Promoting the Pipeline of Diverse Individuals Within Gastroenterology: Reflections From AGA FORWARD Program Scholars

Abstract

The American Gastroenterological Association (AGA) has long focused on health care disparities and is committed to achieving health equity through broad initiatives, such as the AGA Equity Project.1Carr R.M. Quezada S.M. Gangarosa L.M. et al.From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology.Gastroenterology. 2020; 159: 1637-1647Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Globally and in the United States, racial and ethnic minority groups are disproportionately burdened by digestive disease. Chronic liver disease, cirrhosis, and hepatocellular carcinoma are more prevalent in racial and ethnic minority groups.2Ajayi F. Jan J. Singal A.G. et al.Racial and sex disparities in hepatocellular carcinoma in the USA.Curr Hepatol Rep. 2020; 19: 462-469Crossref PubMed Google Scholar, 3Scaglione S. Kliethermes S. Cao G. et al.The epidemiology of cirrhosis in the United States: a population-based study.J Clin Gastroenterol. 2015; 49: 690-696Crossref PubMed Scopus (407) Google Scholar, 4Nephew L.D. Serper M. Racial, gender, and socioeconomic disparities in liver transplantation.Liver Transpl. 2021; 27: 900-912Crossref PubMed Scopus (20) Google Scholar African American people have the highest incidence and mortality of colorectal cancer.5Carethers J.M. Doubeni C.A. Causes of socioeconomic disparities in colorectal cancer and intervention framework and strategies.Gastroenterology. 2020; 158: 354-367Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar African American and Hispanic people with inflammatory bowel disease have more social barriers that worsen inflammatory bowel disease outcomes.6Damas O.M. Kuftinec G. Khakoo N.S. et al.Social barriers influence inflammatory bowel disease (IBD) outcomes and disproportionally affect Hispanics and non-Hispanic Blacks with IBD [published online ahead of print March 24, 2022]. Therap Adv Gastroenterol.https://doi.org/10.1177/17562848221079162Google Scholar Based on other disease states,7Altman D.E. Sun B.C. Lin B. et al.Impact of physician-patient language concordance on patient outcomes and adherence to clinical chest pain recommendations.Acad Emerg Med. 2020; 27: 487-491Crossref PubMed Scopus (6) Google Scholar, 8Street Jr., R.L. O'Malley K.J. Cooper L.A. et al.Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity.Ann Fam Med. 2008; 6: 198-205Crossref PubMed Scopus (337) Google Scholar, 9Cooper-Patrick L. Gallo J.J. Gonzales J.J. et al.Race, gender, and partnership in the patient-physician relationship.JAMA. 1999; 282: 583-589Crossref PubMed Scopus (1525) Google Scholar it is presumed that racial, ethnic, and language concordance between health care providers and patients could be used as a strategy to rectify health disparities and achieve health equity. Although 19% of the US population is Hispanic and 13% is African American,10US Census BureauQuick facts: United States.https://www.census.gov/quickfacts/fact/table/US/PST045221Date accessed: June 23, 2022Google Scholar only 6.6% and 4.4% of practicing gastroenterologists are Hispanic and African American, respectively.11Association of American Medical CollegesDiversity in medicine: facts and figures 2019.https://www.aamc.org/data-reports/workforce/data/table-12-practice-specialty-females-race/ethnicity-2018Date accessed: June 23, 2022Google Scholar Gastroenterology and hepatology fellows from these groups have also been underrepresented historically.9Cooper-Patrick L. Gallo J.J. Gonzales J.J. et al.Race, gender, and partnership in the patient-physician relationship.JAMA. 1999; 282: 583-589Crossref PubMed Scopus (1525) Google Scholar,12Baird D.S. Soldanska M. Anderson B. et al.Current leadership training in dermatology residency programs: a survey.J Am Acad Dermatol. 