Hira Shafeeq, PharmD, BCPS; Roshni Sreedharan, MD
Fostering diversity is an ideal that we strive to achieve in our profession. However, if asked to recall specific examples from the past year in which we have actively participated in promoting diversity in the critical care workforce, many of us might fall short. Women and certain ethnic minorities (specifically, Blacks, Hispanics, American Indians, and Hawaiian/Pacific Islanders) continue to be underrepresented in a variety of medical and allied health professions.1,2 Representation of other identity categories relevant to the practice of medicine, such as socioeconomic class, sexual orientation, gender identity, disability, and religion, remains unknown. Critical care practitioners care for patients and families during the most vulnerable moments of their lives and play an important role in the crucial conversations surrounding the goals of their care. In such situations, cultural sensitivity plays an important role in the outcomes and satisfaction of patients and families with the care provided. Our success in this field is closely related to our ability to create a culture that identifies, fosters, and encourages the professional development of minority leaders.
Diversity in the Critical Care Workforce
The definition of diversity is more complex than just gender and race. Patients, family members, and research subjects report having a more positive experience if they interact with a member of a similar ethnic group.3 There is a dearth of knowledge about the diverse nature of the critical care workforce. Last year, the Society of Critical Care Medicine (SCCM) allowed members to provide their demographic information. Since then, we are beginning to understand diversity among the SCCM membership. This process is encouraging because it highlights the importance of culture, race, ethnicity, gender identity, and sexual orientation in the construct of an individual as a whole. In an effort to promote diversity within SCCM, its Diversity and Inclusion Committee constantly strives to understand the demographic information of members serving in leadership positions, invited as annual Critical Care Congress speakers and awarded fellow or master status in the American College of Critical Care Medicine. The onus of developing diverse critical care leadership is on us, members of the critical care community.
Professional Development of Minorities: The Role of Coaches, Mentors, and Sponsors
Diversity pipelines may aid in recruitment of underrepresented minorities. Entering through the exclusionary door of any particular specialty is not enough to ensure their success in the profession or enhance diversity in the healthcare workforce. These practitioners need continual support in order to become leaders in medicine.3 It is imperative that we understand key elements of professional success in our workforce, especially for members who belong to an underrepresented group. Coaches, mentors, and sponsors can all help pivot the career paths of underrepresented minorities in the direction of growth.
Although the common goal of coaches, mentors, and sponsors is career development, each of them has a distinct role to play. While coaches and mentors provide advice and career counseling and talk through experiences, sponsors are in higher positions and play an important role in speaking up for the person to catapult him/her to higher positions within the system. Sometimes one person can play all three roles at different times. In a case study of minority corporate executives comparing those who achieve the highest level of success with those who remain in middle management, mentorship was the key differentiating quality.4
Mentoring is crucial in creating a successful and diverse leadership in healthcare that may have lasting impact on reducing healthcare disparities and building a stronger, healthier society.4 Effective mentoring is a mutually beneficial relationship that results in professional success and career satisfaction. Mentor-mentee relationships are typically based on perceived similarities, identities, goals, and interpersonal comfort. Evidence regarding the success of assigned mentorships is inconclusive because the mentor-mentee relationship sometimes need to develop organically over time. Women and minorities overall reported having difficulty obtaining a mentor but also reported the highest level of satisfaction with mentors.5-8 Mentee preferences for a mentor differ based on a number of demographic factors, such as gender, race, socioeconomic background, and country of origin. In certain circumstances, mentees might identify or relate to mentors from similar backgrounds and experiences. This could help establish an effective relationship beyond instructional mentoring and enable the mentor to provide career guidance and the psychosocial support that mentees need to establish their professional identity.
The Mentor-Mentee Relationship
Finding a good fit between a mentor and mentee is essential for a successful relationship. Women and minorities face challenges on this front.6,9-11 First, there is a limited pool of diverse mentors available. This might be a reflection of the trickle-down effect, with not enough women and other minorities moving up the ladder to play the role of mentor. Second, underrepresented professionals, both women and other minorities, face unique challenges in their career trajectories. To develop an effective relationship, mentors need to create a supportive space in which mentees are able to discuss their identity and the bias they may face at work. Race is a difficult subject to address and generally considered taboo to discuss in a professional environment. However, it is important to recognize that a mentee’s race, gender, or sexual orientation could render career advancement more challenging. Minorities tend to be more successful if their mentors acknowledge that these challenges exist.6,12 It is important to note that the decision to discuss their personal identity and its impact on their career lies solely with the mentee.
Although some mentees might prefer same-race and same-gender mentors, cross-race and cross-gender mentormentee relationships have also been shown to be effective. Small case studies suggest that minority mentees with a diverse group of mentors, especially those with a cross-race mentor, achieve the highest level of success.12 Mentees also need multiple mentors to address distinct professional needs. Cross-race and cross-gender mentor-mentee relationships might be difficult to navigate initially but can be successful after overcoming the initial phase of discomfort and unfamiliarity with someone else’s experience that is distinctly different from one’s own.
