Well, I'm Lucy Spoluto. I am a radiologist at Vanderbilt. I also oversee our Women in Radiology program, and I am the immediate past president of the American Association for Women in Radiology. And so I'm going to start today's session by talking about mentoring, and then I'll turn it over to Dr. Cannon, who's going to talk about sponsorship, and then Dr. Parikh's discussion will focus on coaching. So this talk is focused on mentoring and radiology, not just for early career. And so I've really found that in the past two years with the challenges of COVID and academics changing a little bit and all of the curve balls that have been thrown to us, that mentoring has been more important than ever. And so I'm looking forward to sharing a little bit about mentoring with you and to answering your questions and having a conversation afterwards. So to start with, I think it's important to understand the difference in a mentor and a sponsor, and I won't talk too much about sponsorship since Dr. Cannon is, but really important to understand the difference in the people who can be influential in your career. And one of the best ways I've heard it described is a mentor is someone who has knowledge and will share it with you. And a sponsor is a person who has power and will use it for you. So mentorship we often think of as being more critical early in your career and focusing on career development. It's ongoing, it's constant, it's regular meetings and regular discussions about career development. While sponsorship can sometimes we think of more critical later in the career, really at all points though, and focusing on career advancement, it can be more episodic and transactional. But really these things kind of exist on a spectrum, from the more private and one-on-one aspects of mentorship and building that relationship to the more advocacy focused efforts of sponsorship. So a mentor is someone who provides you with advice and support. This might transition to a strategizer who is someone who shares their insider knowledge about how to advance within an organization. They can sit down and spend time with you strategizing with a mentee about how to get ahead, how to fill in any developmental gaps in the career that might be blocking your academic progress. This might transition a little bit to a connector, someone who helps to make introductions to influential people in a network. Talking about the mentee with their peers, saying I've met with one of my mentees, I think she'd be a really great spot for this position. Using those interactions to learn more about how a mentee is seen by others, to figure out what those gaps in career development might be so they can work together to fill those gaps. To an opportunity giver, something like an executive who might give their protege a high visibility project or a promotion. To that final step of sponsorship, someone who's publicly advocating for you to either get a promotion or a new position or give a talk or get involved with a research project. Something that the person who's being sponsored might not be able to do themselves when they need someone to give them a hand or an introduction. So really that idea to sponsor someone who's lending you their power. So mentorship is usually a longstanding relationship. Might have regular meetings, weekly meetings, monthly meetings, a lot of planning, a lot of discussions about career development. It fosters career development through a longitudinal personal relationship. A mentor provides advice and feedback to a mentee. But what's really important to think about is we often focus on what the mentee is gaining from a mentorship relationship when really successful mentorship can be transformative for both the mentor and the mentee. And I think that last point is really important. Thinking about how this mentorship relationship is transformative for both the mentor and the mentee. Not only for things like increasing scientific output because you're working on research projects with a mentee, but for general career and personal growth. We learn so much from those around us in a 360 degree fashion. I learn from my mentees almost every day. It's really always interesting to hear their perspectives and their takes on a new way to look at things that as you've been advancing your career, you may forget you may not have that new perspective anymore. So there's so much to learn from mentoring others. Why else is mentorship important? And this came out in the Harvard Business Review recently. And it says a lack of sponsorship is keeping women from advancing into leadership. But really, I think you can insert any of the topics we're talking about into that word where mentorship is. I think a lack of sponsorship, a lack of mentorship, a lack of networking opportunities, all of these things are keeping women from advancing into leadership. And really, you can put any other underrepresented group in medicine or in radiology to where women are stated in this statement. So as radiology strives to improve diversity and inclusion, mentorship will be critical as we develop a diverse leadership. So when we think about mentorship, we often just think about research productivity. And yes, a good mentor can invest time and energy into helping a mentee develop stronger research skills, including development of specific research ideas, really honing in on that spark or an idea and how to move it forward, how to move it forward into an abstract or a publication, refining a research plan, performing statistical analysis, developing academic writing skills. And as a mentee becomes an independent researcher, the mentor can then learn from the mentee in a cyclical fashion. But mentorship goes far beyond research alone. It can help with personal development. This might include formulation of education or other academic ideas, might include offering advice on navigating personal challenges and on work-life balance. Mentorship can also play a key role in retention. In both academic and private practices, physicians with good mentorship relationships are more likely to stay at their institution and be more satisfied with their profession. So supporting mentorship activities, which can be challenging, I know