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How likely are you to recommend this article to your classmates to extend their understanding of the course materials? 

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Which do you feel is the most necessary interpersonal abilities for an ideal mentor

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What do you feel are the most effective forms of mentorship?

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What do you feel are the least effective forms of mentorship?

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What resources (videos, podcast, articles, blogs, etc) would you recommend to enhance they key arguments in this article? 

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What resources (videos, podcast, articles, blogs, etc) would you recommend to enhance they key arguments in this article? 

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What unanswered questions do you have after reading this article?  

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What unanswered questions do you have after reading this article?  

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What connections can you make between this article and your own experiences? 

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What connections can you make between this article and your own experiences? 

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How does this article confirm or challenge your thinking on the role of mentorship? 

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How does this article confirm or challenge your thinking on the role of mentorship? 

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All classmates in EDU5127 are encouraged to post any questions or comments they have relating to the ideas presented. Thank you!

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All classmates in EDU5127 are encouraged to post any questions or comments they have relating to the ideas presented. Thank you!

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"Through mentoring, mentees venture forth on their leadership journey, uncovering strengths, becoming true to values, embracing courage, and, with confidence, anticipating moments to unfold. As a mentor-coach, I have enjoyed authentic conversations with mentees, and have been inspired by their creativity, resourcefulness and wisdom."

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WHEN MENTORING MEETS COACHING: SHIFTING THE STANCE IN EDUCATIONMentoring is often viewed as an effective approach to minimize the isolation that leaders experience, whether they are new to a position or dealing with new initiatives. Similarly, coaching is seen as an effective means to help people build personal and organizational capacity.

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‎The Science of Mentorship on Apple Podcasts

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Is there current data/research on the intersectionality of males and females in leadership/mentorship positions in the field of health care?

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Hello, group and classmates!

Here is an article specifically relating to the gap in leadership regarding gender in health care. As I am not in the health care profession, I admit I find this fascinating. Are there more male doctors than females? Are there more female nurses than male? Our article states, "With respect to surgery, there is a significant disproportion and underrepresentation of women in leadership and higher income roles of surgical departments and surgical specialties" (p. 634).
How does that affect the roles of mentor vs. mentee concerning leadership, and does that somehow contribute to a negative power dynamic (position of authority, expertise, status, or resource), in turn contributing to poor communication, accountability, conflict, company culture, sexism, unconscious bias, etc.? As a leader and mentor, there are many components to consider (mode, qualities, benefits). Still, I hope the focus can primarily be on mitigating the negative power dynamics and establishing trusting relationships that set out to model desired behaviours that support gender diversity, leadership, and management. There must be many mentors and mentees within the health profession who all contribute and foster a positive and supporting learning environment, holding everyone accountable - as per the professional roles and responsibilities of not only the mentor but mentee as well (support, effective communication, and collaboration, acceptance, problem-solving, role model, respect, etc.). I think the first step is acknowledging this power dynamic exists.

Kind regards, Nicole

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The gender leadership gap is well established and well known. However, it differs across industries. In health care, women are notably underrepresented in leadership roles; they represent 65 percent of the overall workforce but only 30 percent of the C-suite and 13 percent of CEO roles, according to Oliver Wyman research.

500 Women In Medicine notes this problem as well. The nonprofit is a satellite organization of 500 Women Scientists and, according to its founder, Kate Gerull, "it is needed because we continue to lose women at every stage of the promotion and advancement pipeline in medicine." While both genders have been roughly equally represented among medical students for the last two decades, only 38 percent of medical school faculty, 23 percent of full professors and 16 percent of deans are women.
Why Does It Matter?
This gap is even more troubling, says Terry Stone, managing partner of Oliver Wyman's health and life sciences practice group, because women make 80 percent of the buying and usage decisions when it comes to health care. "We don't have a 'women in health care' problem," she says, "but a 'women in health care leadership' problem."

The problem is prevalent throughout the health care industry, as Claire Novorol, co-founder of Ada Health, notes in a recent Forbes article. She cites data showing that 9 percent of "healthtech" (health care technology) startups are founded by women, and only 11 percent of healthtech company partners are women. "Diversity in healthtech is also essential for reasons beyond commercial self-interest. It is vital to ensuring that we are getting the right medical outcomes," she writes. Ensuring that research includes diverse groups will help ensure that products, services and treatments are successful for diverse populations. In addition, as AI continues to permeate the industry, diverse teams will make "it more likely that unconscious biases will be recognised and addressed, rather than encoded within the next generation of AI technologies."

"Gender balance helps institutions to reflect the populations they serve and improves health outcomes," write researchers in a recent issue of "The Lancet" focused on women in medicine. They recommend "public promotion of gender equality in the workplace," strong policies on discrimination and harassment, gender-specific leadership training, peer mentoring, and flexible work policies to address this issue.
Engaging Women Throughout the Pipeline
Recent research by Linkage Inc. holds some insights to help bridge the gap. Providing leadership training that differentially invests in women not only helps the women participating in the training but women across the organization as well. "For women to be in an organization and just see that their company is investing in the advancement of women impacts them, whether they participate in it or not," says Jill Ihsanullah, senior vice president of consulting at Linkage. In addition, these women are more likely to recommend their organization to others based on that investment than they are based on other benefits or HR policies.

Women who believe their organization supports them are also 16 times more likely to be in an environment "where women receive consistent feedback and coaching," Ihsanullah adds. Stone, too, says that sponsors and mentors play an important role in helping women in health care advance. Unfortunately, "women have a reported 2.5 mentors, compared to 3.7 for men," and "at the very top of leadership rankings, men are generally the ones making the leadership selections," which generally means selecting other men, whom they've built stronger relationships with.

"Smart people, both men and women, struggle with addressing the female leadership gap," Stone adds. "Marginalization is usually unintentional, by people who mean well. New habits need to form that shape our future mindsets." These habits include "purposely balancing the mentoring and sponsorship playing field and being unafraid to communicate openly about misperceptions."

Recent Training Industry research found that while formal coaching can even the playing field between men and women, women are less likely to prefer coaching as a development tool. Stone believes that for coaching to be engaging, the organization must understand that "many women identify as being a caregiver over an executive. Being coached as a female implies being part of a team that extends well beyond a single person's needs. Coaching helps identify very subtle behaviors that may hold women back in their careers. But this kind of caregiver lens can certainly help change the status quo."

Once women advance, give them opportunities "to create networks with each other," Ihsanullah says. "Because women tend to be so focused on their work and getting their job done, they tend to de-emphasize relationship-building." Making that networking easier will help women to build those relationships, learn from each other, serve as role models and give each other lifts up the ladder.

One initiative 500 Women In Medicine is working on is giving more visibility to female experts and leaders in medicine. By creating a database of women in medicine, the organization hopes to increase the number of women used as sources in the media and asked to speak at conferences. Health care organizations should use this strategy internally, as well: "Successful organizations not only recruit talented and diverse individuals," Gerull says, "but they actively foster and showcase these individuals' skills, talents and abilities."

The bottom line? "Make diversity a top, purposeful priority," says Stone. Identify your success metrics, and track them. Provide training, coaching and mentoring, and networking opportunities. Ensure managers are providing good feedback and are unbiased in their promotion and advancement decisions. By creating a culture where women feel - and are - valued and developed, health care organizations can impact not only their employees but also their customers and patients.

Taryn Oesch, CPTM

Taryn Oesch is the award-winning managing editor for digital content at Training Industry, Inc.

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The Gender Leadership Gap in Health Care: Why It Matters and How to Bridge It

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In health care, women are notably underrepresented in leadership roles; they represent 65 percent of the overall workforce but 30 percent of the C-suite.

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Article - Trigger Warning #MeToo Movement

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Article - Trigger Warning #MeToo Movement

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Yes, here is a great article to explore in regards to intersectionality in leadership as exists in health care. It links with our articles argument that women face systemic barriers in mentorship/mentee roles.

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Abstract

Background: Human resources are at the heart of health systems, playing a central role in their functionality globally. It is estimated that up to 70% of the health workforce are women, however, this pattern is not reflected in the leadership of health systems where women are under-represented.

Methods: This systematized review explored the existing literature around women's progress towards leadership in the health sector in low- and middle-income countries (LMICs) which has used intersectional analysis.

Results: While there are studies that have looked at the inequities and barriers women face in progressing towards leadership positions in health systems within LMICs, none explicitly used an intersectionality framework in their approach. These studies did nevertheless show recurring barriers to health systems leadership created at the intersection of gender and social identities such as professional cadre, race/ethnicity, financial status, and culture. These barriers limit women's access to resources that improve career development, including mentorship and sponsorship opportunities, reduce value, recognition and respect at work for women, and increase the likelihood of women to take on dual burdens of professional work and childcare and domestic work, and, create biased views about effectiveness of men and women's leadership styles. An intersectional lens helps to better understand how gender intersects with other social identities which results in upholding these persisting barriers to career progression and leadership.

Conclusion: As efforts to reduce gender inequity in health systems are gaining momentum, it is important to look beyond gender and take into account other intersecting social identities that create unique positionalities of privilege and/or disadvantage. This approach should be adopted across a diverse range of health systems programs and policies in an effort to strengthen gender equity in health and specifically human resources for health (HRH), and improve health system governance, functioning and outcomes.

Keywords: Gender, Intersectionality, Health Systems, Health Workforce, Leadership, Low- and Middle-Income Countries (LMICs)

Background

It is estimated that globally, the health sector has the highest proportion of women in the workforce compared to other sectors.1 According to the World Health Organization (WHO), in many countries, up to 70% of the health workforce are women.2 In pre-service education, including in medical schools and other healthcare related fields of academia, women's representation has increased, achieving near-parity.3 Nonetheless, leadership in the health sector remains dominated by men, including in top global institutions and multilateral organizations, governments, private sector, and in decision-making structures. Women remain occupying the lower hierarchy positions such as nurses, midwives and community health workers, cadres that often represent positions of lesser authority (but not importance) across the health sector.4,5 For example, in 2020 only 3.5% of the 115 identified national coronavirus disease 2019 (COVID-19) task forces had gender parity among members and only 25% of ministers of health were women; at the 72nd World Health Assembly in 2019 only 22% of member state delegations had a woman as a chief delegate, down from 29% in the previous years; in 2016 only 33.5% of WHO Country Office heads were women.4,6-9 The Global Health 50/50 reports released since 2018, aimed to shed some light on gender equality in 200 major organizations working in and/or influencing the field of global health. The reports note that decision-making power remains in the hands of men, comprising 68% and 80% of board chairs and 73% and 69% of executive directors in the organizations that were examined in 2020 and 2018, respectively.10-12

According to the WHO, gender is a social construct that refers to the characteristics of men and women, including norms, behaviors, expectations and roles associated with being a man or a woman. The concept of gender varies in different societies and over time. Gender interacts with but is different from sex, which refers to the biological attributes of males, females and intersex people.13 For the purpose of this study we use the words woman/women and man/men when referring to gender instead of the more familiar but inaccurate terms female and male.

In a gender analysis of human resources for health (HRH) for the WHO, George notes that " gender, among other power relations, plays a critical role in determining the structural location of women and men in the health labor force and their subjective experience of that location" (p. 5).14 The under-representation of women in leadership positions across health systems, the pay-gap, and physical and sexual violence and harassment are all rooted in gender biases in norms, power, access to resources and entitlements, and values.1,15 The Lancet series on Gender Equality, Norms, and Health further emphasizes that health systems contribute to gender inequalities in health by replicating and reinforcing restrictive gender norms and gender inequalities.5,16 It is for this reason that we focused this study on women's representation in leadership, while acknowledging and emphasizing that gender inequities go beyond the inequities women face. In order to avoid making assumptions and blanket recommendations, it is necessary to examine how gender intersects with other social identifiers (such as age and race) and social stratifiers (such as socio-economic status and professional cadre), and how these are embedded within broader structures of power to influence the professional advancement of women. An intersectional approach allows us to do this.

