A Review of Mentorship in Urology: Are We Satisfied?

Abstract

Purpose of Review

To evaluate the state of mentorship in the field of urology.

Recent Findings

Mentorship has been shown to decrease burnout, increase recruitment of underrepresented minority groups, and have a positive influence on the career trajectory of mentees. Approximately half of surgical residency programs have mentorship programs. The current literature supports the idea that formal mentorship programs are successful based on level 1 satisfaction scores. However, studies are sparse and of low quality. Mentorship program success is rarely objectively measured.

Summary

Structured mentorship programs appear to be beneficial, but require serious planning, evaluation, and ongoing support without which the programs can fail. Future research should be focused on objective and measurable metrics of success.

Introduction

To all of the mentors in urology, a toast to you and the hope that you provide. Mentorship is a collaborative interpersonal relationship that demands time and energy from both mentor and mentee and should be an integral part of training programs. Mentorship is in the service of continued learning and has been identified as a key driver for many different domains including professional development, diversity and equity, wellness, productivity, and career satisfaction [1].

Despite the importance of mentorship in the medical field, its study often lacks scientific rigor. Mentors are often likened to “coaches” or “sponsors,” but these titles are not interchangeable. A coach’s objective is to develop or improve a distinct skill. Their role may also be to integrate a person into a team in order to achieve a collective goal. A sponsor is typically a well-regarded individual that leverages their own power to influence the trajectory of a pupil’s career. A mentor, however, typically knows the mentee on an individual level and aids in achieving the mentee’s unique goals [2].

There are many different types of mentorship relationships [3]. The classic relationship, dyad, pairs one more senior mentor with a junior mentee. Other types include “speed mentorship” where a mentee will briefly be paired with multiple mentors. This type of mentorship works well when it is desirable to cover multiple topics or obtain multiple opinions, with the hope that a longer relationship could develop. “Functional mentorship” is similar to coaching in that it is a relationship structured around the learning of a specific skill. “Peer mentorship” pairs a group of more junior people and enables them to work together to reach their goals. This works well when there is a paucity of senior mentors. Similarly, “group mentorship” works well with limited mentor availability by pairing multiple mentees with a single mentor. Peer mentorship and group mentorship can be combined in “facilitated peer mentorship” [3]. Within a formal program, the mentorship relationship type can be chosen to meet an individual’s and institution’s goals.

Historically, the classic model of mentorship has been a part of surgical training. As surgical training has evolved, so too has the relationship between mentor and mentee. Many questions regarding the best forms of mentorship within training programs remain unanswered. Are formal and structured programs superior to informal curriculums? What is the best way to design an effective mentorship program for urology residents, fellows, and faculty members? The goal of this review is to describe the current published literature on mentorship within the field of urology and other surgical specialties, summarize the best practices on mentorship program development, and identify areas where mentorship programs could be used to advance growth and development within the field of urology.

Does Formal Mentorship Work?

Formal mentorship programs are those that have established an infrastructure for mentoring, though the exact process to achieving such a foundation and the components themselves vary from program to program. Most successful programs share several key components: (1) mentor preparation, (2) planning committees, (3) contracts, (4) pairing of mentors/mentees, (5) mentorship activities, and (6) formal curricula for mentees [3]. Some programs have also provided compensation in the form of time/funding/Continuing Medical Education (CME) credits as motivation for participation.

Formal mentorship programs have been shown to be successful by multiple systematic literature reviews [3–10]. Mentorship programs for physicians have been shown to increase clinical productivity [11], professional development [12–14], academic accomplishment [13, 15, 16], and self-confidence in a career [13]. Mentorship programs have led to increased faculty retention [12, 17, 18] and faculty remaining in academic medicine[12]. In many studies, the participants’ satisfaction with the mentorship program exceeded 90% [14, 19–22]. Additionally, mentorship programs have helped medical students to engage in self-reflection [23] and achieve success on clerkships [24]. Specific departments have used mentorship programs to successfully increase applications to obstetrics/gynecology [25], neurology [26], and primary care [27]. Mentorship programs geared toward those in training have shown participant satisfaction whether the mentees are matched with senior faculty [28], near peers [4], or peers[9].

