How to Sponsor, Coach, and Mentor: A Qualitative Study With Family Medicine Department Chairs

Developing future leaders in health care involves the intentional support of current leaders. ¹ This support is provided in part through mentoring, coaching, and sponsoring—three interrelated but distinct processes essential for developing health care leaders throughout their careers. ¹ The intentional use of these tools is important to diversify leadership and support future leaders of every underrepresented minority, whether by race, gender, sexual identity, language, disability, or other characteristics. ^1-5 While earlier literature often studied these three topics separately, interest has increased in studying them together, clarifying where they overlap and how they are distinct, with the aim of improving the application of these strategies as complementary developmental tools. ^{1, 2, 6-8}

Based on the existing literature, mentoring is broadly viewed as a longitudinal process that guides personal and professional growth through ongoing dialogue. ^{1, 9, 10} By contrast, coaching is typically periodic, iterative instruction that focuses primarily on concrete technical skills. ^{1, 11, 12} Conversely, sponsoring involves an episodic act of specific advocacy designed to help advance a career. ^{1, 10, 13}

When examining these tools, it is instructive to focus on the experiences of department chairs since chairs are generally senior leaders in a department, have gone through many career development phases themselves, and developing junior faculty is considered a core task of their position. Despite the importance of these faculty development tools for chairs and departments, most chairs assume their role with little formal training. ^14-16 This lack of training and awareness can hinder the development of faculty, and prompts the clarification of the meaning and impact of sponsoring, coaching, and mentoring (SCM) for academic advancement.

The limited diversity among department chairs in family medicine prompted the Council of Academic Family Medicine to create a task force to describe concrete steps for leadership advancement in the discipline. This task force was cochaired by one of the authors (J.E.S.P.). The resultant published findings revealed the importance of someone in an SCM role identifying, directing, and supporting opportunities for underrepresented faculty, because many of these opportunities were not overtly or equitably marketed. ¹⁷ Specific career opportunities that could benefit from SCM actions can emerge differently among diverse faculty. Thus, outlining the process for department chairs to implement SCM functions is a necessity for furthering leadership advancement for underrepresented faculty members.

In prior research, we conducted a survey of family medicine department chairs where most indicated that mentoring played a significant role in their career development, with fewer reporting coaching and sponsorship playing significant roles in their advancement. ⁸ To develop faculty, more respondents reported frequent use of mentoring rather than coaching or sponsoring. ⁸ It was difficult to ascertain the validity of the results when recognizing the historical dominance of mentoring in the literature.

At the same time, coaching has become relevant in recent decades, while sponsoring has become more visible in the medical literature only in recent years. ^{1, 7, 8, 11, 13} It can be expected that, because chairs are at the peak of the leadership path, they have taken leadership opportunities made available to them over time and are in a position to regularly sponsor others for such leadership opportunities. Further, it would be expected that chairs provide direction and guidance (elements of coaching) on a day-to-day basis more often than they provide continued career advice (ie, mentoring), leaving that task to senior faculty in their institutions.

We believe the variations in reporting may reflect lack of clarity around the concepts and their use. Papers that clarify the how-to of these elements often include valuable recommendations and guiding principles, and best practices are often based on expert opinion. ^{1, 2} However, there is a lack of empirical work examining how the tools are applied. The goal of this study was to explore how to use SCM for faculty development by clarifying the functions embedded in SCM to ensure that department chairs can be intentional in providing those functions and/or playing those roles for the benefit of all their faculty.

Exploring the how-to and focusing on the actions relevant to each of these faculty development tools allows individuals to perform the actions more effectively. Further, it empowers individuals to seek these elements of career support, evaluate their experience, and subsequently optimize their involvement. Clarifying the steps for engaging sponsors, coaches, and mentors can increase access to these important professional advancement roles for those who are potential leaders and might otherwise have limited guidance in their careers.

We used qualitative semistructured interviews in this study. Two researchers (M.A. and T.R.) completed interviews from December 2020 through May 2021 with chairs of departments of family medicine at medical schools in the United States. We followed a purposeful sampling strategy building on the connections and relationships of the other three researchers (J.E.S.P., D.S., A.W.) with most of the family medicine department chairs across the country to maximize participant diversification by race, gender, sexual orientation, type of institution, and years in the position.

