Women physicians continue to lag behind their male counterparts in academic advancement and in promotion to leadership positions [1]. Women have constituted almost 30% of students admitted to medical school as far back as 1980, and since 2003 men and women have been admitted to medical school in virtually equal numbers [2, 3]. In 1980, 9% of female faculty achieved the rank of full professor during their academic career. The Association of American Medical Colleges 2010 benchmarking report on women in leadership revealed this percentage had improved only modestly to12.5%. This is compared to 30% of all male faculty achieving full professor status in 2010, a stable proportion over the same 30 years [1].

Statistics regarding women faculty in leadership positions are equally disconcerting. In 2010, only 13% of department chairs were female, with numerous medical schools reporting never having had a woman in a department chair or dean position [2, 3]. Women faculty's failure to make substantial gains in academic rank and leadership is even more alarming given the attention and efforts to correct this imbalance for over 20 years [4–19]. Lack of mentoring, demands of clinical practice, and family obligations, as well as poor or absent succession planning, have been identified as possible contributors to these disparities [5, 6, 20–28].

Mentoring has long been an essential component of career advancement within academic medicine and other disciplines [5–10]. Understanding the important role of mentoring has led many academic medical centers to develop, support, and promote mentoring programs. The mentors, mentees, and the programs themselves are challenged by increasing clinical, research, and administrative demands [27, 29, 30]. Beyond the traditional dyadic mentoring model, a number of mentoring models, including multiple- and peer-mentoring models, have been described and studied [31–36]. Peer mentoring, in a variety of permutations, has been described as an alternative to the traditional dyadic mentoring model [33–35, 37–39]. In facilitated peer mentoring programs, faculty typically work collaboratively in groups of 3 to 5 with other faculty who are of similar rank and who have similar academic interests. A facilitator (a faculty member of a higher academic rank) works with the group in meeting their scholarly goals. Very little has been written on the actual outcomes of such nontraditional mentoring models on academic skills and scholarly output of mentees.

Reports of women faculty's greater appreciation of the process of collaboration [40], and differences in preferred work style [41], may lead to a broader applicability of peer mentoring models with women than their male colleagues. Women have reported more difficulty in identifying mentors and developing successful mentoring relationships. Whether gender concordant mentors are of benefit has been a point of dispute [29].

The Department of Medicine at Mayo Clinic, Rochester, Minnesota, has 153 women (24% of total) faculty. Gender disparities in academic rank and leadership opportunities led the department's leadership team to evaluate strategies to close the gap. Focus group discussions and surveys suggested that a lack of mentoring and social isolation were common themes reported by women faculty. Peer mentoring was considered to be a critical ingredient to a multipronged approach to address these issues. By means of this paper, we aim to discuss the process and outcomes of an expanded 12-month facilitated peer mentoring project. Our primary objective was to study the impact of facilitated peer mentoring on scholarly output, specifically manuscripts submitted for publication. Secondary objectives were to study the impact of peer mentoring on self-efficacy of writing skills and networking.

This project was declared exempt by the Mayo Clinic Institutional Review Board.

Five peer mentoring groups, comprising a total of 19 as mentees and 4 as facilitators, formed the project group. Of the 19 mentees, 17 were on faculty in the Department of Medicine of Mayo Clinic, Rochester, Minnesota. The mean number of years on faculty was 6.20 (range, 1.5-22 years). Six of the mentees held an academic rank of assistant professor, 11 had achieved the academic rank of instructor, and the clinical fellow and nurse practitioner had no academic rank. The participants were divided into 5 groups each with 3 to 5 mentees and 1 facilitator.

Groups were encouraged to meet once weekly, and to meet at least monthly with their facilitator. The actual meeting frequency varied widely from every week to once every 4 to 6 weeks. In one group, the facilitator joined the mentees for most meetings. Others met with their mentees at least once a month. Regardless of meeting frequency, mentees had regular e-mail and phone connectivity with other mentees and facilitators between meeting times. The facilitators had a monthly in-person or phone meeting during which they updated the others, discussed successes, problems and roadblocks, and shared best practices.