Many would argue that a mentorship relationship that develops organically or informally is the ideal and preferable to structured mentorship programs. A 2015 study comparing formal and informal mentorship showed that a self-identified “actual mentorship relationship” developed in 70% of cases where a formal mentor was assigned. Furthermore, there was no difference in the number of meetings and subjective “investment in mentorship” between formal mentorship relationships compared with informal ones. This study demonstrated that a formal-organized mentorship intervention increased the prevalence of mentorship without decreasing the quality of mentorship from the perspective of mentees. This is a strong argument for the benefits of mentorship program creation [29•].

A challenge in reviewing the academic literature concerning mentorship program creation is that objective outcomes are very rarely measured, and this “success” is often defined as participant satisfaction. Two systematic reviews by Farkas et al. found that objective outcomes were only measured in 8/20 and 7/30 mentorship programs for women and medical students, respectively [7, 8•]. Similarly, a review by Chua et al. of structured mentoring in medicine and surgery found that only 30 of 71 included articles described an evaluation of the mentoring program [5••]. This is a weakness that is seen throughout the mentorship program evaluation literature. Scientific rigor is lacking from the description of mentorship programs, and no conclusions can be made regarding the effect of individual components of the programs on mentoring outcomes.

Major limitations in the existing literature on mentorship programs include not just the lack of objective data but also a lack of long-term evaluation of the impact of programs on individuals’ careers. There is a need to bolster claims that have been made by subjective and unvalidated studies published in the literature thus far. Newer literature recommends analyzing outcomes such as research grants, publications, validated mentorship evaluations, quality improvement measures, academic advancement, and career satisfaction in a standardized fashion, in addition to more subjective measures [30•].

The Current State of Mentorship in Urology

The current state of mentorship in urology training is variable. In a mentorship survey of 64 urology residency program directors (response rate 54%), 75% approved formal mentorship programs, and 58% had an established program. The most likely reason for not having an established program was the consensus that an informal mentorship program was sufficient. Interestingly, only 5% of residency programs had official training courses for faculty mentors, and 20% had career development courses for trainees. Thirty-eight percent of programs did not have requirements for the frequency of meetings between mentor and mentee [31••]. So even in “formal” mentorship models, there is great variability in curriculum, rigor, and structure across residency programs, and the optimal curriculum, structure, and timeframe for meetings are not well elucidated.

Historically, trainees have sought their own mentors, and this has “worked” since the apprenticeship model of Halsted. However, informal mentorship may self-select for trainees that are more outgoing or have socially dominant traits, possibly excluding more introverted trainees. Additionally, there is a significant risk of perpetuating the inequities already present within medicine and urology if we are not deliberate about how we distribute the valuable resource of mentorship time and commitment.

When considering the other attitudes that exist within the field of urology, mentorship certainly appears to be influential and desired. In a survey of 73, recent and current pediatric urology fellows (response rate of 58%), over 90% had an influential mentor. When choosing where to apply for pediatric urology fellowship, advice from mentors was rated as the most important factor [32]. Similarly, participants in another survey of 111 recent and current pediatric urology fellows (75% response rate) ranked the potential for mentorship as the most important factor when choosing a job after fellowship [33]. Across all urology subspecialties, mentorship was ranked as the second most important factor impacting the desire to pursue a fellowship by graduating residents. In fact, residents with a mentor were 20 times more likely to pursue a fellowship [34]. A separate survey-based study of 1149 successfully matched urology applicants identified strong mentorship as one of the reasons these students specifically elected for urology as a specialty. Even at the medical school level, mentorship appears to be influential in a student’s pursuit of urology [35].

Successful Mentorship Models in Urology

At the medical school level, resident-led mentorship models have shown promise in urology. The UReTER program, led by residents at the University of California San Francisco (UCSF), was created to mentor Black, Indigenous, and LatinX medical students applying for urology residency during the first year of the COVID-19 pandemic in 2020. Mentors (current urology fellows or residents) and mentees (students applying to urology residency) were recruited using social media and email list serves. Each mentor would be assigned up to three mentees and asked to meet at least two times during the course of the application cycle. A total of 101 mentors and 71 mentees were recruited during the initial year of the program, resulting in 71 mentor–mentee pairs of the dyad mentorship model. Follow-up data was collected via a survey sent out on Match Day. Of the 16 survey respondents who participated in the 2021 Urology Match, 94% (15) were matched into a urology program, and 38% (6) felt their match was directly attributable to the program [36].

