Portal de Periódicos da CAPES

Academic Advancement of Women in Medicine: Do Socialized Gender Differences Have a Role in Mentoring?

2008; Elsevier BV; Volume: 83; Issue: 2 Linguagem: Inglês

10.4065/83.2.204

1942-5546

Anita P. Mayer, Julia A. Files, Marcia G. Ko, Janis E. Blair,

Health and Medical Research Impacts

During the past 30 years, women have entered academic medicine in increasingly larger numbers. However, fewer women than men have succeeded in advancing in academic rank.1Nonnemaker L Women physicians in academic medicine: new insights from cohort studies.N Engl J Med. 2000; 342: 399-405Crossref PubMed Scopus (392) Google Scholar Despite numerous studies and reports documenting this failure,2Bickel J Wara D Atkinson BF Association of American Medical Colleges Project Implementation Committee et al.Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.Acad Med. 2002; 77: 1043-1061Crossref PubMed Scopus (250) Google Scholar, 3McGuire LK Bergen MR Polan ML Career advancement for women faculty in a U.S. school of medicine: perceived needs.Acad Med. 2004; 79: 319-325Crossref PubMed Scopus (92) Google Scholar, 4Hamel MB Ingelfinger JR Phimister E Solomon CG Women in academic medicine: progress and challenges [editorial].N Engl J Med. 2006; 355: 310-312Crossref PubMed Scopus (124) Google Scholar progress in correcting this problem has been slower than that predicted by even conservative estimates.5Jagsi R Guancial EA Worobey CC et al.The "gender gap" in authorship of academic medical literature: a 35-year perspective.N Engl J Med. 2006; 355: 281-287Crossref PubMed Scopus (615) Google Scholar In 1985, 10% of female medical school faculty held the rank of full professor.2Bickel J Wara D Atkinson BF Association of American Medical Colleges Project Implementation Committee et al.Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.Acad Med. 2002; 77: 1043-1061Crossref PubMed Scopus (250) Google Scholar In 2006, 12% of female faculty were full professors.6Magrane D Lang J Alexander H Women in U.S. Academic Medicine: Statistics and Medical School Benchmarking 2005-2006. Association of American Medical Colleges, Washington, DC2006http://www.aamc.org/members/wim/statistics/stats06/start.htmGoogle Scholar It has taken more than 20 years for the proportion of female faculty who are full professors to increase 2 percentage points. Among male faculty, 30% have consistently held the rank of full professor over the same 20 years.2Bickel J Wara D Atkinson BF Association of American Medical Colleges Project Implementation Committee et al.Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.Acad Med. 2002; 77: 1043-1061Crossref PubMed Scopus (250) Google Scholar The limited advancement of women in the upper echelons of medicine is not substantially different from that of women in other areas of science, mathematics, and business.7Hewlett SA Luce CB Off-ramps and on-ramps: keeping talented women on the road to success.Harv Bus Rev. 2005; 83 (48, 50-54.): 43-46PubMed Google Scholar, 8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar, 9Committee on Maximizing the Potential of Women in Academic Science and Engineering, Committee on Science, Engineering, and Public Policy, National Academy of Sciences, National Academy of Engineering, Institute of National Academies Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering. National Academies Press, Washington, DC2006Google Scholar Our engineering and business colleagues have described similar issues as they search for greater gender equality in their upper ranks.7Hewlett SA Luce CB Off-ramps and on-ramps: keeping talented women on the road to success.Harv Bus Rev. 2005; 83 (48, 50-54.): 43-46PubMed Google Scholar, 8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar Of female engineering faculty in the United States, 1% are full professors.8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar In business, the Harvard Business Review has reported that women comprise less than 6% of the uppermost ranks (ie, presidents, executive vice-presidents, chief executive officers, and chief operating officers) of Fortune 500 companies.10Eagly AH Carli LL Women and the labyrinth of leadership.Harv Bus Rev. 2007; 85: 63-71PubMed Google Scholar Three years ago, then-Harvard University president Lawrence Summers questioned whether "innate" differences accounted for women's inability to advance in math and science. These statements were made in the context of a discussion about the difficulty of recruiting and retaining women leaders in these fields.11Lawler A Diversity: Summers's comments draw attention to gender, racial gaps.Science. 