Journal of Clinical Psychology in Medical Settings, Vol. 12, No. 3, September 2005 ( C© 2005)DOI: 10.1007/s10880-005-5745-4

Mentoring in the Academic Medical Setting: The Gender Gap

John D. Robinson1,3 and Dawn L. Cannon2

Mentoring is an essential part of success in the academic medical center. The provision of ef-fective mentoring is key to the success of the increasing numbers of women entering medicine.However, the gender distribution within the hierarchy of medicine has not changed in that thepower still resides with men in the system. Currently, men are attempting to mentor women,and so as the proportion of women in medicine continues to grow, they will become moreinfluential in this setting and will become increasingly responsible for providing mentoring tomen. In either case, effective communication across gender lines is an essential aspect of thementoring process. Psychologists in academic medical settings can provide guidance to facultyand staff on the critical aspects of social development and communication, which may affecthow women and men are mentored and the success of this mentoring process, whether acrossor within gender lines.

KEY WORDS: mentoring; academic medical centers; women in medicine; gender communications; socialdevelopment.

Changes within the academic medical centerare occurring such that the gender distribution hasshifted to a majority female population within themore junior ranks, and within certain medical spe-cialties (Barzansky & Etzel, 2004). However, the gen-der of the hierarchy of medicine has not completelychanged. Power in the system still resides with men(See Fig. 1). These changing demographics suggesta need for change in the styles of mentoring that inthe past have been predominantly male oriented. Nolonger should male-oriented styles of mentoring con-tinue to prevail in this environment. Senior facultymust be able to utilize flexible styles of mentoring inorder to assist students, interns, residents, and youngerfaculty of both genders in negotiating the academichierarchy. In this time of transition, psychologists inacademic health centers can play a special role in fa-

1Departments of Surgery and Psychiatry, Howard UniversityCollege of Medicine/Hospital, Washington, DC.

2Office of the Dean and Department of Pathology, Howard Uni-versity College of Medicine, Washington, DC.

3Correspondence should be addressed to John D. Robinson,Department of Surgery, Howard University Hospital, 2041Georgia Avenue, NW, Washington, DC 20060-0002; e-mail:JDRobinson@Howard.edu.

cilitating change by virtue of their specialized knowl-edge of developmental psychology, learning theory,interpersonal dynamics, etc., that bear on the actionsof mentors and the experience of mentees.

Similar mentorship issues arise in the field ofpsychology within academic medical centers due tothe rising proportion of women entering professionalpsychology. According to the American Psychologi-cal Association (APA), in 2003 51% of APA mem-bers were women, 74.7% of graduate student affil-iates were female, and 61.7% of the early careerpsychologists (those with doctoral degrees less than7 years) were women (Kohout & Wicherski, in press).The number of women receiving doctoral degreesin psychology has increased greatly over the past30 years. In 1974, women received only 22.7% ofthe doctoral degrees in psychology, as compared to50.9% in 1986, and 67% in 2000, as reported byKohout and Wicherski. Given the reality of genderissues in the mentoring process, how can we best pre-pare psychology students and other trainees for in-ternships/residencies in academic health centers, andhow can faculty in these centers best approach theirrole as mentors and teachers? We need to approachthese gender issues in the mentoring process both as

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Fig. 1. Percentage of women at different levels of the medical school hierarchy (Adapted from AAMC, 2005).

psychologists and as members of academic health cen-ter faculties who can assist other health profession-als in increasing their effectiveness as teachers acrossgender lines.

THE DEVELOPMENTAL DIFFERENCE

It is well known that mentoring can differ, de-pending upon the gender of the mentor and the

mentee. Common knowledge tells us that mentoringrelationships are more productive when the mentorand the mentee share common experiences. The anal-ysis of issues of cross-gender mentoring must beginwith the recognition that men and women are dif-ferent in a broad spectrum of ways, and that suchdifferences emerge early in life. Developmental psy-chology and common observation teach that from anearly age, boys and girls react differently to the social

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environment. One needs only to look at how childrenplay. Little boys tend to engage in play activities thatrequire aggression and order giving (Eagly, 1987). Inthese games, a leader is designated and others fol-lowing the “commands” of the leader in order to ac-complish a known goal, e.g., as in football or baseball.Rank is very important and power is ascribed to theperson holding the highest designated rank or status.Boy’s games tend to be outcome oriented: focused onthe touchdown, on winning the game, etc. The goalsof the team are important, rather than those of the in-dividual player (Gergen, 1990). In contrast, little girlsat play tend to engage in games that lack hierarchyand favor the acquisition of verbal skills. Establishedleadership tends not to play an important part in theirgames (Leve & Fagot, 1997). Girls tend to be moti-vated more by empathy and the reactions of others;there is more of a tendency to relate to each other in afashion that conveys that all are equal and that thereis no stated hierarchy or leader. Thus, girls tend to re-late to each other on a common basis. Games playedby girls are more process oriented where individualgoals are acknowledged. Status and power are not atissue. For example, when little girls play a game of“house,” all mothers that play are equal in status. Incontrast, boys tend to play games such as football orother team sports where there are definite leaders anda hierarchical system (Gergen, 1990).