we're all stretched with time and with funds these days, but an institution support of mentorship activities can save institutions a great deal of time and money that would otherwise have to be spent on recruitment efforts if we can improve retention. Mentorship also plays a key role in navigating an academic career path. And this is critical no matter what academic track an individual's on. I know many institutions now have tracks beyond research pathways, clinical pathways, education pathways, leadership pathways. So navigating academia has become increasingly challenging. Mentorship can help to define that vision for an academic path and can focus that vision and put it into action. So this idea of mentorship playing a key role in navigating can help you to determine what makes you stand out, what makes you unique, and how you can achieve the career success that you want to. So academia has become really complex and our needs as radiologists have expanded. And so I think that mentorship now extends, often extends beyond one person, one single mentor to this idea of a mentoring network. And so this is an example that I've placed on the screen from the David Geffen School of Medicine at UCLA showing they'd have a mentoring network. How many people it really takes to mentor an individual. And this is an example of a mentoring network for a trainee. So that horizontal dotted line kind of across the middle differentiates between peer mentors at the top from faculty mentors across the bottom. So your peer mentors might be someone at your same R1, R2, R3 level, your chief resident. And your faculty mentors might include your program director or a research mentor, a champion for scholarship. So all of these people can add different aspects to your mentoring network and can share different areas of expertise. But what might this look like later in one's career? So I've adapted that UCLA mentoring network framework to show what a mentoring network might look like later in one's career. So that horizontal line between peer mentorship and senior faculty mentorship fades a little bit. But the idea that it takes a lot of mentors to successfully mentor an individual has not changed. The topics for potential mentorship is really endless. And so I think as you progress from early to mid to later career, the different areas of expertise that you need in your mentorship network might change. Things like work-life harmony. As you move into mid-career, you tend to get asked to do more and more things. Which things might you say no to to maintain that balance? Honing in on a specific research topic and identifying a mentor who's appropriate for that. If your area of interest is teaching, identifying a mentor who can help you to hone in on your education and teaching skills. And these mentors do not need to be within your own institution, within your own department. I think there's lots of opportunity for mentoring across institutions. And then as later in the career, taking on leadership roles. So lots of different individuals can be involved in these mentoring networks. So I think mentoring is key at all career stages. This includes early career all the way back to students, high school students, undergraduate students, medical students, residents, fellows. It doesn't apply only to physicians either, but to the entirety of the medical team, to your staff. Having really opportunities to advance your career improves retention and satisfaction for people involved in all aspects of the medical team. So early in your career, mentorship might help with idea development, skills development for research or education. In mid-career, the challenge of work-life balance can be more challenging as opportunities begin to present themselves. It can help you to bring your ideas to action in that mid-career. And then later career, sometimes we don't think about mentorship in later career, but I've found it's even more important taking on leadership positions, navigating career changes, becoming a mentor yourself. So there's opportunities and need for mentorship at all career stages. So remember, mentoring is not just for early career, and it's not just for academics. In fact, I think this meeting is a great place to start building cross-institutional mentoring networks for early, mid, or later career individuals. Over the years, I've met people at this meeting and other national meetings who have had significant impact on my career. I even met people randomly sitting on the RSNA bus who I've developed working mentoring relationships with. So seize opportunities to be a mentor or to be a mentee. Thank you so much for your time, and please don't hesitate to reach out with any questions or comments. So my name's Sherry Cannon. I am the chair of radiology at UAB, and I'm going to specifically speak to you today about sponsorship. All right, so this talk is not specifically about diversity, although I never mentioned the opportunity, failed to mention it in the opportunity to talk about diversity and its importance. However, I do feel that one of the keys for diversity is breaking that glass ceiling, and in order to do so, sponsorship is really at the core of that. So the lack of formal sponsorship of women has been suggested to be the reason for gender discrepancy in the high-profile position of business as well in academic medicine. And I'd like to point out Dr. Parikh, who you're going to hear from soon, was one of the authors of this important paper, and then actually Dr. Jagshi. Some of you may know her. She has done some work from University of Michigan, radiation oncologist. So women are over-mentored and under-sponsored relative to their male peers. This is from the article that Dr. Subluto recently referenced from the HBR. And women underestimate the role of sponsorship in their advancement. Moreover, those who grasp it actually fail to cultivate this. So let's talk about it, and you hear us describing a lot of the similarities and differences of sponsorship and mentorship, and maybe why are we going on and on about this? Well, I think it's important to be intentional in both spaces, as a sponsor and a mentor, but also as a protege and a mentee. And to do that, you need to understand