2005; 307: 492-493Crossref PubMed Scopus (5) Google Scholar Despite being unsubstantiated and negative, such speculation recognizes that the paucity of female faculty with full professorship is not unique to medicine. Within academic medicine, the demands of clinical practice, family obligations, and lack of mentoring have all been identified as factors that have a detrimental effect on women's careers.2Bickel J Wara D Atkinson BF Association of American Medical Colleges Project Implementation Committee et al.Increasing women's leadership in academic medicine: report of the AAMC Project Implementation Committee.Acad Med. 2002; 77: 1043-1061Crossref PubMed Scopus (250) Google Scholar, 12Angell M Women in medicine: beyond prejudice [editorial].N Engl J Med. 1981; 304: 1161-1162Crossref PubMed Scopus (41) Google Scholar, 13Levinson W Tolle SW Lewis C Women in academic medicine: combining career and family.N Engl J Med. 1989; 321: 1511-1517Crossref PubMed Scopus (155) Google Scholar, 14Carr PL Ash AS Friedman RH et al.Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty.Ann Intern Med. 1998; 129: 532-538Crossref PubMed Scopus (330) Google Scholar, 15Tesch BJ Wood HM Helwig AL Nattinger AB Promotion of women physicians in academic medicine: glass ceiling or sticky floor?.JAMA. 1995; 273: 1022-1025Crossref PubMed Scopus (380) Google Scholar In a published systematic review of the literature,16Sambunjak D Straus SE Marusic A Mentoring in academic medicine: a systematic review.JAMA. 2006; 296: 1103-1115Crossref PubMed Scopus (984) Google Scholar mentorship in academic medicine was reported to increase personal and career development, as well as research productivity, including publications and grant awards. However, mentoring is not always a positive experience.16Sambunjak D Straus SE Marusic A Mentoring in academic medicine: a systematic review.JAMA. 2006; 296: 1103-1115Crossref PubMed Scopus (984) Google Scholar, 17Palepu A Friedman RH Barnett RC et al.Junior faculty members' mentoring relationships and their professional development in U.S. medical schools.Acad Med. 1998; 73: 318-323Crossref PubMed Scopus (302) Google Scholar In fields outside academic medicine, a large body of research addresses mentoring of women. Several reports8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar, 18Limbert CA Chrysalis: a peer mentoring group for faculty and staff women.NWSA J. 1995; 7: 86-99Google Scholar, 19Ragins BR Cotton JL Mentor functions and outcomes: a comparison of men and women in formal and informal mentoring relationships.J Appl Psychol. 1999; 84: 529-550Crossref PubMed Scopus (806) Google Scholar, 20Jacelon CS Zucker DM Staccarini JM Henneman EA Peer mentoring for tenure-track faculty.J Prof Nurs. 2003; 19: 335-338Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar provide insight for medical academics seeking to mentor women physicians. Adequate mentoring of women might not involve traditional dyadic mentoring. New structures and broader visions for the mentoring of female faculty across many disciplines have been described.8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar, 18Limbert CA Chrysalis: a peer mentoring group for faculty and staff women.NWSA J. 1995; 7: 86-99Google Scholar, 21Berk RA Berg J Mortimer R Walton-Moss B Yeo TP Measuring the effectiveness of faculty mentoring relationships.Acad Med. 2005; 80: 66-71Crossref PubMed Scopus (255) Google Scholar, 22Pololi L Knight S Mentoring faculty in academic medicine: a new paradigm?.J Gen Intern Med. 2005; 20: 866-870Crossref PubMed Scopus (185) Google Scholar, 23Pololi L Knight S Dunn K Facilitating scholarly writing in academic medicine.J Gen Intern Med. 2004; 19: 64-68Crossref PubMed Scopus (83) Google Scholar, 24Bussey-Jones J Bernstein L Higgins S et al.Repaving the road to academic success: the IMeRGE approach to peer mentoring.Acad Med. 2006; 81: 674-679Crossref PubMed Scopus (95) Google Scholar We review various mentoring models within the context of socialized gender differences and describe another mentoring model that has had initial success at Mayo Clinic. Although successful mentoring alone cannot be expected to address all impediments to the academic and leadership advancement of women, the academic medical