Another program, #UroStream, paired 111 individuals, including medical students and some graduate students, interested in applying to urology residency in 2020 with 93 urology resident mentors via a social media platform during the COVID-19 pandemic. Among all 111 students, they found that 19% of mentees lacked any affiliation with a urology department, 24% had no urology mentor, and 32% had no exposure to urology at the time of enrollment. Program success was quantified by using the MEMeQ, a validated survey sent out at the conclusion of residency interviews and after Match Day. Among the 29 students (26%) who completed the full MEMeQ, the overall satisfaction was 6.1/7, “very satisfied,” and students identified obtaining guidance on ERAS application and help with residency program selection as their key accomplished goals [37]. These formal mentorship models have shown a measurable positive impact on students.

Mentorship programs have also been described within urology residency programs themselves. Baylor College of Medicine created a 5-component resident wellness curriculum for their urology residency program that integrated structured mentorship, funding for social events, and wellness education [38]. They employed both dyad and group structures of mentorship in their program. They analyzed outcomes on burnout using validated questionnaires. High resident burnout rates were noted at baseline; however, implementation of the wellness program did result in a significant improvement in depersonalization and decreased the level of distress. Though these results were seen after the implementation of a multifactorial system, they provide further evidence that mentorship programs in urology residency can have a favorable impact on resident wellness and burnout.

Mentorship programs also exist regionally and nationally outside of individual institutions. The American Urological Association (AUA) has organized many mentorship programs for urologists at points throughout their careers. For example, the USMART academy provides research mentorship, the AUA Leadership Program provides organizational leadership training, the Young Urologist Speed Mentorship program is run for residents at the annual meeting, and the upcoming Global Residents Leadership Retreat will help residents become more involved with the AUA [39]. Additionally, the Society for Women in Urology and several of the subspecialty organizations run mentorship programs for interested medical students, residents, fellows, and/or faculty; however, there is a paucity of published data on outcomes beyond participation numbers.

Mentorship Programs Across Other Surgical Residency Programs

While mentorship is becoming more common in urology programs, it has also been studied in other surgical specialties. Time is the most difficult barrier to the implementation of formal mentorship programs. This is especially evident for surgical residences where long hours in the operating room are routine, making meetings difficult to arrange.

Only about half of surgery residency programs in the USA have established mentorship programs [40]. The majority of programs are a dyad model where each mentee is assigned to one mentor. One general surgery residency mentorship program that required at least three mentor meetings annually and two social events showed that residents reported an improved perception of faculty involvement and support after the implementation of the program [41]. Another general surgery program described a “Mentor Match” design where both residents and attendings filled out surveys based on the six ACGME clinical competencies. Residents reported perceived weaknesses and were matched with an attending that reported their weaknesses as strengths. One year after implementation, 75% of survey responses indicated they felt as if “Mentor Match” was an effective tool in assigning a mentor, and 83% felt they improved on their weaknesses over the year [42].

Otolaryngology residency programs in both the USA and Canada have published studies about their mentorship programs. One study by Grugel et al. in 2010 found a low percentage of otolaryngology residents had a formal mentor and only 26/71 of respondent residency programs had a formal mentorship program. The authors suggested that the need for formal mentors may be diminished in residencies with fewer residents since they already work very closely with all faculty members [43]. However, a 2010 study of otolaryngology chief residents showed positive benefits of formal mentorship programs. This study assessed the chief residents’ experience with mentorship with 38% of respondents reporting having an official faculty mentor. Most respondents found mentorship outside of an assigned mentor; however, those with assigned mentors reported higher satisfaction with their mentorship. Furthermore, assigned mentorship was reported to influence satisfaction with the residency program and career decision-making [44]. This was largely attributed to research opportunities, as assigned mentors were more likely involved with research and could aid the mentee in those pursuits. With the time constraints of surgical residency, having a research mentor is valuable for interested residents. An otolaryngology program in Canada implemented a formal mentorship program for 1 year and prospectively studied the influence of mentorship on resident wellness and burnout. In this program, residents between PGY-2 and 5 chose their own mentor, while PGY-1 residents were assigned a mentor based on de-identified personality surveys. The PGY-1 residents were given the option of choosing a new mentor at the end of 1 year. Mentors and mentees were encouraged to meet every 3 months. The results of the study demonstrated improved quality of life, stress, and burnout metrics for the residents. However, the study was limited by low power and a short follow-up period of only 1 year. The study did not specify whether the PGY-1 residents retained their mentors after the year [45].