Intersectionality, a concept first introduced by Kimberlé Crenshaw three decades ago, has emerged as a framework for explaining and addressing inequities, and more recently gaining popularity in health outcomes and systems research.17 Intersectionality is defined as promoting " an understanding of human beings as shaped by the interaction of different social locations such as race/ethnicity, indigeneity, gender, class, sexuality, geography, age, disability/ability, migration status, religion. These interactions occur within a context of connected systems and structures of power including laws, policies, state governments and other political and economic unions, religious institutions and media. Through such processes, interdependent forms of privilege and oppression shaped by colonialism, imperialism, racism, homophobia, ableism and patriarchy are created" (p. 2).18

Examples of how inequity manifests in HRH are available in the literature: studies conducted in South Africa have called for a need for improved racial and gender diversity among healthcare providers to meet the needs of diverse societies such as South Africa.19,20 Assessments of cadre inequality in leadership positions in various settings have shone a light on the over-representation of certain healthcare professional categories, such as physicians, that are traditionally considered more "elite."4,21 These so-called elite cadres are historically dominated by men, which further exacerbates gender inequity in health leadership. This gender imbalance in certain professional cadres (eg, nursing being more dominated by women and medicine, dominated by men) is referred to as horizontal occupational gender segregation, a phenomenon known to contribute to lack of motivation and low morale, disempowerment, and maldistribution of the workforce.22

Improving gender equity in health systems and institutions allows for building more equitable and just health systems, unleashing the full potential of the workforce that ultimately benefits populations and their health outcomes. While gender is crucial to understanding opportunities, power and privilege, an intersectional approach allows for a more nuanced view of the dynamics currently at play and levers to sustainably improve health workforce leadership. To this end, the Third Global Forum on HRH produced the Recife Political Declaration on HRH which committed to " promote equal opportunities in education, development, management and career advancement for all health workers, with no form of discrimination based on gender, race, ethnicity or any other basis" (p. 3).23 This commitment displays the growing recognition of the role of gender and intersectional approaches.

This review examines the literature around leadership in the health sector in low- and middle-income countries (LMICs), with an explicit intersectionality lens.

Methods

We conducted a systematized review of the literature on intersectionality in health systems leadership in the context of LMICs. A systematized review process models the systematic review process but lacks some features of a full systematic review, such as quality assessment of identified literature or two reviewers.24 We selected this approach because of the need for more flexibility in the review process, recognizing that there would likely be minimal articles published on this topic.

Literature for the systematized review was identified using five electronic databases; PubMed, CINAHL, Embase, Scopus, and Web of Science. The search keywords and concepts included 'leadership,' 'gender,' 'human resources for health' and 'health systems,' 'intersectionality' and 'low and middle-income countries.' The search terms included relevant equivalents for each concept according to the databases. A combination of search terms was used within each database, using the Boolean operators AND, OR. The search was initially conducted in April 2018 and updated in October 2020 to cover any published papers between April 2018 and October 2020, and included articles starting from January 2000. We limited the search to articles in English. Titles and abstracts were included if they met all inclusion criteria as described in Table 1 . After removing duplicates, the electronic search yielded a total of 7709 titles/abstracts, which were further screened, using the key words and concepts of interest, resulting in 48 articles (see PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] flow chart in Figure). Fourteen of these 48 articles were selected as relevant to gender and leadership in health systems. Upon closer examination of the full text of each article, applying the inclusion criteria, no articles were found that had used an intersectionality framework to explore health system leadership in LMICs. While the 14 articles did not include a discussion about intersectionality as an approach, perspective, framework, or lens, they each did discuss the role of multiple social stratifiers and experiences of health systems leadership. We therefore included the 14 articles, and on reviewing those papers added a further five studies they cited, increasing the number of included papers to 19. An additional seven articles were included based on the recommendation of experts in the field, identified based on their publications, resulting in a total of 25 articles. None of the final 25 papers included an explicit intersectionality lens, but all touched on arguments relevant to this study (Figure, PRISMA flow chart).

Table 1

Parameters

Inclusion Criteria

Exclusion Criteria

PRISMA Flow Chart. Abbreviations: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; LMICs, low- and middle-income countries.

Each of the final 25 articles was examined using an intersectional lens. This was done through coding any social stratifiers mentioned in relation to barriers in progressing towards leadership positions. If the social stratifier had been mentioned in the context of gender or there was a mention of how this stratifier intersects with gender, this was also specifically coded and included in Table 2 .4,5,14,16,17,19-22,25-40 Similar codes were grouped together and gave rise to the emerging themes that have been included in the findings section of this study.

Table 2

Authors

Study

Social Stratifiers Included

Systems and Structures Involved

Results

Gender and Leadership in Health Systems

In the initial steps of the search strategy, we found that the intersectionality framework has mainly been used in the context of social determinants of health and understanding barriers to accessing healthcare in different settings. Much of the literature focusing on women's participation in the health sector focused on the broad categories of health professions rather than more specifically on leadership within those professions. In order to understand how gender intersects with other social stratifiers to influence women's experiences of and opportunities for leadership it is important to first explore the role of gender and how gender inequity manifests within health systems leadership structures. The gender-related barriers identified in this review were focused on barriers women face and included (1) women's relative lack of access to resources that improve career development, (2) women's relative lack of access to mentorship and sponsorship opportunities, (3) lack of value, recognition and respect at work for women and the attribution of success to feminine traits rather than professional competence, expertise or hard work, (4) greater likelihood by women to take on dual burdens of professional work and childcare and domestic work, and (5) assumptions that women have leadership styles that are less effective for top management compared to men. It is notable that there was a dearth of discussion of how these barriers might manifest differently for women from different demographic groups including racial categories and professional cadre, which have been highlighted in literature as resulting in differential experiences for health workers.25,26 Nonetheless, other social stratifiers were discussed to a limited extent within the studies, and these are further explored below. Table 2 summarizes the emerging themes in the reviewed studies.

When exploring leadership as a professional concept and related gendered experiences, Tominc et al highlight that within a broad pattern of women getting fewer leadership opportunities than men, there is also an evolving recognition of a phenomenon of women being offered particularly challenging opportunities, referred to as " glass cliff" opportunities. This term is used to describe a situation where women are offered leadership positions when uncertain and risky conditions decrease the likelihood of their success and set them up them for failure and poor outcomes (eg, fast-track promotion of women to leadership in failing or near bankruptcy companies).27 This, in turn, can have adverse implications for external views about women's abilities as leaders and managers, as well as women's own internal view about their abilities, potentially discouraging them from taking up leadership positions.27

Gendered societal norms and expectations also have a significant influence on women's interest in, and ability to, participate in health leadership.28 A study in Cambodia demonstrated that managers who were men emphasized that women's roles and priorities should be centered around their household responsibilities.29 Similarly, a study conducted with mid-level health managers in Kenya found that women were perceived as having primary responsibility for child nurturing which in turn impacts their willingness and ability to take up senior health management positions, and hinders their career progression.25 Another study with health system managers in South Africa described a manager who was a woman who aspired to be a surgeon alongside her husband, but decided to " put her career on the back burner" when they had children and " allow her husband to follow his dreams."26

A study on women in different professions (outside of the health system) in Sri Lanka, noted that the current work norms of working long hours, stress, and competition, promote a " masculinization of management."30 The general perception being that for women to be accepted as leaders they need to actlike men, but in doing so they risk losing their obligatory attributes of femininity. The study noted that if women try to take on leadership roles building on their feminine attributes, it would be viewed as challenging the right of men to hold positions of power. At the same time, women leaders using those same feminine attributes were at risk of being undermined for an apparent incapability to do the job.30 The description of said feminine attributes was not elaborated on in the study.

Lastly, Zeinali et al have called for incorporating intersectionality in health workforce policy and planning, to account for structures of power beyond the health system that affect woman health workers' career progression. These intersectional considerations are time and location specific and therefore need strong political will, commitment and transparency to be incorporated in health systems and allow for meaningful, non-tokenistic and meritocratic inclusion of health workers at all leadership levels.31

Gender and Childcare/Motherhood: Gendered Roles and Responsibilities

Five studies, conducted by George,14 Newman,22 Alwazzan and Rees,32 Ioannidou et al33 and Muraya et al25 mentioned gender and childcare/motherhood in the context of gendered roles and responsibilities.

In a gender analysis of the HRH done for the WHO, George points to stereotypical work models that assume men are the default and ignore the differences women have, expecting them to conform to the default, or associate these differences to individual women rather than differences structured by the social environment. One such major difference is in the domestic and childcare responsibilities women take up.14 Most workplaces situated in the health system do not account for the specific conditions and needs that exist for woman health workers who have children or are in charge of a household, complicating both their professional and personal lives.34

In a commentary on gender inequality in the health workforce, Newman points to the discrimination women face in recruitment and promotion processes due to the possibility of pregnancy. This discrimination also manifests as lack of organizational support to mothers such as flexible work conditions, parental leave or childcare.22

Muraya et al examined the role of parenthood, family support and domestic help in the professional experience of healthcare managers in Kenya. The topic of receiving support from family and spouses came up with both men and women study participants, however women tended to emphasize more on the positive effects of having a supportive family who appreciate the time constraints of their work. The demands of parenthood came up mainly in the interviews with women healthcare managers, however, it was used as a justified reason for exclusion of women from leadership positions by both men and women in the study.25

Similarly, Alwazzan and Rees pointed to cultural norms and expectations for women in Saudi Arabia, highlighting that society, families, and employers all expect women to prioritize childbearing and childcare. Many of the women participating in the study agreed with prioritizing motherhood, but pointed to the significant role that families, spouses and workplaces can have in creating a supportive and enabling environment. Women in this study were healthcare academics and emphasized the role of organizational support that allows for more flexible work conditions conducive to childcare, as well as elimination of biases that leads to women being overlooked for leadership positions.32

In their analysis of the dental workforce, Ioannidou et al explore various forms of gender discrimination in this cadre and the barriers women face, including the double burden of professional work and childcare. Lack of institutional support for childcare, in terms of allocation of dedicated space and caregivers, financial support and considerations for tenure have all been mentioned to hinder women's advancement to leadership positions in the dental workforce and academia.33

Intersection of Gender With Other Social Stratifiers

Gender, Professional Cadre and Race

Eight studies addressed the intersection of gender, professional cadre and race: Muraya et al,25 Shung-King et al,26 Dhatt et al,4 Filby et al,21 Thackwell et al,19 van Rensburg,20 Williams,35 and George.36

Muraya et al and Dhatt et al report that in Kenya, professional hierarchies play an important role in the appointment of health leaders, with medical doctors being preferentially appointed into leadership positions.4,25 This in and of itself is gendered as the medical field in Kenya was historically dominated by men, although this has gradually changed over time with equal numbers of men and women entering into medical school and holding entry-level medical positions. This is an example of how gender and professional cadre can intersect to influence women's participation as leaders in the health system.

George discussed that in Iran, nurses, which is a cadre dominated by women, were reported to avoid being the decision-makers in a healthcare team even when they had the knowledge and skills, because their autonomy and authority was undermined by the physician-centered culture of the health systems they worked in.36 The healthcare culture was found to revolve around physicians. Teamwork with other cadres was less valued, leading to the discouragement and disempowerment of other professional cadres in taking on leadership roles in health teams. This illustrates how professional cadre can intersect with gender and work cultures, limiting the participation of women in leadership spaces, even in professions dominated by women such as nursing and midwifery as further elaborated below.

A study by Filby et al explored the intersectional nature of gender and professional cadre within midwifery leadership in LMICs. They examined the concept of " gender penalty" to describe the phenomenon they observed where men assume leadership positions even in professions that are disproportionately comprised of women, such as nursing and midwifery, leaving women to fill the bottom of the occupational hierarchy. This, in part, is due to women's job-related skills in caring professions not being treated as professional skills, but rather as qualities of being a woman.21

Another way in which gender intersects with professional cadre is what Williams describes as the " glass escalator." The glass escalator refers to the advantages that men receive even in professions dominated by women such as nursing, allowing them to climb towards leadership levels more easily and quickly compared to women.34 This is in contrast to the previously discussed " glass cliff" concept, where women are put in leadership positions with low success rates, essentially positioning them for likely failure.27

Nonetheless, the "escalator" advantage may not necessarily privilege all men equally, as prior research has shown that behaviors that denote leadership ability in White men are perceived as menacing behavior from Black men,35 highlighting the importance of an intersectional approach. As such, gender intersects with race in this case to disadvantage Black men and potentially prevent them from exercising their leadership traits.35 This example gives additional context to the complex nature of systems of oppression that intersect to create unique experiences of disadvantage. In the South African study of health systems managers' experiences, Shung-King et al observed a combination of gender, race and professional hierarchy in influencing leadership experience. To illustrate, they described a Black manager who was a man recalling that (in addition to the prejudice he experienced as a Black man), as a nurse who was a man he had often faced prejudice from his nurse colleagues who were women, as well as family members and social circles for doing "a woman's job."26 Although his experience did not follow the usual pathways of structural discrimination, it was drawn upon to show how strongly gender intersects with other social identities in influencing people's experiences. The same study found that Black woman managers from a nursing background, experience a " triple-challenge" of gender, professional hierarchy and race in their professional life, even post-apartheid. The authors argue that although in theory equal rights now exist for all regardless of race in South Africa, other insidious forms of discrimination still persist, resulting in unique experiences for health professionals based on the intersections of their gender, race and professional hierarchies. In the other South African focused study, van Rensburg confirms this theory and discusses how the skewed race and gender profiles of the health workforce still persist to some degree, despite affirmative action policies in place.20 When exploring affirmative action policies in South Africa for the training of medical specialists, Thackwell et al discussed the concept of " race fatigue" where Black trainees felt dissatisfied with being the token Black trainee in a White-dominated workplace. Moreover, Black study participants mentioned hostile attitudes towards them due to biases that considered them less competent and ignored their merit because of the affirmative policies. This attitude created implicit barriers in their career progression in the medical field.19

Another example of the complex effects of the intersection of gender with race is highlighted by George in her 2008 study in the United States. She discusses how government funding assists minority women to be trained for lower levels of nursing, leading to their prominent presence at this level. However, the funding does not apply to baccalaureate training which determines teaching and leadership positions, resulting in an inevitable shortage of minority women in higher-level and decision-making spaces.36 This also highlights how well-intentioned policies and interventions - in this case government-assisted education funding - can inadvertently disadvantage intended beneficiaries, "locking" them into particular lower-level categories and limiting their career progression into leadership roles.

