By Natalie Fuller, MD
Mentorship in medicine is often envisioned as something that happens outside the exam room—through scheduled meetings, career advice, or letters of support. In practice, mentorship often matters most in clinical settings, during patient encounters, when something small but consequential happens and someone with authority decides whether to intervene. For trainees whose identities make them more likely to be misidentified, dismissed, or tested by patients, these moments can shape whether medicine feels like a place they can practice with authenticity.
As a medical student on my psychiatry clerkship at Harborview, my interactions with patients were both formative and difficult. I listened as patients described experiences of physical and relational abuse, grief, housing instability, and substance dependence. The gravity of these stories was compounded by my growing awareness of psychiatry’s limited ability to heal in the face of entrenched social inequities. While I now see these experiences as foundational to my interest in advocacy and organized medicine, at the time, they often left me feeling powerless against the magnitude of suffering and injustice.
What helped me navigate this period was not reassurance or praise. It was mentorship—particularly from residents—who noticed when the work was beginning to weigh on me and could say, directly or indirectly, “You’re going to be okay.” Medical trainees are often capable and driven, yet quick to interpret difficulty as personal failure. Near-peer mentors are often the first to notice when critical reflection turns into self-doubt, or when caring deeply begins to interfere with sleep, relationships, and focus.
This lived experience aligns with national data. A study of surgical residents found that nearly one-third reported a lack of meaningful mentorship, with non-White and Hispanic trainees disproportionately affected. Residents who reported meaningful mentorship were significantly less likely to report burnout, thoughts of career change, and suicidality than those without such support (Hill et al., JAMA Internal Medicine, 2020).
Now, as a psychiatry resident, I find myself in a near-peer mentoring role with medical students. On an inpatient rotation this autumn, I noticed a student becoming increasingly burdened by the emotional toll of caring for a patient with treatment-resistant schizophrenia. The student’s comments on rounds—once wry and lighthearted—now hinted at post-work rumination, social withdrawal, and worsening insomnia. Having carried the same weight myself as a medical student, the pattern was hard to miss.
At the end of the week, I met with my student on the Harborview skybridge—a place I often go to reflect. Sitting together, I felt unsure of what I could offer. Just months into my intern year, I still had much to learn myself; however, what I lacked in experience, I hoped to make up for in empathy and candor. We talked about caring deeply for patients, and about how early patient attachments can shape how one practices medicine over time. Listening to my student reflect on their experience, I was struck by the depth and honesty of their self-appraisal. That conversation clarified for me that near-peer mentorship in clinical settings is less about having answers than about noticing when a learner is carrying more than they realize.
My understanding of mentorship is shaped by what I received. As a medical student, residents coached me before rounds, credited shared work, brought coffee on difficult days, and spoke candidly about training. When I experienced moral distress after an attending interaction, it was a resident—only months into intern year—who noticed, made time to talk, and took steps to address it. I have also relied on mentors who have known me longer and in different contexts. What they share is continuity: the ability to remember who someone was earlier in training and to help place current challenges in perspective.
Beyond near-peer mentorship, I have learned how much it matters when support comes from the attending in the room. During a patient encounter, after I introduced myself as Dr. Fuller, a patient addressed me as “Nurse Fuller.” Before I could respond, my attending corrected the patient calmly and directly. While the moment still carried an emotional cost, the immediacy of his response felt like a clear statement of support. The intervention was brief, but it made explicit that misidentification was not something I was expected to absorb as part of the job.
In discussions with co-residents, we often return to examples of attendings who handle these moments skillfully. One early-career psychiatry attending is widely admired for her practice of asking learners how they would like her to respond to undermining or biased comments—whether to intervene immediately, debrief later, or leave the comment unaddressed. This approach aligns closely with how learners themselves describe effective support. A qualitative study of medical students found that ideal supervisor responses to microaggressions incorporate both learner preferences and clinical context, best clarified through anticipatory “pre-brief” conversations (Bullock et al., Academic Medicine, 2021).
For trainees who encounter bias more frequently, these moments accumulate. Being misidentified or subtly undermined may seem minor in isolation, but over time, such experiences can erode confidence and sense of belonging. When mentors respond in real time, they show that professionalism and dignity are not competing values. They also model ways of practicing medicine that do not require trainees to absorb these moments alone.
Becoming an intern has placed me closer to the role of the residents who made my own training manageable. I am still learning how to do this well. What feels clear is that mentorship does not happen only in scheduled meetings or formal programs. It happens in exam rooms, hallways, and moments when a supervising physician decides to intervene, to pause, or simply not to look away.