ARTICLE

Faculty Mentoring Programs in Academic Medicine:

Best Practices and Guidelines

Paula N. Knaus, MA, Cynthia A. Mullen, MMS, Margaret Y. Gordon, MBA, SPHR

ABSTRACT

Even though previous studies have demonstrated a correlation between career satisfaction and success and having a mentor, many institutions in academic medicine continue to struggle with whether they should implement such a program or where to begin. This article -- based on a 2001-2004 qualitative, convenience sample involving interviews with leaders in more than 35 US and Canadian institutions and the review of over 75 mentoring related articles and books – describes the method and outcomes of that sample, highlights components of best practices underway for mentoring medical school faculty at 15 institutions, and offers recommendations for setting-up an academic mentoring program in a medical college. The highlights, along with the Guidelines, could provide a practical guide for institutions considering the planning and implementation or modification of a mentoring program in academic medicine.

BACKGROUND

In academic medicine, traditional, one-to-one faculty mentoring is becoming more prevalent while, at the same time, alternatives to the traditional model are emerging to meet the different cultures and needs of institutions and their junior faculty. In addition to increased information-sharing among institutions, perhaps the driving force behind the expansion of mentoring programs in academic medicine in the last ten years has been the Department of Health and Human Services (DHHS) Office on Women’s Health’s (OWH’s) designation of Centers of Excellence in Women’s Health (COEs)and, under a later, separate designation in 1998, the National Centers of Leadership in Academic Medicine (NCLAMs), created by the National Task Force on Mentoring for Health Professionals (OWH/DHHS).1-4 These designations as COE and NCLAM carried with them grant awards, which supplied the essential funding source to launch the respective program developments.

Although both the COEs and the NCLAMs received funding to promote women’s leadership, it was the NCLAM grant applications that specifically focused on developing demonstration models for mentoring which could be replicated or modified by other institutions. The focus of the COEs and the NCLAMS was to counter the trend of a substantially smaller percentage of women advancing to senior academic ranks or positions of leadership than men within the same time frame.4 AsBickel, et al,5 noted, “The long-term success of academic health centers is . . . inextricably linked to the development of women leaders.” Based on the most recent AAMC data (2002-03), women comprised 49.1%6 of the first year medical students. Among tenured, full professors, however, they represent only 7.9%.7 One of the explanations given by chairs in academic medicine for the paucity of women in leadership positions and at the highest ranks is the lack of effective mentors.5

Through their demonstration models, the COEs and the NCLAMS sought to improve this situation. An outcome of their developed models, though, has been the broader use of mentoring programs for junior faculty, irrespective of gender and race. The NCLAM goals for mentoring are to (1) to foster gender equity in medicine; and (2) to promote leadership advancement of junior faculty, both men and women, into senior faculty positions. 8 Mark, et al,8 conclude that programs such as these not only foster an environment for the development and retention of junior faculty but also recognize the participation of senior faculty. Mentoring programs benefit different institutional constituencies, while strengthening the institution overall.

One NCLAM developed an alternative to the traditional mentoring model. This model was described by Pololi, et al, 9 wherein those authors concluded that a collaborative mentoring program (CMP) created a non-threatening learning environment and overcame nine drawbacks of the traditional mentoring model. The CMP outcomes, carefully selected to develop junior faculty, accomplished the following, to name a few: clarified individual values; guided individual career development plans; developed much needed skills for success; created close, collaborative professional relationships; and provided opportunities for scholarly writing.

Another NCLAM crafted a multi-faceted mentoring model. That University’s approach had three distinct components for the protégés: (1) a series of weekly skill-based leadership development group seminars, (2) seminars focused on University requirements for advancement along with individual academic strategic planning, and (3) based on the junior faculty’s academic goals, a project described in a professional development contract for a one-to-one senior mentoring relationship. 8

With the growing practice of supplementing the traditional mentoring model, institutions have designed individualized programs that meet their needs and those of their junior faculty. By collecting data though a qualitative convenience sample, the authors sought to discover some of the best practices in place at the time of the sample and offer recommendations for establishing or modifying a mentoring program.

METHOD

We approached this project by first reviewing the literature (References)pertaining to faculty mentoring and, in particular, mentoring in academic medicine. The names of some institutions and authors surfaced repeatedly. When contacted, three of those authors* provided invaluable guidance throughout this entire process, most appreciably in the form of advice and direction in developing the list of sample institutions to interview and the 17-point questionnaire. The questionnaire was based on the factors identified in the literature as indicators of a successful mentoring program.

As we refined our sample, we included the following: (1) institutions whose names recurred in the literature as ones with notable mentoring programs in academic medicine, (2) the three Centers of Excellence in Women’s Health (COEs) that had formal mentoring programs,† (3) the four National Centers of Leadership (NCLAMs) that had active programs at the time of our sample, and (4) schools not covered in the other three groups that were recognized by peer institutions as having notable academic medicine mentoring programs. We were particularly seeking institutions which had formal mentoring programs and could address the points in the questionnaire. When contacted, each institution was given the opportunity to be interviewed over the telephone, receive the questionnaire by mail, or receive it by email. Thirty-five institutions agreed to participate in the sample.