Gender, Race, and Ethnicity

Two of the reviewed studies - one in Singapore,37 the other in South Africa20 - examined the intersection of gender and race/ethnicity. The Singapore study focused on the disadvantages men experience in professional settings outside of the health system, but the complex nature of how systems of oppression intersect to create experiences of disadvantage made it important to include in this review to provide additional context. The study examines social capital and the intersection of gender and ethnicities. The authors found that while men of all major ethnicities living in Singapore have an advantage accessing university education compared to their woman counterparts, there is one exception: Malay men are at a disadvantage compared to Malay women when it comes to access to university education. The authors elaborate that this disadvantage experienced by Malay men leads to lower social capital over time, for instance knowing fewer people in high-status jobs. Therefore, while men in general seem to be at an advantage for higher education in Singapore, Malay men experience a unique disadvantage due to the intersection of their ethnicity with their gender.37

In the South African study, van Rensburg examines the distorted race and gender profiles of the health workforce that persist despite the progress made by affirmative action policies in the post-apartheid government. van Rensburg argues that remnants of historical exclusion based on race including in the higher education sector and white-collar professions continue to exist to date in South Africa. This is for example observed in the number of medical practitioners nationally: 16936 (Whites), 8354 (African Blacks), 5314 (Indian) and 927 (colored) (labels are used verbatim from the original paper).20 This is in a country where Black Africans make up 80.2% of the population, with colored, White and Indian/Asian making up 8.8%, 8.4% and 2.5% of the population respectively.41 The outcomes of this racial exclusion, marked by white privilege and dominance, are further skewed by the dominance of men.20

Gender and Culture

Two studies examined gender and culture. Tlaiss34 looked at gender and religion/religious culture and Alwazzan and Rees32 studied gender and generation/age. The study discussing gender and religion in Lebanon's health sector noted that 79% of the public health workforce is comprised of women, but this is not reflected in the leadership positions. Tlaiss considered socio-cultural factors and Lebanon's society that reinforces traditional gender roles around domestic responsibilities as the key reasons hindering women's upward movement in the hierarchy of the health system.34 Furthermore, she discusses the role of religion even in this broader context of gendered norms and roles; highlighting that in Lebanon, Muslim communities are generally more conservative and traditional than Christian communities leading to an underrepresentation of Muslim women in the workforce as a result of traditional norms and obligations placing a higher value on motherhood than social and economic participation. Tlaiss also highlighted the patriarchal organizational culture and implicit biases that see and appoint men as default managers and leaders.34

Alwazzan and Rees conducted their study in Saudi Arabia with women faculty of medical colleges and explored gender and generation.32 They noted that both implicit (for example gender stereotyping) and explicit barriers (such as lack of research opportunities, lack of mentorship, and difficulty in achieving work-life balance) were identified by participants as hindering their career progression. Some examples of gender stereotypes that were given by the study participants included women lacking the physical strength for some medical specialties, or lacking personality traits that would make them " fit for leadership positions."32 The study discussed the intersecting axes of gender and culture when participants stated that their culture places a higher value on domestic responsibilities for women rather than working professionally and is less encouraging of women to occupy professional spaces. Furthermore, women face generational barriers, in that young professionals (of any gender) are not taken seriously despite being qualified, and leadership positions are more readily available to older individuals, even when individuals are equally qualified for a leadership position.

Gender and Financial Status

The study done by Muraya et al looked at the intersection of gender and financial status. In this study, healthcare managers in Kenya nodded to different factors that have enabled or hindered their progress along their careers, emphasizing the importance of financial support in enabling them to take further education or training to better prepare them for leadership. Women also pointed to competing financial interests such as family obligations or prioritizing the cost of their children studying.25 Many of the participants in this study who had children, also emphasized the importance of having domestic help for their household responsibilities, most of which are often expected of women.25 Affording domestic help is another manifestation of the intersection of gender and financial status.

Discussion

We explored the literature around intersectionality of gender and other social axes in health systems leadership, with a focus on LMICs. None of the articles identified using our search strategy had explicitly used intersectional analysis to assess how gender intersects with other social stratifiers. Despite this, it was clear from the 25 papers we did include that gender intersects with other social stratifiers in unique ways to influence experiences and career progression of health systems leaders.

There has been an upturn of focus on the role of women in health systems, and in particular in leadership positions, such as the WHO Global Strategy on Human Resources for Health: Workforce 2030,1 UN High Level Commission on Health Employment and Economic Growth,42 the Global Health 50/50 reports,10-12 The Lancet special theme issue on Advancing Women in Science, Medicine, and Global Health,43 The Lancet series on Gender Equality, Norms, and Health,44 and initiatives such as Women in Global Health and the Gender Equity Hub of the Global Health Workforce Network,45 and most recently, calls for women leading the post-COVID-19 pandemic efforts due to their exemplary leadership of the pandemic response.9,46,47

However, most of these efforts fall short in that they focus mainly on homogenously increasing women's participation in leadership, with little attention is paid to other social axes that intersect with gender to inhibit progression to higher-level positions. This linear, single-layered approach does not reflect the complexities of real-world experiences, including systems and structures of power that interact to privilege certain women over others while excluding many groups of competent women who are minoritized beyond their gender.

An intersectionality approach explicitly focuses on the relationships between mutually constructed processes, systems and structures that lead to social differences and inequities.18 Acknowledging the dynamic interconnectedness of gender with other social identities and locations, especially when considering women who do not fulfill the often portrayed and represented description of women in leadership, avoids delays in adopting solutions that benefit women from different backgrounds and lived experiences. A failure to recognize and analyze diversity among women in leadership risks the portrayal of women leaders as primarily White and from/in high income countries, and of under-representing the visibility and voice of other women leaders. By that very fact, in order to lay a strong, inclusive foundation for change in the gender equality agenda, there have been calls for more visible leadership in global health from LMIC feminist voices.48 Furthermore, leadership concepts and practices are deeply connected to one's identity and lived experiences. Incorporating intersectional analysis in the study of leadership allows for having a full view of one's identity and approach to leadership.

Health systems are often viewed as gender neutral, technical systems, but in reality, they are complex systems imbued with power relations. They are embedded in and shaped by their socio-political contexts, thereby reflecting and reinforcing social norms.38 An intersectional approach is therefore essential in understanding health systems, and the dynamic and complex human experiences and interactions that make up those health systems.26 This approach would allow for better identification of the populations neglected or oppressed by the health system, and deliver interventions targeted to mitigate health inequities. This transition towards more equitable health systems and health outcomes can be strengthened by intersectional gender-transformative workforce policies.49 Examples of key attributes of a gender equitable health system are identified by Percival et al in their 2018 study, including provision of care for men and women across the life span; ensuring equitable access that is unrestricted by social, geographic and financial barriers; operating through evidence informed policies based on relevant, sex disaggregated health data; creation of equitable career opportunities for men and women health professionals; and ensuring equitable health outcomes among men and women and across age groups.38

Increasing Women's Representation Within Health System Leadership: Moving Beyond Gender Parity

The WHO Commission on Social Determinants of Health has clearly stated that social inequities, including gender inequity, are among causes of health disparities and recommends that governments strengthen political and legal systems to acknowledge and support marginalized groups to empower them to represent their needs and claim their rights.15 Commission on Social Determinants of Health recommends empowerment of women and marginalized groups at the micro-level of individual people, as well as ensuring their representation at the macro and meso decision-making levels within and beyond the health system to reduce health disadvantages that result from social inequities.15 Given women's under-representation in leadership, we have focused on this issue in the present paper, while appreciating that gender equity goes beyond women's rights. We have complemented the studies reviewed here by including a few studies on the experiences of men in the workforce to give additional context on how complex systems of oppression intersect with one another to create unique experiences of disadvantage.

Increasing women's leadership in health systems at global, national and subnational levels is a vital step towards addressing women's health challenges, and empowering and recognizing the majority of the health sector's workforce. According to Downs et al, randomized trials have demonstrated that women in leadership positions of governmental organizations are more likely than men to implement policies that are supportive of women and children.50 Including diverse groups of women at all levels of health system leadership is important to ensuring that diverse experiences and perspectives are represented in health system decision-making and contribute to wider societal transformation.51,52 Newman argues that the positive effects of equal opportunity and gender equality in the health sector include: an increased health worker pipeline, an equal chance of being hired, being fairly paid and enjoying advancement opportunities, better work life balance, and improved health services.22 Improving women's representation within health system leadership is therefore, beneficial to all.52

The first step towards identifying and implementing solutions in relation to women's lack of representation within health system leadership is having a clear, robust understanding of the underlying obstacles to the participation of women, from all types of different social identities. Patriarchal structures manifest in complex, multifaceted and reinforcing ways. How these processes affect women of color, Indigenous women, women from LMICs, transgender and other groups of women and even men of color is underexplored and should be a priority for health systems research.39

Where Do We Go From Here?

Based on the themes and intersecting identities emerging from the findings of this study and recommendations made in some of the reviewed papers, we propose the following overarching approaches.

To have more equitable, gender-responsive, and inclusive health systems that reflect these values at all hierarchical levels, examinations of gender biases in health system leadership, using intersectional analysis, is needed. An evidence-based understanding of the key factors influencing gender differences in leadership, and their impact, should contribute to policies and interventions that address drivers of inequity. Implicit and explicit biases and stereotypes are the heart of sexist and patriarchal systems and institutions. Such deeply held beliefs often work in insidious ways to exclude women from enjoying certain privileges and opportunities. Due to their implicit nature, rooted in centuries of patriarchal systems, acknowledgement and transformation of these biases requires conscious, constant effort done at the individual and societal level. Despite their prevalence, gender biases are not static nor universal, but actively debated, discussed and adapted at the individual level. These individual attempts must be collectively and systematically expanded through improved policies and programs in health systems to be more effective. Institutions should publicly state their commitment to gender equality and inform policies that tackle power and privilege imbalances, such as workplace gender equality policies and workplace inclusion and diversity policies.12

Furthermore, many studies pointed to the importance of mentorship in the career progression of women. Mentorship can provide professional support and guidance on career advancement, work-life balance, and professional resilience.50 Navigating complex workplaces or conditions such as parenthood can be done more easily when a mentor shares similar experiences and tips on best practices. Moreover, mentors can champion their proteges, advocate and create opportunities for them.51

The pervasive global gender stereotype that assigns women the role of primary caregiver for children is a significant limiting factor for women's full participation in the workforce and their ascent to higher positions. This stereotype is further reinforced by cultural norms as observed in the studies done in Kenya, Lebanon, and Saudi Arabia. Women's participation in health systems as well as their childcare responsibilities leaves them with little time to invest in their own health and well-being or to pursue leadership training or other resources that enable them to advance in their career. In the absence of institutional support, women overextend themselves to balance their personal and professional lives, plan pregnancies and manage childcare and develop professionally. This division of responsibilities can be improved by adoption of institutional gender-responsive policies that promote parental leave for both parents, flexible working hours, and family-friendly policies to ensure women can enjoy flexible career trajectories and have equal resources and access to leadership roles within health systems. Such policies promote shared parenthood, subsidized childcare and preserve women's connection to their job during their childbearing years. Studies have proven that in fact having more women in leadership positions promotes adoption and implementation of these gender-responsive policies.53,54

Gender and Professional Cadre

Even though the health workforce consists of diverse cadres, medical doctors have historically been appointed to leadership positions. This has undermined the key role of other cadres to a functioning, well-balanced workforce. Leadership quotas for different cadres, management training for any health worker promoted to a leadership position, and mentorship provided by experienced members of staff can ensure a more equitable and inclusive leadership trajectory.

