Lessons from my teachers and mentors

Professor Samual Menahem

Mentoring and peer support has long been an important part of the Melbourne Medical School and professional practice. In this piece, Professor Samuel Menahem (MBBS 1963, MD 1971, MEd 1983) reflects on those who have influenced his own career.

How do you apportion the contribution of those who help to mould your professional development and subsequent practice?

We learn from many teachers, mentors and role models as we evolve from student to clinician. For me, three come to mind – Professor Vernon Collins (MBBS 1933, MD 1936), the Foundation Professor of Paediatrics at the University of Melbourne; Dr Alexander Venables (MBBS 1946, MD 1951), the first Director of Cardiology at the Royal Children’s Hospital; and Professor Emeritus Arthur Clark AM (MBBS 1951, MD 1956), the Foundation Professor of Paediatrics at Monash University.

Professor Collins’ influence led many graduates to undertake training in paediatrics. He was dignified and caring; a role model to emulate. Teaching at that time focused on somatic disorders, but Professor Collins emphasised understanding children within the context of their family and highlighted the pivotal role of their mother.

How did he influence my development? Professor Collins encouraged an enquiring mind to explore important psychosocial issues. To that end I sought out additional lectures, courses etc. – self-directed lifelong learning, the quintessential goal of medical education. I gained clinical experience in the Royal Children’s Hospital’s Psychiatry Department, further enhanced by training as a child/adolescent psychotherapist. The aim was to better communicate with the child patient and to better understand family dynamics. The insights I gained from the required long-term supervision translated to improving my clinical practice. I evolved into a psychologically orientated paediatrician/cardiologist, well documented in subsequent publications.

My first paper on the crying 'colicky' baby questioned the then construct of abdominal 'colic' best treated with Atropine and Phenobarbitone. It was dedicated to Professor Collins, who suggested an active, alert infant was more likely to cry than a placid one who rarely cried.

I subsequently explored the role of the consultant paediatrician, ongoing care for those with chronic illness, recognising the non-presenting problem in clinical practice, addressing the hidden agenda to improve outcomes and studying non-compliant parents refusing sound recommendations.

Professor Collins’ relationship with his students was unique, epitomised by addressing them by their name at his very first contact. That caring approach has permeated my own dealings with students and graduates – teaching at the bedside, mentoring or supervising their research endeavours. Such a commitment remains second only to the commitment to one’s patients.

Dr Venables was an astute clinician – both as a general paediatrician and cardiologist. He demanded the highest standards, which extended beyond his fellows to colleagues. From Dr Venables, one learnt to recognise what one knew and what one still had to learn. That fostered in me a lifelong learning imperative to acquire new knowledge and skills in the ever-evolving subspecialty of paediatric cardiology, one of medicine’s success stories.

He encouraged excellence extending to academic pursuits, as was reflected in the multiple revisions before submission of papers arising from my MD thesis. The apprentice-type teaching he provided was an example to follow. I too maintained a general paediatric approach to better manage each patient, seeking help for issues beyond my expertise.

Dr Venables considered that most cardiology publications audited an ever-changing practice. He praised those who made significant contributions that led to a fall in patient morbidity and mortality. Meticulous with his clinical signs and the data he acquired as a master in the catheter lab, Dr Venables also recognised the importance of psychosocial issues affecting his patients. Every child admitted was seen by the Senior Medical Social Worker, Ms Nichol. At the RCH Centenary Scientific Meeting in 1970, she reported almost a third of the parents separated after having a child with a serious heart abnormality.

I subsequently opted to further explore the psychosocial and ethical issues related to congenital heart disease, the basis of my Higher Doctorate from Monash University. Multidisciplinary studies were developed with important contributions by the allied professionals. These issues have become increasingly important as outcomes improve following significant clinical advances.

Professor Clark, tasked with developing a second academic unit at Monash University, was cognisant of the well-earned reputation of the internationally recognised RCH. He also had to ensure that the clinical service was of comparable standard. He concentrated on advancing neonatology to complement the obstetric services provided by the Queen Victoria Hospital/Monash Medical Centre.

Professor Clark also appreciated the importance of the general paediatrician in a setting of increasing sub-specialisation, recognising that most referrals to the subspecialties arose from them. Sterling research continues to emanate from the newborn services with spin offs into basic research.

With his all-embracing, polite and empathic approach, Professor Clark created an inclusive and fruitful environment. In addition to his subspecialty of paediatric haematology, his holistic approach to patient care further reinforced my earlier experiences that guided my practice. He achieved much from those working with him. He was generous in his praise of their efforts. He fostered close co-operation among his staff, an approach I follow with paediatric colleagues, other subspecialists and allied professionals, resulting in multiple successful collaborations.

Professor Clark’s quiet and unassuming manner towards students and colleagues has profoundly influenced my own practice. Despite his retirement, he has continued as a mentor to me and others. To quote the late Rabbi Lord Jonathan Sacks, “Good leaders create followers. Great leaders create leaders”.

The impact of mentoring

For those still navigating the early stages of their professional career, the opportunities in medicine are immense. They are varied and exciting, each able to enrich one professionally and counter against the 'burnout' sometimes seen among our peers.

Professor Collins emphasised the importance of understanding children in the context of their families. That encouraged increasing self-awareness to achieve the best therapeutic outcomes. Dr Venables demonstrated the need for rigour and competence in one’s sub-specialty, fostering a lifelong pursuit to acquire new knowledge and skills. “Remember your failures and not your successes” to improve your performance, counselled Roger Mee, a famed cardiac surgeon. Professor Clark’s inclusive approach and respect for his colleagues helped achieve the best outcomes while focusing on the needs of the child patient.

The importance of supporting, mentoring and being mindful of the difficulties experienced by students and young graduates remains paramount, values clearly shown by my teachers.

Acknowledgements: Dr Kevin Collins, Ms Prue Venables, and Professor Arthur Clark shared with me their thoughts and insights.

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