Effective Mentorship as a Means to Recruit, Retain, and Promote Underrepresented Minorities in Academic Gastroenterology and Hepatology

Diversity in medicine promotes cultural competency, broadens perspectives, and strengthens our commitment to the medically underserved (1). Despite longstanding awareness of workforce disparities, representation of racial and ethnic minorities (blacks, Hispanics, Native Hawaiian/Pacific Islanders, and American Indian/Alaska Natives), in medical subspecialties, including gastroenterology and hepatology, remains suboptimal (2). In 2019, 9% of gastroenterology fellows and approximately 10% of gastroenterologists were underrepresented minorities (URMs) (3,4).

Mentorship is fundamental to the academic success of early career physicians and is vital for building and maintaining a diverse workforce. Limited attention, however, has been paid to optimizing mentorship to promote the entry into and success of URM trainees and junior faculty in academic gastroenterology and hepatology. A deliberate approach is needed. Specifically, we need strategies for how mentor-mentee relationships are established, maintained, synergized by sponsorship, and appraised for success. In this article, we highlight factors that impact each of these areas and provide action items to maximize the benefit of mentorship toward the advancement of URMs in gastroenterology and hepatology (Table 1).

Table 1.

Key aims and actions to promote successful URM mentorship

Aim	Philosophy	Suggested actions
Establishing mentor-mentee relationships	To ensure equity in mentorship opportunities, implicit bias must be reduced and pairings of early career URMs with mentors should be methodical	Mentors should engage in implicit bias training Mentors should actively seek mentees from backgrounds that are different from their own Formal mentorship programs should pair early career URM physicians with senior mentors URMs should consider early involvement in professional medical societies to increase exposure to URM and non-URM mentors
Enriching mentor-mentee relationships	Conversations that reflect on values, culture, and experiences enrich the relationship and increase mutual understanding	Nonminority mentors paired with URM mentees should engage in open and respectful dialogue about life experiences, culture, and inequality Cross-cultural competency training must be an integral and regular part of medical education, training, and clinical practice
Maximizing the success of mentor-mentee relationships	Frequent monitoring of the mentor-mentee relationship is key to its longevity and success	Mentor-mentee dyads should define their goals and monitor progress toward these goals Mentors and mentees should discuss how to select the opportunities that best fulfill career and personal goals and promote advancement
Promoting the synergistic effect of sponsorship	Sponsorship is essential for academic success; therefore, opportunities for sponsorship should be equitable and viewed positively	Mentors should leverage their experience and knowledge of their institution to help early career URMs identify appropriate sponsors Academic institutions should assess and correct disparities in sponsored activities across the division Sponsored activities should be highlighted during recruitment efforts, interviews, and within academic divisions. In this way, sponsorship is normalized.
Mentoring the next generation of leaders	Exposure to the field of gastroenterology and hepatology and immersion in scholarly activity are necessary to increase URM entry and ultimate success	Diversity initiatives should advertise their programming at conferences, health fairs, and community presentations Mentorship and diversity initiatives should be well-structured and use evaluations to monitor the scholarly outputs and achievements of current and former participants Academic institutions must value contributions to diversity initiatives as citizenship through career promotion and other incentives

URM, underrepresented minority.

ESTABLISHING MENTOR-MENTEE RELATIONSHIPS

Given the paucity of URM faculty in academic settings, the mentors available to early career URMs are predominantly nonminority. Although we would like to believe bias is rare in academia, faculty members at academic medical centers display rates of implicit bias similar to the general population (5). Preconceived opinions and implicit biases may influence how mentors select and interact with prospective mentees (6). Prevalent implicit bias threatens the establishment of mentor-mentee relationships and could explain the lower rates of mentorship reported by URMs (6).

A formal approach toward establishing mentor-mentee relationships is needed to ensure equity in mentorship. Purposeful mentorship programs within gastroenterology training programs and divisions can accelerate career development, achievement, and URM retention (7). No one mentorship program will be applicable to all academic settings. Nonetheless, the effectiveness of a program depends on its ability to link early career URMs with senior faculty members who are dedicated to providing career and research guidance and offering access to their professional networks (1). As mentor-mentee relationships mature, the mentor’s opinions of the mentee will become based on interactions with the mentee and the mentee’s performance, further cultivating the relationship.

In addition to formal mentorship programs, our national professional societies are important venues for mentorship. These organizations provide trainees and junior faculty access to numerous members with various backgrounds, interests, and research and clinical expertise. Participation in national conferences can expand opportunities for URMs in mentorship, career guidance, and research collaborations (8).

Action: Mentors should engage in implicit bias training to ensure bias is eliminated in decisions to accept or decline a mentee’s request for mentorship.

Action: Mentors should actively seek mentees from backgrounds that are different from their own when selecting mentees.

Action: Formal mentorship programs should pair early career URM trainees and faculty with senior mentors to promote equity in mentorship and career success.

Action: URMs should consider early involvement in professional medical societies to increase exposure to URM and non-URM mentors, role models, and sponsors.