Gender and Race/Ethnicity

Sexism and racism both manifest implicitly and explicitly. Individuals at the intersection of these structures of exclusion are often overlooked. One solution to tackle racism in health systems has been the adoption of affirmative action policies, as mentioned in the South African studies. While such policies ensure representation in numbers, it is imperative to make sure selections under affirmative policies take into account other identities such as gender or financial status. Furthermore, implementation of such policies and quotas risks tokenization or race fatigue, as explained by Thackwell et al.19 In order to avoid such views, transparency in selection criteria and meritocracy, even in the affirmative action process can be helpful.

Gender and Culture

Combatting stereotypes and biases is a complex and long-term endeavor. However, health systems and organizations can take important measures to mitigate the negative effects of such biases and actively foster a more inclusive organizational culture where such biases are consistently challenged and eliminated. Implementation of the institutional gender equality policies mentioned in previous sections, adoption of transparent selection and promotion criteria can help avoid cultural biases that exclude competent women, especially of younger age, from leadership opportunities. Supportive initiatives such as mentorship programs and training courses can further assist and invest in the existing health workforce. Mentors can be crucial in sharing experiences of navigating challenging workplaces or conditions and championing their younger colleagues in promotion decisions. Institutional support such as flexible working hours and paid parental leave can improve the working conditions of health workers with childcare responsibilities.

Gender and Financial Status

A recurring theme in the reviewed studies was the financial barriers women faced to pursue further education or leadership training. Investing in the professional development of all health workers, beyond their technical knowledge and expertise, and provision of scholarship schemes and loans for further education can be beneficial to the career progression of health workers. It is important to note that allocating a proportion of such funds to women health workers would ensure that women who are from lower financial backgrounds, those from cadres with lower income, those who have to prioritize personal funds for their children and family, and those who may be overburdened with professional and domestic responsibilities who may not even be prompted to apply for such funds, are not overlooked and ignored by the system. Mentors can be crucial in this step as well, identifying opportunities and nominating candidates.

Consistent implementation of the aforementioned recommendations requires a broader policy shift towards an intersectionality framework. Based on the conclusions drawn from reviewing the literature, we have identified overarching recommendations for policy-makers to describe, commit, act, and transform health systems through an intersectionality framework to reduce inequities. This can be achieved by the reflexivity of policy-makers that ensures recognition of the privilege of being in the decision-making position, and reveals harmful biases, assumptions, stereotypes and exclusions, subsequently leading to the inclusion of a diversity of perspectives. Being mindful and inclusive of, and responsive to, the needs of diverse groups of health workers, considering intersecting social locations and their interconnected domains of power can lead to moving beyond intersectionality-aware policies to intersectionality-transformative policies.40,55,56,58-60

Study Limitations

This study was limited by only exploring articles published in English as the authors main language. We were further constrained by the fact that this project was part of a degree thesis project and therefore limited to one reviewer. Since the initial inclusion criteria included only studies which explicitly used intersectionality as a lens, articles which addressed different social stratifiers but without an intersectionality approach would not have been captured within the search strategy. While this narrowed the number of results, it also showed the dearth of evidence using an intersectionality framework in this field.

Conclusion

Achieving gender equity in health systems leadership at all levels is fundamental to ensuring that the diversity of human resources in the global community is appreciated.4 If we are to advocate for reforming the workplace and workforce in health systems, and for equal opportunities in leadership positions in health systems across nations and in global health, it is imperative to move beyond gender and be cognizant of the different challenges that women face in their career advancement in different settings, due to the intersection of their gender with other social identities, and not dismiss these differences by oversimplifying gender as the only defining aspect of one's identity. Since using an intersectionality framework in considering women's leadership in health systems in LMICs is virtually absent from the discourse, incorporating an intersectional framework in addressing their participation in leadership and researching evidence around it can ensure a more holistic approach that does not only promote advancement of the stereotypically portrayed women in leadership, but all women from different nationalities and races, professional cadres, religions and economic backgrounds. As efforts to reduce gender inequity in health systems are gaining momentum, it is important to look beyond gender as an all-encompassing disadvantage and take into account other social identities that interact with gender and adopt this shift to an intersectional paradigm in programs and policies that are collectively amplified by the health sector. The result of this effort is not only more gender equity in the health workforce, but more equity in general, improving health systems' functioning and downstream health benefits more broadly.

Acknowledgements

The authors would like to acknowledge support from Research in Gender and Ethics (RinGs): Building Stronger Health Systems [Project No PO5683]. RinGs is a partnership across four research consortiums (Future Health Systems, ReBUILD (Research for stronger health systems post-conflict), RESYST (Resilient and Responsive Health Systems) and COMDIS- HSD (Communicable Diseases Health Service Delivery), all supported by the UK Department for International Development (DFID).

Ethical issues

Not applicable.

Competing interests

Authors declare that they have no competing interests.

Authors' contributions

RM, KM, SM, and ZZ conceptualized the review, ZZ conducted the review and prepared the draft manuscript. RM, KM, and SM provided multiple rounds of feedback on analysis, interpretation of data and the manuscript presented by ZZ. ZZ finalized the manuscript. All authors signed off on the final version of the manuscript.

Funding

This work was supported by funds from DFID awarded to the RESYST Consortium. However, the views expressed and the information contained in it are not necessarily those of or endorsed by DFID, which can accept no responsibility for such views or information or for any reliance placed on them. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the article. KM and SM are members of the KEMRI-Wellcome Trust Research Programme in Kenya that is supported by a core grant (# 203077/Z/16/Z) from the Wellcome Trust.

KM is supported through the DELTAS Africa Initiative [DEL-15-003]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa's Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [107769/Z/10/Z] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government.

Disclaimer

Any opinion, finding and conclusion or recommendation expressed in this material is that of the authors and DFID do not accept any liability in this regard.

Notes

Citation: Zeinali Z, Muraya K, Molyneux S, Morgan R. The use of intersectional analysis in assessing women's leadership progress in the health workforce in LMICs: a review. Int J Health Policy Manag. 2022;11(8):1262-1273. doi:10.34172/ijhpm.2021.06

References

1. World Health Organization (WHO). Global Strategy on Human Resources for Health: Workforce 2030. WHO; 2016:64.

2. Boniol M, McIsaac M, Xu L, Wuliji T, Diallo K, Campbell J. Gender Equity in the Health Workforce: Analysis of 104 Countries. WHO; 2019.

7. World Health Organization (WHO). WHO Offices in Countries, Territories and Areas. WHO; 2016.

9. Freizer S, Azcona G, Berevoescu I, Cookson TP. COVID-19 and Women's Leadership: From an Effective Response to Building Back Better. UN Women; 2020.

15. Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. World Health Organization; 2008. [ PubMed]

42. World Health Organization (WHO). Working for Health and Growth: Investing in the Health Workforce. Report of the High-Level Commission on Health Employment and Economic Growth. WHO; 2016.

54. Zeinali Z. Women in health systems leadership-demystifying the labyrinth. In: Morgan R, Hawkins K, Dhatt R, Manzoor M, eds. Women and Global Health Leadership - Power and Transformation. Springer; 2021.

57. Hankivsky O, Jordan-Zachery JS. The Palgrave Handbook of Intersectionality in Public Policy. Cham: Springer International Publishing; 2019. 10.1007/978-3-319-98473-5. [ CrossRef]

58. Hancock AM. Empirical intersectionality: a tale of two approaches. In: Hankivsky O, Jordan-Zachery JS, eds. Cham: Springer International Publishing; 2019. 95-132 [ Google Scholar]

59. Hankivsky O, Grace D, Hunting G, et al. An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity. In: Hankivsky O, Jordan-Zachery JS, eds. Cham: Springer International Publishing; 2019. 133-166 [[ PMC free article] [ PubMed] Google Scholar]

60. Hankivsky O, Jordan-Zachery JS. Introduction: bringing intersectionality to public policy. In: Hankivsky O, Jordan-Zachery JS, eds. Cham: Springer International Publishing; 2019. 1-28 [ Google Scholar]

Articles from International Journal of Health Policy and Management are provided here courtesy of Kerman University of Medical Sciences

# data[].attributes.attachment_link.title
The Use of Intersectional Analysis in Assessing Women's Leadership Progress in the Health Workforce in LMICs: A Review

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Background: Human resources are at the heart of health systems, playing a central role in their functionality globally. It is estimated that up to 70% of the health workforce are women, however, this pattern is not reflected in the leadership of health ...

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How does the literature presented here compare to mentorship modes in other industries like private sector, law, and education?

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A podcast that examines the current and future landscape of fundraising leaders and the power of inclusive mentorship in advancement.

A podcast that examines the current and future landscape of fundraising leaders and the power of inclusive mentorship in advancement.

Breakthrough for our industry

Kim Nyoni is the perfect host for this podcast-he shares case studies and personal experiences with mentorship. He differentiates between being welcoming and truly supporting a colleague, often people who have been marginalized. He walks the talk. This is so important for our industry. THANK YOU!

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A podcast that examines the current and future landscape of fundraising leaders and the power of inclusive mentorship in advancement.

# data[].attributes.body
Confirms - this article confirms my thinking that women face systemic barriers when it comes to mentorship in the workplace.

Challenges - this article challenges me to think about stereotypical male and female dichotomies (ie. are all males goal/achievement oriented and all women well-being and collaborative oriented? when it comes to mentorship?

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What style of mentorship is most relevant to your professional context? How has this helped you develop in your role?

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What style of mentorship is most relevant to your professional context? How has this helped you develop in your role?

# data[].attributes.body
In my last role as a educational consultant, I had been involved in the multiple mentoring model, which meant I was mentored by several mentors simultaneously, noting that each
mentor was facilitating the development of a particular area. I had one dyadic mentor, who officially took on the role of formally meeting with me to discuss my goals, challenges, skills, and well-being. We both identified as female and had a positive experience. I also had several mentors who identified as male. These were supervisory officers who oversaw different portfolios in education. These individuals mentored me in solving complex problems and thinking creatively and critically about issues relating to education. This too was a positive experience, but we never discussed well-being or met formally to discuss. Gender played a role in the degree in which both the mentor and mentee engaged. This leaves me to question how much of this is systemic and how much of this is learned socialization behaviours? Either way, I felt I benefited from having a diversity of mentorship models to experience. Moving forward, I hope to seek ways to continue to diversify the mentorship models I engage with.

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Hello, group and classmates!

One of the essential concepts I learned from the article is the importance of understanding what type of mentor you want to be - meaning - that the various mentorship models can be utilized across varying professions based on the organizations or personalized needs, wants, goals, and objectives as a mentor vs. mentee. The article discusses mentor responsibilities such as providing guidance and feedback while at the same time providing the mentee with support throughout the learning process (varying modes). If that is the main focus, then that can be translated across all professions: find a method that works best for the mentor and mentee.

Kind regards, Nicole

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In our recent report on mentorship, 37 percent of HR professionals said employees are not being supported to reach their full potential.

That leaves a lot of employees who are not performing as well as they could. Did you know that a workplace mentoring program could turn that all around?

‍

Are mentors all that important in the workplace today?

It's easy to think that your employees should take the initiative for their growth and development. After all, being a self-learner allows them to be in control. It also demonstrates initiative, which is an excellent skill to have. Unfortunately, this kind of thinking can lead to high turnover rates.

Suppose you're thinking that providing employees with training programs, online courses, and opportunities to attend conferences and summits is enough for their development. In that case, you could be setting yourself up for a morale disaster.

According to our State of Coaching and Mentoring report, 60 percent of HR professionals say that mentoring in the workplace is essential. Moreover, 62 percent expect to see more of it in the future.

Mentoring in the workplace has proven beneficial in a number of ways, including:

Improve employee skills

Increase engagement rates

Reduce turnover

Create positive atmosphere

In our survey, 72 percent of HR representatives said that mentoring positively impacts the organization and individual development.

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15 critical roles that mentors play in the workplace today (and in the future)

Mentorships have been around for thousands of years. Over time, the way we mentor has adapted to the changes in the workplace, for example, remote workplace mentoring. In other words, mentors play a number of crucial roles in an organization. Let's unpack a few.

