Oh, the big green button, thank you, sorry. So I have no financial disclosures or conflicts of interest which leads to my first bit of data for this talk. 98% of orthopedic industry payments go to women, or sorry, to men, which leaves 2% for women and means that most women orthopedic surgeons like myself have no financial disclosures. We'll talk a little bit more, or think a little more about that in a few minutes when we discuss the concept of advocacy. So I have a few titles relevant to this talk and Dr. Spiker already went over those so I will move forward with that. Advocacy is where I would like to start and I'm not planning to speak today about political action or the lobbying definition that we usually associate with that term at this sort of a societal meeting like ours nor am I going to speak about the very important role we can take as physicians in advocating for care or policies that benefit our patients. Rather, a broader definition like the one you see here describes the advocacy that I'm going to talk about today. In this context, advocacy represents an action on behalf of others and though we all recognize that definition, we may not have considered it juxtaposed with the concept of mentoring. The difference between these terms, mentorship and advocacy is one of the points I hope you'll take home with you this afternoon and we'll hear a lot more about it later in my talk. Since this is a sports medicine meeting, I thought I'd illustrate my next point by showing you one of my favorite teams. I am the team doctor for this group of fabulous young ladies who took home their sixth national championship this spring. Go Badgers. Their coach is Mark Johnson of Miracle on Ice fame and he's renowned for his capability as a hockey player and hockey coach. But I would add that he's also one of the best mentors that I've ever seen for young women and I'm really enthusiastic and proud to be associated with that team. He's an excellent example of coach as mentor and like Mark, a coach may be a mentor but there are distinct differences between these three roles and I think they're worth defining them. All of them may offer help to a young physician. An advisor offers strategies regarding a specific aspect of professional development. Their role is often very focused and time limited. A coach, speaking now in a professional setting, serves as a private tutor or a counsel to instruct and improve performance and indeed our department occasionally hires a coach to help a struggling faculty member do a better job with communication or collaboration in his or her daily work. In contrast to a teacher or a coach, a mentor is a trusted counselor who guides the professional development of an individual over time. The value of mentorship has been long established. It refers to the concept of guidance by a wiser, experienced person for another person of less experience and the word is derived from the name of the teacher whom Odysseus trusted to raise his son while he was away at war and truly the mentoring relationship at its best has a bit of the sacrosanct about it. It is a selfless relationship carried out solely for the betterment of the mentee. Mentorship is focused on career development of the mentee and it has been shown to increase research productivity, academic promotion, faculty retention and career satisfaction. In fact, mentorship has been described as central to the mission of academic medicine. It capitalizes on the intellectual resources of the institution, the mentors, and seeks to develop leaders in research, patient care and education, the mentees. It ultimately enhances success in each of these areas and promotes faculty diversity and leadership. Formal mentoring takes several forms. Dyadic mentoring refers to the one-on-one relationship between a senior mentor and a junior mentee and it's the traditional form of mentoring. Team or network mentoring is similar but introduces a committee or group of members, each bringing different expertise to the table and together their joint interaction adding to the value of the process. Peer mentoring has been shown to be an effective adjunct to the more traditional forms and within this model, a group of colleagues provide each other with advice and counsel but finally, facilitated peer mentoring includes a senior member overseeing the peer colleagues. Mentoring is found not just in academic medicine but also across professional societies and organizations and many now have mentoring programs for young members such as the one we're attending today. In addition to formal programs, societies offer traveling fellowships that pair a group of young members with a godparent mentor for a week or more of experiential learning in the U.S. or abroad and then informal mentorship often occurs in committee work or through membership in smaller societies and of course, through relationships that you've already formed with your fellowship director or residency faculty. Each situation provides a unique opportunity. There are some characteristics of effective mentors and I've listed them here for your consideration. Mentors are altruistic, they're committed to the success of their mentee, they exhibit good moral and ethical character, honesty, integrity, trustworthiness. An effective mentor respects the mentee and the mentoring relationship and this is exhibited by absolute confidentiality, open-mindedness and acknowledgement by the mentor of his or her mentee's contributions to the group. An effective mentor has humility and is personally open to sharing his or her own stories and experiences. He or she provides emotional support and he or she should be an excellent communicator and adept listener. An effective mentor is a guide or a facilitator, not a dictator or a director and he or she helps the mentee draw conclusions and form a plan, encouraging self-sufficiency. The effective mentor possesses valuable knowledge and about the institution, profession and academic culture and he or she provides honest, constructive feedback in a supportive manner. He or she provides vision to the mentee, assists in self-reflection and keeps both parties accountable to their mission. Above all, the mentor advocates for and protects the mentee and we'll revisit advocacy in a minute. On the flip side, we can talk about how to be a good mentee. You should plan regular meetings, review a one-year plan and highlight areas where you'll need your mentor's support, ask for help. Summarize the discussion that you have with a brief email to be certain you and your mentor are on the same page. Stay in touch between meetings, email back and forth to seek feedback and make small adjustments and schedule additional meetings if necessary. Recognize the mentoring you receive and express gratitude to your mentors. Be conscientious and considerate about your mentor's time and energy and though mentoring is greatly rewarding, it also is quite time-consuming. Finally, listen to your mentor without being defensive. Distinguish the message and focus on the useful information being conveyed. Let's