From the President's Desk

Welcome to another informative edition of AWNings brought to you through the efforts of many, but most especially through the editorial and desktop publishing efforts of Dr. Linda Pike.

The academic year is gliding past us, and many AWN projects are in process. As mentioned in the last newsletter, the AWN has become an advocate for the Helena Hatch Special Care Center for women and children with AIDS. This center was developed by Dr. Vicky Fraser and is currently under the medical directorship of Dr. Linda Mundy. As the initial start-up funds came from a Special Projects of National Significance award, a 5 year, nonrenewable grant that expired this fall, the center is now suffering from the funding loss. Dr.Ís Mundy and Fraser, and myself met with Dr. Jim Crane in December in order strategize about plans to regain funding and support the operation. The meeting was a good start, and many ideas were discussed for on-going support of this endeavor. A follow-up meeting is planned.

The Contemporary WomenÍs Health Symposium on December 10, 1999 was once again declared a great success by all who attended and by the CME office. There were 109 attendees. I would like to take this opportunity to thank Dr.Ís Diane Merritt and Barbara Zehnbauer, program chairpersons, for their tireless efforts in planning and actualizing this symposium.

There are plans for another "Wake up to Women" breakfast gathering within the next two months. Dr. Debbie Rubin is planning this session.

Diana Gray, M.D., President

Editor's Thoughts

Over the years of putting together AWNings, I have read many articles on and have had numerous faculty members recount to me their experiences with mentoring. From both personal observation and scholarly publications, I have come to realize how crucial mentoring is for the career development of women faculty.

Besides the usual problems of adapting to a new environment and learning grantsmanship, women must deal with many small disadvantages that are not faced by most of their male colleagues. Problems with children and childcare top the list, but equally important are negotiations skills, access to information via informal networks, ability to attend important meetings (or even social functions) during non-business hours, and just knowing how to fit in with the group. Society has different expectations for men and women with respect to professional behavior. Women have a much narrower range of behaviors or personal attributes that are "socially acceptable" . Failure to meet some of these more subtle "expectations" can negatively impact a career. How is one to know all these things if someone doesn't tell you ?

Hiring an individual to increase the number of women on the payroll, is not sufficient to promote career development in women. If women are to succeed, they need to be mentored. Despite all the evidence that mentoring contributes strongly to the success and productivity of the mentee, women at WUSM receive little mentoring. The faculty survey done during the summer of 1997 provided strong evidence that in all departments and on all tracks, women received significantly less mentoring than men. Now, in the year 2000, no progress has been made toward the goal of providing this invaluable career assistance to women.

This seems counter-productive. If you hire a woman because she is the best candidate for the job or even just because you felt you should hire a woman, it seems to me that you would want to give that woman the best chance of succeeding. This means actively mentoring that individual and perhaps doing so in a way that is different from what would be done for a male faculty member.

I am in the process of raising a son and a daughter. My daughter wants to be a psychiatrist; my son wants to be a nuclear physicist and a radiologist. I want both of them to succeed but they are very different. Some of the differences I see are clearly gender-related.

But rather than explaining to my daughter that I'm going to deal with her in the same way as I deal with her brother, I alter my parenting strategies to deal with her on her own terms and help her to be her best. I take a completely different tack when helping my son and help him in the ways that seem more appropriate.

The same should be true for dealing with male and female faculty. Women are here to stay in medicine and science. It is time that the administration realizes that they are squandering a valuable resource by taking a one-size-fits-all approach to supporting their faculty. Women lead a different life and need different kinds of support. WUSM can and should provide the appropriate types of support to their women faculty. It is in the best interest of the institution that all their faculty flourish and become "all that they can be."

In his recent meeting with the AWN Board, Dean Peck asked that we develop a long term strategic plan for career development of women faculty at WUSM. This represents an opportunity for AWN to set goals and develop programs to assist women faculty now and in the future. Given the importance of mentoring, I feel a centerpiece of any such strategic plan needs to be a strong mentoring program that deals effectively with all aspects of women's career needs. I hope you will all contribute to this effort by bringing forward your concerns and, more importantly, your ideas.

In the meantime, this special mentoring issue of AWNings was designed to provide information on what mentoring is, how it affects career development and how other institutions are trying to provide this support to their faculty. Please use this as food for thought regarding what we can do at WUSM to enhance mentoring, particularly among women faculty. I would like to publish your thoughts and ideas on mentoring in the next issue of AWNings. I would also like your response to this special issue of AWNings and any ideas you may have regarding other possible topics for special coverage. Please send your comments to Linda Pike , Box 8231 or pike@biochem.wustl.edu.

Making Use of Mentors

The current generation of senior leaders came up during an era when medicine was an apprenticeship and one-on-one mentoring was taken for granted. Thus, mentoring was rarely spoken of or written about except in occasional tributes. The concept is certainly ancient. As is well-known, Mentor in Greek mythology was the teacher and guide of Telemachus, son of Odysseus, who set out into the unknown in search of his wandering father. Less well-known but certainly of interest is that this teacher was actually the goddess of wisdom, Athena, in disguise!