the roles. So a sponsor is really one who advocates for the advancement of another, a protege that is, and encourages them that they are ready. Now this later part really falls into the area of mentorship and coaching, and we do have to recognize that there is overlap. So who is a sponsor? Someone who has a rich network, who is typically advanced in an organization that is a highly ranked leader, at the proverbial table is what we're talking about here. And it's someone who publicly advocates for another. So when does sponsorship occur? When is it needed in one's career? And I would say at every step. And some specific examples in the academic world, nominating someone else for committee activity, maybe that's more of an earlier career, as they're more advancing in their career, perhaps to give a talk at RS&A, and then for a leadership opportunity at a later stage, and then ultimately, an honor or an award for another individual. So there really is needed, I would argue, at every stage. Now something that's important at the core of sponsorship is reputation, because you have to remember that sponsor is putting their reputation on the line and advocating for another. So that must be understood and frankly respected. So again, let's talk about mid-career, because oftentimes that's kind of the group of individuals who perhaps are left out. And this is another article talking about mentorship may not be enough, and what is the role of sponsorship? And this was one of the earlier articles, and although not that early, you can see by the date 2019, really that talked about sponsorship. In this case, Hopkins, at Johns Hopkins, they took a group of chairs and their mentees and their protégés and asked them in a structured interview of important characteristics of sponsorship. And this is what they learned. Sponsorship is typically episodic and focused. Effective sponsors, as I mentioned earlier, are established and well-connected talent scouts, and I think that's an important descriptor. Effective protégés rise to the task and remain loyal. Again here, reputation is on the line. Trust, respect, and weighing risk are key to successful sponsorship relationships. And it's critical to career advancement. So again, as we talk about a little bit of the overlap between mentorship and sponsorship, we can see here mentorship, as Dr. Spoluto has already mentioned, is about career development, professional growth. Some describe it as transformational, longitudinal, critical in early career, but really, I agree with Dr. Spoluto, important at every step. Sponsorship shifts a bit, and it moves over to career advancement, moving up that ladder. It is typically focused, and while it is transactional, often focused on a specific position or opportunity, I would argue it can be equally transformative. Now clearly, there is overlap between the two, and we must recognize that. It is key in professional relationships. Both participants benefit. One needs to have multiple mentors and sponsors, and again, this must be intentional. You must actively cultivate these individuals. At the core of both is a relationship. Mentors develop, whereas sponsors drive. Mentors support, whereas sponsors promote. Mentors encourage advancement. Sponsors enable this advancement. Mentors offer insight, but sponsors champion visibility. And again, a continuum of thanking them. Perhaps it's not just mentorship and sponsorship, rather a progression from mentor to strategizer, as Dr. Spoluto has already described, all the way to the advocate. And keep in mind, sometimes sponsorship works when the protege is not even aware. I love this description, to help separate. Mentors are like Sherpas who can guide us to climb towards our goals. Sponsors tell others that we can climb, and coaches work with us to clarify the mountain we want to climb. So let's talk a little bit about leadership and radiology. This is the Society of Chairs in Academic Radiology Departments. These are just the academic radiology departments. And in the early 2000s, about 5% of our membership was women. We have increased that now to almost 20% of radiology chairs are women. And part of this was development of a LEAD program. This is a leadership development opportunity that is a combined effort between SCARD and GE Healthcare, and its sole purpose is to increase the number of women radiology chairs. We're now in our third cohort. This is a year-long training program. But what's interesting about this, it's not just about leadership development, which there's a year of that. It's not just about the networking opportunities that exist, and we also have mentoring within this program. But a key activity of this program is sponsorship. Women cannot nominate themselves for this. They have to be sponsored by their chair. So it actually takes usually the men at the proverbial table to actively sponsor their women. And now we have women who are selected from all over the United States. Again, we're in our third cohort right now. We had to take a pause for COVID. But this is just one example of opportunities for sponsorship. And with that, I'm going to challenge you. So I would challenge each of you to take an opportunity to sponsor in the next six months. And one of the activities that I do with my faculty, and this is just a made-up calendar, so don't try to read it, invariably, usually about mid-career, I will have faculty members that come to me that are overwhelmed. They have said yes to too many activities on too many committees, too many presentations, et cetera, and are overwhelmed. So I have them do, I actually have them do a two-week exercise of literally printing off their calendar, and the first pass going through, and note the things that you like. You know those days when you look at your calendar, your schedule for the day, and you're looking forward to a meeting, or forward to an activity. You also know those activities that perhaps you don't look forward to, and you need to be honest with yourself. Go through, make an assessment of what you like, what you don't like. Then go through that assessment with your mentor to see, are there things that you don't like that maybe you can exit out of? Have that conversation. And then here's