Creating Effective Mentors
In most institutions, mentors learn the mentoring process by reviewing didactic resources, trial and error, and learning from their colleagues. Formal mentor training, which includes discussions on diversity and implicit bias training, can be beneficial in creating effective mentors. Mentors need to gain an understanding of the underprivileged groups in our society and negative stereotypes associated with certain groups around work ethic, intelligence, and leadership abilities. This understanding will help them identify and eliminate the unconscious bias surrounding these stereotypes and advocate for their mentees. Effective mentorship for minorities requires a mentor who understands the psychosocial needs of their mentees and supports them. A mentor’s acknowledgement that disparities exist in our society may help the mentees continue on the path to leadership instead of being discouraged and accepting defeat when faced with challenges. A recent randomized controlled trial of mentoring interventions for underrepresented minorities in academia showed a positive impact of mentor training on the psychological needs satisfaction of the mentees.13 This further emphasizes the importance of formal mentor training programs and their role in the development of successful mentor-mentee relationships leading to mentees’ professional advancement.
Suggestions for Creating Effective and Productive Mentor-Mentee Relationships
Suggestions for mentors:
- Consider formal mentor training programs that include unconscious, implicit bias and cultural sensitivity training unconscious, implicit bias and cultural sensitivity training
- Improve your understanding of challenges faced by mentees whose identities are distinct from your own. For example, complete the implicit bias test endorsed by Project Implicit.14
- Establish mentorship goals based on the needs and career goals of the mentee.
Suggestion for minority mentees:
- Understand your needs and benefits from different types of mentorship—informal versus formal mentorship, functional mentorship, assigned versus self-identified mentorship, peer mentorship. Identify one that works best for you in your situation.
- Establish a network of mentors who can fulfill your multifaceted mentoring needs.
- Consider identifying mentors outside your home institution to provide a different perspective and broaden your network.Give special consideration to national and international professional networks.
- Be forthcoming about your goals and needs from a mentor during annual reviews.
A distinct disparity exists in the representation of minorities and women in the critical care workforce. As a consequence, their advancement to leadership positions appears to be minimal. A diverse critical care team fosters inclusivity and is supportive of all team members. At the same time, it helps provide culturally sensitive and ethical care for patients. Professional development of minority members of the critical care workforce is imperative in order to create diverse leaders and policymakers of the future. Conscious effort must be made to diversify the workforce and establish mentorship and coaching programs for the professional advancement of underrepresented groups.
- U.S. Department of Health and Human Services. Health Resources and Services Administration. Bureau of Health Workforce. National Center for Health Workforce Analysis. Sex, Race, and Ethnic Diversity of U.S. Health Occupations (2011-2015). Rockville, Maryland: Health Resources and Services Administration; 2017.
- Lane-Fall MB, Miano TA, Aysola J, Augoustides JGT. Diversity in the emerging critical care workforce: analysis of demographic trends in critical care fellows from 2004-2014. Crit Care Med. 2017 May;45(5):822-827.
- Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003 Dec 2;139(11):907-915.
- Kelly RL. 2015 Kelly Report: Health Disparities in America. Washington, DC: Congressional Black Caucus Health Braintrust; 2015. https://robinkelly.house.gov/sites/robinkelly.house.gov/files/2015%20Kelly%20Report.pdf. Accessed March 26, 2019.
- Fox S, Corrice A. Mentoring in academic medicine: the current state of practice and evidence-based alternatives. Washington, DC: Association of Medical Colleges; https://www.aamc.org/download/477040/data/mentoring_in_acadmed_current_state.pdf. Accessed March 26, 2019.
- Mahoney MR, Wilson E, Odom KL, FLowers L, Adler SR. Minority faculty voices on diversity in academic medicine: perspectives from one school. Acad Med. 2008 Aug;83(8):781-786.
- Emrich C, Livingston M, Pruner D Oberfeld L, Page S,. Creating a culture of mentorship. Chicago, IL: Heidrick & Struggles; 2017. https://www.heidrick.com/Knowledge-Center/Publication/Creating_a_culture_of_mentorship. Accessed December 31, 2018.
- Rio A. Mentoring matters, especially for women and minorities. February 8, 2018. Chief Learning Officer. https://www.clomedia.com/2018/02/08/guide-improving-mentoring-opportunities-women-minorities. Accessed January 1, 2019.
- Carapinha R, Ortiz-Walters R, McCracken CM, Hill EV, Reede JY. Variability in women faculty’s preferences regarding mentor similarity: a multi-institution study in academic medicine. Acad Med. 2016 Aug;91(8):1108-1118.
- Walensky RP, Kim Y, Chang Y, et al. The impact of active mentorship: results from a survey of faculty in the department of medicine at Massachusetts General Hospital. BMC Med Educ. 2018 May 11;18(1):108.
- Welch J, Sawtelle S, Cheng D, et al. Faculty mentoring practices in academic emergency medicine. Acad Emerg Med. 2017 Mar;24(3):362-370.
- Thomas, DA. The truth about mentoring minorities. Race matters. Harv Bus Rev. 2001 Apr;79(4):98-107, 168.
- Lewis V, Martina C, McDermott MP, et al. A randomized controlled trial of mentoring interventions for underrepresented minorities. Acad Med. 2016 Jul;91(7):994-1001.
- Project Implicit; 2011. https://implicit.harvard.edu/implicit/takeatest.html. Accessed December 31, 2018.