Mentoring, fellowship training and academic careers of women urologists
Lori B. Lerner, Assistant Professor of Urology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA 02130, USA.e-mail: Lerner_lori@hotmail.com
In 1996, 9.4% of urology residents were female, which had more than doubled to 21% by 2007 . Presumably, with more women entering residencies, more women urologists are seeking fellowship training and careers in academic urology. If true, what influences a woman’s choice to pursue fellowship?
Mentorship is important in academic medicine for medical students, residents, fellows and faculty members. Mentoring can have a positive impact on career advancement, productivity and satisfaction . Interestingly, women in academic surgery report having mentors less often than male colleagues. When mentors are available, they are often male , which is likely to be the case in urology, a traditionally male-dominated field. With more women entering urology, evaluation of mentor availability, emotional support and gender deserves attention.
METHODS AND RESULTS
A Veterans Affairs (VA) Boston Healthcare System Internal Review Board-approved 114-item questionnaire was sent in 2007 to all board certified women urologists yielding a total of 354 women with a 69% response rate (n= 243) [4,5]. In all, 100 women (42%) pursued fellowship training: Female (45%); Paediatrics (19%); Oncology (10%); American Foundation for Urologic Disease/Research (9%); Laparoscopy and/or Endoscopy (8%); Infertility (5%); other (4%). Age at completion of residency (range 26–44 years) did not affect fellowship training nor did academic achievements before residency. In all, 23 of 176 (13%) women obtained Master’s degrees and three completed a PhD. These women were no different from the general group concerning fellowship training (P= 0.17), yet women with academic appointments (assistant, associate or full professor) were more likely to have a Master’s degree (P= 0.03). Women working in academic and VA hospitals were more likely to be fellowship trained (P < 0.001 and P= 0.01, respectively) as opposed to those in a community environment (P < 0.001). There were no differences amongst military and county/public women urologists.
Of all respondents, 71% reported mentors during residency, male and/or female. However, neither mentorship nor gender influenced pursuit of fellowship (P= 0.12). Fellowship-trained urologists were more likely to have peer-reviewed grants (P < 0.001). There were no differences between women with fellowships and those without in salary or overall life satisfaction (95% of the entire cohort chose ‘moderately satisfied’ or ‘very satisfied’).
Given the statement, ‘Women medical students need role models of successful women faculty members’, 89% agreed/strongly agreed. In all, 62 of 240 (26%) women reported female mentors during training and 155 (65%) reported male mentors. Of these respondents, 45 (19%) indicated they had both male and female mentors, while 70 (29%) had no mentor at all. Although 181 (75%) of respondents received emotional support/encouragement by attending staff, this had no bearing on the pursuit of a fellowship or employment in a university environment (P= 0.13).
Women urologists are interested in advanced urology training with nearly half completing a fellowship beyond residency training. While predictable that Female and Paediatric fellowships are most popular, all subspecialties are represented, supporting the broad interests of women urologists. Interestingly, not all women urologists in university-affiliated hospitals, presumably with residency training programmes, were fellowship trained.
Determining factors predictive of fellowship training is difficult. Graduating at an earlier age from residency, academic merit including class rank in medical school, obtaining a first choice urology residency, or advanced degree did not increase the likelihood of fellowship training. Lawton et al.  found that board scores, publications, and awards were not predictive of fellowship training and/or academic careers in neurosurgery. In contrast, positive feedback from academic faculty increased the likelihood that residents would pursue fellowship . Reported factors influential in surgical/surgical subspecialty fellowships include: intellectual appeal; prestige; clinical opportunities in the field; economic gain and/or lifestyle [7,8]. Graduating ophthalmology residents pursuing fellowships list desire to obtain special skills, perceived more favourable job market, and/or prestige as major determining factors .
Regarding mentorship, it seems logical that women with mentors during residency would be more likely to pursue advanced training. This was not the case in the present study because of the high number of women reporting mentors. However, while our percentage is higher than that reported by the Bradbury et al.  study where 35% of women reported no mentors at all, there is still room for improvement.
Mentoring is perceived to be associated with many positive outcomes for the protégé including knowledge, support, guidance, professional identity, and improved psychological adjustment/positive career attitudes . Many believe mentorship is essential in academic medicine and should be available . Studies have suggested that women academic surgeons progress faster professionally when they are mentored and many women report lack of mentorship as problematic . The benefits of mentorship are not gender specific and any junior faculty member who is encouraged and advised will perform better in their career .
Additionally, mentorship can influence specialty selection, so it would follow through that women with strong mentors in residency may choose to follow the same fellowship path [11,13]. The present study did not specifically address this issue, but this is worthy of prospective investigation, querying all current fellows directly. Individuals in academic environments appear to view mentorship as more important than those in non-academic settings, particularly with research. As for mentored fellows choosing to enter academia, results are varied .
Despite mentor influence on specialty choice, trainees’ interest in academic medicine wanes as they progress through medicine . The belief that academic careers lead to less time for family/personal pursuits may deter many from following this path. In the present study, there was no difference in work hours or life satisfaction between those women with an academic appointment and/or working in an academic environment than those removed from academia.
Our respondents felt that female medical students should have female surgical role models. Role models exert strong influences on career choices of medical students . Female medical students who have more interaction with female surgical faculty are more likely to enter surgical careers . Conversely, female medical students agree that appropriate surgical role models to emulate are lacking . There also appears to be a differential response of surgeons as regards to recommending surgical careers to female students. Male surgeons recommend surgery less to women than men, as do women surgeons, but the difference is less significant . Interestingly, the present study mirrored these results, despite high satisfaction levels reported by the cohort.
There is much to be understood and learnt from this study including factors that influence fellowship and mentorship, irrespective of gender. All residents should have a mentor during their training and feel supported by their attending staff; a goal that will ultimately be to the benefit of the entire urological community.
CONFLICT OF INTEREST