community must move beyond the point of continuing to describe the problem and begin to develop and institute concrete solutions. The terms sex and gender are not synonymous. Biology determines our sex; society determines our gender. This last statement is not presented as an absolute truth but rather to promote a civil discussion in the midst of what has become hot-button territory. Whether biology has a role in the ultimate expression of behavior need not be debated. Even if society as a whole is moving toward rearing all children in less gender-constricted ways, most adults still function as men and women according to certain socialized gender differences. Men and women think and behave differently in the workplace.25Fenwick GD Neal DJ Effect of gender composition on group performance.Gender Work Org. 2001; 8: 205-225Crossref Scopus (93) Google Scholar, 26Maier M On the gendered substructure of organization: dimensions and dilemmas of corporate masculinity.in: Powell GN Handbook of Gender and Work. Sage Publications, Thousand Oaks, CA1999: 69-94Crossref Google Scholar Early family socialization and schooling experiences result in different work styles and goals.27Gilligan C In a Different Voice: Psychological Theory and Women's Development. Harvard University Press, Cambridge, MA1982Google Scholar These socialized differences lead women to place a greater priority on interpersonal satisfaction and integration than men do. Women are most often motivated by encouragement, whereas men respond to challenge. Men, through the male socialization model, value competition and individual achievement, whereas women more readily respond to collaboration and group affiliation.27Gilligan C In a Different Voice: Psychological Theory and Women's Development. Harvard University Press, Cambridge, MA1982Google Scholar The high value that men place on individual achievement leads them to be much more concerned about rank and ranking behavior, whereas women are more inclined to engage in leveling or equalizing behavior.28Robinson JD Cannon DL Mentoring in the academic medical setting: the gender gap.J Clin Psychol Med Settings. 2005; 12: 265-270Crossref Scopus (15) Google Scholar In both work and social settings, men quickly and informally establish a hierarchy that governs how they relate. In contrast, women quickly establish equalizing relationships, even with their obvious subordinates.28Robinson JD Cannon DL Mentoring in the academic medical setting: the gender gap.J Clin Psychol Med Settings. 2005; 12: 265-270Crossref Scopus (15) Google Scholar Observable differences between men and women in ambition and goal setting have also been described.7Hewlett SA Luce CB Off-ramps and on-ramps: keeping talented women on the road to success.Harv Bus Rev. 2005; 83 (48, 50-54.): 43-46PubMed Google Scholar A survey of professional women in 200429Hewlett SA Luce CB Shiller P Southwell S The hidden brain drain: off-ramps and on-ramps in women's careers. Harvard Business Review Research Report, March, 2005, 1–140.http://www.womenscareersreport.hbr.orgGoogle Scholar revealed that women rarely describe themselves as extremely ambitious, although women in medicine are more likely to do so than women in business are. Only about 20% of those surveyed, including physicians, identified attaining a powerful position as a career goal. Instead, women found it much more important to be able "to associate with people they respect" (82%) and to "be themselves at work" (79%); they also considered it "extremely or very important to have the opportunity to collaborate with others and work as part of a team" (61%).7Hewlett SA Luce CB Off-ramps and on-ramps: keeping talented women on the road to success.Harv Bus Rev. 2005; 83 (48, 50-54.): 43-46PubMed Google Scholar These gender differences in work style, ambition, and goal setting can have implications for successful mentoring models. Traditional Mentoring Model. Mentoring traditionally follows a dyadic model. In these mentoring partnerships, an experienced person (a mentor) is paired with a less experienced individual (a mentee)30Merriam-Webster Online Dictionary.http://www.m-w.com/dictionary/googleDate: 2007Google Scholar within the setting of a long-term relationship built on mutual trust and shared interests. When this pairing occurs informally, the 2 persons find each other on the basis of their shared interests and mutual appeal.31Bhagia J Tinsley JA The mentoring partnership.Mayo