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Mentorship Is Not Enough

Exploring Sponsorship and Its Role in Career Advancement in Academic Medicine

Ayyala, Manasa S., MD; Skarupski, Kimberly, PhD, MPH; Bodurtha, Joann N., MD, MPH; González-Fernández, Marlís, MD, PhD; Ishii, Lisa E., MD, MHS; Fivush, Barbara, MD; Levine, Rachel B., MD, MPH

doi: 10.1097/ACM.0000000000002398
Research Reports

Purpose To explore how sponsorship functions as a professional relationship in academic medicine.

Method The authors conducted semistructured interviews with Johns Hopkins University School of Medicine faculty in 2016: department chairs (sponsors) and faculty participants of an executive leadership development program (protégés). Using editing analysis style, the authors coded interview transcripts for thematic content; a coding framework and themes were derived using an iterative process.

Results Five themes were identified from 23 faculty interviews (12 sponsors, 11 protégés): (1) Mentorship is different: Sponsorship is episodic and focused on specific opportunities; (2) Effective sponsors are career-established and well-connected talent scouts; (3) Effective protégés rise to the task and remain loyal; (4) Trust, respect, and weighing risks are key to successful sponsorship relationships; (5) Sponsorship is critical to career advancement. Sponsorship is distinct from mentorship, though mentors can be sponsors if highly placed and well connected. Effective sponsors have access to networks and provide unequivocal support when promoting protégés. Effective protégés demonstrate potential and make the most of career-advancing opportunities. Successful sponsorship relationships are based on trust, respect, mutual benefits, and understanding potential risks. Sponsorship is critical to advance to high-level leadership roles. Women are perceived as being less likely to seek sponsorship but as needing the extra support sponsorship provides to be successful.

Conclusions Sponsorship, in addition to mentorship, is critical for successful career advancement. Understanding sponsorship as a distinct professional relationship may help faculty and academic leaders make more informed decisions about using sponsorship as a deliberate career-advancement strategy.

M.S. Ayyala is assistant professor, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.

K. Skarupski is associate professor, Department of Medicine, and associate dean for faculty development, Johns Hopkins University School of Medicine, Baltimore, Maryland.

J.N. Bodurtha is professor, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

M. González-Fernández is associate professor and vice chair for clinical affairs, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland.

L.E. Ishii is professor, Department of Otolaryngology–Head and Neck Surgery, chief quality officer for clinical best practices, and senior medical director for clinical integration, Johns Hopkins Health System and Johns Hopkins University School of Medicine, Baltimore, Maryland.

B. Fivush is professor, Department of Pediatrics, and senior associate dean for women, Johns Hopkins University School of Medicine, Baltimore, Maryland.

R.B. Levine is associate professor and associate vice chair for women’s academic careers, Department of Medicine, and associate dean for faculty educational development, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: http://orcid.org/0000-0002-1138-1289.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: This study was approved by a Johns Hopkins Medicine Institutional Review Board (IRB00083916, date of approval December 18, 2015).

Previous presentations: Findings from this study were presented at the Society of General Internal Medicine Annual Meeting, April 2017, Washington, DC.

Correspondence should be addressed to Rachel B. Levine, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave./Mason F. Lord Building, Center Tower, Suite 2300, Baltimore, MD 21224; telephone: (410) 550-9875; e-mail: rlevine@jhmi.edu.

In academic medicine, mentorship has long been considered the most important type of professional relationship for career development.1 Since the first in-depth reports on mentorship in the 1980s,2 , 3 studies have cited having an effective mentor as integral to both professional and personal growth.4 Mentorship fosters development through a longitudinal personal relationship in which the mentor provides advice, feedback, and coaching to the mentee. Successful mentorship is transformative for both the mentor and mentee, though the primary focus is on the mentee.2

Mentorship has been shown to have a significant impact on mentees’ personal development, academic career path, and research productivity,4 in addition to improving their career satisfaction.5 Ineffective mentorship can lead to difficulty in retaining junior faculty, disillusionment with academic medicine, and decreased grant funding.6 Given the link between effective mentorship and academic productivity,7 many institutions have developed structured mentoring programs.8–10

