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Social Science—What Is Needed

Mentoring, coaching, and sponsorship occur in a variety of settings and transition points. Orlando Kirton, M.D., M.B.A., Abington-Jefferson Health, moderated a panel in which two social scientists discussed these relationships and the environments in which they play out. Stacy Blake-Beard, Ph.D., Dartmouth University and Simmons College, focused on mentoring, coaching, and sponsorship as sources of critical support and feedback. Laura Morgan Roberts, Ph.D., University of Virginia, spoke about racially just workplaces to advance true inclusion of people with diverse talents. A robust question-and-answer period followed their presentations.

SOURCES OF CRITICAL SUPPORT AND FEEDBACK

Dr. Blake-Beard said she would build on the insights brought out by the previous panel of mentors and mentees. She noted mentoring, coaching, and sponsorship relationships are important to her both as a course of study over the past decades and in her own development.

Referring to the earlier discussion about mentoring across races, genders, and other characteristics, she identified the concept of intersectionality (Crenshaw, 1989) as the recognition that people have different identities, and they learn from each other based on both similarities and differences. “To give a name to what others have brought up, when we show up, we show up as more than one thing with many dimensions of our identities. There are challenges and opportunities when we acknowledge this,” she said.

Although the concepts intermingle and play off each other, she defined the different relationships:

Benefits gained from a mentor include hearing clear and realistic expectations, active listening and thinking about how to help, and self-disclosure and thus vulnerability. It is necessary to be willing to take risks and be proactive in getting a mentor. Managing feedback from the mentor or sponsor is often not explicitly discussed, but it is important to learn how to use that feedback, she added.

There are challenges, especially for people of color, in getting support. She noted none of these ideas will seem new to participants, but it is important to give names to them and consider how they are interrelated. They include tokenism, “that aspect of our lives where we stand out because we are one of few.” A dilemma is how to get close to another person and share thoughts and feelings without being perceived as too close. Stereotypes exist; she referred participants to the implicit association test¹ that can help reveal a person’s implicit biases and internal stereotypes and how quickly inferences are made.

How to get real feedback from a mentor, not just general positive reinforcement, is also a challenge, especially when the relationship occurs across dimensions of difference (e.g., race, gender, institutional type). Particularly related to race and ethnicity, she pointed to the concepts of protective hesitation and protective defensiveness. In protective hesitation, “the mentor doesn’t give honest feedback out of fear of being perceived as racist, homophobic, sexist, or any other dimension.” Yet, she noted, this can result in not offering feedback that the mentee should have. Dr. Blake-Beard considered this as “protecting myself [as the mentor], not the mentee. The irony is in trying not to hurt the recipient, the mentee is hurt because they do not get full information.” Protective defensiveness can also occur, in which people of color build a shell around themselves in situations where they stand out as a minority. “The challenge is what if that shell gets so thick, feedback that you need will not penetrate it. The irony is that in trying to protect ourselves so much, we do not hear what we need, such as how to apply for a position.”

Accessing support means paying attention to whom to ask for support, when to ask, and how to ask. “You may have to figure out a way to connect with them,” she pointed out. “All these people at the heart of it want you

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¹ See https://www.projectimplicit.net.

to succeed. But to provide that support, there has to be a two-way street.” She suggested keeping intersectionality in mind, and overcoming both protective hesitation and protective defensiveness.

She also stressed the need not to have just one relationship to draw on for support, but to have a network that includes peers, friends and family, advisors, and professional associations. She noted a saying, “If you want to go fast, go alone; if you want to go far, go with others.”

TOWARD A RACIALLY JUST WORKPLACE

Dr. Morgan Roberts said she was asked to place the workshop conversations in the context of organizational change, and specifically how mentoring, coaching, and sponsoring fit within a broader suite of initiatives with respect to leading racially just organizations. She drew from two edited volumes she published on the topic (Roberts et al., 2016; Roberts et al., 2019), with more than 50 studies from more than 100 global scholars about what it means to truly value difference in organizations. Three interrelated steps are critical: acknowledging, affirming, and acting. She noted her more recent book, Race, Work, and Leadership, includes a contribution by Dr. Blake-Beard.