the opportunity. If you identify things that perhaps aren't right for you anymore, they're not in your wheelhouse, perhaps no longer a passion, exit out of those gracefully. If there are terms to it, please finish out your term. But in your exit, take it as an opportunity to sponsor someone else, assuming it's a good committee. Don't sponsor someone for a dump committee. But if it's a good committee, tell the chair, hey, my schedule is such that I just can't do this anymore. However, I know so-and-so who would be great at this. Because we have to actively sponsor. We have to do so with intentionality. So with that, and again, this is somewhat based upon, for those of you who read Marie Kondo, The Magic Art of Tidying Up, this is the Kondo effect for calendars. So be a sponsor. And the last three slides of this, I've put in several references for you as well around sponsorship and its role. So with that, I will say thank you and turn it over. Good afternoon. My name is Dr. Jay Parikh. I'm Professor of Radiology and Divisional Wellness Lead for the Division of Diagnostic Imaging at the University of Texas MD Anderson Cancer Center. It is my honor today at RSNA to be able to present the following talk entitled Coaching, Not Just Intended for Early Career. To begin, let's look at some broad concepts related to coaching. Coaching has been very well established for decades now in the business, sports, music, and lifestyle sectors. It is now increasingly being used in healthcare. That being said, one of the ironies about coaching is that there is no current universally accepted definition as pointed out in these references in front of you. As pointed out in this article from Medical Education in 2018, there are, however, specific attributes inherently found in coaches. First of all, coaches use individualized real-time feedback. Aims and outcomes are emphasized. It is not oriented towards process. Facilitation of new behaviors is emphasized, and it is inherently assumed that coaches have experience and expertise in the domain that is being addressed for the benefit of the coachee. As emphasized in this article published recently in the Journal of the American College of Radiology, coaching in its essence represents a human partnership. There is goal-setting, strengths are identified by the coach in the coachee, with leverage potentially of positive psychology, focusing on intrinsic motivations, and generating accountability of the coachee. In the end, the real goal is to develop the best selves of the coachees and to make it a sustainable long-term outcome. Within the medical space, the majority of literature and literature reviews such as these have focused on two primary areas with respect to physicians. First, using coaching as a tool to help improve skill sets for physicians, and secondly, using coaching as a tool to assist medical education. As both these reviews point out, there is a relative lack of robust data in the coaching space. That being said, the balance of literature does seem to support coaching for both these distinct domains. One of the challenges is the overlap of data of coaching related to mentoring because of confusion over these two terms. Let us then try to focus and distinguish between coaching and mentorship, which has repeatedly been confused in the literature. Coaching has a purpose for constant pushing for improved performance of the coachee. The approach is that of a collaborative relationship between the coach and the coachee. The number of individuals being coached may be one or many in a team. Typically, coaching is done for defined periods of time. The primary technique that is used in coaching is self-reflection, and again, the outcome is that of goal setting for the coachee. In contrast, mentorship, the purpose is really to try and use personal experiences of the mentor to motivate and guide the mentee. The approach is that of discussion. Typically, there is a one-on-one individual relationship between the mentor and mentee. There are typically no restrictive time limitations between the mentor and the mentee in their relationship. The technique that is primarily used by most mentors is that of advice and guidance, and the mentor may or may not use goals as an outcome to decide the success of the relationship. The difference between coaching, mentorship, and sponsorship should be relatively clear to most of the attendees by the end of this session between the three talks that will be provided. In its core essence, however, a coach talks to you, a mentor speaks with you, and a sponsor talks about you. Another potentially exciting use of coaching in the healthcare space would be that of leadership training and that of a leadership style using coaching. As a backdrop, however, we wish to emphasize that there is significant skepticism right now within the business sector about the value of leadership training. These two articles, in which Dr. Bier from the Harvard Business School is primary author, calls into question the expense of training, calling it the great, quote-unquote, training robbery, quote-unquote. The estimated annual spend in 2015 in the United States alone was $160 billion, with a B, $160 billion in leadership development in business corporations. Across the globe, there was an estimated $356 billion invested in leadership development. There is interest as well in spending significant dollars in the healthcare space if for no other reason to try and improve physician retention in healthcare systems. The AMA estimates that it costs anywhere from $500,000 to $1 million expense to replace every physician that leaves a healthcare system, and this was recently corroborated in a blog published by Atrius, one of the healthcare systems within the United States. Recently, the group from Cambridge published a systematic literature review that looked at evidence-based leadership development for physicians. Using a computer database approach, they found almost 19,000 potential studies, and after using exclusive criteria, found 25 relevant empirical studies, which underwent systematic coding and analysis. They used a validated instrument called the MRSCI, which stands for the Medical Education Research Study Quality