2012; 66: 622-625Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar There are numerous challenges that hinder recruitment and retention of underrepresented in medicine (UIM) faculty in academic gastroenterology and hepatology, including lack of adequate mentorship, sponsorship, and opportunities for leadership. The Fostering Opportunities Resulting in Workforce and Research Diversity (FORWARD) Program, funded through an R25 awarded by the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (R25DK118761), is a 2-year program that aims to provide training for skills development in research careers and leadership, as well as provide active mentoring for UIM gastroenterologists and hepatologists.Physician-scientists who are UIM are more likely to conduct research in health disparities,13Hoppe T.A. Litovitz A. Willis K.A. et al.Topic choice contributes to the lower rate of NIH awards to African-American/black scientists.Sci Adv. 2019; 5eaaw7238Crossref PubMed Scopus (253) Google Scholar,14Anyane-Yeboa A. Quezada S. Rubin D.T. Balzora S. The impact of the social determinants of health on disparities in inflammatory bowel disease [published online ahead of print March 17, 2022]. Clin Gastroenterol Hepatol.https://doi.org/10.1016/j.cgh.2022.03.011Google Scholar however, <3% of NIH-funded physician-scientists are Hispanic or African American.15National Institutes of HealthData by race.https://report.nih.gov/nihdatabook/category/25Date accessed: June 23, 2022Google Scholar To improve diversification of the scientific workforce, the NIH developed a funding opportunity and the request for applications encourages educational programs to recruit talented junior faculty from diverse backgrounds, specifically racial and ethnic minority groups underrepresented in biomedical, behavioral, clinical, and social sciences research.16National Institutes of HealthPart 1: overview information. NIDDK Partnerships with Professional Societies to Enhance Scientific Workforce Diversity and Promote Scientific Leadership (R25 - Clinical Trial Not Allowed).https://grants.nih.gov/grants/guide/rfa-files/RFA-DK-22-004.htmlDate accessed: June 23, 2022Google Scholar In 2019, ten scholars from institutions throughout the United States were selected to form the inaugural AGA FORWARD cohort. Four scholars were gastroenterology fellows, 5 were gastroenterology junior faculty (including 1 pediatric gastroenterologist), and 1 was hepatology junior faculty. Five identified as Black or African American and 5 identified as Hispanic or Latinx. A large proportion (70%) of the initial cohort was female, which also provided an opportunity for AGA to address gender inequities among physician-scientists.Scholars were paired with a mentor and received executive coaching from senior AGA staff. In addition to attending the AGA Future Leaders Program and AGA/American Association for the Study of Liver Diseases Academic Skills Workshop, scholars received additional training in manuscript development, grant writing, and management of research laboratories and personnel (Figure 1). When the COVID-19 pandemic began in year 2, AGA and FORWARD leadership devised an opportunity to provide moderator training, and scholars subsequently moderated an AGA seminar series entitled “GI Forging Forward,” with topics focused on developing, understanding, and implementing guidelines during the pandemic.17AGA UniversityYour hub for GI education.https://agau.gastro.org/diweb/catalog/q/Forging-Forward/?_ga=2.254791176.1082814212.1652104550-586689187.1652104550Date accessed: June 23, 2022Google Scholar Herein, we present our experiences, as well as the benefits and lessons learned from participating in the inaugural FORWARD cohort.Mentorship and SponsorshipThe AGA FORWARD Program was structured to provide a team-based approach to mentoring through the following 4 key mechanisms: home institution mentor, AGA FORWARD mentor, executive coach, and academic skills specialist. This structure fostered skills in development, networking, interpersonal insight, and advice (Figure 2). FORWARD scholars and mentors regarded as experts in their respective fields were matched based on areas of mutual interest. Mentor–mentee pairs met in person and virtually at prespecified time points throughout the 2-year program. Mentors received training on how to mentor effectively. The agenda for mentor–mentee meetings was guided by a formal curriculum. In addition to one-on-one mentoring, network mentoring was used during in-person gatherings. FORWARD alumni reported productive structured mentored sessions in which opportunities were provided to discuss challenges in research and guidance on areas of expertise that were otherwise not available within their home institutions.Figure 2The FORWARD Program uses a team-based approach to mentorship, which includes the home institution mentor, the AGA FORWARD mentor, academic skills specialists, and executive coaching. The aim of this approach was to deliver tailored programming, mentorship, and services that meet the unique needs of each FORWARD scholar.View Large Image Figure ViewerDownload Hi-res image Download (PPT)One