The social science perspective is useful because of the interrelatedness between the economic, education, housing, justice, and health sectors, she said. In 2020, the Business Roundtable, whose members are CEOs from leading corporations, committed to advancing racial justice across these sectors in recognition that the issues have implications for the viability of the economy (Business Roundtable, 2020). Long-standing and perpetual problems related to wealth inequality and income disparities have been exacerbated by the COVID-19 pandemic. The wage gap as a function of inequality and racism has largely remained unchanged for decades, and the numbers are even more sobering because of the pandemic. When talking about diversity broadly stated, she pointed out that some of the nuances are lost, because the experiences of Black professionals are different from those of people of Latinx and Asian origin.

Black people comprise about 3 percent of senior executive positions, about the same as in health-care leadership. There seems to be a ceiling, even though diversity is stated as a goal for society and the economy. “Diversity of thought jolts us into cognitive action in a way that homogeneity does not,” she said, referring to work by Katherine Phillips (2014). “But the lived experience fails to deliver on that promise.” She has focused her recent

writing on the disconnect in many organizations between the promise of hiring a diverse or more culturally competent workforce and doing the work to value differences. This, she said, is where relational work like mentoring, coaching, and sponsoring comes in.

Even if diversity is a stated goal based on business needs, most do not want to “put in the work and make the investment to build the relationships,” she said. Protective hesitation and defensiveness, as explained earlier by Dr. Blake-Beard, come into play. Despite underinvestment in building a diverse workforce, there is an expectation to receive returns. There is also a moral case for doing the right thing, stemming from what has been inflicted on Black and Brown people, often by medical institutions, including in enslavement and post-enslavement. Specifically,

Empirical research that she has undertaken identifies challenges that Black and Brown professionals face in health care, higher education, financial services, nonprofits, and other fields. She and colleagues identified common patterns across sectors, which she categorized as the “Four A’s”: access (increasing representation in the pipeline); authenticity (building inclusion and belonging); advancement (getting ahead); and authority and accountability (having to struggle for respect as Black professionals). In research she and Dr. Blake-Beard did in the Boston area, they learned many Black health-care professionals were recruited into clinical care positions to meet underserved communities but overlooked when it was time to pick new leaders. Many left Boston or health care entirely because they felt they could not advance in the system.

As the daughter and sister of physicians, Dr. Morgan Roberts said she has listened to them and other Black doctors talk about repeated experiences with microaggressions. They speak of being mistaken as someone without a medical degree and treated with less respect. They often receive career advice that indicates lowered expectations or pigeon-holing into certain roles. “These dynamics undermine authority, and the systems are not held accountable,” she said. Black physicians and other health-care professionals are carrying the burden of a cognitive or emotional tax, and feel less connected. The promise of diversity that will bring resources to benefit patients

and society becomes undermined. Professionals of color cannot bring their full authentic selves or identities to the workplace, and instead tuck themselves behind a protective mask.

She noted the concern about violence and oppression expressed during the summer of 2020. Institutions pledged to make changes in the service of greater freedom and equality. But what happens in institutions is a pivot from designing intentional programs for high-performing Black professionals to what she termed “what about-isms”—that is, what about other marginalized groups. She stressed that she did not disagree with this concern, but broadening the aperture can shift attention away from addressing violence and oppression against Black people. “Over time, we include everything, and therefore do not address much of anything except the comfort level of the people who are most powerful,” she observed.

Dr. Morgan Roberts returned to the three areas of acknowledging, affirming, and acting to engage people’s heads, hearts, and hands. It involves, she said, acknowledging how race shapes organizations, societies, and lives; affirming the value of racial diversity and the growth and potential for advancement for underrepresented minorities; and acting to create a climate where racial diversity, justice, and inclusion can thrive. That climate, she added, will benefit everyone. She invited leaders to take up this affirmation: “Acknowledging the presence of bias and affirming the value of difference will not diminish the worth of my contributions or the validity of my hardships.”

Dr. Morgan Roberts urged caution with “one size fits all” related to diversity, since it tends to move people back into their comfort zones and not address the needs of the most vulnerable. Creating cultures of inquiry around race is important, but people often avoid conversation about race. Individuals must remain open to learning; interested in having conversations about race; curious about organization’s practices; willing to use data-based decision-making about admissions, promotions, and funding; and prepared to call out subtle and overt discrimination. “Invite people to tell their stories,” she urged. “What does race mean to you? What is your ‘why’ for engaging in this work?”

She shared her own “why” for her engagement by closing with several photographs that included a new memorial to enslaved laborers at the University of Virginia (UVA), in front of which members of the UVA Health system knelt in honor of George Floyd. She noted her own connections with UVA, as a current faculty member, alumna, and descendant of family members on her mother’s side who worked as cooks at the university in the 1800s.