There is increasing awareness, however, that mentorship may not be sufficient for career advancement, particularly for women and underrepresented in medicine (UIM) faculty.11 , 12 The concept of sponsorship is gaining recognition in academic medicine, in part due to its popularity in the business setting where mentorship is similarly viewed as important but not sufficient to guarantee advancement, specifically to high levels of leadership and for women and minorities. In the business context, sponsorship is defined as

active support by someone appropriately placed in the organization who has significant influence on decision-making processes or structures and who is advocating for, protecting, and fighting for the career advancement of an individual.13

With sponsorship, a protégé is put forward by a sponsor for high-visibility, career-advancing opportunities.14 In academic medicine this may include being recommended for a leadership role, an award, or a high-profile speaking opportunity.15

Although there are myriad studies on mentorship in academic medicine, there are almost none on sponsorship. We conducted this qualitative study to explore how sponsorship functions as a professional relationship in academic medicine—specifically, how sponsorship relates to mentorship, who gets sponsored, who does the sponsoring, what makes for a successful sponsorship relationship, and the impact of sponsorship on career advancement.

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Method

Study design and sample

We performed a qualitative study using one-on-one, semistructured interviews with a sample of sponsors and protégés at the Johns Hopkins University School of Medicine (JHSOM) in 2016. We defined a sponsor as a faculty person in a position of influence and power who would be able to advance the careers of other faculty. We used a purposeful sampling strategy based on this definition and invited all JHSOM clinical department chairs to participate in the study.

We defined a protégé as a faculty person with high leadership potential. To identify protégés, we contacted faculty who had participated in the Johns Hopkins Medicine Deans Leadership Program between 2009 and 2014. Participants in this internal executive leadership training program are nominated by department chairs specifically for their leadership potential. We oversampled for women and UIM faculty among protégés.

We aimed to recruit 10 to 15 sponsors and 10 to 15 protégés to interview for the study. Sponsors and protégés were not recruited as sponsor–protégé pairs. We contacted potential study participants via e-mail and invited them to be interviewed as part of a study about paths to leadership in academic medicine. Study participants did not receive compensation or incentives. This study was approved by a Johns Hopkins Medicine Institutional Review Board.

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Data collection

We conducted one-on-one, semistructured interviews lasting 30 to 40 minutes each. An interview guide was developed based on the existing literature on mentorship1 , 6 , 16 and sponsorship13 , 17 using an iterative process among the study authors. We conducted four pilot interviews (two with sponsors and two with protégés) to gauge the length of the interview and to ensure clarity of questions. We revised on the basis of these pilot interviews, and our final interview guides varied slightly for sponsors and protégés (Appendix 1).

We asked each participant to read a short vignette about sponsorship and definitions of the terms sponsor and protégé just before we started the interview (Box 1). Interviews were conducted in person by two members (M.S.A. or R.B.L.) of the research team. Interviews were audiotaped and transcribed, and transcripts were deidentified. To maintain confidentiality, we collected limited demographic data, including gender, rank, specialty (protégés), and years as department chair (sponsors). All study participants provided written consent.

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Box 1Vignette and Definitions Provided to Participants at the Start of Semistructured Interviews in Study Exploring Sponsorship and Its Role in Career Advancement in Academic Medicine, Johns Hopkins University School of Medicine, 2016

Vignette

A high-performing employee at a large company has been overlooked multiple times for opportunities for promotion to higher levels of leadership. They have thrived in their work and have had numerous successes in their professional and personal lives, which they credit in large part to strong relationships with excellent mentors, none of whom are in executive leadership roles.

The next week, this employee presents at a company meeting. An executive leader happens to be present and is impressed with the employee’s skills. They see high potential in this employee and reach out with additional high-visibility opportunities.

A few months later, in a closed meeting in the executive suite, this employee is recommended by this executive leader for a promotion to an executive leadership position. The other leaders at the table remark with high regard on the employee’s work and wonder at how they had not heard of this employee sooner. The employee interviews for the position and is unanimously approved for promotion.