Now that the numbers of residents and junior faculty are at an all-time high while funded time for academic endeavors continues to decrease, conditions at most academic medical centers are not conducive to the mentoring of trainees or faculty. Nor is academic medicine doing a good job of creating mentors; in fact, most evaluation and reward mechanisms provide disincentives. These are generic, multi-faceted and under-addressed faculty development challenges.

Studies of mentoring in academic medicine have just begun to appear. A large study of 4,000 full-time faculty that defined mentoring as a "dynamic reciprocal relationship between an advanced career incumbent and a protégé" found that half of the respondents reported having a mentor and that having a mentor was a positive predictor of career satisfaction. A survey returned by 676 women surgeons revealed that those with a mentor worked significantly more hours (64/week) than those without (58/week) and published more papers (7.5 vs. 4.7). Attendees of AAMC's two Women in Medicine Professional Development seminars in 1994 were asked to describe mentored and mentoring experiences. Of the 277 mentee/mentor dyads described by the 102 respondents, 112 were successful dyads, 107 unsuccessful, and 58 potential but missed relationships. A recent study of medical students found that a higher proportion of men than women reported having a mentor; since women were more likely than men to be seeking kindness and approachability in a mentor, it is not surprising that they were less successful in finding a mentor.

Looking more broadly at "collegial relationships," Hitchcock and colleagues examined the best studies published between 1963 and 1991. Successful faculty (i.e. those who get promoted and produce significant research) frequently consult colleagues. Mentor-protégé relationships were seen to be especially important for junior faculty; peer-oriented relationships, however, endure longer than those with mentors. The most important source for developing colleague relationships is professional associations, while the least important source is one's own institution. Women were less likely than men to have faculty of higher rank or associates from previous institutions in their networks; women also consistently rate their networks as less effective at helping them build a professional reputation.

There are many reasons why women tend to under-utilize relationships at work and to need more assistance than men in identifying and making the best use of mentors. First of all, many women do not realize that the unwritten rules of the game are more important to success than the written ones; they therefore underestimate how key networks and mentors are. Second, women's developmental stages are more complex than men's, i.e., their careers are less likely to proceed incrementally upward, such that men mentors have a harder time fully identifying with women proteges and vice-versa. Moreover, in forming professional relationships, their less-than-equal status in society disadvantages women because there is a tendency for men to relate to them in terms of their social roles, e.g. father-daughter, husband-wife.

Few women would seek to limit their networks to women, but cross-gender mentoring relationships entail extra challenges. So as not to have to worry about sexual harassment or intimacy issues, men may avoid mentoring women. Since women are newer to the workplace, mentoring a woman also may entail an increased risk of failure. Other difficulties are that. Despite good intentions, some senior men paternalistically over-protect women trainees. A study in one internal medicine department found that mentors more actively promoted their men than their women mentees' participation in professional activities outside the institution. In this study, women were also three times more likely than men to report that their mentor utilized their work to advance the mentor's career rather than the protégé's.

One question that arises among senior women who are now expected to mentor is "how can I be a good mentor when I never had one?" Much can be learned from observing the successful mentoring relationships of others. It is also useful to conceptualize this process in terms of levels of involvement. At the first level "Teaching," the mentor transfers knowledge and/or skills to the mentee; the major investment is simply time. At the next level of "Personal Support," the mentor also provides motivation, direction, and confidence-building to the mentee. At the third level, "Intervention," the mentor protects the protégé, actively markets the mentee, provides access to institutional resources which would otherwise be unavailable, and may even forego other potential mentee relationships. At the highest or "Sponsorship" level, the mentor may arrange admission to elite groups for the mentee and help secure appointment to select committees. At this level, the mentor risks her reputation because her judgment will be called into question if the mentee is deemed ineffective.

Advice to Proteges

1. Because of the rapid pace of change in academic medicine and because of competition for the best mentors, it is expedient to think in terms of a continuum of collegial relationships (coach, guide, advocate, role model, advisor) and to call on different individuals for help with different goals and needs. Always take into account the values and character of individuals from whom you seek advice.

2. Proteges must be selective in what they absorb from a mentor. Women sometimes feel dishonest if they do not embrace the whole character of the mentor, but a more practical approach is to consciously not emulate what does not seem right to you.

3. Create a "support-listen-respond system," using another person to help you think through options. Ask a trusted colleague to play the devil's advocate with you to challenge your unspoken assumptions, assess your skills and deficiencies, and provoke you to consider alternatives.

4. Take the attitude that you can learn from every person, from bad as well as good examples.

5. When seeking consultation and advice, be sure you're getting a recipe for the 1990's rather than the 1970's.

6. In women more than men, seeking wise counsel may be interpreted as a sign of weakness. Therefore, be careful how you frame your request, e.g., "I have this issue I'm trying to think through" or "I'm really impressed by how you handled that, would you be willing to let me understand how you managed that?" And then don't feel rejected, if the answer is no.