Compared to otolaryngology residencies, orthopedic surgery residences are often larger, with between 5 and 7 residents per year in most programs. A 2018 survey of orthopedic surgery residents demonstrated over two-thirds of the programs had either a formal or informal mentorship program. Most of the respondents (52%) obtained their mentor on their own, and most were obtained during PGY-1 year (51%). Despite the higher percentage of mentorship in this survey, 31% of residents still reported burnout. Satisfaction with mentorship was positive at 77%. The authors believed an organic and non-required mentorship program to be the most effective form due to residents’ ability to choose a relatable mentor in line with their interests. However, they further discuss that it may be beneficial to have a formal, assigned mentorship model during the early, formative years of residency with the flexibility to pursue other mentors later in residency. This allows residents to have structured guidance early on in training while not limiting them to a mentor they may not relate as well to [46].

A 2020 survey of neurosurgery residency programs described a robust mentorship culture in neurosurgery with 65% of survey respondents reporting formal mentorship programs. For most programs, a mentor was assigned to a mentee based on their career or research interests. Their study described better ACGME outcomes for residents in mentorship programs that had been established for more than 5 years compared to programs that were less than 5 years old. These outcomes included ACGME survey results, oral and written board exam pass rates, faculty interest, and publication output [47•].

In ophthalmology, a study from Canada described that most residents reported not being aware of a formal mentorship program at their institution, and 52% of ophthalmology residents lacked a mentor [48].

Overall, although the data is of low quality and volume, surgical specialties have had similar experiences with mentorship thus far. While few programs have a formal program, those that do have yielded positive results for their residents. The difficulty among all specialties is the time required for implementation. Other specialties have also echoed the belief that smaller residency programs may have less need for formal mentorship, and informal mentorship will suffice, due to the already more intimate relationship between residents and attendings.

Failure of Mentorship Program Implementation

The most common objectives for mentorship programs include professional or career development, academic success, networking, faculty retention, and increased diversity/inclusion [3]. Program failure, then, can be characterized as failure to meet one or more of the program objectives. Programs fail for a variety of reasons. This failure can be at either the program level or the individual level. Examples at the program level that can lead to failure include misaligned program focus (i.e., focus on launch or matching pairs instead of content and structure of program), lack of institutional support, and inadequate mentor/mentee time availability [49, 50]. A 2022 commentary about mentorship in urology suggested that possible causes of mentorship program failure include lack of clear communication about expectations within mentorship programs and formal commitment at the institutional level [50]. For example, lack of protected time for mentoring could result in a perception that the institution does not see mentorship as an important academic activity. Recent literature supports the notion that strong institutional support for mentorship at all levels is key. A commentary published in 2019 recommends the use of incentives such as research grants, awards, and inclusion of mentorship involvement during consideration for promotion to establish a broad culture in support of mentorship [30•]. The actual cost of implementing a mentorship program for an institution is worthy of further study.

Programs can also fail if the mentor–mentee relationship fails. Ultimately, mentorship is about the relationship between two or more people, and this relationship is subject to the same positive and negative influences as any human relationship. The relationship is strengthened by shared values, clear expectations and goals, and setting boundaries [51]. Prior to entering a mentorship relationship, both the mentor and mentee must do a self-evaluation. A mentor may ask themselves: “Do I want to do this? Do I have the skills to do this? Do I have the time to do this?” If the answer to any of these is, “no”, then it is not the right time to take on a mentoring role.

Mentorship to Increase Diversity

The field of urology remains heavily underrepresented by female, Black, and Latinx physicians. While representation is improving for some groups, significant barriers to advancement for women and underrepresented racial/ethnic minorities continue to exist. Mentorship has been identified as a key contributor to improving the representation of these groups in urology and other areas of medicine.

While women have accounted for 50% of medical students since 2003, they represent only 22% of full-time professors, 16% of department chairs, and 17% of medical school deans. This demonstrates a lack of representation in leadership roles in academic medicine. Women are also more likely to leave academic medicine and not be promoted to leadership positions. Mentorship has been proposed as being critical in providing the support needed to overcome this gender bias. Despite the known benefits of mentorship, women have been shown to be statistically less likely to have a mentor compared to male colleagues [52]. A 2019 systematic review by Farkas et al. aimed to identify and describe current mentorship programs across medical residencies that were specific for women. Their results showed an overall positive impression of mentorship programs, as they were all highly rated by participants. Interestingly, although subsets of participants valued gender concordance, there was no overall difference in mentorship satisfaction among gender-discordant and concordant pairs. This indicates that female mentorship can still be implemented if there is a lack of female senior faculty [8•].