Clin Proc. 2000; 75: 535-537PubMed Scopus (51) Google Scholar Recognition of the difficulty that some people have in accessing this informal relationship, especially those who are marginalized (such as women and minorities), has led some institutions to initiate formal mentoring programs in which mentors are assigned mentees.32Fried LP Francomano CA MacDonald SM et al.Career development for women in academic medicine: multiple interventions in a department of medicine.JAMA. 1996; 276: 898-905Crossref PubMed Google Scholar, 33Mark S Link H Morahan PS Pololi L Reznik V Tropez-Sims S Innovative mentoring programs to promote gender equity in academic medicine.Acad Med. 2001; 76: 39-42Crossref PubMed Scopus (67) Google Scholar Formal and informal traditional mentoring models have been shown to increase advancement of mentees.17Palepu A Friedman RH Barnett RC et al.Junior faculty members' mentoring relationships and their professional development in U.S. medical schools.Acad Med. 1998; 73: 318-323Crossref PubMed Scopus (302) Google Scholar, 19Ragins BR Cotton JL Mentor functions and outcomes: a comparison of men and women in formal and informal mentoring relationships.J Appl Psychol. 1999; 84: 529-550Crossref PubMed Scopus (806) Google Scholar Drawbacks to the traditional model include inadequate skills to be an effective mentor, personality clashes, sexual dynamics, different work styles, and conflicting demands on time.34Pololi LH Knight SM Dennis K Frankel RM Helping medical school faculty realize their dreams: an innovative, collaborative mentoring program.Acad Med. 2002; 77: 377-384Crossref PubMed Scopus (171) Google Scholar A mentor of the opposite sex can provide the mentee with insights that are lacking in a sex-matched pair. However, sex-matched mentoring can establish mentoring pairs that maximize the opportunity for mutual understanding, similarity in work styles, and role modeling. Relevant to this discussion is the fact that the dyadic model of mentoring is based on the male socialization model previously outlined. Two major components typify this approach to mentoring: (1) a greater priority is placed on informational and technical conversation than on guidance and psychosocial issues and (2) a greater focus is placed on challenging the mentee and stressing independence.8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar This mentoring style often emphasizes separation over integration, independence over relationship, and competitive tasks over collaboration. Although some women have been mentored very effectively within this model, the model is hierarchical in style, involves a ranked rather than level relationship, and might not be a good fit for other women. Multiple-Mentoring Model. In the multiple-mentoring model, the mentee is encouraged to construct a mentoring community. Multiple mentors are sought to address and support the various aspects and needs of the mentee as he or she advances along a career path. These mentors meet various academic needs, such as providing support and guidance for research interests, educational pursuits, and clinical practice goals. Other mentors can provide psychosocial support by offering insight into work-life balance, work relationships, and work politics.8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar This mentoring model has advantages for women because it allows them to look for and construct a powerful network within their discipline. The mentoring team can include junior and senior staff members, which provides the opportunity for collaborative or hierarchical relationships or both. The model also encourages women to seek out other women, within or outside their discipline, who can serve as role models and provide psychosocial support. This type of mentoring model has been described but has never been studied quantitatively for outcomes.8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar Also, multiple mentoring has never been formalized; therefore, the burden of building a mentoring community falls on the individual mentee. Finding a diverse set of helpers during the stressful launch of a new career might be challenging. Peer-Mentoring Models. Peer mentoring is another strategy that builds a mentoring community while simultaneously de-emphasizing hierarchy and seniority. Various permutations of this mentoring model have been described in the medical, science, and business literature.8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar, 18Limbert CA Chrysalis: a peer mentoring group for faculty and staff women.NWSA J. 1995; 7: 86-99Google Scholar, 22Pololi L Knight S Mentoring faculty in academic medicine: a new paradigm?.J Gen Intern Med. 2005; 20: 866-870Crossref PubMed Scopus (185) Google Scholar, 24Bussey-Jones J Bernstein L Higgins S et al.Repaving the road to academic success: the IMeRGE approach to peer mentoring.Acad Med. 2006; 81: 674-679Crossref PubMed Scopus (95) Google Scholar, 35McDaugall M Beattie RS Peer mentoring at work: the nature and outcomes of non-hierarchical developmental relationships.Manage Learn. 