By Margaret Gatti-Mays, MD, MPH, Kathryn Lurain, MD, MPH, and Fatima Karzai, MD

For the first time, women comprise more than half of medical students in the US.¹ Gains have been gradual with women making up 40% or more of graduating medical students for the last 20 years and 40% or more of graduating residents for the last 10 years.² In 2015, more than half of academic instructors in the clinical sciences were women, but as women ascend the academic ladder, there is considerable drop out in all academic institutions. Only 43% of assistant professors, 33% of associate professors and a dismal 20% of full professors are women.² Despite significant improvement in women medical school matriculants, only one-third of practicing physicians are female.³

The advent of female professional groups has been important in gathering support for the advancement of women in medicine. While many of these groups are on the national level, individual chapters are often exclusive and physicians at levels of training are isolated from each other. Like the decision to pursue a medical specialty, the decision to pursue a career in research, academics, or leadership occurs early in training.¹ The 2017 Association of American Medical Colleges (AAMC) survey of matriculating female medical students found that 62% anticipated participating in research, 33% were interested in being medical school faculty and 22% in becoming an administrative leader, such as a department chair or dean.¹ Without appropriate guidance or longitudinal mentorship from senior female leadership on how best to pursue a leadership or academic position, it is difficult to ensure the proper foundation for an academic career path. Mentors are vital in providing knowledge about the hidden curriculum⁴ which involves aspects of professionalism, ethics, and other topics not formally taught in medical school. This includes identifying and coping with inherent gender biases,^5,6 and is one of the main areas where senior female rather than male mentors may be more beneficial to female physicians early in their academic careers.

Studies have shown that a close connection with a mentor is an important component for success,⁴ but identifying senior female mentors is often difficult with so few women in leadership positions. As a result, women often choose mentors of lower rank (instructor versus assistant, associate, or full professor) than their male colleagues.⁷ This leads to women receiving mentorship from less experienced members of the faculty who may not have the skillset to foster a successful academic career. As more women matriculate into medical school, there is an increasing burden placed on existing female leaders. Mentorship by both males and females is vital to advancing early-career female physicians. Sometimes the issue is finding male mentors willing to invest their time with many colleagues holding implicit biases as to why women don’t succeed in medicine and academia (i.e., family responsibilities, less interest in research and leadership roles).⁶ Furthermore, many early-career female physicians worry that their male mentors may not fully understand the implicit biases faced by women in the field (i.e., inability to teach the hidden curriculum).⁴ If the leaky pipeline of women leaders in academic medicine and research is going to be corrected, women must be mentored by men and women. 

Social media is helping to alleviate some of the burden at individual institutions and advance the concept of longitudinal mentoring. Social media groups on Twitter and Facebook allow for connections with mentors of all levels as well as for group mentoring. ASCO has recently instituted an international “virtual mentoring” program to pair early-career ASCO members with mentors outside of their region.⁸ A similar type of virtual mentoring program could help early-career female physicians gain translational mentorship from senior female faculty.

 Deliberate efforts by academic institutions to encourage more early-career women to pursue leadership roles is important. For example, the Women Scientist Advisors at the National Cancer Institute support and promote career development as well as address issues that women scientists face.⁹ Longitudinal mentoring by senior level women and men will help to foster an interest in research and leadership starting early in training. Social media is changing the way mentoring relationships are being forged with access to female leadership outside of one’s academic institution as well as access to group mentoring. There is no one solution to fixing the leaking pipeline. Rather, it will take the whole academic village.

The authors work in the National Cancer Institute of the National Institutes of Health: Dr. Gatti-Mays in the Laboratory of Tumor Immunology and Biology of the Center for Cancer Research, Dr. Lurain in the Medical Oncology Service, and Dr. Karzai in the Genitourinary Malignancies Branch of the Center for Cancer Research. They generated the concept for the manuscript and all authors were equally involved in the drafts and agreed with the submission of the manuscript for publication. The views expressed here are those of the authors and do not necessarily reflect the views of the NCI or NIH. The authors have no conflicts of interests to disclose. There was no funding received for this study. The authors would like to acknowledge the NIH Intramural Loan Repayment Program.

References

1. American Association of Medical Colleges. Matriculating Student Questionnaire: 2017 All Schools Summary Report. 2017.
2. American Board of Internal Medicine. Workforce Trends in Internal Medicine Training - Academic Years 2007/2008 through 2016/2017. 2018.
3. American Association of Medical Colleges. The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership, 2015 -2016. 2017.
4. Levine RB, Mechaber HF, Reddy ST, et al. "A good career choice for women": female medical students' mentoring experiences: a multi-institutional qualitative study. Acad Med. 2013;88:527-34.
5. Turban S, Freeman L, Waber B. A Study Used Sensors to Show that Men and Women Are Treated Differently at Work. Harvard Business Review. October 23, 2017.
6. Edmunds LD, Ovseiko PV, Shepperd S, et al. Why do women choose or reject careers in academic medicine? A narrative review of empirical evidence. Lancet. 2016;388:2948-58.
7. Gordon MB, Osganian SK, Emans et al. Gender differences in research grant applications for pediatric residents. Pediatrics. 2009;124:e355-61.
8. Abraham J. A mentor in the U.S. and a Mentee in India Discuss Breast Cancer Cases Over the Phone - and in Person: An ASCO Virtual Mentor Program Experience. ASCO Connection. 2016.
9. National Cancer Institute. NCI Women Science Advisors. 2017.