Instrument, and what they found using this analysis is that the balance of literature does support that physician development through leadership training supports outcomes for the individual physician, as well as outcomes related to patients, which could potentially help organizations. One of the effective interventions that was identified was coaching. However, the study, like others before it, have pointed out the need for more objective data with endpoints to monitor the benefit longitudinally of coaching. There has been significant interest as to whether or not coaching can also be used as a tool by leaders to help address burnout of physicians and other healthcare professionals in their organizations. According to the World Health Organization, burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. Note the emphasis on this being an occupationally related phenomenon. There are three dimensions of burnout, namely one, feelings of energy depletion or exhaustion, two, increased mental distance from one's job with associated negativism or cynicism, and three, reduced professional efficacy. Within the past half a decade, significant peer-reviewed literature has been published regarding the domain of burnout within the specialty of radiology. Presented in front of you are six independent peer-reviewed publications in six different journals performed by six different collaborator groups involving six different cohorts of subspecialties in radiology. For all six subspecialties, the burnout assessment using validated tools or questions exceeded 50% of radiologists in these subspecialties. Early studies using coaching to help physicians experiencing burnout appear to be positive. This study, which was carried out at the Mayo Clinic, had 44 physicians who were allocated to the intervention of coaching and 44 who were allocated to the control. What they found is that the interventional arm, namely those that had coaching, burnout decreased by 17.1% over the sessions after five to six months. In contradistinction, the control arm, in which there was no intervention of coaching, saw that burnout increase by 4.9%. Remember that this study is relatively small in number. In addition, the coaching sessions on average by the external professional coaches cost an estimated $1,400 per physician to actually receive the coaching to help them address burnout. One of the ways to potentially help curb some of the expenses related to coaching may be to use a group coaching approach or what is called coaching circles. This was recently described by Dr. Michael Fishman and colleagues in this article in JACR from Boston University. What they point out is that self-discovery and self-inquiry can be actually performed as a group. In a circle of trust, relations can build and there can be reduction of isolating barriers amongst members of the group, helping to form a team concept. While coaching is important and can help improve the personal resilience of physicians trying to overcome burnout and achieve professional fulfillment, this model from Stanford for Wellness eloquently points out that there are three primary components that will contribute to physician professional fulfillment, namely the culture of wellness, efficiency of practice as well as personal resilience. The balance of literature currently suggests that culture of wellness and efficiency of practice probably represents 80% of the opportunity to improve the environment and help improve burnout in physicians including radiologists. Only about 20% of personal resilience can potentially be assisted through methodologies such as coaching. In summary, we need to focus on redesigning processes through systems approaches as opposed to trying to continuously redesigning individuals. That being said, every little bit helps and coaching is certainly a potential step in the right direction. Earlier in this presentation, we emphasized that one of the attributes expected of a coach is to have expertise and experience in the area that the coach is actually practicing in. One of the issues that will need to be worked out with further research are different stressors in different sub-specialties of radiology. In front of you is a recently published study in the Journal of Breast Imaging that looked at the prevalence of stressors amongst breast radiologists. If we look at the list of stressors, for example, the top three such as practicing faster, work-life balance issues and fear of lawsuits, we could potentially see how many of these may carry over into other sub-specialties of radiology. However, what is less clear is if other issues such as dealing with regulations from quality insurance and MQSA and dealing with difficult patients, for example, really would cross over into other specialties with less patient contact and less accreditation issues. Future research will help carry this out and will help ascertain whether or not coaches of one sub-specialty of radiology may still be as effective for other sub-specialties of radiology. So what are the take-home points that the attendee should walk away with from this presentation? First of all, in tandem with the eloquent presentations provided by Dr. Cannon and Dr. Spoluto, the differences between coaching, mentorship and sponsorship should be now clear to the attendee. In this specific session, we called out that there is in the business sector significant skepticism regarding the value and efficacy of leadership training. That being said, leadership training continues in healthcare with coaching being one of the tools used. The recent analysis and review conducted by the Cambridge Group does have evidence suggesting that the balance of literature supports outcomes of behavioral improvement in the individual physicians as well as outcomes infecting patients and healthcare systems being improved as well. As far as coaching as a tool for helping physicians with burnout, early studies do look promising, but in general, much more robust studies are needed with longitudinal outcomes to help better demonstrate the potential value of coaching. Thank you so much to all of you for your attention.

radiology

mentoring

sponsorship

coaching

career development

professional growth

diversity