A total of 183 residents returned completed surveys for an overall response rate of 73% (183/250). The sample was 52% female, with 38% self-reporting as White, 31% as Black/African American, 17% as Asian or other, and 14% as Hispanic/Latino. Residents trained in both primary care (43%) and non-primary care (51%) specialties; the majority (58%) were PGY-3 and above. Nearly half (48%) of respondents estimated their medical education debt at more than $150,000.
Forty-eight residents participated in focus groups; 2 focus groups with 7 and 11 self-identified Black/African American residents occurred at the NMA conference, 2 focus groups with 11 and 12 self-identified White or Asian residents occurred at AMA, and one focus group of 7 self-identified Hispanic/Latino residents occurred at NHMA. Demographics were similar to survey respondents, except focus groups included more males (50%), Black/African Americans (37%), Hispanic/Latino (15%), and trainees PGY-3 and above (66%) (Table 1).
The majority of survey respondents (88%) were interested or very interested in academic medicine as a career (Mean Likert Score = 1.84, 95% Confidence Interval = 1.73-1.95), with 8% being neutral. Eight-five percent of Black/African American, 91% of Hispanic/Latino, 92% of Asian/other, and 88% of white residents were interested or very interested in academic careers. There were no significant differences by race and ethnicity, estimated medical education debt, or other resident characteristics (all p > 0.05) (Table 2).
Overall, 70% of residents reported having sufficient mentorship to purse an academic career with 17% reporting insufficient mentorship and 13% neutral. Among Asian/other residents, 26% agreed or strongly agreed that they did not have sufficient mentorship to enter academia, compared to 16% of Hispanic/Latino, 16% of Whites, and 14% of Black/African American residents. Additionally, 72% of residents knew how to utilize mentors to advance their career, with 13% reporting not knowing how to use mentors and 14% neutral. Nineteen percent of Asian/other residents, 16% of Black/African American, 10% of White, and 8% of Hispanic/Latino residents agreed or strongly agreed that they did not know how to use mentors to advance their careers. There were no significant differences by race and ethnicity, estimated medical education debt, or other resident characteristics (all p > 0.05) (Table 3).
The majority of residents (93%) believe that mentors are a positive or very positive influence in the decision to pursue a career in academic medicine, with 6% unsure. Among Hispanic/Latino residents, 100% believed that mentors are positive or very positive influences on the decision to purse academic careers, compared to 97% of Asians/others, 91% of Whites, and 89% of Black/African American residents. Because of numerous small cell sizes (all contingency tables have < 5/cell in > 50% of cells) and expected values less than 1, no chi-square analyses were performed (Table 3).
Associations between interest in academic medicine careers and attitudes about mentorship were examined. Interest in academic medicine negatively correlated with the question “I do not have sufficient mentorship to pursue a career in academic medicine” (r = -0.27, p < 0.01). That is, residents who reported having adequate mentorship were more interested in academic medicine as a career than those with inadequate mentorship. Similarly, participants’ interest in academic medicine negatively correlated with the question “I do not know how to utilize mentors to advance my career” (r = -0.26, p < 0.01). Specifically, residents who were able to work with their mentors to advance their careers were more interested in academia than their counterparts. No correlation between interest in academic medicine careers and the question “Rate the influence of mentors/role models on pursing an academic medicine career” was identified (r = -0.12, p = 0.13).
Participants described clinical work, teaching, research, administration, and policy work as the core domains of academic medicine. Primary care respondents, regardless of race/ethnicity, frequently described academic careers as clinical precepting and affiliations with universities more than other respondents. Some respondents conceptualized pursing academic interests through other venues such as local professional societies and opportunities to influence municipal, state, and national healthcare agendas.
Three major themes about mentorship emerged from the focus group data: (1) qualities of successful mentorship models; (2) perceived benefits of mentorship; and (3) the value of racial/ethnic and gender concordance (Additional file 1: Table S1). Successful mentoring was characterized as an engaged and personalized process. Residents preferred a more individualized approach for identifying mentors rather than arbitrary assignments, and expressed concerns about faculty using checklists rather than tailoring mentorship to the specific needs of the mentee. Mentors were described as filling concrete knowledge and process gaps, role modeling desired behaviors, and key to gaining access to academia. Some residents described the need for multiple mentors in order to provide guidance in multifold areas of development.
White residents were the only group that raised concerns over some training programs taking an assembly-line approach to the production of academicians. The same respondents described mass production models as antithetical to the individualized mentoring model necessary to support trainees interested in academia.
Networking was an identified benefit of mentorship that included a sense of increased social capital that opened doors, improved the transparency of processes, and created opportunity. Exposure to professional networks provided awareness and access to well developed systems, preventing the need for mentees to make connections and forge pathways independently. The value of networking was more commonly discussed among non-minority residents.
Black/African American, Hispanic/Latino, and female residents described value in identifying mentors with similar demographics and shared sense of history. The ability to see oneself and one’s future potential in a faculty member added to their perceived value as a mentor. Black/African American and Hispanic/Latino participants described the need to identify mentors with an understanding of their personal and professional career trajectories. Gender and racial/ethnic concordance was described as desirable and encouraging. Incompatibility was perceived as an obstacle for minority mentees, requiring explanation of the context and nuances of their situation to non-minority mentors. Female residents raised concerns about the availability of female mentors in traditionally male-dominated fields (e.g. surgery) and in high-level leadership positions across all disciplines.
Respondents described actively seeking out mentors of the same gender and race/ethnicity, but expressed difficulty finding such mentors. Related to this finding, minority residents described a sense of responsibility for addressing the gaps in minority mentorship for future generations of physicians. This desire to give back, as well as a sense of appreciation and respect for the mentorship they received, were both described as primary drivers in their decision to pursue careers in academic medicine.