Overcoming Division and Bias in Mentorship: Maximizing Bidirectional Growth in Medical Training Open Access

Individuals who identify as underrepresented in medicine (UIM) face distinct challenges before and during their medical education and training.¹  Current strategies to improve the experiences and address the shortages of UIM trainees and faculty have ranged from targeted recruitment efforts, educational sessions for UIM and minority populations, and intentional pairing of UIM faculty mentors with UIM trainees. While these efforts are necessary, they bring about change slowly and have inadvertently brought upon the “minority tax” for UIM faculty.²  It is simply not possible, nor equitable, for UIM faculty to shoulder the burden of mentoring or coaching all UIM trainees in their educational systems. To address the challenges of limited UIM faculty, we developed a workshop exploring the power of narrative stories to leverage understanding and improve mentoring relationships between UIM trainees and non-UIM faculty by finding common ground through life experiences.

We developed a 90-minute workshop based on a qualitative study published in 2004 entitled “A Fly in the Buttermilk: Descriptions of University Life by Successful Black Undergraduate Students at a Predominantly White Southeastern University.”³  We introduced 5 themes from the reference texts: (1) unfairness/sabotage/condescension; (2) isolation and connection; (3) “They seem the same, I’m the one who’s different”; (4) “I have to prove I’m worthy of being here”; and (5) invisibility and super visibility. We developed a worksheet for participants to self-reflect on a theme that resonated with them and utilized small and large group discussions to explore the impact of these themes. This workshop aimed to prepare participants to develop cross-cultural coaching/mentorship relationships with trainees whom multiple themes may have impacted. We presented this workshop locally and nationally throughout 2022, obtained immediate feedback, and assessed its long-term impact.

We recruited participants (N=64) from a variety of pediatricians and pediatric subspecialties, as well as program directors and associate program directors of internal medicine, family medicine, anesthesia, and general surgery, to complete the immediate feedback form during our national presentations. These participants experienced this workshop at the Pediatric Hospital Medicine Meeting, annual Stanford Medical Education Forum, Riverside University Health System Graduate Medical Education Retreat, or Association of Pediatric Program Directors Meeting in 2022. Nearly all (95%, 61 of 64) agreed that this activity was a worthwhile investment in their professional development, was relevant to their professional role, and taught them new knowledge and skills (Figure). Most (89%, 57 of 64) participants felt more equipped in cross-cultural coaching/mentorship, and 70% (45 of 64) agreed they would likely use a facilitator’s guide to plan a workshop at their home institution (Figure).

To evaluate the long-term impact of this single-series workshop, we recruited participants from our local institution and the national conferences referenced above to complete a Qualtrics survey. We received 27 follow-up surveys. All (100%) respondents agreed that using these themes in stories decreased barriers when working with mentees of different cultural or racial backgrounds (Figure).

Based on participant responses, our one-time workshop had both a short- and long-term impact. Decreasing barriers between individuals with different racial, ethnic, cultural, and socioeconomic backgrounds is critical to developing resilient, diverse health care teams. Using these 5 themes and associated personal stories may help build connections among team members by lowering barriers between mentors and mentees of different cultural or racial backgrounds. To make this workshop and its supplemental documents available for anyone, we created a website with access to the project’s background, a PowerPoint and worksheet, and an optional Zoom session to develop a way to apply this information to their respective institution. This website can be accessed at https://sites.google.com/llu.edu/theflyinthebuttermilk/home.