These trends in gender differences continue laterinto life. When one observes adult social behavior, itcan be noted that men tend to cluster according to per-ceived “rank.” It can be observed that upon meeting,men frequently attempt to ascertain place of work, ti-tle, and rank. This is an attempt to informally establisha hierarchy by which they will relate. We have oftenheard military spokespersons discuss the importanceof “unit cohesion,” where all members of the unit areclear as to how they function; all members share acommon goal with little disruption and struggling forpower within the ranks. Military organizations havea definite “rank” structure where members of lesserrank follow the orders of those with higher rank.

Intriguing differences between the sexes alsoseem to exist with respect to leadership—the exer-cise of influence or authority within groups. When at-taining leadership positions, females tend to adopt amore democratic approach than males, inviting moreinput from group members and allowing them greaterparticipation in decision making (Eagly & Johnson,1990). Further, females tend to devote more atten-tion to maintaining good relationships with subordi-nates than do males. Eagly and Johnson (1990) spec-ulate that such differences may derive, at least in part,

from the fact that females possess better social skillsthan males, and so are more effective at using a demo-cratic or participative style of leadership (Baron,1992). In essence, men tend to direct while womentend to facilitate, each playing to what are oftenstrengths. These characteristics, of course, carry overinto adult life in a wide range of settings, and so willlikely affect behavior in academic medical settings.

It is noteworthy that men are often perceivedas more successful in positions of leadership thanwomen. Perhaps game playing and related childhoodinfluences contribute to this tendency, which may bea carryover from men’s early developmental tenden-cies to seek and have experiences that prepare themfor positions of command. Moreover, there are indi-cations that women whose socialization experiencesinclude competitive sports experience are more likelyto attain higher positions. Del Jones (2002) noted thatmale CEOs often have backgrounds in competitivesports. He reports a February 2002 study by the Op-penheimer mutual fund company, which found thatwomen who follow that same path are more likelyto become executives. Eighty-two percent of execu-tive businesswomen played organized sports after el-ementary school, as compared to only 61% of adultwomen in a separate Internet survey of the gen-eral population. The Oppenheimer study found thatnearly half of women who make more than $75,000a year identify themselves as athletic. The results ad-vance a 1997 survey by the Women’s Sports Foun-dation that found that 80% of female executives inFortune 500 companies identified themselves as hav-ing been “competitive” and “tomboys” in their youth.Today, the number of girls playing high school sportsis approaching 3 million, up from 300,000 in 1970.Though sketchy, the data suggest two trends, namely,women exposed to male competitive sports are likelyto climb higher in organizational settings and thatmore young women are having such experience. Thelong-range effect of young women increasing partic-ipation in male competitive sport on women’s careerpaths remains to be seen. Much will depend on therelative importance of nature versus nurture. Perhapssuccessful businesswomen are born competitors and,therefore, drawn to athletics at a young age. Alterna-tively, competitive sports may ignite a drive in womenand teach lessons applicable to business and othercompetitive organizational settings—or both factorsmay be important.

There is no doubt that the structure of academicmedicine constitutes a competitive organizationalsetting, a setting with many characteristics that re-semble those in competitive sports. Teamwork and

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hierarchical leadership are key aspects of organizedmedical practice. Competitive sports, which are tradi-tionally seem as male games, teach lessons in team-work and leadership; discipline and perseverance; thecourage to take risks; and the ability to learn from fail-ure. Medical students and residents face comparablechallenges as they progress through medical school,residency, and the faculty ranks. Success depends onhow well one negotiates these challenges.

GENDER DIVERSITY IN MEDICINE

As is the case in many other previously male-dominated professions, the face of medicine is be-coming increasingly female. The American Associ-ation of Medical Colleges (AAMC) reported that,between 2002 and 2003 alone, the number of first-time female applicants to member medical schools in-creased by 8.5% (2002 = 12,649; 2003 = 13,730). Thenumber of female matriculants increased by 1.2%,as did the number of women accepted. For 2003,there were 8,212 female and 8,326 male matriculantsin American medical schools. The 2002 applicationyear marked the first time that women outnumberedmen as first-time applicants, with women accountingfor 50.8% of the applicants (AAMC, 2004). Givencurrent trends, the 2005 application year may be thefirst time ever that the number of female matricu-lants in medical school will exceed that of their malecounterparts. Ascending the hierarchy of medicine,one finds similar trends, though not a gender rever-sal in most cases. The Journal of the American Medi-cal Association (Barzansky & Etzel, 2004) reportedthat in August 2003, more than half of postgradu-ate trainees in the following specialties were female:dermatology (57.5%), family practice (51%), medicalgenetics (56%), obstetrics and gynecology (74.4%),pediatrics (68%), and psychiatry (52%). In contrast,only 10.2% of thoracic surgery residents, 9.4% of or-thopedic surgery residents, and 12% of neurologi-cal surgery residents were female. Among faculty inAAMC member institutions, change is sluggish, butoccurring nevertheless.

