Cross-cultural mentoring refers to a mutually enriched, intentional, and continual relationship with someone who belongs to a contrary gender, race, culture, religion, nationality, and socioeconomic background. The key focus of such a relationship is on vision, values, and virtues without considering either the mentor or mentee's differing opinions. The mentor guides the mentee and assists in the personal and professional qualities of the mentee. The significance of cross-cultural mentoring is impactful to the professional development of physicians. Increasingly, we encourage our physicians early in training to seek out mentorship relationships among physicians in practice to help them gain and share knowledge, teach new skills, broaden their network, and facilitate career decision-making. However, less talked about, but just as significant, are the benefits and learning that mentors can derive from mentees. Cross-cultural mentoring brings diversity with inclusive excellence, but attention is given to the mentee's emotional and social needs.

Interestingly, both mentor and mentees benefit from expanding their thought footprint to think and rethink beyond their ability level to develop mindsets without discrimination, creating clear pathways and visions. Cross-cultural mentoring positively contributes to changing the perspectives of physicians in training and during early and mid-career. Both the mentor and mentee are engaged in a relationship that requires them to exchange thoughts and ideas that alter both the mentor and mentee's mindsets. These mutually beneficial exchanges ultimately benefit the patients we treat.

While cross-cultural mentoring is essential to supporting and developing individuals from historically underrepresented groups, there are challenges to effectively developing a successful road map. Barriers such as lack of effective programs, diverse mentors, cross-culturally competent mentors, and trust are critical to developing effective mentor-mentee relationships.

Lack of effective programs

Cross-cultural mentorship programs are strengthened through formalized institutional programs. There is limited literature that evaluates the extent of mentorship programs (both formal and informal) within academic institutions, especially in anesthesiologists' early career transitions. In 2016, a third of the residency programs reported an 88% incidence of a formal mentorship program (Teaching and Learn in Communication Science & Disorders 2017;1). When evaluated for efficacy, most mentors and mentees did not assess the effectiveness of their relationship and the ability to determine the pairing's success. What is known in the current literature is that poor mentoring experience and relationships are not only ineffective but can lead to detrimental outcomes for the mentees in the future (asamonitor.pub/3jsdIdq).

Availability of diverse mentors

Historically, mentor-mentee relationships have emerged from informal interactions of individuals who share mutual interests and personal comfort. Unfortunately, this creates a barrier for enhancing cross-culturally competent relationships as this method relies on shared similarities rather than common goals as a requirement for the connection.

As early as the 1980s, Thomas and Alderfer reported that race has significant influences on the dynamic of mentoring relationships. Subsequent studies suggest that the strongest predictor of the successful pairing of mentor relationships and career advancement was race. As trust, communication style, and cultural nuances associated with race were noted to be necessary to mentees pairing with a mentor, the availability of diverse mentors within positions of influence are a barrier to underrepresented groups.

In a 2005 report of the Association of American Medical Colleges (AAMC), it was revealed that of approximately 114,000 full-time medical faculty, 52,000 held the rank of associate professor or higher. Sixty-three percent of these senior faculty (33,000) were white males (Journal of Teaching and Learning 2020;14:43-58). In 2018, the AAMC report indicated that most faculty with associate professor or higher rank were white and male (Frontiers: The Interdisciplinary Journal of Study Abroad 2018;30:77-91). This data demonstrates a continued persistence of disparities in mentors and leadership within early medical education.

Cross-culturally competent mentors

Historically, informal and formal mentor-mentee pairings relied heavily on the commonality of a shared culture or value system. The impediment to a cross-culturally competent mentorship relationship stems from differences in implicit biases, stereotyping, and culture abiding self-imposed constraints.

The lack of awareness of these nuances support the perpetuation of values by founding leaders and are then subsequently adopted by the next generation of leaders or culture members. While there may be mentors available to sponsor mentees, there is a need for competent mentors who possess insight into the nuances in which race, gender, and culture impact relationships. Often, this requires the time, motivation, and training of mentors and mentees to foster cross-culturally competent relationships.

Trust

Mentor and mentee relationships require the development of trust over time. Such trust requires open dialogue, the ability to succumb to vulnerability, and the ability to engage in candid conversation. Frequently, emotions of fear and willingness to work through challenging issues involving gender, ethnicity, religion, sexual orientation, race, socioeconomic status, culture, and historical power differences make it uncomfortable for both the mentor and mentee to connect. In failed mentor and mentee relationships, the lack of trust and comfort to work through the dialogue results in avoidance in a discussion. Unfortunately, this silence may erect barriers to trust and perpetuate obstacles to advancement for these underrepresented groups.