Sponsor and protégé definitions

A “sponsor” is a person in an organization who is in a position of influence and power (with access to networks and resources) who actively supports the career of a “protégé” whom they have identified as having high potential.

A sponsor may advance a protégé’s career by nominating them for leadership opportunities and introducing them into important career networks. Sponsorship is focused on career advancement and rests on power.

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Data analysis

All transcripts were read by three researchers (M.S.A., K.S., R.B.L.), who used an “editing analysis style”18 in which they read the transcripts to identify meaningful segments of text and to develop initial categories from the data into a provisional coding template. The remaining members of the study team each read five or six of the transcripts and used the provisional template to code categories. Following this step, the entire study team met to edit the categories and to create a final coding template. The team organized the categories in the coding template into themes. M.S.A. and R.B.L. then reread all transcripts to confirm the final coding template and the identified themes, and to select representative quotes for presentation. The entire team met to review the final themes and agree on the selected quotes using an iterative process. Minor edits were made to the selected quotes for readability. We attributed the quotes to a sponsor or a protégé and provided the gender of the participant. To maintain confidentiality, we did not include information on race/ethnicity. To further validate our conclusions, we shared the themes with study participants and invited their feedback to confirm or refute our analysis. No study participants disagreed with our findings.

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Results

Twenty-three faculty participated in the study interviews (12 sponsors and 11 protégés). Table 1 describes participant characteristics. Four of the participants were UIM faculty. All of the sponsors were men, and 6 of the protégés were women. One protégé had a PhD, and the remainder had MDs. The following specialties were represented among the protégés: anesthesia and critical care medicine (n = 2), surgery (n = 2), neurology (n = 1), internal medicine (n = 5), and behavioral science (n = 1).

Table 1

Table 1

We identified five themes from the interviews: (1) Mentorship is different: Sponsorship is episodic and focused on specific opportunities; (2) Effective sponsors are career-established and well-connected talent scouts; (3) Effective protégés rise to the task and remain loyal; (4) Trust, respect, and weighing risks are key to successful sponsorship relationships; and (5) Sponsorship is critical to career advancement. We describe each theme below and include representative quotes.

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Mentorship is different: Sponsorship is episodic and focused on specific opportunities

Participants described sponsorship as distinct from mentorship, but they also named some key overlapping features (Figure 1). Both relationships were viewed as essential in academic medicine: Mentorship was described as addressing one’s overall longitu dinal career development, whereas sponsorship was characterized as episodic and focused on specific high-visibility opportunities that position protégés for career advancement and often meet an institutional need. This balance between promoting talented faculty and meeting an institutional need was described by one of the sponsors.

Figure 1

Figure 1

I think you actually have to actively work at it and try to identify the people who are the right combination for roles and for your organization. (Male sponsor)

An ongoing personal relationship was viewed as secondary, or not necessary, to connecting a talented person with an opportunity.

Whereas a mentor has a long, ongoing developmental relationship, a sponsor is … in a position where they can create an opportunity for a talented person. (Male sponsor)

[A] sponsor is more position-related [than what] I think of as mentoring, which I think is deeply personal. In an administrative position, I act as sponsor to many more people than I act as mentor to because I’m obligated to advance careers of people that I really have no relationship with. (Male sponsor)

One sponsor described an experience in which he had been selected to present a plenary at a national meeting. He explained that he did not have an ongoing relationship with the sponsor who put him up for this opportunity, yet the impact on his career was significant.

And that event singularly, because of the people who were in the audience at that time, who heard me give that talk, really substantially helped my career. (Male sponsor)

Participants described how mentorship and sponsorship relationships had differing importance and impact at various career stages. Having multiple sponsors throughout one’s career was seen as useful. Early in one’s career, advice and coaching from a mentor were viewed as most useful in forging a career path. Later on, access to career-advancing opportunities accompanied by the backing of a sponsor was viewed as critical.

Well, early on I think mentorship’s very important to just learning how [to start your] career. But as you become more senior I think sponsorship is more important to career advancement. (Male protégé)

One sponsor, describing his own career trajectory, explained how sponsorship becomes essential as a protégé begins to move up the organizational ladder, noting that mentors need to be in positions of power and influence to be effective at this stage.