Underrepresented in medicine (URiM) racial and ethnic groups may also benefit from mentorship programs. Numerous studies have emphasized the importance of expanding diversity in medicine and the potential benefits for patient care. Despite the known benefits of mentorship for URiM groups, studies have shown they are less likely to have a mentor both as a trainee and as faculty [53]. A systematic review in 2021 of mentorship programs for URiM demonstrated positive results for all types of mentorship models, although the dyad model was the most common. They identified several themes across their review including the importance of institutional support, using resources effectively, and utilization of both non-URiM and URiM faculty mentors. They found that racial/ethnic concordance between mentor and mentee did not impact satisfaction with mentorship [54]. For urology specifically, Black physicians only make up 2% of all urologists. Several programs have emerged in recent years to provide support for Black and other URiM groups including establishing mentorship programs. The nonprofit group urology unbound developed the R. Frank Jones Urology Interest group aimed at providing a pipeline for URiM groups in urology. The program provides mentorship, research opportunities, and professional development. In 2021, 31 of the 39 group members applying for urology residency matched [55]. The previously mentioned UReTER program was a successful pilot project for Black, LatinX, and indigenous students interested in urology. Other mentorship programs aimed specifically for URiM groups have demonstrated early success from the University of California Los Angeles (UCLA) and the University of Michigan [56, 57].

As women and URiM groups are still grossly under-represented in medicine, especially in Urology, mentorship represents a crucial element in the goal of expanding diversity. Despite a lower percentage of these groups as established urology faculty, it is evident that mentorship can be successful regardless of gender or race/ethnicity. These early studies emphasize the heightened value of mentorship programs for women and URiM groups.

Mentorship and Burnout

Access to structured mentorship programs may mitigate the effects of physician burnout. Physician burnout appears to be a multifactorial issue that can start as early as medical school. In a national study of urology trainees, 17.6% experienced depression, and 11% endorsed suicidal ideation. Self-reported burnout was predictive of suicidal ideation (OR 7.6 [95% CI 2.5–23]), with access to mental health services being protective (p = 0.016) [58]. The implications of burnout are well understood by Urology residency program directors, considering 87% of 72 program directors surveyed agree that residents should be screened periodically for burnout [59•].

In a national survey of 211 urology residents (of 1011 contacted), access to structured mentorship programs was shown to be associated with decreased burnout (60% versus 75%, p = 0.02) [60••]. Lack of access to mental health services was also a key factor in predicting burnout (OR 5.4, p < 0.001). Residents who did not have a structured mentorship program had both decreased access to mental health services and were more likely to be working more than 80 h per week [60••, 61•]. Collectively, these studies highlight the importance of mental health resources and formal mentorship in mitigating the ill effects of burnout in light of the high prevalence of burnout in urology. The fact that access to mental health resources is correlated with the existence of a formal mentorship program suggests a possible global trainee support issue underlying both. A formal mentorship program could potentially be used to assess for burnout and identify at-risk trainees.

Mentorship Program Design

While the benefits of mentorship are well established, the creation of a formal mentorship program should not be undertaken without serious planning and consideration. Mentorship programs are not unique to medicine, and when thinking about their design, it is helpful to borrow from business [49]. While there are an unlimited number of ways to go about this process, it is useful to walk through the general process of mentorship program design using the AXLES model (Align, eXperience, Launch, Effectiveness, Support), a stepwise process proposed in “Mentoring Programs That Work” by Jenn Labin (Table 1).

Table 1.

AXELS Model for stepwise mentorship program creation [28]. The Align and Experience steps together can form written a ‘Program Charter’

Align to a purpose	Key aspects/decisions:
	• Mentoring purpose statement
	• Program objectives
	• Stakeholders
	• Participants (learners and mentors)
	• Benefits to mentors and mentees
	• Success measures
	Taking in to account talent needs and institutional culture a “Purpose Statement” can be written
Design the eXperience	Five key design decisions must be made. These are:
	1. Structure
	2. Schedule
	3. Matching
	4. Learner Participation
	5. Mentor Participation
	For learner and mentor participation this includes how they will enter and exit the program as well as expectations for participation
Launch	• Program launch: virtual vs. in person, big event vs. soft launch, guest speakers, panel discussion
	• Welcome guide for participants
Evaluate Effectiveness	• Four levels (New World Kirkpatrick Model)
	• Frequent and Consistent Check-ins
	• Evaluation Plan
Support	Mentor preparation
	• Explain expectations
	• Provide practice
	• Review resources, mentor skillset/toolbox
	• Communicate
	Learner Resources and Support Participant Community