1997; 28: 423-437Crossref Scopus (42) Google Scholar In a peer-mentoring model, people of similar rank who share interests work together toward common goals. This model has been successful in that it allows some balance in both time flexibility and level of commitment when women must deal with unpredictable family and child-care responsibilities or career interruptions.18Limbert CA Chrysalis: a peer mentoring group for faculty and staff women.NWSA J. 1995; 7: 86-99Google Scholar This model can help women maintain some academic productivity during their childbearing and child-rearing years.18Limbert CA Chrysalis: a peer mentoring group for faculty and staff women.NWSA J. 1995; 7: 86-99Google Scholar Peer mentoring benefits participants by providing mutual support, facilitating mutual learning, allowing different perspectives, and developing friendships.22Pololi L Knight S Mentoring faculty in academic medicine: a new paradigm?.J Gen Intern Med. 2005; 20: 866-870Crossref PubMed Scopus (185) Google Scholar, 24Bussey-Jones J Bernstein L Higgins S et al.Repaving the road to academic success: the IMeRGE approach to peer mentoring.Acad Med. 2006; 81: 674-679Crossref PubMed Scopus (95) Google Scholar Women peer mentors can encourage each other collaboratively by envisioning their success as part of their group affiliation, which nicely parallels the socialized gender differences described. An important disadvantage of peer mentoring is inexperience within the group if participants have no clear access to more experienced colleagues for technical support.24Bussey-Jones J Bernstein L Higgins S et al.Repaving the road to academic success: the IMeRGE approach to peer mentoring.Acad Med. 2006; 81: 674-679Crossref PubMed Scopus (95) Google Scholar Logistical problems can also arise about whose needs are to be met first and by what time. As a result, participants in peer-mentoring groups sometimes find that their careers advance at different rates, with some peers being more productive than others.8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar The slow progress of women in medicine in achieving academic rank has been well documented. Academic promotion is less likely for female faculty than for their male colleagues of similar duration of appointment.36Nattinger AB Promoting the career development of women in academic medicine [editorial].Arch Intern Med. 2007; 167: 323-324Crossref PubMed Scopus (26) Google Scholar As of 2006, 85% of full professors at academic medical centers were men.6Magrane D Lang J Alexander H Women in U.S. Academic Medicine: Statistics and Medical School Benchmarking 2005-2006. Association of American Medical Colleges, Washington, DC2006http://www.aamc.org/members/wim/statistics/stats06/start.htmGoogle Scholar At the College of Medicine, Mayo Clinic, 91% of full professors are men. This disparity has clear implications for leadership. Academic rank is a primary factor in selecting department chairs, and such rank is granted, for the most part, in recognition of academic productivity—published papers and funded grants. By both these measures, female faculty lag behind their male colleagues.5Jagsi R Guancial EA Worobey CC et al.The "gender gap" in authorship of academic medical literature: a 35-year perspective.N Engl J Med. 2006; 355: 281-287Crossref PubMed Scopus (615) Google Scholar, 15Tesch BJ Wood HM Helwig AL Nattinger AB Promotion of women physicians in academic medicine: glass ceiling or sticky floor?.JAMA. 1995; 273: 1022-1025Crossref PubMed Scopus (380) Google Scholar Mentorship has been shown to positively influence academic productivity of both men and women.16Sambunjak D Straus SE Marusic A Mentoring in academic medicine: a systematic review.JAMA. 2006; 296: 1103-1115Crossref PubMed Scopus (984) Google Scholar The socialized gender differences