and residents made me aware, a couple of decades too late, of how much I had missed as a student by not asking for help and advice from older students when I faced the same quandaries; how much more I could have gotten from each rotation with some advance advice or warning, how many wheels I had to reinvent—often badly—because it didn’t occur to me to tap the collective memories of those just ahead of me in the process. This also seems to be a time when the definitions of, and differences between, role models, advisors, and mentors preoccupy us.

Academic medicine is entering a potential crisis point recruiting and retaining our youngest colleagues, with many of the traditional rewards of academia eroded by changes in practice. Adding to this the rapidly fading visibility of radiologists as en face consultants, as digital practices render us faceless and occasionally voiceless. Absence does not make our consultants’ hearts grow fonder. Early and frequent exposure to radiologists not just as clinical consultants but also as educators, advisors, role models, and mentors may help us retain our visibility, continue to attract strong and well-rounded people to our field, and do the right thing for our juniors.

Many radiology educators are passionate student and resident advocates and are in a position to better see, and be seen by, these groups than many other faculty members. By self-selection, we get more and more involved, becoming the go-to person for advice, information, mentoring, the match, job decisions, problems, and lifelines. At the same time, we also become the ones tapped by our departments and our School of Medicine (SOM) to represent radiology on ever-expanding committees, advisories, and panels are asked to contribute more to the curriculum and expected to keep up with exploding technology—and then wake up to discover, even with the evolution of the teaching portfolio, that we are considered unpromotable because our endeavors may not conform to traditional academic measures of excellence. This intense involvement, in terms of time, effort, and emotion, may consume our professional and personal lives. When we ask for help we may hear, “The junior faculty need to publish to get ahead; the senior faculty are too busy—no one else wants it. Juggle.”

Important Epiphany Number One

One need not do 100% of everything personally to do it effectively. Off-loading to juniors may mean it is done better . For years, I patiently responded on demand when first-year students asked, ”So, ummm, like, what’s a radiologist do ?” An important formative moment requiring sincerity and personal contact, was this the teachable moment in which one could turn a student on or off? Yes, but it is a moment better handled by the third- or fourth-year students who more recently struggled through that process, who know the subculture and quirks of the school, who will get intensely and passionately involved, and who, at the same time, will reassure the student and pass on the culture of a successful and intelligent career search. When so queried now, I respond promptly with a brief explanation of vertical counseling and with a list of third- and fourth-year students and recent grads who have agreed to act as advisors, informants, and mentors.

Getting started

Pick a group you have already been advising—such as the current third- and fourth-year medical students. Start forewarning them that in turn you are going to refer basic science students to them and expect your clinical students to “pass it forward” down the ladder. Then do it. When orienting your new first-year residents each July, advise them that you will be referring medical students to them for advice, match tips, and career and survival skills. Weed out the residents who just aren’t appropriate and then start referring students. It helped beyond description, in revving up this system that most years we have kept from one to three of our superb ex-students in the residency. They tended to be eager and able to jump aboard, whip around and help the students just behind them. They knew I expected it. Reach up, reach back down—a ladder was forming.

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