What I then began to realize was … that mentors probably were not enough, but also that some mentors have high positions and can push people. (Male sponsor)

One protégé noted that a mentor who is highly placed and well connected can also be a sponsor.

I was trying to think in my personal career who has functioned as a sponsor, who’s been a mentor. I think my mentor happens to … have a lot of power. So I think he also functions as a sponsor. (Female protégé)

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Effective sponsors are career-established and well-connected talent scouts

An effective sponsor was portrayed as always on the lookout for talent and being part of influential networks (locally and nationally). Both sponsors and protégés agreed that a sponsor should be established and not threatened by a talented protégé.

They’re a talent scout.… They recognize the skills that [protégés] already have and are in a position to help the individual who’s already high performing. (Male sponsor)

The senior person has this sense of security, sense that they have accomplished things and it’s no longer about them trying to get more and more credit, more and more fame, that they’re willing to share that. (Male sponsor)

One sponsor described in detail how a sponsor connects a talented protégé with career opportunities.

A sponsor … articulates the strengths of the [protégé] and endorses them to others. They look out for opportunities that may be compatible with [the protégé’s] skill set and they promote them. They help [the protégé] figure out how to navigate the maze. (Male sponsor)

Finally, both sponsors and protégés described the importance of the sponsor providing unequivocal support for a protégé.

[S]ponsorship is a more proactive thing … where the sponsor is going to actively go to bat for someone. (Male sponsor)

A good sponsor is someone who is going to follow through and is really committed to supporting you. If they’re going to put you up for something where you’re kind of stretching a bit, they’re going to ensure you’re a success. Obviously, you have to do the hard work. But they have your back. (Male protégé)

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Effective protégés rise to the task and remain loyal

Sponsors and protégés characterized effective protégés as talented, driven, and loyal. Sponsors focused on the protégé’s ability and motivation to make the most of a career-advancing opportunity.

The individuals who I think are most successful have fire in their belly. There has to be an element of independent drive.… It’s people who have goals that I think go beyond the immediate possibility. (Male sponsor)

Protégés need to demonstrate potential to be noticed by sponsors.

It’s time to make sure that you’re [the protégé] playing to your strengths because … people are watching. (Male sponsor)

[Someone] who’s willing to take the chances and the opportunities. (Female protégé)

As mentioned in the previous theme, a sponsor must provide complete support to a protégé when sponsoring him or her in a career opportunity. In return, loyalty in a protégé was viewed as critical.

I think there has to be an element of loyalty because if you bite the hand that feeds you then it makes that sponsor probably more … wary of working with you, promoting you, or talking to others about you. (Female protégé)

Because a sponsor has to consider departmental and institutional needs and success, a protégé must be fully committed to the task in addition to his or her personal success.

They’ve got to express a level of desire to be part of the team and to contribute to the mission, the department and everything. (Male sponsor)

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Trust, respect, and weighing risks are key to successful sponsorship relationships

The successful sponsorship relationship was described by participants as based on trust and respect, with clear benefits for both parties. These features can motivate the sponsor to leverage his or her reputation to act as an advocate for the protégé. In addition, the protégé needs to feel that the sponsor has his or her best interests in mind and will offer opportunities in which the protégé can succeed. Trust ensures that the protégé feels accountable, as the sponsor’s credibility and reputation are on the line.

There’s a mutual respect, that they [the protégé] understand what I’m trying to do and respect my time and respect that this is something very special. I think that mutual respect is very important. (Male sponsor)

One protégé echoed the concept of trust in the sponsor–protégé relationship when reflecting on being offered a potentially risky career-advancing opportunity.

This is a big thing that you’re asking me to do and I don’t want to fail. And so trusting this sponsor is not going to put you in a position where you would fail miserably, or if you did fail, they would help to figure out why, so that it doesn’t happen again. (Female protégé)

Both sponsors and protégés acknowledged the potential downsides to sponsorship. A risk for sponsors is backing a protégé who does not meet their expectations and performs poorly.