Our diverse backgrounds helped build a space for critical reflection. Investigator expertise and positions were complementary. M.A., who led the project, is a family physician with a PhD in research methodology. J.S.P. served as a department chair for more than 25 years in two institutions and has served on the faculty of a national leadership program for minority health science faculty for more than 3 decades. D.S. has served as a department chair for 2 years. T.R. is a family medicine faculty member, and A.W. is a researcher who serves as the executive director of the Association of Departments of Family Medicine and has worked with department chairs for 10 years.

We used an operational definition for the construct of SCM based on our literature review.8 We shared the definition with participants at the start of the interview. We defined “sponsoring” as an episodic action in which an individual provides help with career advancement of someone else. We defined coaching as a “periodic and focused instruction, often iterative in nature, following an ‘observe, provide feedback, re-observe’ process for the coach, to help with skill improvement.” Finally, we defined “mentoring” as a longitudinal process aimed at career development through dialogue-based guidance. ⁸ Table 1 presents the defining terms shared with participants in the interviews. Participants were asked about their experiences receiving and providing SCM, with follow-up prompts to clarify the when, what, whom, how, and why about the experience.

We collected basic demographics of participants. We piloted the interview guides with the members of our team, who are a chair (D.S.) and chair emerita (J.S.P.), and revised the questions and flow based on their feedback. The final interview guide is available in Appendix 1. The University of Washington Institutional Review Board approved the study (reference number: STUDY00011949).

M.A. and T.R. conducted interviews via the Zoom videoconferencing platform. We audio recorded and transcribed all interviews. Four study team members (M.A., J.S.P., D.S., T.R.) reviewed the transcripts and provided peer debriefing for the coding done by M.A. using NVivo 11 Pro qualitative software (QSR International, Melbourne, Australia). The study team met for 1 hour per week to develop the protocol, revise the interview guide, reflect on interviews, and conduct the analysis.

M.A. first coded every reported experience into one of six categories: receiving mentoring, providing mentoring, receiving coaching, providing coaching, receiving sponsoring, and providing sponsoring. The group reviewed the coding. The coded excerpts were thematically explored with input from J.S.P., D.S., and T.R. to show the concrete actions taking place (eg, providing advice, offering help, giving feedback). These concrete actions were then organized in an iterative process within broader categories. Constructs representing and summarizing the categories of related actions were then developed to clarify the how-to of SCM. To name the topic areas and content of each activity involved in SCM, we used in vivo coding (ie, capturing the word as said). We grouped the topic areas into more inclusive categories and developed word clouds to visually present the results. We included supportive quotes to represent each construct. With help from T.R. and input from M.A., J.S.P., and D.S., A.W. reviewed every quote and edited them down for brevity and clarity.

We interviewed 20 participants; demographic characteristics are shown in Table 2. Participants identified how to use SCM. They also indicated the variety of topics and content that SCM encompasses. In what follows, we present the how-to of coaching, mentoring, and sponsorship, with illustrative quotes for each of the SCM main actions included in Table 2, Table 3, Table 4. The word clouds describe the content and topics for SCM in Figure 1.

Participants identified six main actions sponsors perform, as listed here. Table 3 presents quotes that illustrate each of these main actions performed by a sponsor:

1. Identifying opportunities: The sponsor identifies positions and experiences for the sponsoree’s professional growth.

2. Recognizing an individual’s strengths: The sponsor helps the sponsoree articulate and connect their unique talents with the opportunities in front of them.

3. Encouraging opportunity-seeking: The sponsor recommends an opportunity and prompts the sponsoree to embrace it.

4. Offering tangible support: The sponsor allocates the sponsoree funding, time, and resources to facilitate success or enhance candidacy for future opportunities.

5. Optimizing candidacy: The sponsor introduces the sponsoree to training and experiences that improve their résumé. They also enhance the sponsoree’s local and national visibility by helping them network.

6. Nominating as a candidate: The sponsor puts forward the sponsoree’s name for an award or position and makes a case for their fitness. At times, they suggest the person’s name to those in charge as their own replacement.