CRITICAL MASS

Despite the increasing number of women inmedicine, the female component of the medical work-force can be conceptualized as a pyramid, with muchlarger numbers of lower-status (medical students, res-idents, and junior faculty) females comprising the

pyramid’s base than males (See Fig. 1). This statusinequity is amplified in certain overwhelmingly maledisciplines, e.g., surgery, cardiology, orthopedics, etc.In these nearly all-male enclaves, female residents andfaculty can feel isolated and be isolated, either inad-vertently or deliberately. Any minority is expected toconform to the behavioral standards and to inculcatewithin themselves the cultural beliefs of the majority,and also to be excluded from social and professionalnetworks. Medical women in overwhelmingly maleenvironments may find themselves in such situations.Because the environment is less welcoming, genderdiversity will be slow to arrive. This creates a viciouscycle in which women remain few and far between,and their isolation continues. Over time, if gender eq-uity is achieved, i.e., if a critical mass of women de-velops in some now heavily male-dominated special-ties, behavioral conformity and cultural assimilationto male-dominated values may begin to recede.

These issues arise not only for women in heavilymale medical specialties, but also for women in se-nior faculty and administrative positions. Women gainpromotion and tenure less frequently, and female fullprofessors are in the minority. It has been noted andinformally observed that women are usually given de-partmental and college-wide committee assignmentsthat are not seen as powerful, decision-making po-sitions. Except in female oriented departments suchas pediatrics, family medicine, and OB/GYN, thereare few women in senior administrative positions inmedical departments. Also, few women serve as deansof academic affairs in medical schools or as medicalschool deans. According to AAMC, of the 125 medi-cal schools in the United States, only 13 are headed byfemale deans (Chapman, Personal communications,Office of Women in Medicine, Association of Amer-ican Medical Colleges, January 3, 2005). Moreover,women on the decanal level tend to be in positionsresponsible for student affairs, public affairs, etc.

IMPLICATIONS OF INCREASED GENDER DIVERSITY ONMENTORING IN THE MEDICAL PROFESSIONS

Heilman, Wallen, Fuchs, and Tamkins (2004)found that women in traditionally male-dominatedfields, such as medicine, face a difficult hurdle. Ifthey succeed, their coworkers, both male and fe-male, may unfairly see them as unsociable and dif-ficult to work with. In this study, successful womenwere characterized as more selfish, manipulative,and untrustworthy. Thus, women succeeding in a

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traditionally male-dominated profession were viewedas unpleasant persons. Both men and women tendto penalize women for success—a tendency that maylimit women’s progress in traditionally male fieldssuch as medicine. Women who succeed in lines of workthat are not male-dominated or thought of as off limitsto women are probably viewed more favorably, and somay face fewer barriers to success (Dingfelder, 2004).

The impact of increased gender diversity is, andwill continue to be, felt in a myriad of ways, not theleast of which are the challenges and opportunitiessuch diversity will present to the mentoring relation-ship. Mentoring and being mentored are critical el-ements of optimal professional growth and develop-ment, and many believe that mentoring others is partand parcel of dues paid in return for mentoring re-ceived in the past. Given a male-dominated professionwhere mentoring must take place, what happens whenthere are more women to be mentored, and increas-ingly more women who are in a position to mentor?Moreover, what happens when men mentor women,and women mentor men? Given developmental dif-ferences between the genders, and if ease of negoti-ating the medical hierarchy is gender related, cross-gender mentoring may present special challenges.

CROSS-GENDER MENTORING

The prevalence of males in higher-status posi-tions within the medical hierarchy provides muchmore frequent opportunity for the male men-tor/female mentee pair to operate than the femalementor/male mentee pair. Within medicine, as inmany fields, the latter relationship is a relatively re-cent phenomenon, and so much of the discussionhere will center on the male mentor/female menteerelationship.