[Y]our own reputation. If you pick someone who’s not a winner, you’re not going to have as much credibility next time…. I think that sponsorship really has a risk to the sponsor in terms of their own reputation, their own integrity, their own credibility. (Male sponsor)

Although most protégés expressed appreciation of the opportunities that sponsorship provides, they also recognized the challenge of saying no. In addition, they raised the risk of being viewed only as an extension of their sponsor.

If you’re a protégé, and you have a sponsor who’s giving you opportunities, they’re going to give you opportunities that probably were offered to them. The risk is that you would just be perceived as the younger version of that person. (Male protégé)

Another risk shared by participants was that the sponsor may not be able to fulfill his or her role regardless of the protégé’s potential.

[T]here are risks that you’re not going to succeed for an individual, that you’re not going to be able to place them and achieve the goals of the relationship. I mean if someone’s coming to you for sponsorship, then you should have some deliverable stuff. There’s the risk that things don’t work. (Male sponsor)

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Sponsorship is critical to career advancement

Participants agreed that sponsorship is critical to advancing to high-level leadership roles.

It’s very unusual for an individual to ascend the academic ladder or ascend into leadership positions … solely based on their own skills, productivity, and contributions.… This is certainly something that I’ve had the advantage of, having had sponsorship. I think it had critical impact in terms of the opportunities I had and where I am today. There’s no question about it. (Male sponsor)

Sponsors and protégés also described benefits of sponsorship beyond the advancement of a particular protégé. These included increasing the overall talent in an organization and facilitating leadership development, leadership succession, and transition planning.

Sponsorship is important to help identify where the talent is and connect resources and provide networking. I think sponsors … can help facilitate more rapid skill development and leadership development in the academic institution. (Female protégé)

Participants acknowledged a tension between the concepts of sponsorship and merit as the foundations of academic advancement. One sponsor acknowledged his own blind spot in promoting others.

I think that the less glittery people, the less showy people, tend to have a risk of being ignored in a sponsorship sort of role where I’m looking across a field and I tend to find one like me.… I think the challenge as a leader is to become a sponsor for the more quiet folks. (Male sponsor)

One protégé expressed concern that sponsorship does not always stem purely from merit.

In the ideal world people should be able to get to wherever—purely on merit and what they do. (Male protégé)

This dissonance in who gets sponsored and who seeks out sponsorship also emerged with regard to gender. Sponsors and protégés agreed that women likely experience sponsorship differently from men. Participants viewed women as less likely to seek out sponsorship but also as needing the extra support it provides to be successful.

Women are less inclined to put themselves out there and may not have the same bravado or ability that some of the men do in terms of self-promoting. You’ve got to do that to some degree. Some of these things you’ve got to seek out. (Male sponsor)

I think that women do have a different pathway.… [T]hey have to have a more solid structure for them to do really, really well.… I do think that women require a lot more; they would need someone to really look out for them. (Female protégé)

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Discussion

Our work represents one of the first in-depth studies of sponsorship in academic medicine. Using qualitative methods allowed us to explore sponsorship as a professional relationship, in particular by clarifying how sponsorship relates to mentorship and by describing the impact of sponsorship on career advancement.

The similarities and contrasts between mentorship and sponsorship in academic medicine have not been well described prior to this study. These are highlighted in Figure 1, which was created using information from the literature1 , 4–6 , 9 , 11 , 13 , 17 , 19 , 20 and expanded by our research findings. Many of our participants (especially the sponsors) understood the nuanced differences between mentorship and sponsorship, including the distinction that sponsorship is focused on career advancement, predicated on power, and concentrated on the execution of particular opportunities that are beneficial to the sponsor, the protégé, and often the institution. Perhaps more important, some participants were aware that a mentor can also be a sponsor when that individual is in an influential role with access to resources and power.

Timing in one’s career influenced the value placed on each type of relationship. Our participants echoed findings of prior studies that viewed mentorship as especially important for early career development.7 However, they also recognized that sponsorship is of potentially greater value later in one’s career when there are fewer opportunities to advance to high-level positions and when the support of a powerful sponsor can open doors to critical opportunities and networks.

