Mentoring is an art form developed in the United States in the 1970s within large private companies and corporations and is used to support junior staff. Since the 1990s, mentoring programs have emerged in various medical professions, most frequently in the field of nursing though, rather than physician practice. Formal mentoring programs for medical students and doctors did not develop until the late 1990s (Buddeberg-Fisher and Herta 2006).



Despite the availability of other satisfying or more lucrative career opportunities for the bright and altruistic, admissions to medical schools remain desirable and competitive, thanks largely to an influx of talented and qualified female and minority applicants.  Premedical and medical education has always been stressfully competitive and a financial burden. "Stress in medical school" even merits its own individual entry on Wikipedia.



For as long as I can remember, I’ve always wanted to become a doctor. However, I did not realize all the challenges I would have to face in order to make my dreams come true, and I also did not know who I was going to meet along the way to help me become a successful medical student.  When I was reapplying to medical school, I was told gaining more clinical experience could strengthen my application. I reached out to as many physicians as I could in order to shadow them.


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change is possible (step 2). As the individual merges into the process of change, as step 3 indicates, questioning begins. In step 4, the person develops an action plan to make the changes, and then when success in the change is apparent, the new behavior is maintained... what has been possible has now occurred, noted in step 5.

What originally began as a threat to the self noted in step 1, ends in step 5 with the changes; the maintenance of success is based on a continuing realization that the behavior has successfully changed and continuing practice is required to keep the new behavior in place.

The Neuroscience of Change

The study of the brain, particularly within the fields of social, cognitive, and affective neuroscience, is beginning to provide some underlying brain insights that can be applied in the real world (Lieberman, 2007). Two themes are emerging from social neuroscience. First, much of the motivation of human beings driving social behaviors is governed by an overarching organizing principle of minimizing threat and maximizing reward (Gordon, 2000). Secondly, several domains of social experience draw upon the same brain networks to maximize reward and minimize threat and are also the same brain networks used for primary survival needs (Lieberman and Eisenberger, 2009).

The "SCARF" model developed by David Rock (2008), includes five domains of human social experience for collaborating with others: 1. status, 2. certainty, 3. autonomy, 4. relatedness, and 5. fairness. The SCARF model uses the old approach - avoid response that has been reported in the medical and psychological literature for generations. This principle represents the likelihood that when a person encounters a stimulus (the new change), the brain will either tag the stimulus as  “good” and engage in the stimulus (approach), or the brain will tag the stimulus as “bad,” and then will disengage from the stimulus (avoid it). The approach - avoid response is a survival mechanism that has been in humans since caveman walked the earth and it is designed to enable people to stay alive by quickly and easily remembering what is good and bad in the environment (an automatic brain valence [+-] system).  However, this causes substantial physiological and psychological stress for persons who are adapting to change. The amygdala, a small almond-shaped object that is part of the limbic system, plays a central role in humans for conditioning us to whether something should be approached or avoided. By using small cycles of change, as noted in Figure 1, a person can more easily adapt to required changes, necessary for them to adjust to their environment and to teams.

Our brain wants things to be certain. The brain is a pattern-recognition machine that is constantly trying to predict the near-future.  The brain wants to know the patterns occurring moment-to-moment. It craves certainty, so that prediction is possible. When we are confronted with a new electronic health record or a new demand from our medical supervisor, this interferes with the brain’s ability to predict and it must use dramatically more resources, involving the more energy-intensive prefrontal cortex to process moment-to-moment experiences. This uncertainty, in turn, produces an “error” signal in the orbital frontal cortex and takes the attention away from an individual’s goals, forcing him/her to pay attention to the “error.”

By understanding the domains in the SCARF model noted above and finding personalized strategies to effectively use brain insights for small cycles of change, we can become better leaders, managers, facilitators, coaches, teachers, and physicians.


As physicians, we are required to master changes on a daily basis. Very shortly, we will have to deal with changes in the Accountable Care Act. At some point, we will be required to deal with changes in our electronic health record system. Medical organizations are struggling with the demands of physicians to make changes in the Maintenance of Certification (MOC) process. Everyone wants some kind of change from us, and adaptation is the watchword.

Change is integral to life, and it accounts for evolution. It is certainly built in to all biological systems on this planet. If change has always been an integral part of life, why do we resist it so? Why, in every generation do we have Luddites? What goes through a person’s mind when they are informed of or predict change? Is my position safe? What will I have to do? What will I need to know? Am I capable and confident with new direction? Do I have any say about this, or any control over what is about to happen? Do I really need to change? Do I have time for this? How am I going to do that and this? How will this impact what I have already done? (Crowder and Friess, 2013).

The Psychology of Change

As Crowder and Friess (2013) describe in their book, the amount of changes and their effect upon us is protean. Their text describes Theory Z: This is described as “consensus decision-making,” and it establishes strong bonds of responsibilities between team leaders and team members with a high importance placed on finding people with  


the right skills, both “hard” skills (e.g., technical), and “soft” skills (e.g., creative thinking) for team creation. Consensus decision-making is currently taught to medical students by incorporating advanced registered nurse practitioners, physician assistants, doctorates of nursing, and a plethora of other medical providers as members of medical teams.

These new team demands are challenges to us as individuals. The psychology of change has been studied by self-affirmation research (Cohen and Sherman, 2014). Whether people see their environment as threatening or safe marks a dichotomy between the perceptions of environmental challenge to one’s self-integrity.  Psychological threat represents an inner alarm that arouses vigilance and the motive to reaffirm the self. Psychological threat can sometimes trigger positive changes, but it also can impede adaptive coping.

As Cohen and Sherman (2014) point out in their article on the Psychology of Change, self-affirmation is necessary for coping strategies and adaptations. Figure 1 describes a cycle of change in mental strategy. In the first step, when the person begins to contemplate change, it is not unusual to deny that this is possible. As contemplation continues, the individual comes to the realization that the expected


Robert P. Granacher, Jr., MD, MBA practices clinical and forensic neuropsychiaty in Lexington and Mt. Vernon, KY. He is a noted scientific author and past president of the Kentucky Psychiatric Medical Association. He is currently president-elect of the Lexington Medical Society and Clinical Professor of Psychiatry at the University of Kentucky College of Medicine.