‍

1. Building the next generation of leaders at the company

Mentors are vital for preparing high-potential employees for leadership positions. They can do this in several ways. Some mentoring is needed to help employees cultivate skills to be successful leaders, such as communication capabilities. In addition, mentors pass along vital information and wisdom they've gained through their experiences. This knowledge-sharing role of mentors is essential for succession planning.

‍

2. Improving performance

From improving employee performance to increasing the production and revenue of your organization, mentoring plays a significant role in how well your company does now and in the future. As mentioned, 72 percent of HR professionals agreed that mentoring positively impacts an organization's performance.

‍

3. Bridging the gap between generations

Cultivating connections in the workplace can be a challenge, but mentoring can help bridge the gap, particularly between generations of workers. Senior employees have a lot to offer the next generation. Mentorships can create a safe space for mentees to take risks and learn from their mistakes. The relationship between a senior employee and their mentee can also break down barriers and stereotypes between different generations of workers. In the end, it will lead to a more positive workplace atmosphere and a collaborative team.

‍

4. Setting up new hires for success

Using mentorship as part of your onboarding process has benefits across the board. You'll ensure that your new employees are well-trained in workplace culture and policies. Mentors can also help new hires develop good habits and practices. Additionally, it helps new faces on the team build connections in your company. And these connections create a sense of belonging for your employees.

‍

5. Creating more inclusive company cultures

Inclusive company culture is a must-have in today's workplace. There is no room for division if you're aiming for success. Mentorship programs at work can be designed to break down barriers and build collaborative cultures. There are many ways you can approach this challenge, including pairing mentors who come from different backgrounds. In this setting, the mentor and mentee will develop an understanding and respect for each other.

‍

6. Highlighting diverse talent

Mentoring can be used to develop diverse talent among your ranks. Employees from minority backgrounds face unique challenges. Providing them with a mentor to encourage and support them goes a long way in helping them succeed. Investing in your diverse talent through mentorship will benefit your employees and your organization.

‍

7. Accelerating employee development

With worker shortages impacting various industries, focusing on employee development helps organizations overcome this challenge. Through mentorships, you can enable your staff to develop the skills needed for the future. It can strengthen your organization's ability to succeed in the long run.

‍

8. Making remote work, work

Over the past couple of years, we've seen an increase in remote work and its challenges. Employees have reported suffering from feelings of isolation, burnout, and other mental health issues. The key ingredient is connection.

According to one HR professional in a report by HR Exchange, employees look forward to social interactions at work:
"It's hard to duplicate that over a screen," Todd Reeves, SVP, People Operations & Technology at Expedia Group, said. "But we also recognize our employees really appreciate having the flexibility to manage work and life responsibilities. A hybrid approach means they have the best of both worlds - connection and flexibility."
Remote mentoring programs help employees overcome these challenges and be successful and productive no matter where they do their jobs.

‍

9. Retaining top talent

Many industries are facing a talent shortage. Spending time, money, and effort to attract and hire top talent is just one of the keys to gaining quality employees. You need to offer them something more than a paycheck. While incentives can include benefits and rewards, they should also include learning and development opportunities, such as mentorships. Investing in your employees through a mentorship program demonstrates that you're an employer who cares about their employees. And that is worth sticking around for.

‍

10. Encouraging more collaboration

It takes a team effort to get the job done. Cultivating a culture of collaboration is another hurdle that your organization faces. Our State of Coaching and Mentoring report found that companies with a higher percentage of mentors were over two times more likely to say that coaching leads to improved organizational performance. In other words, mentorship encourages collaboration.

‍

11. Giving every employee a voice

Today's employees are not just looking for a job. They want a career. And they want to feel like they matter to your company. Mentorships allow your employees to feel like they have a voice and are valued.

‍

12. Encouraging meaningful growth-focused relationships

Mentorships revolve around the connection between a mentor and mentee. At its best, it is a meaningful relationship that can change an individual's life. Through the experience, your employees will practice their connection-growing skills. A mentee and mentor will get to know each other and build respect and accountability while doing so. Mentoring also requires participants to work on their practical communication abilities.

‍

13. Transferring knowledge about company failures (so history doesn't repeat itself)

It's vital that your employees share information and ideas with each other. It can help teach employees what to do and what not to do. Senior employees can pass along knowledge about past company failures as lessons to younger employees in a mentoring capacity. This information will help your organization prevent history from repeating itself.

‍

14. Maintaining the well-being of the company

Your employees' health directly impacts the productivity of your organization. When your staff have low levels of well-being, they're more likely to be absent. From stress to burnout, mentoring can help your employees handle the demands of their job so that you can maintain the well-being of your company.

‍

15. Increasing employee engagement

Employee engagement is a serious issue in many workforces. Even if your employees show up to work each day, are they giving you their best? Or are they looking for a way out? Mentorships build connections and feelings of belonging. These, in turn, can increase employee engagement. When your employees are engaged in their work, they are less likely to underperform or leave.

‍

Every employee should have a mentor; here's how to do it

Starting a workplace mentoring program doesn't have to take extra time and effort. Technology can help build a successful and engaging mentoring program with mentoring software.

With Together, you can invite employees to register for your mentoring program via email. Participants can quickly build a profile on our platform, and our algorithm takes all the work out of the pairing process.

Find out how easy it is with a free trial of Together's mentoring software.

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15 critical roles mentors play in the workplace [2022 report on mentorship] | Together Mentoring Software

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Every employee should have a mentor at work. Why? Here are 15 critical roles mentors play in an employee's development and the company's success. | Ryan Carruthers

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Here is an website to consider when making this comparison.

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A Guide to Legal Mentors and How to Find One

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Having a legal mentor throughout your career can help you become a better, happier, and more successful lawyer. Read on to learn more.

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I am curious if there is any research out there on formal vs informal mentorship and if one of these is more beneficial?

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Yes, there is a lot out there. I found this scholarly article that might help you explore formal vs. informal forms of menorship.

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I wonder if there are any validated criteria for setting up formal mentorship relationships - should mentees/mentors be matched based on personality? career path? gender?randomly?

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I work in health care and feel very grateful to have many different types of mentors. Some mentors have been arranged formally through mentorship programs, however most often, my mentorship relationships have occurred organically.

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Working in health care, all of these mentorship types have been applied to me at one point or another. However, the most important mentors have been those that occurred informally.

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Confirms - this article confirms my experience of gender disparity in senior academic positions

Challenges - this article challenges me to think about how to facilitate mentorship for ethnic minorities

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Adam Grant on Instagram: "New podcast: busting the 3 big myths of mentoring—and learning from one of the most incredible mentoring relationships I’ve ever encountered. Link in bio"

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13K likes, 104 comments - adamgrant on October 18, 2023: "New podcast: busting the 3 big myths of mentoring—and learning from one of the most incredible ..."

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View this post on Instagram

A post shared by Adam Grant (@adamgrant)

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Listen to this episode from WorkLife with Adam Grant on Spotify. Mentoring plays an important role in growth and success for both mentors and mentees. But finding the right mentor - and being an effective one - is easier said than done.

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Here is a neat video that explores how some have approached the matching process from a skills, gender, equity, and inclusion perspective.

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How to Match Mentors and Mentees: 3 Strategies for Effective Mentor Program Matching

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I find role modelling an interesting concept in the mentor/mentee relationship. Sometimes the mentee just needs a mentor to be human and authentic, as we are more than just an employee coming to work. We are entering into these workspaces with many layers and complexities in our lives. There is a fine balance between remaining professional and being a friend, as we've seen in previous articles in this course and in the Better Conversations book. I have to make a concerted effort to remain on that line. I want to be genuine with mentees/mentors - as I am/have both, but I do find there is a struggle of "what is the right thing to say/do" and "what is the honest thing to say/do" Personally, I know the difference, so when a mentor gives me the "right thing to say vs. the honest thing to say" I respect them for upholding what they believe is professional standards, but I lose trust. On the other hand, when a mentor gives me "too much honesty and not enough of the professional/political response" I lose respect, but not necessarily trust. I trust people that allow you to know exactly where you stand with them, but I respect people make you toe a line of professionalism all the time. The questions is, what is more important in mentorship - trust or respect? What is the best way to be a role model who is both authentic and professional?

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I would be very excited to see some future research when it comes to the age of mentor-mentee relationships.

What dynamics in a mentor-mentee relationship change when the mentee is older than the mentor? Are these relationships successful?

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I believe that a team-based style is the most effective leadership style in education. Due to the number of stakeholders in the educational landscape, there are often a number of people and opinions when it comes to any given situation that directly involves this student. For that reason, a team-based mentorship style is vital for the mentor-mentee working in this setting.

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This article provides a solution for the lack of mentors available and discusses the concept of "Mutual Mentoring".

This is a creative solution to address the need for more mentors!

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Mentors’ Beliefs About Their Roles in Health Care Education

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Mentors’ Beliefs About Their Roles in Health Care Education

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Hello, Group and Classmates!

I think this article is a fantastic additional resource related to mentorship, as the article we chose discusses mentoring models and methods of delivery (team, peer mentoring, etc.). The attached article is a resourceful tool as it discusses intent: using the educational theory (the how) of teaching to decide what mode of mentorship (intent) works best in relation to a professional context.

"Awareness of their mentoring position can help mentors understand why they act the way they do in certain situations and how this behavior affects their mentees’ learning and development. It can also help mentors identify personal learning needs and, consequently, provide opportunities for faculty development."

Simply, as a mentor, understanding your goals, needs, values, and interests will help establish the mentor role you choose, enabling a sense of trust and mutual respect as both roles (mentor and mentee) are considered; in turn, facilitating learning opportunities - as discussed in our article summary.

Kind regards, Nicole

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Having a committed mentor is valuable to students in health professions education. Not only can mentors promote mentees' academic development, performance, satisfaction, and success, but they also can help them cope with the conflicting demands of career development and private life. How mentors shape their practice is influenced by their personal beliefs about the goals and purposes of mentoring, what valuable mentoring activities to engage in, who should decide on the focus of the mentoring relationship (mentor or mentee), and which strategies and methods should be used to enact these beliefs. Given the idiosyncratic and contextualized nature of these beliefs, mentors have their own unique ways to interpret and enact their mentoring., Stimulating mentors to make explicit their beliefs and critically examine them can raise awareness of why mentors act as they do in particular situations and, if necessary, allow them to regulate these beliefs to engage in more suitable mentoring. Because there is a paucity of studies of the personal beliefs of mentors in health professions education, we know little about the content of these beliefs and how they bear on the way mentors develop and enact their approaches to mentoring. Inspired by Kelchtermans' "Who I am in how I teach is the message," we set out to identify how mentors' "self" shows in their mentoring. More specifically, this research aims to contribute to the development of theory on mentoring and mentoring beliefs, thereby taking into account the complexity of the work as well as its idiosyncratic and contextualized nature.

Becoming a mentor is not just a natural extension of being an experienced teacher. It requires specific knowledge and skills. Consequently, expertise acquired in lecturing or clinical teaching, for instance, does not automatically transfer to one's work as a mentor. Learning how to be a mentor therefore requires faculty development initiatives that specifically target the mentoring role. This approach resonates with the growing research base underscoring the need for faculty development initiatives aimed at acquiring, maintaining, and improving mentoring skills.,,,

This need for faculty development initiatives, combined with the notion that how mentors mentor is based on individual beliefs, strongly suggests that training mentors cannot go without identifying and tapping into those beliefs. Indeed, researchers have argued that "professional development should not only concern instrumental knowledge, but also involve one's normative assumptions ... as these are enacted in practice." Hence, we should ask mentors to reflect on their personal mentoring practice because doing so will serve a dual purpose. First, it will make mentors aware of their beliefs and allows for adjustment if needed. The mere act of thinking about what they do, how they do this, and why they do it this way may itself foster development.,, Second, it may allow training to be personalized because beliefs can be incorporated in mentor training programs, for example, through role-plays, individualized coaching, or by using cases from the mentors' workplace.

This study is specifically concerned with identifying mentors' beliefs. To operationalize mentors' beliefs, we used Kelchtermans' concept of the personal interpretative framework. Initially, based in grounded theory, this conceptual framework was developed as a set of sensitizing concepts that could be used to reconstruct and analyze the professional development of teachers through their biographical career stories. The initial framework was developed based on an exploration of the literature. Although originally constructed from research on the professional development of experienced primary teachers in the early 1990s, Kelchtermans' notion has recently been taken up successfully in research on the identities and practices of other educational groups, including beginning teachers, teacher-educators, and educational leaders., The personal interpretative framework acts as a lens through which teachers make sense of and act in the professional situations in which they find themselves., Rather than being static, the content of the personal interpretative framework is dynamic and results from the meaningful interactions between the individual teacher and his or her professional working context (including the curriculum, collegial environment, student population, available resources, and faculty development initiatives).