Best practices for cross-cultural mentoring

All individuals can serve as cross-cultural mentors, provided they have the time and desire to succeed in this rewarding endeavor. The recommendations are best understood when they are framed in the context of a shared understanding of mentorship. As such, it is paramount first to identify and adopt an operational definition of mentorship (Am J Trop Med Hyg 2019;100:9-14). According to the National Academy of Sciences, “Mentorship is a professional, working alliance in which individuals work together over time to support the personal and professional growth, development and success of the relational partners through the provision of career and psychosocial support” (Am J Trop Med Hyg 2019;100:9-14).

Skill set

Those motivated to mentor mentees whose backgrounds or identities differ from their own are charged with using an evidence-based approach to support mentorship. They must be adept at navigating cultural boundaries, including gendered, racial, socioeconomic, geographic, and personal. Leadership should support initiatives that validate, honor, and develop the power of diversity (Liberal Education 2014;100). Mentors should center their efforts on a binary viewpoint in which the mentee is a solitary individual and part of a larger social backdrop. It is incumbent on mentors to employ inclusive approaches such as cultural responsiveness, active listening, and stepping away from “colorblindness,” instead of mindfully recognizing that culture-based dynamics can influence mentoring relationships (Am J Trop Med Hyg 2019;100:9-14). Mentor and mentees must acknowledge the influence of their identities on their ambitions and career paths, including the potential for imposter syndrome to disrupt mentorship. Accordingly, mentors should consider their mentees' individual lived experiences. Given the intricacies of cross-cultural mentoring, mentors “need to possess certain attributes or virtues, including active listening skills, honesty, a nonjudgmental attitude, persistence, patience, and an appreciation for diversity”(Liberal Education 2014;100).

Institutional support

Mentorship should be awarded and recognized by the institution. Leadership must incent and, in turn, reward and visibly identify mentors for inclusive mentorship in the same vein that effective teaching is recognized (Am J Trop Med Hyg 2019;100:9-14). Recruitment, retention, tenure, promotion, and performance appraisal of faculty should include all forms of formal and informal mentorship that occur outside of the academic and clinical structure (Am J Trop Med Hyg 2019;100:9-14).

Boundaries

Inherent in a mentoring relationship is the possibility that sensitive issues will arise. The mentor must be conscious of and negotiate appropriate ethical boundaries with the mentee. Mentors must attempt to achieve a meaningful relationship with their mentee but always preserve appropriate power balances and ethical boundaries (Am J Trop Med Hyg 2019;100:9-14). “Mentoring relationships are not identical to peer relationships, which are usually predicated on horizontal or egalitarian reciprocity. Nor are they synonymous with the more vertically oriented parent-child relationship, where the child is completely dependent on the parent for sustenance and resources” (Liberal Education 2014;100). Mentors must create boundaries and resist “becoming friends” with their mentees (Liberal Education 2014;100). Nevertheless, mentors must assume different roles as the mentor/mentee relationship evolves. “Encouragement” instead of “prescriptive advice” should inform the “take-home” message of interactions. Mentors should avoid becoming overly invested in the mentee's choices, lest they be disappointed in a mentee's decisions, thereby damaging the relationship. A neutral third party should periodically review negative experiences in the mentoring experience. This individual should serve as an ombudsman to identify, investigate, and address negative mentoring experiences (Am J Trop Med Hyg 2019;100:9-14).

Cross-cultural mentoring should be an integral component in the life cycle of the medical student, resident education, and throughout the professional development of early and mid-career physicians. The opportunity gains bring an integrated successful approach to continual development and achievement. It broadens the perspective in the professional development of both the physician mentor and physician mentee. The broadening perspective of a clinician in the mentor-mentee relationship is critical for both involved. More importantly, the resultant effects of a more expansive view of different cultures by a physician are exhibited in the interactions of the physicians as they care for patients. As we strive to enrich the mentor/mentee relationship through cross-cultural mentoring, we ultimately improve the quality of care provided to the patients we treat.

Disclosure:

Dr. Luis E. Tollinche is a grant recipient for research on neuromuscular blockade and holds a consultant role at Merck & Co.

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Crystal C. Wright, MD, FASA, Associate Professor, Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston.

Crystal C. Wright, MD, FASA, Associate Professor, Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston.

Lisa P. Solomon, DO, FASA, Vice Chair, Department of Anesthesia, Swedish American Hospital, Rockford Anesthesiologists Associated, LLC, Rockford, Illinois.

Lisa P. Solomon, DO, FASA, Vice Chair, Department of Anesthesia, Swedish American Hospital, Rockford Anesthesiologists Associated, LLC, Rockford, Illinois.

Luis E. Tollinche, MD, FASA, Attending Anesthesiologist and Clinical Member, Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, New York.

Luis E. Tollinche, MD, FASA, Attending Anesthesiologist and Clinical Member, Memorial Sloan Kettering Cancer Center, Department of Anesthesiology and Critical Care Medicine, New York, New York.