The following are a few pitfalls to keep in mind:

1. Over-identification, over-reliance or enmeshment can occur, where a mentee adopts a mentor to the exclusion of other potentially helpful relationships. Such exclusivity is sometimes encouraged or even demanded by a mentor, who may in turn become dependent on the protégé's labor and support.

2. Over identification may become exploitation, where the mentor uses the mentee for his or her own advancement. For clues to the likelihood of exploitation by a mentor, look at the mentor's family. How are the marriage and parenting roles of the mentor played out?

3. Boundary violations are common in any situation where there is vastly unequal power between the parties, especially in mixed gender mentoring. The often intense and private nature of mentoring relationships both makes the development of personal intimacy more likely and can give the appearance of personal intimacy even in its absence.

4. Be on the lookout for "toxic mentors." Cloggers leave you out of the loop. Wreckers initially take pride in what you do and what you have achieved, and then suddenly nothing you do is right. Escape artists tell anyone and everyone that they are mentoring you and have high hopes for your advancement, but they are never around when you need them.

From:

AAMC web page on career development

Mentoring in Biomedicine

The importance of mentors is widely acknowledged in clinical medicine and in the basic sciences. Mentoring is a widespread phenomenon in our society; in academic medical centers it is central to efforts to transfer to younger colleagues something of the landscape they are entering. Further, it appears to be a central force in the replication of key elements of professionalism represented in medicine in a particularly powerful way. It appears to have special importance in the academic enterprise in medicine, in which the pursuit of excellence and of accomplishment behaves to a significant degree as a transmissible characteristic.

Mentoring: The Forgotten Fourth Leg
of the Academic Stool

We in academic medicine sit, not always comfortable, on a three-legged stool that supposedly defines our profession: teaching, research, and patient care. Over my 40 years in academe, I have suspected--subliminally to be sure--that something was missing in this definition of what we are about and that a fourth leg was being ignored. I discovered the missing leg while listening to an eloquent and moving lecture given at a recent annual meeting of the American Clinical and Climatological Association. Jerry Barondess, its then president, spoke about mentoring and its fundamental importance to what we academicians do (excerpted in above article).

Sitting at the ACCA talk that day, I was able to transfer the aforementioned subliminal niggle to an epiphany-generating part of my brain. Of course! Mentoring is what we senior faculty do much of the time (if we're lucky enough to be at universities and in departments that foster this priceless activity). Priceless, I mused, but generally uncompensated, at least monetarily, in this era of "bottom-line" accounting. In fact, at the time of the lecture, my department co-chair and good friend, Tom Ferris, and I were working out a new strategy to measure and reward the "productivity" of our faculty. This, to set stipends in a more formulated manner than that hitherto attempted in our department. Our departmental accountants could track clinical billings and research stipends with astounding accuracy, and surely those would become measures of "productivity." But, we reckoned, "productivity" does not equal worth in our profession--a profession grounded in the Hippocratic mandate that mature physicians transmit wisdom and experience to imaginative and energetic apprentices; that is, the mandate that we mentor.

Although we and most other department of medicine chairs recognized at the time that compensation formulas must include the difficult-to-quantify education efforts of faculty members, attainment of this laudatory goal--albeit the topic of abundant rhetoric--remains to this day pretty murky in most institutions. At best, quantity--but rarely quality--of teaching is taken into account by diverse formulas. As unsettling as this deficiency might seem, the lecture raised for me an even greater source of unease: manely, that my just-recognized fourth leg of the academic--mentoring--is generally ignored completely in accounting spreadsheets used to figure faculty compensation.

Yet Barondess informs us that "mentoring activities represent a powerful focus as we address academic concerns in medicine, because they contribute crucially to the priorities, academic styles, and career patterns of future faculty, and in this way shape the medicine of the future." As an example--one to which I particularly resonate--he notes that through mentoring a "protégé learns whether it is truly important, in the course of the case presentations, to go to the bedside, or whether such visits are pro forma, on the basis that these days the patient is the data and the data are the patient. Such distorted priorities (represented by the latter choice) are easy to learn and difficult to unlearn." Moreover, it seems to me, they result from mentor deficiency.

If these distortions are to be avoided, we in leadership positions had better start honoring and encouraging the mentor efforts of our faculty, who, without such encouragement, will surely turn their harried backs on this endeavor to pursue more readily accountable tasks. Should this occur, the academic stool, lacking a sturdy fourth leg, will be wobbly. Too bad for the stool, and too bad for the faculty who will be robbed of a most satisfying privilege of our profession--the change to emulate Mentor, the friend, educator, and character-shaper of Ulysses' son, Telemachus. Moreover, the robbed faculty will look not unlike that which Alfred North Whitehead, the noted Harvard philosopher-mathematician, defined as unfit nearly a century ago; in his words: "The danger is that it is quite easy to produce a faculty entirely unfit--a faculty of very efficient pedants and dullards. The general public will only detect the difference after the university has stunted the promise of youth for scores of years."

By Harry S. Jacob

Editor-in-Chief

Journal of Laboratory and Clinical Medicine (1997) 129: 486