major benefit of FORWARD was that scholars engaged in both formal and informal peer mentoring.18Cree-Green M. Carreau A.M. Davis S.M. et al.Peer mentoring for professional and personal growth in academic medicine.J Investig Med. 2020; 68: 1128-1134Crossref PubMed Scopus (18) Google Scholar An example of informal peer mentoring is the utilization of a text-messaging group to receive quick feedback regarding clinical, research, or leadership questions. Some FORWARD scholars created a formal writing accountability and peer-mentoring group that meets for 1 hour each weekday. Scholars set goals, discuss progress with writing tasks, and provide advice regarding grant applications. Perhaps more importantly, participation in this writing group has served as a great source of moral support. Participating scholars celebrate each other’s victories and provide guidance and encouragement when roadblocks emerge. Academic medicine can be isolating, especially for UIM faculty who are often the only people of color in their division or department.19Royal K.D. Cannedy A.L. Dent G.A. More on diversity and inclusion in academic medicine: the isolation of Black females.Acad Med. 2016; 91: 896Crossref PubMed Scopus (4) Google Scholar Participation in the FORWARD Program has allowed for fellowship with, and peer mentorship from, others who have similar lived experiences. Increased utilization of teleconferencing during the COVID-19 pandemic provided the necessary infrastructure, making it feasible for scholars scattered throughout the United States to engage regularly. This arrangement has been so beneficial that it is still ongoing and constantly evolving to meet the emerging needs of participants.Recognizing that sponsorship is an important aspect of career development and success, FORWARD embedded mechanisms for promoting the careers of mentees. A sponsor advocates and helps to promote a junior faculty member’s career by facilitating introductions to key experts in the field and invited presentations and leadership opportunities, which are important metrics for promotion. The COVID-19 webinar series is an example of sponsorship; scholars who served as moderators for these sessions were able to work and engage with key society leaders.17AGA UniversityYour hub for GI education.https://agau.gastro.org/diweb/catalog/q/Forging-Forward/?_ga=2.254791176.1082814212.1652104550-586689187.1652104550Date accessed: June 23, 2022Google Scholar In many cases, mentors and mentees continue to meet regularly and alumni continue to benefit from sponsorship and mentorship.Academic and Research SkillsA critical aspect in the development of future leaders in gastroenterology and hepatology is fostering a strong foundation in academic and research skills. To address disparities in NIH funding,20Valantine H.A. Lund P.K. Gammie A.E. From the NIH: a systems approach to increasing the diversity of the biomedical research workforce.CBE Life Sci Educ. 2015; 15: fe4Crossref Scopus (55) Google Scholar,21Bernard M.A. Johnson A.C. Hopkins-Laboy T. et al.The US National Institutes of Health approach to inclusive excellence.Nat Med. 2021; 27: 1861-1864Crossref PubMed Scopus (6) Google Scholar FORWARD partnered with an independent consulting firm. Through this partnership, scholars engaged in structured modules focused on the following key components of academic and research skills: research leadership development, grantsmanship, and manuscript development. In preparation for the transition to independence, scholars gained skills in laboratory team management and team-based science. Markers of success included 135 manuscripts since the cohort’s inception and 40 articles published in high-impact journals. FORWARD scholars were also able to translate their research goals into successful early career grant applications—since beginning the program, 2 have received funding from the Mentored Clinical Scientist Research Career Development Award (K08/K23), 1 is funded by an institutional KL2 Award, and 2 are funded by academic societies and/or foundations. One scholar received an early-career, new principal investigator award for an NIH R01. In addition to these grants, scholars also successfully competed for institutional pilot awards and industry-sponsored grants. In total, FORWARD scholars received notices of awards for 18 of the 30 grant applications submitted since the program’s inception. Two have been promoted to assistant professor and 3 have been promoted to associate professor.LeadershipDespite