The first step is to identify a talent need or gap that the mentorship program will address. Possible talent needs include attrition of top talent, ineffective recruiting and onboarding, long time to succeed in critical roles, lack of leadership in the talent pipeline, loss of institutional knowledge, disengaged employees, diversity and inclusion gaps, job performance and skills gaps, and limited internal networks. While there may be many needs, it is important to identify 2–3 that are most critical and if not addressed will result in disaster.

Next, the “experience” of the mentorship program can be designed. This includes the structure, schedule, matching, and entry/exit of participants from the program. Each one of these can be tailored to the needs of an individual institution. Will the program run annually with new participants? Or will participants enter and then be paired with a mentor indefinitely? Do they switch mentors every 3 months? Should the number of meetings be assigned or be left up to the mentor/mentee pairs? The experience is the key area where changes can be made based on feedback and evaluation of the program. Planned alignment to institutional goals and design of experience should happen before the program is officially launched.

For programs that will run on a cyclic basis, it can be helpful to have a “launch event” where mentors and mentees gain some of the skills or knowledge necessary to be successful in the program, and key program information is disseminated. For virtual mentorship programs, the program launch may be done asynchronously or via a virtual platform.

After a mentorship program is launched, it must be evaluated for effectiveness. There are many ways to evaluate a program; however, fundamentally, it is important to collect information from both mentors and mentees. Feedback from this program assessment can then be used to improve the program experience for mentors and mentees. One method of evaluation, the New World Kirkpatrick Model, is discussed below [62].

Lastly, the mentors and mentees in a program require ongoing support. This can include resources to help develop mentor skill, frequent communication from program leadership, and a welcome guide that is easily accessible. By supporting the participants in the mentorship program, it helps to build community, long-term buy-in from mentors, and ultimately program success. This support and program management can create significant administrative needs, which is why it is important to consider the ongoing support needs during the program design. Mentorship programs that are launched without the infrastructure to be evaluated, iteratively adapt, and have long-term support are destined to fail.

As discussed earlier, within the medical education, literature oftentimes the only measure of success for a mentorship program is participant satisfaction. The New World Kirkpatrick Model [62] is one method of evaluation that can help expand and improve mentorship program evaluation. This model includes 4 levels of achievement, and the evaluation will incorporate information from all 4 levels (IMAGE). The model starts with the desired outcome, level 4, and then works backward to behaviors (level 3), learning (level 2), and reactions (level 1) that should happen to achieve the level 4 outcome. For example, consider a mentorship program that is designed to increase the diversity of the urology residency applicant pipeline. The level 4 outcome could be measured by calculating the number of underrepresented minorities applying to urology after implementing the program. Level 3 involves the demonstration of “behaviors” that will lead to level 4 results. In the example, this could be a demonstration of skills that would make a student successful in a urology clerkship, production of published research papers, or leadership in a urology interest group. Level 2 is “learning” gained from the mentorship program that will lead to the behaviors above. In the example, this could be demonstrating knowledge about the field of urology, relevant anatomy and pathology, and the application process. Lastly, level 1 is “reaction” or satisfaction with the program. Many published mentorship programs only collect level 1 data. It is important to define these strategic results that will translate to the success of a program. In the example, a successful program would generate a positive reaction to the mentorship program leading to learning the appropriate information about urology. This learning would then translate success in important parts of the urology residency application process (i.e., clerkships, research, commitment to the field). These behaviors then translate to successful application and match into urology residency. The lower-level results can be measured to evaluate if the program is progressing toward the original goal and then changes made in an iterative process to improve the program.

Conclusions

Formal mentorship programs can and do work in urology and other surgical specialties; however, more robust and rigorous data collection is needed. The benefits of mentorship for professional development, well-being, and productivity are well described, and the impact of mentorship on increased diversity and equity within medicine cannot be ignored. An initial investment of resources and planning is required when creating a formal mentorship program, and this investment should not be treated casually. The creation of a mentorship program is an iterative process, and programs can progress based on concrete outcomes and measurement of validated metrics.

Compliance with Ethical Standards

Conflict of Interest

The authors declare no competing interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.