Figure 1 illustrates the personal interpretative framework in context. Its 2 main dimensions are professional self-understanding (PSU) and subjective educational theory (SET). The first dimension, PSU, refers to how teachers conceive of themselves in their role and comprises 5 components: self-image, self-esteem, task perception, job motivation, and future perspective. The first component, self-image, is descriptive; it denotes how teachers typify themselves in their teaching role. Although largely based on self-perception, it also reflects and incorporates feedback from others (including teachers' students and colleagues). The second component, self-esteem, is evaluative, revealing how teachers evaluate their practice by answering questions such as how well do I do? The third component, task perception, mirrors what teachers feel they should or should not do as teachers. Fourth, job motivation is a conative element, which articulates the reasons teachers choose to enter, continue, or leave their profession. Future perspective, finally, refers to teachers' future expectations of their job.

Figure 1:

The personal interpretative framework, from a study to explore mentors' beliefs about their role in health care education. Eighteen faculty who mentor undergraduate students in the Medicine, Biomedical Sciences, and Health Sciences programs at Maastricht University, Maastricht, the Netherlands, participated in semistructured interviews between December 2017 and January 2018, to reconstruct their personal interpretative frameworks. The framework is a continuous interaction between mentors and their professional working context. It consists of 2 dimensions: professional self-understanding (PSU) and subjective educational theory (SET), which mutually interact, as indicated by the double-headed arrows. Both PSU and SET consist of multiple components, respectively describing the what and how of mentoring.

The second dimension of the framework, SET, encompasses teachers' individual system of knowledge and beliefs about teaching that informs their decisions on how to act in particular situations. Just like PSU, SET is intrinsically personal as teachers ponder, what works best in this particular situation? and why would this work? Teachers derive their SET from a combination of personal experiences, hearsay, and best practices learned from colleagues, as well as from more formal sources such as research or professional development support.

For professional development of mentors, it is important that mentors reflect on their beliefs about mentoring. Professional development by mentors cannot solely be aimed at changing knowledge and skills; without tapping into mentors' individual beliefs, the process would not yield durable professional development. Hence, to improve mentoring, we must not only teach mentors how to mentor but also help them to gain insight into their individual mentoring beliefs, so that they can adopt desirable mentoring characteristics,,, in the mentor-mentee relationship. To enable them to gain this insight, in this study, we reconstructed mentors' mentoring beliefs through the personal interpretative framework.

Method

Design

Using a multiple-case study approach, we conducted semistructured interviews with mentors to explore the content of their personal interpretative framework. A "case" refers to a single mentor in interaction in his or her professional working context (see Table 1). Professional working context could, for example, be interactions with colleagues, conversations with mentees, faculty development initiatives, or self-directed initiatives to learn more about mentoring. We chose to define our cases as an interaction of mentor and professional working context because it aligns with our theoretical frameworks' notion of the personal interpretative framework being in constant interaction with the current professional working context.

Table 1 - Mentoring Characteristics of 3 Educational Programs at the Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands a

Setting

Given the exploratory nature of this study, we sought to maximize relevant heterogeneity in participants' career trajectories and professional working contexts. We purposefully selected, 18 mentors from Maastricht University in Maastricht, the Netherlands. The mentors were selected from 3 undergraduate programs, specifically Medicine, Biomedical Sciences, and Health Sciences, that clearly differ in the extent to which mentoring forms an integral part of the curriculum, the duration of the mentoring program, the number of mentees assigned to each mentor, the use of portfolios to support mentoring, and the type of assessment by the mentor (see Table 1). Mentors were faculty at Maastricht University providing mentorship to undergraduate students. Mentors engage in preparatory mentor skills training and attend hands-on information sessions throughout the year. They are expected to meet with their mentees 3 to 5 times per year, on both an individual basis and during group sessions. The individual meetings between mentors and mentees are usually centered around personal and professional development goals of the mentees. In both the Medicine and Biomedical Sciences programs, mentoring is a longitudinal part of the study program, integrated in programmatic assessment and supported by e-portfolios., At the time of the interviews, all participants had completed at least 1 academic year of mentoring. Consequently, they had all completed preparatory mentor training and had gone through at least 1 complete cycle of mentoring, so they had experiences and examples to reflect on during the interviews.

Participants

We recruited participants via email, which led to a sample consisting of 4 mentors from the Medicine program, 12 from the Biomedical Sciences program, and 2 from the Health Sciences program. Twelve of our mentors were female, 5 were male, and 1 did not wish to reveal gender and age. The mean age of the mentors we interviewed was 48.9 years (SD = 7.6).

Data collection

The interview guide (Supplemental Digital Appendix 1 at https://links.lww.com/ACADMED/A792) was based on earlier research on the personal interpretative framework and built on the framework in that it covered all its components with a particular focus on mentoring. Open-ended questions were included to encourage deep reflection and storytelling. Before we conducted the interviews with the selected mentors, we tested the guide.,, L.M.L. interviewed the participants and, in consultation with the team, iteratively adapted the interview probes during the interview period. The face-to-face interviews were conducted in December 2017 and January 2018 and lasted approximately 1 hour. All interviews were audiorecorded, transcribed verbatim, and anonymized before further analysis.

Data analysis

Data were analyzed in a 2-step procedure. First, we did a within-case analysis to understand the uniqueness of each case. Second, we completed a cross-case analysis to build a general pattern of explanation and identify differences and commonalities across cases, that is, patterns in mentors' understandings of their role as a mentor and approaches to the practice of mentoring.,

We started the within-case analysis by coding the transcripts. An initial coding scheme based on the theoretical framework was complemented with descriptive codes summarizing the content of specific fragments of data. To make sure the meaning of codes was clear and unambiguous, P.W.M.V.G. double-coded 2 of the interview transcripts that were coded by L.M.L. Overlap and differences in the interpretation of codes were discussed between L.M.L. and P.W.M.V.G. until a satisfactory level of understanding of, and distinction between, codes was reached. Based on the coded transcripts that ensued, we were able to compile a synthesis text, (i.e., a biographical case report) that shared a common structure reflecting the theoretical framework. (For the case report template, see Supplemental Digital Appendix 2 at https://links.lww.com/ACADMED/A793). The case reports contained extensive quotes from the interviews (thick descriptions), thus preserving the richness of the data while at the same time making the large amount of data more manageable for the cross-case analysis.

We started the cross-case analysis, by comparing the biographical case reports. Reports were compared on their summaries, characteristic statements, and illustrative quotes and keywords. Based on the PSU and SET content of these phrases, we grouped reports in different ways until distinctive and meaningful clusters of PSU and SET types could be distinguished. We searched our data for as many different types as possible, but only if they meaningfully differed from each other. In addition, we ensured that we clustered in such a way that the PSU and SET of each mentor fit within 1 of the clustered types. Several rounds of close reading and clustering the biographical profiles resulted in the identification and description of 3 types of PSU and 3 types of SET, which combined into 4 distinct mentoring positions. The 4 positions were subsequently described in detail and extensively discussed by the research team. After completing this process, we read all the interviews once more and checked them for full consistency with the positions identified. To confirm that we interpreted the mentors' beliefs correctly, we invited all participating mentors to join a session in which L.M.L. explained the full study, described the results, and discussed the meaning of the results with the participants.

We used ATLAS.ti Version 8.2 (Scientific Software Development GmbH, Berlin, Germany) and Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington) to manage data throughout the analysis.

Researcher reflexivity

Two members of the research team (P.W.M.V.G. and L.M.L.) are mentors in one of the undergraduate programs, and L.M.L. is a mentor trainer as well. This affiliation may have influenced the researcher-participant relationship, as well as the data collection and analysis. In recognition of the relationships of L.M.L. and P.W.M.V.G. to the research, the researched, and the research setting, every step in the process, as well as intermediate findings were thoroughly discussed with the other team members, who had a more distant relationship with participants and did not hold mentor roles in the targeted study programs. Yet as researchers who are knowledgeable in the field, they may have been better able to ask relevant questions and to follow up during the interviews and encourage mentors to name specific examples to illustrate their answers. The academic background of the research team members was diverse, albeit complementary: educational sciences (L.M.L. and E.W.D.), cognitive psychology (P.W.M.V.G.), and pedagogical sciences (E.V.). This diversity contributed to a rich, diligent, and multiperspective interpretation of data but also safeguarded against blind spots.

Ethical approval

Ethical approval was granted by the Ethical Review Board of the Netherlands Association for Medical Education (NVMO-ERB reference number 944).

Results

From our within-case and cross-case analyses, we distilled 3 types of PSU and 3 types of SET, which, when combined, constituted the following 4 mentoring positions, which are summarized in Table 2: (1) facilitator, a service-providing, responsive mentor; (2) coach, a development-supporting, responsive mentor; (3) monitor, a signaling, collaborative mentor; and (4) exemplar, a service-providing or development-supporting, directive mentor.

Table 2 - Mentoring Positions and Mentors Holding These Positions, From a Study to Explore Mentors' Personal Interpretative Framework, Maastricht University, Maastricht, the Netherlands, December 2017-January 2018 a

These positions should not be regarded as fixed and stable innate traits but rather as reflecting the different conceptualizations and combinations of mentors' PSU and SET, as well as different conceptualizations of mentors' working relationships with mentees, which may dynamically vary across contexts and over time. Therefore, mentors will probably not only display PSU and SET types from their own position but also make use of the other positions, depending on the context.

In the next paragraphs, we will describe each position in terms of the 2 dimensions of the professional interpretative framework, illustrated with quotes from the mentors who participated in the study (M).

Position 1: The facilitator

A facilitating mentor is an approachable first point of entry, a familiar face, whose PSU is centered around providing the mentee a certain level of "service." This service includes, for example, explaining to the mentee how the academic world works and how to self-direct one's study, or putting the mentee in touch with others, such as study counselors, the board of examiners, or psychologists. Facilitating mentors see themselves as sources of information, being a stable, ever-present factor during their mentee's study career:

I always interpreted mentoring as a point of contact students have, something very close. When they enter, everything is new, there are many students, [I can be] the one person they regularly see throughout the year, whom they can always ask questions. Even simple questions, or questions they don't know whom to ask, they can ask me. (M11)

Although facilitating mentors acknowledge the benefit of using a portfolio for documentation purposes, they tend not to use it to guide their interactions with mentees. Therefore, they will work with the portfolio insofar as it is required by the study program but will not use it as a yardstick for determining the mentee's study progress.

The SET of facilitating mentors is responsive, meaning that they do not proactively intervene in their mentees' development but leave it to mentees' initiative when it comes to getting in touch, asking questions, or making requests. Mentors with a responsive SET can be seen as "available on call" when mentees need them: "I think I'm accessible, but I also think I'm not a difficult mentor, one who asks difficult questions. I much prefer being there for my student at the moment they need me." (M12)

A mentor with a responsive SET is there for the mentee when needed, stays on top of things, and keeps track of the mentee's academic progress.

Position 2: The coach

The primary aim of the coaching mentor is to nurture a development-supporting PSU, looking at mentees as unique individuals, and not simply as students or future professionals: "... students should be who they are and accept who they are." (M04) More specifically, this type of mentor encourages mentees to think about their development in the broadest sense, not only in terms of academic achievements but also with respect to meeting the challenges and demands of one's personal and future professional life, thereby supporting the development and well-being of their mentees. Because their PSU is development oriented, coaching mentors rely more on the information in the mentee portfolios than facilitating mentors do; portfolios allow them to see their mentees' learning goals and reflections, see their assessment scores and feedback, and check whether they need additional support. As with the facilitating mentor, the coaching mentor allows the mentee to actively steer and deploy the mentoring relationship toward growth and development, resulting in a responsive SET, where the mentee is in the lead: "I keep pushing, but I don't pull.... I cannot drag my student into something and hope they follow along." (M04)

Position 3: The monitor

A monitoring mentor holds a signaling PSU, which means that the monitor can provide suggestions or advice and may deploy his or her own network to the benefit of mentees' development. Given this signaling goal, a monitoring mentor uses the mentee's portfolio as an instrument to follow up on how the mentee is doing and to signal potential downward or upward trends in his or her development. Monitoring mentors can then point this out to their mentees:

I feel it's my role to tell students, "This is not a clever thing to do, you need to make choices here." But it is not my task to tell students which choice to make.... I can point students to issues they create and ask, "Why do you think so? What is more important to you? You are the one making the decisions here." (M23)

A monitoring mentor aims to assist the mentee in becoming a reflective learner and to support self-understanding by mirroring the mentee's behavior and supporting structured, deep reflection. According to their own description, a monitor is a critical friend who is in a mutually respectful relationship with the mentee, in which the mentee is often regarded as an equal partner rather than a junior or novice.