DISCUSSION

Dr. Kirton asked Dr. Blake-Beard about the role of coaches. She said career development is a “team sport,” and people need different supports at different times in their careers, as the previous panel highlighted. The two presenters commented on the fact that they have “created a team for each other.” When Dr. Morgan Roberts was an undergraduate at UVA considering a Ph.D. in psychology, her advisor was an alumnus of the University of Michigan, as was Dr. Blake-Beard. “I cold-called her,” Dr. Morgan Roberts recounted. Dr. Blake-Beard helped guide her as she applied to graduate school and entered the job market. Over the years, they have had a “multiplex” set of relationships. Dr. Blake-Beard echoed previous comments by stressing that the relationship goes both ways.

A participant asked how to approach unconscious bias and microaggressions. Dr. Morgan Roberts replied that it depends on “your frame of reference and sphere of influence.” As a bystander, she drew on the saying, “If you see something, say something. One of the simplest things is to be on alert and vigilant about stereotypical comments, even in the form of a joke or teasing.” But she noted situations, such as going on rounds as a medical student and hearing a disparaging comment about a patient, when the student does not have the power to say anything. “I get that. But if you do have more power, speak up.” As a direct target rather than a bystander, she recommends “picking your battles.” She noted she wrote articles for Harvard Business Review with tips, including to “pause, call attention, and inquire” (Roberts and Washington, 2020; Roberts et al., 2020).

Offering to serve as a mentor, especially across races and genders, was also discussed when a participant asked for recommendations about how to reach out to more junior faculty with an offer to mentor. “Let people know you are available by your activities and how you send out messages,” Dr. Blake-Beard suggested. “People will not naturally assume you are willing. Be thoughtful—be explicit that you want to support people across the dimensions of difference and offer opportunities that get over the natural walls and boundaries that people put up.” With Dr. Audrey Murrell, she edited a book on this topic (Murrell and Blake-Beard, 2017) that includes a chapter co-authored by Dr. Morgan Roberts, as well as a chapter co-authored by Dr. Barabino and Dr. Banton (see Chapter 4). When she started her graduate career in 1989, “people didn’t talk about mentoring across differences. Mentoring was about white men mentoring other white men.” She also noted the concepts apply internationally.

The presenters were asked about differences in mentoring Ph.D. versus medical graduates for career success. Dr. Morgan Roberts said, “With mentoring and medical graduates, there is a tension whether you are pursuing a career in academic medicine or one that is primarily or exclusively clinical.” Some elements may draw more Black medical graduate students into clinical practice, including financial needs and incentives. Her dissertation and a follow-up survey focused on Black medical students and the tensions they feel in definitions of success, especially when they are shouldering high levels of student debt. Mentors may struggle with helping students understand how they can pursue various paths and still feel they are contributing to the community, she commented. She pointed out the parallels in Ph.D. training, and in choosing between a tenure-track career at an R1 institution or work in the world of practice. “These are some of the complexities that may create more similarities for [doctoral and medical school] Black students who are trying to figure out how to pursue success on their terms.”

Dr. Blake-Beard elaborated on mentoring across dimensions of differences. The mentoring literature talks about mentoring across phases and stages. A relationship starts with an initiation phase of how to connect with each other, be vulnerable, and share. Subsequent stages cover cultivation of the relationship, possibly followed by separation in which the two people move apart and must decide whether they want to recommit. Mentoring across differences is not easy, and there will be times when the two people move apart from one another, and they may or may not come back together.

In terms of making the business case for organizational change, Dr. Morgan Roberts listed three outcomes of interest: intellectual capital (growing and developing a set of cognitive resources to solve problems); organizational effectiveness (to improve efficiency and benefit from the contributions and questions of people usually on the margins); and innovation (diversity of thought to tackle systems-level challenges). To these three, she added the business case needs to account for sustainability. “How are we continuing to grow and develop a diverse and representative set of leaders who will help us operate to build a stronger society?” Sustainability is often related to climate change and the environment. In health care, sustainability relates to wage inequality, as greater than 70 percent of lowest-wage workers in health-care systems are women of color and are exposed to all forms of toxicity. “If our business case for diversity is only about having more people at the top and then we declare victory, that is short sighted,” she said, and pointed to ground-breaking research by Adia Harvey Wingfield (2019) about the unique experiences and hardships across class in health-care set-

tings. “To bring together moral and desirable business outcomes in making the business case, we must think of the whole system,” she said. Dr. Blake-Beard noted that organizational research in which she has been involved also takes into consideration what happens if diversity is not addressed, such as retention and reputation.