described can lead to the conclusion that women in general need a more supportive and collaborative mentoring model. While some women have been successfully supported by both male and female mentors in the traditional dyadic model, new mentoring models are emerging in medicine and other disciplines.8Chesler NC Chesler MA Gender-informed mentoring strategies for women engineering scholars: on establishing a caring community.J Eng Educ. 2002; 91: 49-55Crossref Scopus (171) Google Scholar, 18Limbert CA Chrysalis: a peer mentoring group for faculty and staff women.NWSA J. 1995; 7: 86-99Google Scholar, 22Pololi L Knight S Mentoring faculty in academic medicine: a new paradigm?.J Gen Intern Med. 2005; 20: 866-870Crossref PubMed Scopus (185) Google Scholar, 37Thorndyke LE Gusic ME George JH Quillen DA Milner RJ Empowering junior faculty: Penn State's faculty development and mentoring program.Acad Med. 2006; 81: 668-673Crossref PubMed Scopus (90) Google Scholar Several peer-mentoring models have been described, with some encouraging results.22Pololi L Knight S Mentoring faculty in academic medicine: a new paradigm?.J Gen Intern Med. 2005; 20: 866-870Crossref PubMed Scopus (185) Google Scholar, 24Bussey-Jones J Bernstein L Higgins S et al.Repaving the road to academic success: the IMeRGE approach to peer mentoring.Acad Med. 2006; 81: 674-679Crossref PubMed Scopus (95) Google Scholar, 38Lewellen-Williams C Johnson VA Deloney LA Thomas BR Goyol A Henry-Tillman R The POD: a new model for mentoring underrepresented minority faculty.Acad Med. 2006; 81: 275-279Crossref PubMed Scopus (87) Google Scholar The disadvantages of peer mentoring include the group's lack of connection to experienced leadership, as well as the potential need for mediation in difficult time-management and goal-setting issues. A unique peer-mentoring model was developed at Mayo Clinic after we surveyed the female faculty to ascertain their level of interest in academic advancement and mentoring.39Mayer AP Blair JE Files JA Peer mentoring of women physicians [letter].J Gen Intern Med. 2006; 21: 1007Crossref PubMed Google Scholar In this model, 3 to 5 women with similar academic rank, interests, and goals were identified as a peer group. A more experienced group of female faculty served as facilitators, setting expectations, designating a tailored curriculum, and acting as mediators and liaisons to provide the support the members needed to succeed. Metrics to document success include published papers, promotion in academic rank, and academic career satisfaction. This facilitated peer-mentoring model addresses the key components of the female socialization model. The facilitated peer-mentoring group provides encouragement and collaboration within the context of a group affiliation. It would be speculative at this point to state any conclusions about our peer-mentoring model. Simply instituting a new mentoring model will not eliminate the barriers to academic and leadership advancement faced by women in medicine. Although adequate mentoring is important, it is only 1 of many factors necessary for such advancement. Academic medical centers, including our own, have made great strides toward ensuring diversity within their ranks. Nonetheless, the lack of diverse leadership (women hold only 11% of department chair positions6Magrane D Lang J Alexander H Women in U.S. Academic Medicine: Statistics and Medical School Benchmarking 2005-2006. Association of American Medical Colleges, Washington, DC2006http://www.aamc.org/members/wim/statistics/stats06/start.htmGoogle Scholar) has been identified as 1 possible reason for women's inability to climb higher than the bottom rungs of the academic ladder.36Nattinger AB Promoting the career development of women in academic medicine [editorial].Arch Intern Med. 2007; 167: 323-324Crossref PubMed Scopus (26) Google Scholar The time has come for reasoned and targeted interventions to address these differences. Modest institutional investment, such as that in our new mentoring model, can be invaluable. Leadership support is crucial to these efforts. Without this support, the diversity we seek at our academic medical centers will occur only at the bottom of the academic and leadership ladder. We acknowledge Drs Victor F. Trastek and Jorge Rakela for providing institutional support of our facilitated peer-mentoring project and Dr Michele Y. Halyard for her assistance in expanding our mentoring efforts.