At the end of the 12-month project, 9 manuscripts were submitted (mean/group 1.25, SD 0.50, range 1-3) by the 5 groups. Of the 9 submitted, 6 papers are in press or have been published and another 2 have been invited to be revised and resubmitted. In addition, 1 peer mentoring subspecialty group designed and completed a clinical research project, and at the time of manuscript writing had presented their findings at a national meeting. They are working on completing the manuscript related to this project. The distribution of papers and academic work completed was not equal between the groups: 1 group completed 3 manuscripts, 3 groups completed2 manuscripts, and 1 group completed1 manuscript. Another group did not focus on manuscript writing, but on clinical protocol design and execution. In addition, 1 of the groups who completed 2 manuscripts also completed and submitted a grant.

Although each mentor and participant signed an agreement to consistently participate in the group mentoring sessions, the individual groups were not asked to commit to a specific frequency of meetings and were not required to document number and length of interactions. Thus, data on the distribution of frequency or total number of hours the groups met are not available.

Participation in the peer mentoring program was associated with the achievement of several additional academic and career goals. Among these participants were 2 individuals who pursued advanced degrees: a masters of public health and a masters in academic medicine, and the appointment of 1 individual as a divisional practice chair. Four individuals received 5 grants (4 institutional grants and 1 position on a KL2 grant). These achievements were distributed throughout the groups without concentration in the groups with the higher manuscript completion.

The facilitators were highly satisfied with the peer mentoring program (mean satisfaction score 4.4, SD 0.55; scale range 1-5) and with the overall interaction of their individual peer mentoring groups (mean 4.8, SD 0.45; scale range 1-5). The facilitators' satisfaction with the quality of the papers was also high, with a mean satisfaction score of 4.25 (SD 0.50; scale range 1-5). All facilitators and 89% of the peer participants reported that they were willing to both facilitate future peer mentoring groups and recommend the program to other faculty members.

A recent call for cultural change acknowledged the disappointing progress in the advancement of women in academic medicine [3]. This project was intended to modify reported lack of effective mentoring for women faculty and therefore maximize academic opportunities for women in the lower academic ranks. The results of this 1-year effort led to 9 manuscripts (6 of which at the time of this report are either in press or published) and 5 institutional grants. Moreover, when surveyed, participants reported improvements in their career satisfaction, a higher level of engagement in academic pursuits, and progress in formulating specific plans relevant to achieving career goals. Even with respect to acquiring specific skill sets, such as skills with PowerPoint software and other tools, comprehensively reviewing the medical literature, identifying funding opportunities, and learning how to apply for academic promotion, the peer participants reported gains based on pre- and post-survey results. Based on tangible evidence of accomplishment, such as publications and grant funding, as well as participant surveys, this project was deemed a success and has now been expanded to all male and female junior faculty in the department of medicine.

Peer mentoring, as used in this project, has been described as an effective mentoring method for both male and female faculty [15, 16, 19–21]. At the present time, little published data exist regarding the scholarly output of mentees enrolled in such models to determine whether gender differences will be seen in academic productivity and advancement. One clue in predicting success may be the collaborative underpinnings of most peer mentoring approaches. A recent qualitative study of faculty views on collaboration revealed that women appreciate the process of collaboration in and of itself, independent of the collaborative product. Male faculty reported an interest in collaboration only as a means to the end result, or academic product [40].

In our facilitated peer mentoring program, participants were, by design, required to work in a collaborative manner within their own peer group. Also, when queried, the mentees reported an improvement in their ability to effectively network with other physicians to find opportunities for collaboration. Our questions, as posed, did not delineate participants reporting an improvement in networking skills in isolation; rather, it was asked in the context of networking as a way to find opportunities for collaboration.

Our program also explored the efficacy of a peer-to-peer mentoring group guided by a more senior faculty member who was gender-matched and acted as a facilitator. The peer mentoring groups in this study were loosely constructed around 3 models of collaboration described by Schneider [22, 29]. Our intent had been to require the peers to self-identify potential peers and, hence, groups by chosen interest. Groups were constructed to reflect shared values, interests, and skill sets to as great an extent as possible. This highly structured approach, which allowed peers to choose their peer mentoring groups but did not require them to find their own mentor, may have accounted for the successful outcomes of this project. Moreover, the fact that the facilitators served on a voluntary basis and were specifically chosen for this purpose may have led to a highly conducive environment that promoted academic accomplishment among women faculty.