The collaborative SET of a monitor entails that, depending on mentees' needs in the varying stages of their study trajectory, the mentor flexibly adapts the level of support and involvement, which translates into a collaborative relationship with mentees:

Some sort of "let them swim and we'll stand there holding a lifebuoy." I think that is better than ... just standing there, holding a rescue hook all the time, saying "come over here.".... In the end, students need to do it. If they want to make use of [mentoring], OK. If not, that's OK too. (M20)

Position 4: The exemplar

An exemplar usually does not have a clear preference for either a service-providing or a development-supporting PSU but can engage in both. This mentor may normatively use personal experiences when advising a mentee and may have an initiating role in discussing concerns about the mentee's functioning. Consequently, the exemplar is more directive in his SET compared with the responsive mentors (facilitator and coach) and collaborative mentor (monitor). Rather than "solving" an issue for the mentee, the exemplar encourages the mentees to try to solve issues themselves or refers them to dedicated professionals. He or she does follow up on such referrals but keeps a professional distance. A mentor who acts like an exemplar can be stern toward a mentee who does not meet expectations and can decide to take action on that as well:

Well, I sent one of them off to the student counselor; he was asleep during our meetings. And why? Going out 'til 5 o'clock on Saturday, on Sunday. You don't do that in my group, buddy. So I told him, "I think you're overestimating yourself." So I called the student counselor and managed to get him there. (M05)

Conversely, when mentees do their best or show interest in the professional field of their mentors, they can learn a lot from the personal expertise of these mentors who position themselves as exemplars. They then, for example, take the time to show mentees what they do as academics: "Some [students] are already performing quite well, right? Five minutes in a conversation I thought, 'Well that's that, nothing to add anymore, everything is going quite fine.' And then I took him to see our research facilities." (M10)

Discussion

This study aimed to reconstruct mentors' personal interpretative framework on the basis of in-depth interviews with 18 mentors from 3 undergraduate programs. We distilled 4 mentoring positions from our analysis: the facilitator, the coach, the monitor, and the exemplar. Each of these dynamic positions represent a coherent set of normative beliefs about what are meaningful mentoring activities to engage in, who should decide on the focus of the mentoring activity (mentor or mentee), and which strategies and methods should be used to enact these beliefs. Both the facilitator and the coach adopt a responsive approach (SET) to mentoring but differ in terms of the activities they engage in with their mentees. While facilitators aim for a service-providing PSU, coaches tend to focus on development support. Monitors, however, interact with their students on a more collaborative level and help them to recognize and track their progress. Exemplars, finally, have no clear preference for either service provision or development support, and nurture a more directive mentoring SET.

The results of our analysis can be used to support professional development of mentors. Mentors can be asked to analyze and reflect on their mentoring and the context in which it takes place. This analysis and reflection makes them more aware of the beliefs that are the foundation of their mentoring, which can contribute to more durable changes in the professional development of mentors.

It is important to note that the 4 mentoring positions are not intended to be a prescription for what mentoring practice should ideally look like, since mentoring inherently is contextualized and dynamic.,, Rather, the goal of this research was to provide an interpretative description of the diverse ways in which mentors think about their goals and practices. Implicit in the notion of the personal interpretative framework is the idiosyncratic, yet deeply contextualized and dynamic sense of self mentors bring with them to particular situations. The position mentors prefer, embodying their set of cognitions, guides the way they interpret a particular situation or context and how they act accordingly. At the same time, however, these positions are modified by their interaction with that context, for example, by the type of mentee, formal or informal mentoring, and the requirement to assess students or not. Consequently, positions should not be seen as stable, innate traits, but differing over time and between contexts. When mentors become aware of their current position, they can reflect on it and decide whether this position is still appropriate,,, for interacting with their mentee. Mentors can make use of multiple positions instead of rigidly holding on to a certain role. Accordingly, mentors could decide to strengthen their position, which could be supported by, for example, individual coaching or tailored faculty development.

Given the contextualized and dynamic qualities of these positions,,,,, we welcome future research that extends this study to include mentors working in vastly different mentoring programs and settings (e.g., programs with a strong portfolio-based assessment, informal mentoring, programs without preparatory mentor skills training) or mentors at different stages in their mentoring career. In an informal mentoring setting where mentees independently initiate mentoring and only contact their mentor when they feel they need to, for instance, we might expect mentors to adopt a signaling-responsive mentoring position.

In this study, the personal interpretative framework offered us a refined analytical tool to reconstruct and visualize the complex reality of mentoring beliefs. The theoretical framework was initially developed for research in primary education, but it has been applied to other fields as well., We used interviews for reconstructing mentors' personal interpretative framework. Interviews are time intensive. Therefore, future research could explore more time-efficient methods, for example, surveys, which can be used to reconstruct mentors' personal interpretative framework.

A limitation to the present study in general is the composition of the sample. For practical reasons, that is, limited availability of mentors in the 3 programs, we interviewed mentors who were relatively new to mentoring (< 1.5 years of experience). Because PSU and SET are always in development, mentors' personal interpretative framework is bound to change over time. For that reason, it would be interesting to explore whether mentors with more prolonged mentoring experience hold positions that are distinct from their less seasoned counterparts.

Conclusions

Although mentors' positions are inherently dynamic and context specific, being aware of their position can help mentors to understand why they act the way they do in certain situations and how their behavior affects their mentee's development. It can also help mentors to identify personal learning needs and, consequently, provide opportunities for faculty development. The present research adds to the theoretical knowledge about mentoring in health professions education and can give rise to future innovations in faculty development targeting mentors., Mentors who acquire and practice their mentoring skills through training and are reflectively aware of how and why they mentor can be highly valuable facilitators, coaches, monitors, or exemplars to their students.

Acknowledgments:

The authors thank all participating mentors for their invaluable contributions to this study. The authors are also grateful to Angelique van den Heuvel for her help in preparing this manuscript and to Stephanie Meeuwissen for sharing her valuable insights on mentoring.

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Mentors' Beliefs About Their Roles in Health Care... : Academic Medicine

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ractice. In accordance with the personal interpretative framework, the authors operationalized mentors' beliefs as professional self-understanding (the what) and subjective educational theory (the how) of teaching and sought to identify different mentoring positions. Method Using a qualitative approach, the authors conducted semistructured interviews between December 2017 and January 2018 with 18 undergraduate mentors from Maastricht University in Maastricht, the Netherlands.

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The Importance of Mentorship (health field).

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The Importance of Mentorship (health field).

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Hello, Group and Classmates!

Our article briefly discusses culture, so I thought this video/blog would be a great addition as it discusses the role of mentor vs. mentee from the perspective of diverse cultures. Most interestingly, how important the role of the mentor is to the mentee and vice versa (medical journey) and how being invested in one another is "key to a successful relationship." This is essential to recognize, as cultural mentoring enables people from diverse backgrounds to share and gain insight from and with one another.

Kind regards, Nicole

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The Importance Of Mentorship!! | Increasing Diversity In Medicine | Med School Vlog

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I think group mentorship would work well for my professional context because there is room for peer interaction which can be very helpful in the field of education. Peer interaction can promote collaboration and collective learning.

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Hello, Group and classmates!

The article touched upon this topic briefly (p. 631); however, as technology is an essential component - not only in the health and science field but education overall (for example, this course and program offered at Ottawa U), I think it is vital to discuss and evaluate the role virtual mentorship has now and in the future! Mentors and mentees may be in different locations, and learning how to mentor effectively is critical for the mentee's success and, more importantly, how to maintain and foster meaningful relationships and personal connections.

I find the flexibility and convenience of virtual mentoring an advantage as team members can meet at a convenient time for all, and there is a more significant amount (colleges - both mentor and mentee to participate) available within an organization - the virtual space allows everyone to participate!

Kind regards, Nicole

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What mentoring and coaching models support cultural diversity?

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What mentoring and coaching models support cultural diversity?

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There are ways to modify existing mentoring and coaching models to support diversity. Here is a website that gives some tips on using reverse mentoring to increase diversity and inclusion.

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Diversity and Inclusion

It's natural that companies want their employees to feel nurtured, valued and supported. But it's only a successful effort if everybody is feeling that way.

A diverse and inclusive organisation is therefore one that employs and equally supports people of all genders, races, religions, sexual orientations, abilities, ages, backgrounds, appearances, and languages.

There are many ways companies can be actively improving their inclusivity in order to achieve a truly diverse workplace. One of those ways is by using mentoring for diversity and inclusion.

The benefits of mentoring are extensive. But by utilising mentoring for diversity and inclusion, you can make a deeper impact. In this guide, we'll talk you through how mentoring can support diversity, equity and inclusion initiatives, and provide some tips from our learnings here at Guider.

But first...

Why is diversity and inclusion important?

Everybody navigates the world differently. Our characteristics - both physical and personal - affect the way we experience life, resulting in a vast range of perspectives.

In order to best understand anything (be it a problem, a method, or an experience) we need to have as many of these perspectives involved as possible.

Seems intuitive doesn't it?

Unfortunately not. When managers were asked for factors stopping them implementing diversity, many quoted the worry that too many differing opinions would hamper productivity.

When the reality is, diversity in organisations has been proven time and time again to have a positive impact on innovation and success. When it comes to decision making, diverse teams outperform both individual and non-diverse teams, making better business decisions every time.

Naturally, this positively affects the bottom line. A study by BCG found that companies with diverse management teams make 19% more revenue, showing how D&I is not limited to an HR goal, but is ultimately good for the economy.

We've written another handy guide on Racial Diversity in the Workplace, which includes actionable tips for businesses to step up and tackle systemic racial inequality. ‍

What is diversity and inclusion in the workplace?

Firstly, it's important to acknowledge that diversity and inclusion are different things:

Diversity is the goal for a workforce to be made up of a broad variety of people.

Inclusion is a method to ensure everybody is equally factored into that group.

So, despite diversity and inclusion being grouped together, the way to tackle these issues can actually be contradictory.

For example, if you're looking to run a mentoring program to increase diversity, you may select a particular minority group and pair individuals in that group with mentors in order to achieve a goal. However, this will not be inclusive if you only make the program available to that one group.

This is something to be aware of before you group them together and set up a 'Diversity and Inclusion Mentoring Program'.

11 Examples of inclusion

What does inclusion look like in real-life? Here are 11 examples of inclusive behaviours at work in action:

1. Make sure everyone is heard. Noticed someone was interrupted in a meeting? Actively direct the attention back to that person to give them the chance to finish speaking.

2. Create a collaborative environment in which everyone can contribute ideas.

3. Set-up pronoun options on your company communications tools.

4. Make sure everyone has the chance to speak in meetings by actively inviting them to talk.

5. Allow people to select their best ways of working for example 1:1 meetings or a quiet environment for working.

6. Practice active listening with your colleagues.

7. Focus on fostering psychological safety where people aren't afraid to make mistakes.

8. Openly give credit for ideas and success to the correct person.

9. Create channels for open feedback that go both ways.

10. Provide non-alcoholic drinks options at company socials as well as food options that take into account dietary needs..

11. Implement a bank holiday exchange scheme that means people can celebrate the religious holiday of their choice each year.

What is equity and equality in the workplace?

Another pair of key terms is equity and equality. With diversity, equity and inclusion or diversity, equality and inclusion often grouped together you may wonder what these words mean.

Equality means giving everyone the same opportunities and resources.

Equity means allocating opportunities and resources so that everyone can achieve the same outcome.

As you can see, these two terms are similar but not the same. Aiming for equity will mean paying greater attention to the way that you allocate your time and resources. This accounts for the systemic inequalities and barriers that exist that cannot be overcome with the same resources.

Find out more about the benefits of embedding mentoring in your diversity and inclusion initiatives with Guider. ‍

How to promote diversity and inclusion in the workplace through mentoring

Workplace mentoring programs are a great way to promote diversity, equity and inclusion in the workplace. As we've outlined, there are differences between the key terms, so the way you approach setting up your programs will differ depending on who you are trying to support.