The mentoring relationship can be conceptual-ized in several ways. The basic elements are similarto those of other relationships. Both parties thinkand feel, both narrowly within the relationship, andbroadly, within the context of the immediate environ-ment and larger society; they also communicate, ver-bally and nonverbally, and act, and each element ofthe relationship is dynamically responsive to a com-plex interaction of all other elements. There are alsocertain behaviors/roles that characterize the mentor-ing relationship. From the mentor’s perspective, theseinclude, but are not limited to: champion, cheerleader,compatriot, guide, challenger, and role model. Theseroles intersect and interplay with different styles ofcommunication and behavior seen in the mentor-

ing relationship. In selecting a mentor, mentees areguided by assumptions related to who has the mostexpertise, and who will be most willing to take thetime and effort to share that expertise with a more ju-nior colleague. Assumptions related to the mentor’srelative “busy-ness” and levels of commitment to ca-reer are weighed, along with the mentor’s approach-ability and perceived circle of influence. In order tobe mentored, the mentee must, at least temporarily,be in or assume a complementary, and often (thoughnot always) subordinate role.

It is noteworthy that the concept of the menteeas subordinate can provide the most basic of chal-lenges to the female mentor/male mentee relationshipin a male-dominated society, particularly if the femalementor possesses some characteristics that may tendto lower her status in the eyes of her potential malementee. For example, if the female mentor is youngerthan many of her peers, or is a member of an ethnic mi-nority group traditionally seen as less powerful thanthat of the mentee, the mentee may not be acceptingof a subordinate position at any time. In this example,or simply as a result of gender bias, a woman men-tor may be perceived less easily as champion, com-patriot, guide, challenger, and role model, therebyshortcircuiting the mentoring relationship before itbegins. Specialties such as obstetrics and gynecology,in which women faculty constitute a clear majority,provide especially fertile ground for the explorationof these aspects of the female mentor–male menteerelationship.

At the heart of many mentoring relationships isthe idea that the mentee aspires to be like the mentorin some way, and that this can realistically be achievedby the mentee. Role modeling is key to an optimallysuccessful mentor/mentee relationship. Sometimes,cross gender pairing may not work merely becausethe mentor literally does not “look like” someone thementee can eventually become. The mentee must re-spect the expertise and the assumed good intent ofthe mentor, then follow the guidance provided or takeup the challenge offered. A good mentor would notcoax a mentee in the wrong direction or challenge thementee to take an action that would delay or workagainst the mentee’s progress.

THE LANGUAGE AND BEHAVIORS OF MENTORING

Differences between the genders in communica-tion and language styles are thought to develop froman early age (Eagly, 1987). Communication acrossgenders in the context of the mentoring relationship

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parallels communication across gender lines in otherrelationships. Men in mentoring roles tend to “tell”the mentee what to do and what is expected. Femalesin mentoring roles tend to “ask or advise” the menteewhen giving direction. This can cause a problem incommunication when the mentor is of a different gen-der than the mentee. Thus, if men tend to communi-cate and “hear” differently than women, then malementors will tend to communicate differently than fe-male mentors, and female mentees will tend to receivethose communications differently than male mentees.Even within a traditional medical hierarchy, those ofboth genders who are flexible and able to call upona number of different modes of communication, ascircumstances dictate, will be able to work with thegreatest variety of people, whether as subordinate,colleague, or superior.

Men tend to operate more comfortably when ev-eryone concerned observes the prevailing hierarchy.“Ranking” behaviors are those that place the menteesquarely in his or her “place,” e.g., actions such ascalling the mentee by first name, but never extendingthe invitation reciprocally, consistently arranging theagenda of a meeting in a certain rank order, such thatthe subordinate station of the mentee is repeatedlyemphasized, and so forth. Women, on the other hand,are more inclined to engage in leveling behaviors thattend to blur or minimize status differences, and whichhelp the mentee begin to see him or herself as a col-league rather than as a subordinate. For example, amentor might level by having the mentee over for aninformal dinner with the mentor’s other colleagues,or inviting the mentee to address the mentor by hisor her first name, and so forth. What is the ideal com-promise? A mix of styles that includes ranking wherenecessary and appropriate, and leveling where ableand comfortable, thus providing models of flexibilityfor the mentee, that have the advantage of allowinghim or her to “try on” collegial behavior at appropri-ate times.

CROSSING THE DIVIDE

With the increasing number of women attendingmedical school and assuming positions as residents

and faculty, it is important that mentoring oppor-tunities be expanded. Cross-gender mentoring canbe very effective in accomplishing this, but in orderfor this to be effective, various styles of communi-cation that tend to be gender based must be under-stood. Knowledge of developmental psychology canbe helpful in understanding and enabling more effec-tive communication between genders. We must un-derstand the role of power and status with respect tomen and women and how these roles enable or im-pede progress in the academic medical setting. Psy-chologists in academic medical centers can play a keyrole in teaching effective communication skills to bothgenders, and can also serve as advocates for genderequity by monitoring women’s advancement in thesesettings.

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