Participants noted that sponsorship does not require a personal, long-standing relationship. In the business literature, sponsorship is explicitly described as a transactional relationship or a strategic alliance where each party has clear goals and expectations.21 The transactional nature of sponsorship provides a stark contrast to mentorship, which, as we mentioned earlier, is often described as highly personal and transformative. Faculty who are more comfortable with traditional mentorship relationships may struggle with this difference. This finding also highlights the organizational and cultural differences between academic medicine and business settings, as well as the importance of fully understanding both the benefits and the potential pitfalls of sponsorship.

Our participants recognized that sponsorship is critical to high-level advancement in academic medicine. Professional networks are critical for career success and are a fundamental feature of sponsorship.22 A sponsor’s effectiveness relies on his or her access to and influence in professional networks. Our participants emphasized that sponsors must know how to use their influence and calculate the risk related to backing protégés. Faculty who are not aware of the importance of networks and influence may align themselves with mentors who are not also able to serve as sponsors and fully advance their careers. This may be particularly true for women.12 In business settings, mentors of women tend to have less “organizational clout” than those of men and therefore to be less able to serve as sponsors and advance women’s careers; however, when women’s mentors are highly placed in the organization, women are just as likely as men to be promoted.17 In academic medicine, junior faculty women are more likely than their male colleagues to value gender concordance in mentoring relationships and may fail to recognize the need for support from more senior faculty and from leaders and mentors outside their own department or institution.23 , 24 This may limit women’s success as there are many fewer women than men in high-level leadership positions with power and influence.25

In addition, protégés need to be “seen” by sponsors as having high potential. This may be challenging for faculty who are uncomfortable or concerned about potential negative consequences associated with self-promotion. Advocates of sponsorship from business settings view sponsorship as a way to address the so-called double bind that women face in which women who promote themselves are penalized for appearing too ambitious or self-promoting.13 Sponsorship enables an influential backer to vouch for a female protégé and highlight her strengths. Although participants in our study did not explicitly describe the double bind faced by women, both protégés and sponsors stated that women may be less likely to seek out opportunities and may require extra support.

Participants in our study acknowledged that women likely experience sponsorship differently than men do. Recent research in academic medicine demonstrated that women are less likely to report having been the recipient of career-advancing opportunities—defined as being offered invitations to speak at a national meeting, to write an editorial, or to serve on an editorial board or a national committee—compared with their male counterparts.15 Many thought leaders in academic medicine have pointed to sponsorship as one strategy for addressing gender diversity in leadership.11 , 26–29 Understanding the benefits and the potential risks of sponsorship will be useful in moving this agenda forward. As we noted earlier, many institutions have used research that addresses best practices and barriers in mentorship to develop programs to ensure that faculty benefit from effective mentoring relationships. Our findings provide initial evidence about sponsorship that may inform institutional efforts to promote sponsorship through similar programs.30

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Limitations

Our study has several limitations. First, our participants were from a single academic health center, and therefore the unique institutional culture may limit the generalizability of our findings. Second, as with all qualitative studies, the views of the researchers may have influenced the design, analysis, and presentation of the findings. Strengths of our qualitative methodology include the use of clear definitions, a reasoned rationale for inviting participants, and validation of our findings with participants. Third, because of our study selection process, we included only the views of sponsors and protégés while missing the important additional perspectives of those who have not benefited from sponsorship. Fourth, all of the sponsors in our study were men. However, this likely accurately represents the majority of sponsors in academic medicine based on our definition. Finally, there are other factors and types of professional relationships that affect career advancement in academic medicine beyond what our study reveals. For example, coaching is increasingly recognized as a useful tool in enhancing job performance through behavior change and skills acquisition.31 There are likely important differences and similarities between coaching, mentorship, and sponsorship relationships.

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Conclusions

Our findings suggest that sponsorship, in addition to mentorship, is critical for successful career advancement in academic medicine. Understanding sponsorship as a distinct professional relationship, with both benefits and potential pitfalls, may help faculty and academic leaders make more informed decisions about using sponsorship as a deliberate strategy for career advancement. Further research may elucidate how sponsorship can best function in academic medicine.

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Appendix 1

Appendix 1

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