Over the next several months, the questionnaire was administered to the 35 sample medical institutions. As the collection and compilation of responses progressed and neared completion in 2003, the programs of 15 schools‡ surfaced because of their innovative approaches, successful outcomes, or esteemed designation as COEs or NCLAMs with a demonstration model. These 15 schools were the ones that had centrally managed mentoring programs in place. In December 2003 and in early 2004, each of those 15 was again contacted to capture any program updates since the data were first reported in the survey. It is the practices of these 15 schools that are highlighted in this paper. §

HIGHLIGHTS OF BEST PRACTICES

We identified and captured the distinctive aspects, or components, of the 15 selected mentoring programs from the convenience sample. While the compilation of Components does not attempt to describe in detail each institution’s program, it categorizes the responses to the points on the questionnaire, the factors essential to a successful program. Some of the responses reflect unique applications of those essential factors. When used in conjunction with the Guidelines, they provide specific considerations – more than that – decision points -- which could serve as a valuable aid to institutions planning and implementing or modifying a mentoring program.

Not all of the selected programs have the same purposes, characteristics or components of best practices, although one can find similarities among some of them. What they have in common is this:support from the school’s top leadership, target junior faculty, and are custom designed to fit their particular university’s culture and management style. The differences among them, however, are more numerous. As reinforced by our sample results, “No one model of mentoring fits all institutions.”3

Among our selected institutions in the project sample, 100% of the 15 institutions used one-to-one mentoring relationships, two (13.3%) used solely one-to-one mentoring, and 13 (86.7%) used other types of mentoring, most frequently group and/or peer mentoring, in combination with their one-to-one mentoring program.

Training for mentors and/or protégés as well as the availability of written resources were prevalent among the schools. Fourteen out of 15 (93.3%) schools have either written guidelines or training programs or both for mentors and protégés. The written guidelines include an information-rich web site about mentoring and policy manuals, while the training includes learner-centered workbooks with references, informal group events, and individual and group consultation.

In eleven of the institutions (73.3%), a written policy exists to support and endorse a formal mentoring program within the institution. These policies vary widely. Here are some examples: (1) every member of the junior faculty is required to have a mentor; (2) participation relies on protégés to volunteer; (3) participating protégés are nominated by departmental chairs; or (4) all department chairs are required to file a mentoring plan for each junior faculty member, including the name of the official mentor and a schedule for annual meetings. A written policy, though, may not be necessary when mentoring is engrained into the philosophy and culture of the institution. One institution did not have a written policy for this reason. Another simply stated it did not have a policy. The remaining two (13.3%) schools intend to or are developing one.

Depending on how long the mentoring programs had been in place and the size of the institution, the number of active mentoring relationships during a year varied from 3 to 350. Not all of the schools tracked the number of mentoring relationships.

Mentoring relationships generally functioned primarily as advisory or evaluative or a combination of the two. Although, in our sample, ten (66.7%) functioned primarily as advisory and one (6.7%) as evaluative, three (20%) functioned as both. At one of the schools, the function was determined by the mentor and the protégé.

To encourage participation of junior faculty, four schools specifically stated that they gave some kind of release time. The release time ranges from 5% of the junior faculty member’s salary for seven months, to 10% of the salary, to release time to attend a meeting/conference. While most institutions do not provide CME credits for attendance at the leadership development programs and seminars, some do for some of them. One school certifies the participation of all protégés.

Where the institutions addressed them, the practices associated with the administrative and programmatic framework of the mentoring program primarily (46.7%) fell within the purview of Faculty Affairs, Faculty Development, or the Dean’s Office. Even though most programs seemed to be unfunded or under-funded, they strove to accomplish all that they could because of the value of the program. One school indicated it was a “labor of love”. In some instances, funding was provided by the Dean’s Office or other internal or external source. Some of that funding was minimal. At the time of our sample, one NCLAM program had funding that was expected to continue for three years and one COE program was receiving funding from the DHHS/OWH grants. One of the institutions currently receiving the grant funding was pursuing donor endowments to ensure the continuity of the program. Staffing, as well, was limited with administration of the mentoring programs usually being one among several other responsibilities. Five (33.3%) of the 15 institutions mentioned having one or more staffing resources dedicated solely to the mentoring program. Three (20%) additional schools indicated they received funding from the Dean’s Office, although they did not state they were specifically part of the Dean’s Office. One school had mentoring as part of its Leadership Program for Women’s Health Center of Excellence (WHCOE) of the School of Medicine University Health Services.

Each program is truly unique. The highlights of the 15 programs included in this article are categorized in List 1 under a series of headings such as approaches to mentoring programs, purposes, strategies for program marketing, eligibility, matching process, measurable program objectives/outcomes, and much more.