Let's look at some examples:

Mentoring for Diversity - aka Reverse Mentoring

The aim of mentoring programs for diversity is to support and empower minority employees in their career progression, developing their skills and network to increase leadership succession.

This typically involves pairing high potential employees from minority groups, with senior management level employees to diversify the talent pipeline within organisations. This is known as reverse mentoring for diversity and inclusion. The other types of mentoring an be used for diversity mentorship programs too, but reverse mentoring is often the most common.

As with starting any mentoring program, businesses looking to implement a diversity mentoring program must first outline the goals. Try and be more specific here than just 'fostering a culture of diversity' - perhaps you're looking to increase employee retention within a minority group, or encourage more black women into leadership roles. Whatever the goal is, define it before starting and understand how you will measure success.

Depending on the goal, size of organisation, and current diversity status, the way the program is set up will differ. In order to avoid the contradiction of a highly-exclusive diversity program, you can make it open but prioritise the under-represented groups that it is aimed to support.

For a full step by step guide to setting up a mentoring program, check out our full guide:

Read our guide: How To Start A Mentoring Program‍

Mentoring programs for inclusion

Alongside a tailored diversity mentoring program, HR and L&D teams can also run mentoring programs supporting a culture of inclusion. You can utilise your employee resource groups (ERGs) to promote and recruit participants to your program.

A good example of where mentoring for inclusion can have a real impact is age discrimination within the tech industry. 41% of IT and tech workers have witnessed age discrimination in the workplace, and 32% fear losing their roles due to ageism.

In this case, a number of companies have seen great success from reverse mentoring. Younger employees mentoring older employees and supporting them in their learning of digital skills can be hugely beneficial to everyone involved.

In this kind of mentorship, the younger employee will naturally also learn a lot, creating an inclusive culture of learning and development.

By making mentoring an integral part of your company culture, you will naturally foster the sharing of knowledge, aspiration and development amongst all your employees, contributing to a diverse and thriving workplace.‍

‍Striving to create a diverse, equitable and inclusive workforce should be a number one priority for all businesses.

While external training and courses may have a positive impact, particularly with leadership teams, the best way to enact change is through the people already within the business. This is where diversity and inclusion mentoring can really make an impact.

Mentoring harnesses the people in an organisation to learn and grow together, to share experiences and knowledge, and level up inclusivity in the workplace across the board. That's why mentoring is such an effective method to support diversity, equity and inclusion in your organisation.
Want to find out how Guider can help? Book a demo now to speak with our reverse mentoring experts. Read more: LGBTQ+ Mentors in History Reverse Mentoring a Complete Guide Tackling Unconscious Bias in the Workplace DE&I Statistics to Bookmark in 2023 Unlock the Power of ERGs in Your Workplace How to Build Psychological Safety at Work How to Avoid Rainbow-Washing This Pride Month 6 Effective D&I Strategies to Implement

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How to Improve Diversity and Inclusion with Reverse Mentoring - Guider

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Learn how reverse mentoring can contribute to enhancing diversity and inclusion within organisations. We discuss the top reasons in this blog, read here.

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I really connected with the part of the article that talks about diversity and mentoring. As an individual from a different cultural background than a lot of my peers, having a mentor who understands my cultural background can be helpful for me when navigating the workplace. There are so many unwritten rules that those who grow up here in Canada know but as an immigrant coming from a different culture, I am not aware of these rules! Having a mentor from my cultural background who understands the system and the rules would have been beneficial to me when I joined the workforce in Canada.

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Hello, group and classmates!

I had not heard the term reverse mentoring until I read the article above. I think this is an invaluable concept and highly effective for promoting inclusion and diversity in the workplace. I think the fundamental idea within the reverse mentorship framework is that it is about the sharing of perspectives that are different from their own (mentor vs. mentee); it provides insight, bridging the gap between different cultures, age groups, gender groups, etc. fostering collaboration and the sharing of knowledge, breaking down stereotypes, contributing to a positive workplace environment.

Kind regards, Nicole

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Why reverse mentoring is so powerful for diversity and inclusion initiatives | Michelle Ferguson

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Hello, group and classmates!

Here is another little blurb about reverse mentoring from the link above!

Benefits of reverse mentoring

The reverse mentoring programme will:

Create the opportunity for the mentee to hear diverse perspectives, to generate better awareness and understanding of inclusion, and ultimately inspire action within their own organizations.

Create the opportunity for under-represented groups to share their views on inclusion and build a senior network.

Connect people across different companies and help build cross-industry networks.

How does it work?
Mentoring partnerships are made up of two individuals from different, non-competing companies across the food and consumer goods industry.
Reverse mentoring partnerships comprise:

A mentee – a senior person who can impact the business culture (typically Director, General Manager, Head of level). Someone looking to broaden their understanding of inclusion and who wants to be part of leading change in our industry.

A reverse mentor from an under-represented background who would benefit from the opportunity to grow an external network and support a mentee to broaden their knowledge and understanding of inclusion. Someone who wants to be part of leading change in our industry.

Hope you enjoy and kind regards, Nicole

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Benefits of reverse mentoring

The reverse mentoring programme will:

Create the opportunity for the mentee to hear diverse perspectives, to generate better awareness and understanding of inclusion and to ultimately inspire action within their own organisations.

Create the opportunity for under-represented groups to share their views on inclusion and build a senior network.

Connect people across different companies and help build cross industry networks.

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The reverse mentoring programme will: Create the opportunity for the mentee to hear diverse perspectives, to generate better awareness and understanding of inclusion and to ultimately inspire action within their own organisations. Create the opportunity for under-represented groups to share their views on inclusion and build a senior network.

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Hello, group and classmates!

I think an effective mode of mentorship that fosters cultural diversity would be, as the above article supports, peer mentoring. Our group's article states that "peer mentoring is very collaborative and mutually beneficial as the relationship is formed among the mentor's peers or colleagues. In this situation, the mentee may be more inclined to share their difficulties and questions with peers who are at an equal or similar level of knowledge and seniority, as opposed to senior faculty" (p. 631).

I think this is an effective strategy as pairing up peers allows for collaboration amongst those with similar goals, interests, and challenges. I feel it promotes understanding and respect while valuing different perspectives among diverse groups in an empowering way.

Kind regards, Nicole

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Hello, group and classmates!

As a previous ECE and current analyst manager for CRA, many connections regarding mentoring have been and are currently relevant between the article and my experiences that allow me to develop as a manager and previous mentor to early childhood educators.

One of the most valuable connections I have made beyond my mentorship style is the skills and abilities "deemed necessary in defining an ideal mentor" (Henry-Noel et al., 2018, p. 631). I feel that my skills and abilities as a mentor have progressed as I have learned, coinciding with my current learning from the summarized article for this assignment. Sometimes, I lose focus on the skills necessary and have been guilty of being quite didactic. As a previous ECE, I was always approachable but only occasionally available as I was finding my way as a mentor, student, and employee. My experiences in connection to this article confirm my thoughts regarding mentorship in terms of focusing on skills I can gain as a mentor, leader, and manager; most important to me are trust, respect, flexibility, and understanding of others' perspectives.
For example, as a younger ECE on my educational and professional journey, I was often asked to mentor students in the ECE program. I enjoyed this responsibly immensely, but as I was beginning to develop my skills, I realized now that I had much to learn regarding my communication skills, expanding my viewpoints and considering new ways to approach situations. This article has allowed me to make a deep connection to my understanding that I, as the mentor, was learning, along with the mentee, and that was acceptable - we were both on a journey of learning and discovery, a partnership as "each mentor [and mentee] brings a different knowledge, but that also has interaction and communication between the several mentors whereby facilitating more efficient and effective mentoring" (Henry-Noel et al., 2018, p. 632). I have learned that partnerships are critical to everyone's success and that effective communication and collaboration "is mutually beneficial as the relationship is formed among the mentors, peers, or colleagues" (Henry-Noel et al., 2018, p. 632).

Kind regards, Nicole

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Hello, group and classmates!

Confirmations: As a previous teammate mentioned, this article has confirmed my assumptions that regarding culture and gender, many barriers contribute to systemic power dynamics within the health profession that contribute to ineffective mentor/mentee relationships that minimize opportunities for these groups to advance professionally.

Challenges: An imminent challenge in the health field would be how (mentorship programs, policies, procedures, and awareness), to mitigate systemic oppression for genders and cultures to ensure workplace environments and mentor/mentee relationships promote inclusivity and knowledge sharing as "while there is an increase in the diversity of females and ethnicities of medical student applicants, students, residents, and physicians, there must be continual implementation of mentoring programs that tackle ethnicity, socioeconomic status, and gender diversity" (Henry-Noel et al., 2018, p. 636).

Kind regards, Nicole

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A thought-provoking topic.

Not being in medicine, I rarely consider the male-female dynamic in this field, although if you pushed me on it, I would guess that the domain of surgeons is very masculine in its orientation. Much like working in a kitchen, I would imagine there's a great deal of yelling, ordering around and tremendous pressure. The hours would be long and unpredictable. Patients would die on the table in front of you, sometimes because of a mistake you've made. The list of responsibilities required of a surgeon make this a specialisation that most men wouldn't dare undertake, let alone women. In the end, however, all that matters is one's skill and I would hope that we could open up more pathways for women so that they can successfully achieve their dream of being a surgeon.

While I hesitate at the thought of establishing sex quotas for surgeons, I certainly approve of facilitating women's growth in this area via a mentoring approach. It's not clear to me that the competitive world of medicine lends itself to this, however.

Oh well, I guess I'll add this issue to my long list of criticisms of our medical system. ;)

-Peter Moore

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Thank you for your response, Peter. I would agree that more pathways should be open for women given what the research shows. As a next step for those in the health care field, I would want to look at what those pathway might look like and identify the barriers to those - other than their gender ;) However, as you mentioned, with such a strained health care system in Canada, mentorship might fall to the side while they try and sustain themselves.

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Great presentation and use of an interactive online platform to facilitate the discussion among us classmates :)

I would appear that nearly everyone chose "approachable" as the most necessary interpersonal ability for a mentor. I'm curious to hear your thoughts on this. Based on your knowledge and personal experiences, why do you believe that is so?

Sarah McAllister

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Hi Sarah,

Thanks for the question. For me, coaching and mentoring is about relationships, and in my experience, the better the relationship, the more profound the experience. I think the mentee needs to feel comfortable asking questions and being honest/vulnerable in the learning journey to grow. If they can't approach the mentor/coach with questions or struggles, then they become passive consumers of knowledge and experience, and it's surface-level growth. When they can approach the mentor/coach with their questions and challenges, the mentor can get to know them on a deeper level and can help provide more personalized guidance. I suppose, in a sense, it depends on the objective too. If it's a skill someone is trying to learn, (ie. how to use Excel) perhaps its not as significant as if it's a job they are trying to learn long-term.

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Hello, group and classmates!

I have used many mentorship styles in my professional journey as an ECE, Human Resources Rep., and in a few positions in the government, currently, an Analyst Manager. I find many skills within the various mentorship frameworks often overlap (collaboration, feedback, role-modeling, partnership, trust, communication, etc.), allowing me to utilize different modes regarding specific professional contexts based on the mentee's needs.

As an analyst manager, historically, my mentor style has been quite didactic as there are so many policies and procedures to implement, often a barrier to establishing effective communication and collaboration as I am just purging information. Usually one-on-one (various stakeholders determine skills necessary for roles), I do, however, provide guidance and monitor progress, identifying strengths and weaknesses and helping the mentee achieve their professional goals within the organization (Henry-Noel et al., 2018, p. 631). As I have progressed professionally and personally, I place immense value on collaboration and establishing meaningful relational partnerships with mentors and mentees that are authentic and that contribute to the concept of shared knowledge. It has been my experience that authenticity and collaboration are vital to a successful mentor vs. mentee relationship, regardless of what style one chooses to implement, dependant more on characteristics that define an effective mentor, calling upon the skills necessary at the time.

My goal, however, is to remain focused on the team atmosphere and mentor/mentee attributes, employing all to mentor one another while fostering leadership skills, which strengthens an organizational culture (participation) as "a successful mentorship program hinges on... the anticipated goals of a mentorship relationship, and characteristics of the participants" (Henry-Noel et al., 2018, p. 632).

Kind regards, Nicole

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This presentation and padlet were so detailed! I can tell how much care, thought and time was put into it. It is disappointing, but not surprising, to hear about the challenges that females face in the medical field in terms of mentorship. Thanks for sharing your presentation!