Dr. Reede asked about issues related to Black people advancing to leadership positions in organizations. Dr. Morgan Roberts said the Boston study identified as a barrier the lack of socialization into leadership and administration. Gifted medical care providers are not automatically skilled managers or administrators. Given the professional underrepresentation of Black adults in managerial and administrative roles, most Black medical students and graduates did not grow up in this world. They feel they are “late to the party” to acquire the informal socialization needed to succeed in leadership roles. Many try to compensate in positive ways by pursuing higher education. Another study that looked at 50 years of Black graduates from Harvard Business School (HBS) found they were more likely than white graduates to have more pedigrees from a resume standpoint, such as having graduated from higher-ranked institutions before matriculating at HBS or earning joint degrees while getting their M.B.A.s. Another dynamic was many respondents said they were actively discouraged at various points from pursuing leadership roles.

A participant asked for advice for newly hired Black faculty who find they are forced to operate at a lower level than they had expected. Dr. Morgan Roberts suggested “strategically managing visibility…. When we feel overwhelmed and defensive, we adopt a strategy that undermines our advancement, in which we say we are going to put our heads down and let the work speak for itself.” Instead, she said it is important to be proactive in networking relationships, be transparent, and frame one’s strengths and contributions in terms of leadership. Dr. Blake-Beard added that this situation speaks to intersectionality. Having individual agency does not erase the problems of structural racism, but given the challenges of structural racism, it is important to navigate and strengthen one’s agency. Dr. Morgan Roberts added that allyship has been another recently discussed concept, and sometimes it is important to find the right allies who can do diversity work because of their privilege. Confidantes are needed who can provide authentic feedback, said Dr. Kirton. Dr. Morgan Roberts agreed. Twenty years ago, when they both lived in Boston, she and Dr. Blake-Beard often met for dinner to support each other. As “one of the only,” the spotlight is bright, she observed.

When asked about a mentor training framework, Dr. Blake-Beard suggested several effective practices. It takes more than just commitment. Both mentors and mentees need training and support, beginning with a solid orientation. Dr. Morgan Roberts said she has seen “an ebb and flow” in institutional practices. The University of Michigan set explicit diversity targets and held itself accountable for achieving those targets, and the university was sued. Research findings from the 1990s seemed to be gaining traction, but an adverse response also occurred, she said, as shown by the fact there are fewer Black men in medical education now than 30 years ago.

Steps to reinvigorate initiatives go back to what has been shown to work, Dr. Morgan Roberts said. These steps include buying into the value of diversity, not equivocating, looking holistically at the characteristics that people bring to a situation, and defining leadership competencies through the lens of inclusion. Corporations are setting financial targets around hiring and promotion, she added. The Nasdaq just announced that companies that want to be listed on their exchange must disclose the racial and gender composition of their boards and have at least two diverse candidates within 4 years. There is still work to do, she said, but the bottom line is companies are starting to be more explicit about setting expectations, tying to CEO compensation, credentialing, and rewarding individuals.

In response to a question from Dr. Morgan Roberts about what she is hopeful about, Dr. Blake-Beard said she is hopeful that people realize that the future depends on raising and making visible these issues. Dr. Morgan Roberts said she is hopeful that people are talking about these issues more openly and publicly than even a few years ago. Dr. Kirton suggested the brutality around George Floyd’s death and the COVID-19 pandemic may present a generational opportunity for transformative change. Dr. Blake-Beard said the benefits to diversity are global, although Dr. Morgan Roberts warned there must also be a level-set of expectations: “Representation is one piece and there has been progress, but it is a journey and we must remain committed.”

The workshop co-chairs closed the session and the first day of the workshop. Dr. Morgan Roberts thanked the participants for providing a unique experience and provocative thinking. Knowledge from different directions provides clues about how to improve hospitals, medical schools, and other organizations. Dr. Reede stressed the need to keep in mind the arc of careers beyond medical school to different points of transition. Racism at societal, institutional, and individual levels can hinder achievement, she said, and she thanked participants for their clarity and commitment in blazing trails

and preparing others to continue the work. She said conversations such as those that have taken place at this workshop need to be part of the conversation in the academy, academic medical centers, research organizations, government, and in public and private spaces.

REFERENCES

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