PROGRAM EVALUATION

As with the other aspects of a mentoring program, the schools approached evaluation differently. Eleven (73.3%) of the selected 15 institutions had some kind of formal program evaluation. At least one included mentoring as a criterion in the evaluations of chairs and asked faculty to evaluate chairs on equity and mentoring. Several made mentoring a part of its performance, promotion, tenure, and/or post-tenure review criteria. At least four (26.7%) had a formal annual program evaluation with a report to the program coordinator/ director. Forty-seven percent (7) stated that they involved the participants in the evaluation of the program. One included mentoring in faculty activity reporting. Almost all allowed for mid-course corrections which may encompass refocusing on the program goals, modifying individual goals, identifying individual skill development for the protégé, or even selecting a different mentor(s).

Fourteen institutions had established objectives for their programs. Ten of those (66.66%) followed-up with measuring quantitative and/or qualitative outcomes. One used extensive benchmarking while another had a computerized faculty tracking system to monitor the success of the program. The outcomes measured by those institutions are included in List 1.

Of the four schools that did not have a program evaluation process, three were planning to implement one; however, one was not because of the highly decentralized nature of the mentoring program.

Invariably, the program evaluations included the program’s strengths and weaknesses. As expected, the flexibility of multiple types of programs was considered a strength, as was training for mentors and protégés. Not surprising either, funding availability varied widely and program participation as a mentor or protégé required the commitment of a very precious resource – time. The strengths and weaknesses of the mentoring programs as identified by the 15 selected schools are in List 2.

CURRENT RECOMMENDATIONS

At this juncture where we discuss recommendations, it is important to point out that the National Task Force on Mentoring for Health Professionals (DHHS/OWH) determined that two principles are paramount to the success of any mentoring relationship or program: 1) institutional commitment and 2) institutional rewards and recognition to mentors.4 Without institution-wide commitment, the chances of a program’s survival are minimal. The absence of commitment virtually guarantees the absence of resources. As stated earlier, at least one institution, in an effort to ensure continued, consistent funding for its highly valued mentoring program, is pursuing donor endowments. Without institutional commitment to mentoring, this approach to program funding, in all probability, would not have been sanctioned.

Serving as a mentor is a major commitment. Formally recognizing and rewarding mentors’ commitments and contributions to the mentoring program encourage their participation. Two of the schools stated that faculty mentoring is woven into the fabric of the school culture where senior faculty are willing participants in the mentoring program and embrace mentoring as their responsibility and duty for the development and retention of junior faculty. Even so, recognition of faculty as mentors is included in their institutional reward and recognition programs. The methods of reward and recognition may be financial incentives, such as release time or a stipend; the inclusion of mentoring and junior faculty development as criteria for promotion; and/or institutional or departmental awards for distinguished mentors. Examples from our selected 15 institutions include the certification of participates, plaques, and monetary awards ranging from $500-$1000 per person; five (33.3%) institutions have awards at the department, college and/or institution level (e.g., Best Mentor of the Year Award, Outstanding Mentor Award, Teaching Excellence Award, Realization of Dreams Award, Distinguished Mentor Award, and Outstanding Women Faculty Award); seven (46.7%) include mentoring criteria in teaching portfolios, scholarship, appointment, performance, promotion, tenure, and/or post-tenure review. One school is developing a recognition program for mentoring, two (13.3%) indicated they do not have a recognition program, and four (26.7%) specifically stated they do not give release time. Two, however, specifically mentioned that they do give release time.

In addition to the two principles of successful mentoring programs espoused by the National TaskForce on Mentoring for Health Professionals, we offer a number of recommendations for consideration when enhancing or introducing a mentoring program (Appendix). One in particular warrantsmention and explanation here: like-gender/race pairing versus cross-gender/race pairing of mentors and protégés. As David A. Thomas10 observed, for cross-gender or cross-race mentoring relationships, a current approach embraces the concept that “what worked for you may not work for me” due to differences in advice and style. Successful cross-gender/race mentoring is dependent on the mentor’s appreciation and understanding of the career developmental and advancement challenges the protégé faces at different career stages. Without that, cross-gender or cross-race mentoring relationships may not develop beyond instruction-giver to emotional supporter and nurturer. Although a school may be tempted to try to match the gender and race of mentors and protégés, which may lead to frustration when there is a shortage of effective mentors, it is the protégés who have had the benefit of a supportive, cross-gender/race mentoring relationship that have been the most successful. In successful cross gender/race mentoring relationships, protégés and mentors have talked openly about race-related (or gender-related) issues and dealt with the potential barriers. Another success factor in mentoring, regardless of whether the relationships were cross- or like-gender/race relationships, is the diversity of the protégés’ network. Protégés, whose mentors have encouraged and guided diverse network building, subsequently, have a diversity of members in their networks, which, ideally, include not only diversity in race and gender, but also, of necessity, diversity in function, rank/position, location, age, and culture.10 There may be situations or the school’s culture where it is beneficial to have a mentor and protégé of like-gender/race. Where an institution does not have a sufficient number of women or minority senior faculty to accomplish this, a school could consider asking physicians in the community to participate as mentors, perhaps in a multiple-mentor program. Most importantly, ensure that the protégé is in an encouraging, healthy mentoring relationship which leads to an understanding of differences, genuine interest in the success of the protégé, and strengthening not only the mentoring relationships and the program, but the gender and racial/ethnic diversity within academic medicine to better serve the diverse patient, student, and resident populations.