Designing Effective Mentorship for Underrepresented Faculty in Academic Medicine

Mentorship is critical for the success of faculty underrepresented in medicine (URiM). Only 13% of US physicians are from URiM groups—American Indian/Alaska Native, Black or African American, Latinx (Hispanic or Latino), Native Hawaiian or other Pacific Islander, and Southeast Asian—although these groups comprise 34.1% of the general population.^{1, 2} URiM faculty face unique barriers in an academic medicine environment that continues systemic segregation, discrimination, and a culture of elitist traditions built centuries ago. ^3-10 Although family medicine is the most diverse medical specialty, little training exists for mentors to provide culturally responsive mentoring. ¹¹

This paper presents a model for URiM mentorship that is academic society-based and addresses mentee and mentor perspectives. Mentoring Underrepresented Faculty for Academic Excellence (MUFAE) was a program designed to meet the unique needs of URiM faculty in years 1 to 5 of their career. Program objectives included (1) identifying the needs of URiM faculty, (2) training mentors to provide culturally relevant mentorship, and (3) providing ongoing support and feedback to the mentor-mentee pairs to promote retention and career satisfaction.

The Institutional Review Board at Halifax Health deemed this study exempt.

The Society of Teachers of Family Medicine (STFM) created the Underrepresented in Medicine Initiative with four work groups: mentorship, leadership, pipeline, and scholarship. The mentorship work group (MWG) developed MUFAE to increase effective mentorship for URiM faculty. STFM staff provided scheduling, recordkeeping, and other administrative support. In 2020, MWG created a mentoring model to (1) address unique needs of URiM faculty, (2) facilitate conversations about racism and oppression, and (3) foster mentorship as a mutual, trusting relationship to share expertise. MWG elicited mentors and mentees through STFM’s national list serves and paired them together for 1 year. Participation was voluntary without compensation. All mentees self-identified as URiM. Mentors, representing diverse cultural backgrounds, self-identified as White (50%), URiM, or other minority, non-URiM cultural groups (50%). Mentees completed a background form that included their cultural identity and importance of having race concordant mentors. MWG made pairings based on mentees’ preferences for race concordance whenever possible. This paper focuses on only the first year of MUFAE (2020-2021), written prior to conducting the second year of the curriculum (2021-2022).

MWG held three training seminars for mentors to help mentees set academic and self-care goals. Twenty-five mentor-mentee pairs participated, meeting monthly. MWG also held virtual group check-in meetings with (1) mentees only, (2) mentors only, and (3) mentors and mentees combined. The check-ins allowed the mentors and mentees to learn from one another and give MWG formative feedback. Table 1 describes the program in more detail.

MWG created a pre- and postassessment survey to identify mentees’ professional needs and areas of improvement for the program. The pre- and postsurveys included eight items about general career needs (items 1, 2, 4-7), specific URIM needs (item 3), and needs related to doing work in diversity, equity and inclusion (item 8). The survey also included one open-ended question: “Describe what you hope to gain from the MUFAE mentoring experience.” Responses were used to plan the project. MWG distributed the survey via SurveyMonkey (SurveyMonkey Inc) before mentees started the program and again in the last month of mentorship. Response options for items 1 through 8 included a 5-point Likert scale with options for “strongly disagree,” “disagree,” “neutral,” agree,” and “strongly agree” coded from 1 to 5, respectively. The surveys were linked by last name and administered in July 2020 (pre) and again in July 2021 (post). Generalized estimating equations (GEEs) with bias-corrected (small-sample) standard errors were conducted.¹², ¹³ A colleague from the URiM initiative who did not participate in this program analyzed the pre- and postassessments.

MWG participants attended the virtual check-ins and took extensive notes for the purpose of gathering feedback for ongoing curricular improvement. MWG participants reviewed and discussed these notes at monthly planning meetings. The MWG leader (KF) compiled all notes, and MWG participants reviewed them, identifying common themes. The notes represented information gathered for ongoing curricular development, not for assessing program effectiveness. Table 2 shows the evaluation methods and responses.

Of the 25 mentees who began the program, 22 (88%) stayed in contact with their mentors throughout the year. Twenty-two mentees completed the preassessment, and 17 (77% of completers) filled out the postassessment. In response to the open-ended question on the preassessment, mentees identified several needs, including guidance for advancement and promotion and a safe space to discuss minority tax issues. In response to the quantitative assessment items on the postassessment, mentees reported significant increases in (1) receiving mentorship focused on their needs as URiM faculty members, (2) feeling equipped to take their career to the next level, and (3) being able to find resources to support academic interests around health equity and antiracism work.

From reviews of virtual check-ins, MWG identified that:

1. Mentees appreciated support from fellow mentees.

2. Mentors had good suggestions when sharing difficult experiences as URiM faculty.

3. Mentees appreciated the help to advance in their careers.

4. Mentees felt gratitude for their URiM mentors as role models.

5. Mentors appreciated the safe space created to discuss difficult issues with one another.

6. Mentors from URiM and other minority cultural/ethnic groups valued communicating with one another about mentoring challenges.

7. White mentors valued the opportunity to advance allyship skills in addressing racial/cultural injustices.

8. Suggestions for the future included giving mentees more information on promotion and advancement, and spreading MUFAE to other institutions.

MUFAE was created to address the dearth of mentors trained to address needs of early career URiM academic faculty. Mentees reported feeling an increased (1) ability to succeed in academic medicine and (2) sense of mentorship addressing their needs as URIM faculty, which has been identified as essential for success.¹⁴ MUFAE’s strengths include its use of resources of a national network, diversity of mentors, basis in an academic society, specialty specific focus (family medicine), emphasis on faculty development for mentorship, mutual learning relationship, and explicit mentoring about racism’s effect on faculty in academic medicine.

Limitations include small sample size, inability to standardize the pre- and postassessment, fewer completed postassessments than preassessments, and lack of anonymity in participants’ survey responses. Variations in the amount of contact between mentee-mentor pairs also limit generalizability of the findings.

This program offers valuable contributions to literature on URiM faculty mentorship. It replicates findings that targeted mentorship projects for URiM faculty by URiM faculty can be effective.¹¹ Reflections from mentees support studies showing satisfaction within URiM mentorship programs even when mentor-mentee relationships are race-discordant.¹⁵ Both mentees and mentors expressed strong appreciation for this program, which is unique. Guevara et al¹⁶ identified only minor increases in URiM faculty retention associated with targeted faculty development yet did suggest that programs like MUFAE, with an ongoing training and monitoring component, may increase faculty retention over time. Verduzco-Guttieriez et al emphasized the critical need for academic medical societies like STFM to commit to culturally responsive mentoring for URiM faculty. ¹⁷ This program can become a national model for other academic society-based URiM-focused mentoring projects.

This project was sponsored by the Society of Teachers of Family Medicine (STFM) and financially supported by the STFM Foundation.