7. Promising support: Sponsors offer to make themselves available to help further develop the skills of sponsorees if they get a position. They offer guidance and resources along the way to ensure the sponsoree’s success.

Participants identified seven main actions a coach performs, as listed in this section. Table 4 presents quotes that illustrate each of these main actions performed by a coach:

1. Clarifying: The coach explicitly describes to the coachee the how, what, why, where, and when of specific skills or situations. Such explanations aim to help the coachee navigate professional situations and attain a specific end. The coach also explains the underlying rationale of the suggested approach.

2. Advising: The coach offers tailored guidance to the coachee and instructs them on best practices based on experiences. They act as guides and suggest strategies to achieve the desired outcome.

3. Giving resources: The coach provides the coachee with the means to link with different opportunities or connect to alternative options.

4. Performing critical appraisals: The coach helps the coachee asses the quality of their work and identify skill needs. To achieve this task, the coach observes the coachee or sees examples of their actions (eg, reads their emails, listens to talks they give) to help them recognize what needs improvement.

5. Giving feedback: The coach provides the coachee with assessments of their performance. They tell them what they are good at and provide encouragement. They point out areas where the coachee needs work and help the coachee work with their strengths and weaknesses.

6. Reflecting: The coach has a conversation with the coachee to ask what they are thinking about, check in, and help them contemplate. In specific cases, they talk about how the coachee felt and consider different scenarios for responding to a situation. The coach shares perspectives and reaffirms values in a nonjudgmental approach.

7. Scaffolding: The coach gets involved with the coachee on a project and engages in the iterative development process. They help them complete the tasks that are new or outside their comfort zone. For example, in coauthoring a paper, the coach lets the coachee write the first draft, then the coach makes edits and give examples of improvement areas rather than carrying out the work themselves.

Participants identified six main actions the mentor performs, as listed in this section. Table 5 presents quotes that illustrate each of these main actions performed by a mentor:

1. Checking in: The mentor keeps an open door and stays available for their mentee. More importantly, they actively reach out by calling, emailing, or setting up regular meetings. Over time, a long-term relationship solidifies between them, and in many instances, it becomes a friendship.

2. Listening: The mentor provides an opportunity for the mentee to talk and ask questions. They recognize what the mentee wants and learn about the mentee’s interests. They help mentees interpret situations and gain perspective as the mentor acts as a sounding board.

3. Sharing wisdom: The mentor describes and reveals the written and unwritten rules of how things work in academia. This presents opportunities and transfers information regarding potential new directions for the mentee.

4. Directing: The mentor describes a pathway for achieving career success by helping the mentee understand the organization’s culture, naming learning strategies and calling attention to blind spots.

5. Supporting: The mentor provides guidance, encouragement, and protection to the mentee as they mature in their personal lives and grow their careers.

6. Collaborating: The mentor works with the mentee to develop projects and helps them build their skills to complement others on the team.

Our study clarified the distinctions of SCM for faculty development. We examined how to employ SCM from the perspective of chairs of family medicine departments, who influence organizational processes and provide resources that drive faculty development. Department chairs can significantly influence the future academic workforce. This highlights the importance of their own personal and professional experiences as well as how they subsequently lead their departments. We provided a detailed description of the processes and functions that take place with each approach.

Our work moves beyond previous studies that looked at the subject matter separately or relied on expert opinions in developing how-to recommendations. Extensive studies have looked at SCM, with more emphasis on the last two. ^18-23 Recently, however, sponsoring has emerged as a topic of interest to help address the lack of diversity in leadership positions, which are typically dominated by White males. ^{10, 13, 24} The three roles are distinct but can be seen as ambiguous and interchangeable because they are often examined and described separately. The added clarity based on our empirical work will be helpful guiding chairs and other leaders and enhancing their skills in developing a diverse professional workforce. ^{1, 2} Further, our findings invite conversation to intentionally incorporate SCM into the chairs’ responsibilities. We present SCM as an identifiable series of actions that do not happen by chance. SCM require fidelity to a complex process associated with specific roles, responsibilities, and a sequence of steps within a defined time frame to achieve the greatest faculty productivity and advancement. To succeed at SCM, department chairs need to build scheduled time and spaces with faculty to complete the elements our paper outlines for each strategy. Ensuring success also requires monitoring to evaluate the impact of these actions and inform the need for course correction. Without this intentionality, activities related to SCM are likely to rely on similarities in interest, values, gender, race, or other cultural characteristics. Making SCM intentional with defined expectations could help address the inattentiveness (at best) and often discrimination and exclusion that currently limits the diversity in academic medicine leadership. ²⁵