ENRICHING MENTOR-MENTEE RELATIONSHIPS

Maturation of the mentor-mentee relationship is enhanced by meaningful informal interactions and conversations during meetings where values and experiences are shared (9). Open communication enriches the relationship and reveals commonalities. Although it may be uncomfortable initiating these discussions, avoiding conversations about culture, race, ethnicity, and disparities inherently limits the potential for growth of the mentor-mentee relationship. Expanded cultural competency training is needed to increase comfort in engaging in these important conversations (10).

Action: Nonminority mentors paired with URM mentees should engage in open and respectful dialogue about life experiences, culture, and inequality.

Action: To promote communities of inclusivity, cross-cultural competency training must be an integral and regular part of medical education, training, and clinical practice.

MAXIMIZING THE SUCCESS OF MENTOR-MENTEE RELATIONSHIPS

Goal setting is key to the success of mentor-mentee relationships. When goals are defined by tangible deliverables, progress can be periodically reviewed internally by the mentor-mentee dyad and externally by department leadership. A well-drafted plan should be constructed with attention to critical benchmarks (e.g., publications, grants, and community contributions) and the timeline necessary for career advancement. Although flexibility is important, structure is essential for the mentee to evaluate new opportunities within the context of their career (and life) plans. Many junior faculty may feel pressured to agree to lead or volunteer for unfunded university or community service initiatives. Clearly defined goals are crucial to assess the value of such opportunities, as is mentorship to navigate the politics of saying no or negotiating support. This balance is particularly important for URMs as frequent requests to join diversity initiatives can increase the “minority tax” and slow career promotion (11).

Action: Mentor-mentee dyads should regularly define their goals and frequently monitor progress toward these goals.

Action: Mentor-mentee dyads should discuss the merits of opportunities that are presented to the mentee to assure that accepted positions promote career satisfaction and advancement.

PROMOTING THE SYNERGISTIC EFFECT OF SPONSORSHIP

A sponsor is an individual in a position of leadership and authority that has the capability to provide others with opportunities and tools essential for career advancement (12,13). Sponsored activities include committee appointments, leadership opportunities, national collaborations, awards, and national talks (13).

For URM trainees and early career physicians, finding sponsors is often challenging for 2 reasons. First, the scarcity of URMs in positions of leadership dictates that sponsorship is overwhelmingly provided by nonminorities. Unlike mentorship, sponsorship does not need an established relationship. Thus, sponsorship is more vulnerable to implicit and explicit bias (13). Sponsors may select candidates who remind them of themselves (13), favoring some groups over others. Second, although success in academia all but presupposes previous sponsorship, seeking and accepting sponsorship may be uncomfortable for URM trainees and junior faculty (13). Those underrepresented in medicine face accusations, covert and overt, that they are undeserving. This environment fosters an “imposter syndrome” that may ingrain an aversion to seeking and accepting opportunities that are perceived as partly non-merit-based, such as sponsorship.

Action: Mentors should leverage their institutional knowledge and experience to help identify sponsors for early career URMs.

Action: Academic divisions should assess for disparities in sponsored activities. When identified, these instances should serve as opportunities to improve sponsorship equity.

Action: Sponsored activities should be highlighted during recruitment efforts, interviews, and within academic divisions. In this way, sponsorship is normalized, and any falsehoods that sponsorship validates feelings of not belonging are dispelled.

MENTORING THE NEXT GENERATION OF LEADERS

To increase diversity in gastroenterology and hepatology, effective mentorship strategies must be implemented along the entire medical education pipeline. Early mentorship opportunities for URM undergraduate and medical students can promote the recruitment and retention of students interested in digestive diseases. Here, mentorship requires an approach focused on using role models and tailored mentorship to increase exposure to and enthusiasm for academic gastroenterology and hepatology.

There are several effective models that follow this philosophy. Programs such as the Investing in the Future program have the advantage of exposing URM medical students and residents to gastroenterology through experiences led by URM trainees and faculty (14). However, the interest sparked by these events must be linked to longitudinal mentorship opportunities to motivate continued progress toward a career in the field. Noteworthy in this regard is the Promoting Research Opportunities Fully Prospective Academics Transforming Health program for URM medical students that aims to increase research knowledge and experience through guided mentorship (15). Participants who complete this program self-report increased support, improved research skills, and stronger confidence that a career in academic medicine is attainable.

Finally, the efficacy of diversity initiatives relies on dedicated URM and non-URM faculty. Far too often faculty participation in these efforts is insufficiently weighted in career advancement decisions (11). We must rethink how we value the time and resources of those who lead these initiatives and provide incentives in the form of financial compensation or credit toward promotion.

Action: Diversity initiatives should advertise their offerings at medical conferences, undergraduate institutions, medical schools, and health fairs.

Action: Mentorship initiatives should be well-structured and use evaluations to monitor the scholarly outputs and achievements of current and former URM participants.

Action: Academic institutions must value contributions to diversity initiatives as citizenship through career promotion and other incentives.

CONCLUSION

A focus on mentorship is one mechanism by which we can increase the entry, experience, retention, and advancement of URM trainees and junior faculty in gastroenterology and hepatology. Effective mentorship requires a multilevel approach that aims to maximize the success of the mentor-mentee dyad by acknowledging and addressing bias, embracing cultural competency, promoting the pipeline, and reinforcing a goal-oriented approach for the career promotion of the URM mentee. Our recommendations aim to achieve these attainable goals, and we hope that they will be adopted widely.