If You Can’t See It, You Can’t Be It

Abstract

T he under-representation of women in cardi-ology is widely recognized. In 2017, women represented 42% of internal medicine residents and only 23% of cardiology fellows (1). These disproportionate numbers have been attributed to workplace barriers faced by women, including gender and parenting discrimination, challenges in balancing family responsibilities, radiation exposure during pregnancy, and lack of professional advancement (2). As of a 2018 survey of internal medicine residents, female residents were more likely to have a negative perception of cardiology due to concerns about adverse job conditions, interference with work-life balance, and lack of diversity within the specialty (3). However, this survey also revealed that women highly valued the presence of a positive role model as a part of their professional development (3). The positive influence of a mentor in a trainee's career decision-making process has been supported extensively in the surgical literature where women are also underrepresented. Female medical students were more likely to choose a surgical career at institutions with a higher proportion of female faculty surgeons (4); both men and women who identified a positive surgical role model were more likely to choose a surgical career (5); and female physicians and trainees in surgical specialties placed more importance on mentorship in their careers compared with men (6). This was recently echoed in a survey of cardiology fellows, which revealed that a lack of female role models had a negative effect on a female fellow's decision to pursue a career in interventional cardiol-ogy (7). These survey data are initially discouraging, but on closer look, offer an impactful conclusion: female residents are significantly influenced by the presence of positive female role models when making career decisions. How can this knowledge be used to bridge the gender gap in cardiology? Increasing mentorship for women trainees, especially at the level of residency , has the potential to promote the recruitment of women into cardiology. Mentorship allows for professional guidance and sponsorship but also provides visibility into the specialty. Although female cardiologists are more likely to have same-sex men-tors (2), the responsibility of mentorship does not fall solely on women in cardiology. Women in cardiology have the unique ability to serve as role models for female trainees; however, diversity in mentorship is key. A mentor can be found in a man or woman, faculty or fellow. As a female internal medicine resident, one of us (N.V.C.) can attest to the invaluable impact of mentorship during residency. The actions of a female faculty cardiologist (J.K.H.) put me on a path to pursue a career I had not previously imagined-a career in cardiology. I feared the same conditions cited by the recent survey data: work-life imbalance, adverse work conditions, and lack of diversity in a male-predominant specialty. But, through the guidance of my mentor, I had the opportunity to debunk these misconceptions. Mentorship additionally provided me with a role model who can relate to and guide me through challenges, access to a professional network that includes faculty members and fellows-in-training, exposure to clinical and academic opportunities , and, most importantly, sponsorship. Through