There are a number of possible explanations for the variable outcomes among the mentoring groups. Facilitator and participant engagement, discrepancies in baseline academic skills, and frequency of group interactions all could have played a role in the degree of each group's success. As above, the facilitators and participants were not required to log meeting times or report on the degree of individual engagement, but all participants did sign a good-faith agreement to remain active participants. Of note, the group that completed only 1 manuscript was comprised of individuals from different specialty divisions, whereas the other groups included individuals from the same specialty or division. This diversity in background may have led to a slower ramp-up period for this group.

In response to the survey item, "I have the skills necessary to take a clinical question and develop a clinical research project," peer participants' responses did not show a statistically significant improvement over time. This result was not unexpected, perhaps because the project was designed to enhance the writing skills of the peer groups by producing clinical review articles or resurrecting and publishing results from a previously acquired data set. The relatively limited 12-month time frame prompted a stronger emphasis on publishing, which constitutes a solid criterion for academic promotion at most academic medical centers, and less emphasis on idea generation and research project initiation.

As in traditional mentoring relationships, although the gist of instruction regarding manuscript writing was likely similar across all groups, the timing and method of instruction would have varied based on immediacy of issues being discussed in the group, the content of the manuscript, the baseline knowledge of the group members, and the interaction between the facilitators and mentees. Item 14 on the assessment survey, "I have identified an effective mentor," showed a nonsignificant improvement at the end of the program; we are unsure if this means that the various groups were dissatisfied with the mentor assigned to them or if this reflects the participant's response to finding an effective traditional one-on-one mentor.

This program was not designed to serve the facilitators in any way; there were, however, unexpected benefits from their perspective. These included the opportunity to interact with motivated early-career faculty, to participate in a novel and exciting department-wide program, and to serve as coauthor on papers with a variety of fresh topics. Thus, this new program itself was truly bidirectional in its benefits, providing positive effects among both participants and facilitators.

This study is not without limitations. First, although this study spanned a full year, we do not have data on long-term outcomes beyond the project year. It remains to be seen whether the favorable effects observed here are in fact sustained and whether they ultimately lead to academic promotion and increased leadership roles among these women faculty. Secondly, in an effort to be evenhanded in allocating opportunities, this facilitated peer mentoring intervention was provided to all interested junior women faculty within the department of medicine. Traditional one-on-one mentoring continues to be the mainstay for mentoring models in the department, and this project was introduced to engage faculty without such mentors, which likely accounted for the lower number of women who signed up for the program. We did not compare the academic achievements of the faculty who did not sign up for the program with those who did, as this was beyond the scope of the study. Third, in the absence of a comparative arm that might have included either another intervention or no intervention, it is impossible to assess accurately the true positive impact of this facilitated peer mentoring approach. It remains possible that the program self-selected for highly motivated individuals who might have been productive independent of their participation in the program. We point out that this third criticism could be raised regardless of details on the participants or specifics related to the program, and that it remains a criticism of any mentoring program that does not include a control group. Nevertheless, we also point out that this program's heavy emphasis on introducing the mentees to the practical aspects of acquiring clinical research skills, writing papers, and getting these papers published likely had a direct effect on the favorable survey and productivity outcomes described here.

Future efforts may include extending the duration of the intervention, assess long-term outcomes, and seek comparative data that might result from studying other approaches. Although the peer participants in our women-only program did not strongly advocate same-gender mentorship, future studies might also focus on whether different mentoring approaches might resonate better with some groups versus others based on gender distribution.

Mentors are a valuable resource within academic medical centers, and the spirit of altruism that drives such mentoring also drives the academic accomplishment of faculty at most academic medical centers. The current project extended such mentoring opportunities to junior women faculty, demonstrated preliminary positive outcomes in terms of academic accomplishment, and suggests a need for further study of this and other mentoring programs for women faculty.