the increase in individuals who are UIMs matriculating in medical school, UIMs continue to be underrepresented in higher academic ranks and senior leadership positions across the board.22Lee T.H. Volpp K.G. Cheung V.G. et al.Diversity and inclusiveness in health care leadership: three key steps. NEJM Catalyst Innovations in Care Delivery. Published June 7, 2021.https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0166Date accessed: June 29, 2022Google Scholar Leadership is a critical component of physician competence, yet existing leadership curricula in graduate medical education is limited and the best approaches to developing leadership skills for physicians remain undefined. Medical students have expressed the need for structured leadership training programs,23Quince T. Abbas M. Murugesu S. et al.Leadership and management in the undergraduate medical curriculum: a qualitative study of students' attitudes and opinions at one UK medical school.BMJ Open. 2014; 4e005353Crossref PubMed Scopus (36) Google Scholar and residents are not prepared for informal or formal leadership roles after graduation.12Baird D.S. Soldanska M. Anderson B. et al.Current leadership training in dermatology residency programs: a survey.J Am Acad Dermatol. 2012; 66: 622-625Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar,24Blumenthal D.M. Bernard K. Bohnen J. et al.Addressing the leadership gap in medicine: residents' need for systematic leadership development training.Acad Med. 2012; 87: 513-522Crossref PubMed Scopus (161) Google Scholar The need to foster leadership development for physicians in training, particularly for UIMs, has been widely recognized. As part of its strategic plan, AGA FORWARD addressed the gap of leadership development. During individual meetings with the career coach, scholars polished leadership skills with tailored strategies, enhancing the scholars’ overall potential as a future leader in academia.FORWARD leadership training included critical content areas, such as self-awareness, emotional intelligence, and conflict resolution, which are pivotal for becoming a successful leader. Scholars completed an in-depth 360-degree assessment in which they received candid performance feedback from their peers, supervisors, and direct reports. In one-on-one executive coaching sessions, scholars used this feedback to leverage their strengths and plan strategies to develop areas of weakness. Participation in such structured career and leadership coaching is pivotal for junior faculty, who often juggle multiple research and clinical responsibilities and struggle with producing meaningful outputs in these roles. Scholars benefited greatly from dedicated and tailored leadership advice from exceptional AGA leaders who shared their experiences and insights on becoming a successful leader. As a result of the program, FORWARD scholars excelled in their current leadership positions—5 achieved new leadership roles at the departmental, institutional, or national level. As FORWARD scholars continue to lead, they will draw from the lessons and strategies learned and will continue to inspire medical students, residents, and fellows of color interested in gastroenterology and hepatology.ConclusionsThe AGA FORWARD Program represents a model of success for professional organizations and academic institutions interested in developing targeted programs aimed at increasing academic, research, and leadership skills in groups who have historically been UIM. The intensive 2-year experience was constructed to equip future leaders in gastroenterology, hepatology, and academic medicine with many of the tools needed to succeed. Historically, marginalized groups have limited awareness of, and access to, such transformational opportunities. The FORWARD Program has been successful because it was tailored to fit the needs of its participants. In a preprogram AGA survey and focus group meetings, UIM respondents indicated that lack of knowledge about how to become an investigator, lack of mentorship and sponsorship, and lack of visibility in national organizations were barriers to success and advancement. Programs looking to emulate the success of FORWARD should initiate the process by engaging with stakeholders and conducting a needs assessment to ensure that the subsequent program is responsive to the needs of prospective participants.The AGA FORWARD Program could be improved by further tailoring content to the needs and academic goals of participants. In