shift gears a bit. The value of mentorship in its varied forms is clear but if we look at the business world, promotion and leadership are more closely tied to the concepts of advocacy and sponsorship than they are to mentorship and the difference between these roles is quite specific. A mentor can be almost anyone who will help you think through the process of navigating your career but an advocate is someone who will create opportunities for you. By definition, an advocate is an experienced senior leader who takes an active interest in promoting the career of his or her protege and the advocate gives advice, enlarges or stretches the protege's perception of what is possible and above all, serves as a sponsor. What constitutes a sponsor? From the perspective of the mentee, a sponsor uses chips on my behalf. He or she exchanges something of value to meet my needs. A sponsor advocates for promotion and makes connection to senior leaders. A sponsor promotes my visibility and connects me to career opportunities. He or she makes outside connections of value and gives career advice. In examining the roles of a sponsor, the value of such an individual is quite clear. Advocates or sponsors look for opportunities to showcase your skills and abilities, to open doors, to make a case for your advancement. Critically, advocates are in a position of power that enables them to do this. The ability of an advocate or a sponsor to advance the career trajectory of a protege has been termed the sponsor effect. It's clear that it works in business where larger percentages of individuals with sponsors ask for raises, accept stretch assignments and advance at a satisfactory rate. Go back one. Advocates create career traction and pointedly, the authors of the next article acknowledged that there are very few, sorry, one moment here, I got a little bit off. In medicine, sponsorships concept is gaining ground and in a qualitative study from Johns Hopkins, researchers identified perceptions regarding the value of sponsorship in academic medicine. Interviewees for this article confirmed the distinct nature of sponsors and mentors and agreed that sponsorship is critical to career advancement, especially to the highest level roles. Pointedly, they acknowledged that women are less likely to seek sponsorship but require the support it provides in order to be successful. This last finding that women are less likely to ask and just as likely to need sponsorship illustrates a particular problem. In general, it's known that sponsors and proteges look alike. A study among business executives showed that nearly three quarters of executives choose proteges whose race and gender match their own. This is not surprising but in orthopedic surgery as in other areas, most sponsors, remember these are career established, powerful individuals, do not look like women or other under included minorities and there are simply not enough women and minority sponsors to do the job. Let's look at this closely. In data collected by the AOS, we see the not so amazing rate of change in numbers of women in our academy. Here in 2008, 4% of all orthopedic surgeons were women. 10 years later in 2018, we have a whopping 5.8% representation. But I do think we're doing slightly better than the historical rate suggests. This data shows that women under 40 comprise almost 16% of orthopedic surgeons with declining representation in older decades reflecting the very low percentage of women trainees 15, 20 and 30 years ago. It's these younger women shown here and in the first red bar who need those mentors, advocates and sponsors that we've been discussing. This same academy data shows an incremental decrease in the Caucasian composition of our organization falling from 89% in 2008 to 85% in 2018 and this represents less than 1% growth in most racial categories. So given the significant lack of diversity in our field, how can we incorporate advocacy to make a change? As I've shown here, there are societies in place to mentor women and there are pipeline projects to increase the numbers of incoming women and under-included minorities in our ranks. But once they get in, there is much more that must be done to help them grow in leadership roles. Most of you are younger than me and so many of you may be wondering who is this woman here on the right? That's Madeline Albright, the first woman Secretary of State. A favorite quote of hers admonishes each of us who are underrepresented minorities of our special charge to help others. We've already noted that there are not enough senior women and under-included minorities to provide sponsorship for the next generation. There's an obvious solution and we turn again to business leaders for advice. In this recently published article by two noted experts, the case is made that advocacy is integral to the achievement of gender balance and diversity. Noting that women receive less information on career advancement and have fewer opportunities for mentorship or advocacy in business, the authors promote the notion that men must be better mentors and sponsors for women and they give the following advice. Men in positions of power must sponsor protégés from a diverse talent pool, identify stretch roles in which their protégés will excel, provide opportunities for development and growth, and introduce their protégés to influential people in their organization or industry. They must champion their protégés for recognition and help them persist against difficulties over the long haul. I am certainly not the first to suggest that with the privilege of power comes the duty to serve, but this most certainly is a way to serve our societies and our patients, sponsoring others to increase diversity in our ranks. So in summary, mentorship, especially in academic medicine, is of major significance in the grooming and advancement of young faculty. In private practice, mentorship serves a similar role in guiding a surgeon as he or she establishes their practice and navigates through the early years. I encourage you to look at your opportunities to find a mentor or two or three to help you attain your professional goals, whether research-oriented or clinical or society leadership. Finally, it's important to note that sponsorship or advocacy is critical to the advancement of others to leadership positions. It relies upon action, and it revolves around the creation of opportunities for visibility and leadership by those in power. Critically, the improvement of diversity in our organization requires responsible sponsorship of our leaders, and as you move into these positions, I encourage all of you to be responsible leaders. If you chair a program or organize a committee, consider all the options before you, not just those who look like you. Be open to the promotion and sponsorship of any worthy candidate. In that way, our organization and our specialty will thrive, capitalizing on the power of each member to achieve our goals. Thanks for listening. Thank you. Thank you all.

mentorship

advocacy

sponsorship

orthopedic surgery

gender balance