An institutional SCM program must balance multiple priorities and economic constraints. Decision-making for faculty and departmental leaders reflects institutional requirements for clinical, teaching, and research productivity. Unscheduled half-days that are available for SCM are challenging to identify. Our study calls attention to building SCM functions into the written position descriptions of high-level leaders like department chairs, and for SCM to be defined as part of the job and not add-on elements attended to only if time allows. Such functions can be included in offer letters and job descriptions as explicit tasks the chair will be held accountable for performing. Further, institutions should consider incorporating an evaluation of SCM in annual performance appraisals, linking SCM accomplishments to faculty incentive plans, and intentionally allocating budgets to fund SCM training activities. Such funds can be spent to hire coaches for the chair and to train faculty champions to develop infrastructures for SCM.

Our study has three main practical implications. First, we distinguished the definitions and actions of the three approaches so that leaders can purposefully select the approaches most likely to achieve individual faculty goals. Over time, using all of these tools in a balanced mixture is likely optimal. These distinctions set expectations for the persons receiving and providing SCM so they can stay focused on actions appropriate to the mode of SCM and the setting. Second, explicit expectations for action taking place across SCM modes allows for evaluation of the effectiveness of these interactions. This evaluation of the effectiveness of individuals in leadership positions can use the perspective of the person performing the act or of the recipient. Third, naming these actions as distinct and intentional facilitates skill development for the person performing the role or function. A recipient can also learn to explicitly seek or become more likely to receive all three. Learning to provide and receive SCM could prove effective in increasing the use and equitable delivery of these approaches.

Our study has two major strengths. We ensured a diverse sample of participants by accounting for ethnicity, race, generational span, and sexual orientation. This diversity of perspectives was fruitful in showing various patterns of interactions and approaches that represent the broad and deep cultural pipeline in our current workforce that represents the nation. We studied the experiences of chairs in family medicine, but the broad spectrum of family medicine, including pediatric care, obstetrics, and some procedural training, allows for broader generalizability of our findings to other disciplines. This approach makes our findings relevant to most, if not all, of academic medicine.

Our study has three main limitations. First, the topics of SCM have become more salient in the past few decades. The experiences of chairs may have varied by their seniority in the field, and some might have received or provided SCM without using the current terminology. Second, our work depended on the recall of our research participants over time, sometimes multiple decades. Remembering experiences and describing them as they occurred may vary from one participant to another. Third, we fell short of addressing diversity in the broadest sense. We included a diverse sample, but we have not yet examined differences in any diversity domains. Further, although we included representations of race/ethnicity, gender, and sexual orientation, we were not intentional in exploring religious, language, ability, or other types of diversity.

Future research will explore the experiences of minorities and women in SCM, including supporting factors and strategies they use to build resiliency. We will look closely at the diversity of experiences by race and gender, addressing intersectionality and additional characteristics of diversity. We will also explore how individuals from underrepresented groups compensate for the lack of SCM in their workplace. Further, we will explore efficient learning strategies by gauging the perspectives of participants around learning objectives, and the content will provide an innovative approach to developing future departmental leaders. Finally, we will develop evaluation tools to use within the context a 360° evaluation of those in the position of leadership to examine whether they are providing adequate SCM that equitably meets the needs of all for whom they are responsible. We also could explore the chairs’ ability to utilize this information to better identify faculty who have these skills more naturally, and proceed to delegate some of the responsibility to those faculty who could help. These additional steps will not only support the importance of SCM as part of the department chairs’ approach to faculty development, but emphasize its role in ensuring a vibrant academic workforce that represents our nation.