our cohort, all participants worked on developing academic skills synchronously; however, it may be more beneficial for some to focus on developing manuscripts and others to focus on grants, depending on existing skills, career stage, and goals.Due to significant attrition of UIM faculty in academic medicine, fellows and junior faculty from UIM groups may experience difficulty identifying role models and mentors. The AGA FORWARD Program engaged and prepared allies in methodologies to fill the mentor gap, which enabled scholars to achieve success. The partnership of mentors and allies is an important component of the program and ensured that mentors have the skills needed to provide guidance to mentees who likely have had very different lived experiences as UIMs navigating academic medicine. Pipeline programs are proposed as a solution to increase the number of UIM physician-scientists, and by extension may improve health disparities and incrementally advance us toward achievement of health equity. However, simply increasing the number of UIM scholars without implementing systems of support is unlikely to achieve the intended goal. The beauty of the AGA FORWARD Program was its multifaceted approach, which ensured that scholars would benefit from one component or another, depending on their individual needs. As the pipeline expands, similar programs could be piloted at the society, departmental, or institutional level, and could be the key to overcoming decades of structural barriers to success. The FORWARD Program is a critical step toward achieving a vision of inclusive leadership in medicine that reflects the diversity of our population and patients. The American Gastroenterological Association (AGA) has long focused on health care disparities and is committed to achieving health equity through broad initiatives, such as the AGA Equity Project.1Carr R.M. Quezada S.M. Gangarosa L.M. et al.From intention to action: operationalizing AGA diversity policy to combat racism and health disparities in gastroenterology.Gastroenterology. 2020; 159: 1637-1647Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Globally and in the United States, racial and ethnic minority groups are disproportionately burdened by digestive disease. Chronic liver disease, cirrhosis, and hepatocellular carcinoma are more prevalent in racial and ethnic minority groups.2Ajayi F. Jan J. Singal A.G. et al.Racial and sex disparities in hepatocellular carcinoma in the USA.Curr Hepatol Rep. 2020; 19: 462-469Crossref PubMed Google Scholar, 3Scaglione S. Kliethermes S. Cao G. et al.The epidemiology of cirrhosis in the United States: a population-based study.J Clin Gastroenterol. 2015; 49: 690-696Crossref PubMed Scopus (407) Google Scholar, 4Nephew L.D. Serper M. Racial, gender, and socioeconomic disparities in liver transplantation.Liver Transpl. 2021; 27: 900-912Crossref PubMed Scopus (20) Google Scholar African American people have the highest incidence and mortality of colorectal cancer.5Carethers J.M. Doubeni C.A. Causes of socioeconomic disparities in colorectal cancer and intervention framework and strategies.Gastroenterology. 2020; 158: 354-367Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar African American and Hispanic people with inflammatory bowel disease have more social barriers that worsen inflammatory bowel disease outcomes.6Damas O.M. Kuftinec G. Khakoo N.S. et al.Social barriers influence inflammatory bowel disease (IBD) outcomes and disproportionally affect Hispanics and non-Hispanic Blacks with IBD [published online ahead of print March 24, 2022]. Therap Adv Gastroenterol.https://doi.org/10.1177/17562848221079162Google Scholar Based on other disease states,7Altman D.E. Sun B.C. Lin B. et al.Impact of physician-patient language concordance on patient outcomes and adherence to clinical chest pain recommendations.Acad Emerg Med. 2020; 27: 487-491Crossref PubMed Scopus (6) Google Scholar, 8Street Jr., R.L. O'Malley K.J. Cooper L.A. et al.Understanding concordance in patient-physician relationships: personal and ethnic dimensions of shared identity.Ann Fam Med. 2008; 6: 198-205Crossref PubMed Scopus (337) Google Scholar, 9Cooper-Patrick L. Gallo J.J. Gonzales J.J. et al.Race, gender, and partnership in the patient-physician relationship.JAMA. 1999; 282: 583-589Crossref PubMed Scopus (1525) Google Scholar it is presumed that racial, ethnic, and language concordance between health care providers and patients could be used as a strategy to rectify health disparities and achieve health equity. Although 19% of the US population is Hispanic and 13% is African American,10US Census BureauQuick facts: United States.https://www.census.gov/quickfacts/fact/table/US/PST045221Date accessed: June 23, 2022Google Scholar only 6.6% and 4.4% of practicing gastroenterologists are Hispanic and African American, respectively.11Association of American Medical CollegesDiversity in medicine: facts and figures 2019.https://www.aamc.org/data-reports/workforce/data/table-12-practice-specialty-females-race/ethnicity-2018Date accessed: June 23, 2022Google Scholar Gastroenterology and hepatology fellows from these groups have also been underrepresented historically.9Cooper-Patrick L. Gallo J.J. Gonzales J.J. et al.Race, gender, and partnership in the patient-physician relationship.JAMA. 1999; 282: 583-589Crossref PubMed Scopus (1525) Google Scholar,12Baird D.S. Soldanska M. Anderson B. et al.Current leadership training in dermatology residency programs: a survey.J Am Acad Dermatol. 2012; 66: 622-625Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar There are numerous challenges that hinder recruitment and retention of underrepresented in medicine (UIM) faculty in academic gastroenterology and hepatology, including lack of adequate mentorship, sponsorship, and opportunities for leadership. The Fostering Opportunities Resulting in Workforce and Research Diversity (FORWARD) Program, funded through an R25 awarded by the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (R25DK118761), is a 2-year program that aims to provide training for skills development in research careers and leadership, as well as provide active mentoring for UIM gastroenterologists and hepatologists. Physician-scientists who are UIM are more likely to conduct research in health disparities,13Hoppe T.A. Litovitz A. Willis K.A. et al.Topic choice contributes to the lower rate of NIH awards to African-American/black scientists.Sci Adv. 2019; 5eaaw7238Crossref PubMed Scopus (253) Google Scholar,14Anyane-Yeboa A. Quezada S. Rubin D.T. Balzora S. The impact of the social determinants of health on disparities in inflammatory bowel disease [published online ahead of print March 17, 2022]. Clin Gastroenterol Hepatol.https://doi.org/10.1016/j.cgh.2022.03.011Google Scholar however, <3% of NIH-funded physician-scientists are Hispanic or African American.15National Institutes of HealthData by race.https://report.nih.gov/nihdatabook/category/25Date accessed: June 23, 2022Google Scholar To improve diversification of the scientific workforce, the NIH developed a funding opportunity and the request for applications encourages educational programs to recruit talented junior faculty from diverse backgrounds, specifically racial and ethnic minority groups underrepresented in biomedical, behavioral, clinical, and social sciences research.16National Institutes of HealthPart 1: overview information. NIDDK Partnerships with Professional Societies to Enhance Scientific Workforce Diversity and Promote Scientific Leadership (R25 - Clinical Trial Not Allowed).https://grants.nih.gov/grants/guide/rfa-files/RFA-DK-22-004.htmlDate accessed: June 23, 2022Google Scholar In 2019, ten scholars from institutions throughout the United States were selected to form the inaugural AGA FORWARD cohort. Four scholars were gastroenterology fellows, 5 were gastroenterology junior faculty (including 1 pediatric gastroenterologist), and 1 was hepatology junior faculty. Five identified as Black or African American and 5 identified as Hispanic or Latinx. A large proportion (70%) of the initial cohort was female, which also provided an opportunity for AGA to address gender inequities among physician-scientists. Scholars were paired with a mentor and received executive coaching from senior AGA staff. In addition to attending the AGA Future Leaders Program and AGA/American Association for the Study of Liver Diseases Academic Skills Workshop, scholars received additional training in manuscript development, grant writing, and management of research laboratories and personnel (Figure 1). When the COVID-19 pandemic began in year 2, AGA and FORWARD leadership devised an opportunity to provide moderator training, and scholars subsequently moderated an AGA seminar series entitled “GI Forging Forward,” with topics focused on developing, understanding, and implementing guidelines during the pandemic.17AGA UniversityYour hub for GI education.https://agau.gastro.org/diweb/catalog/q/Forging-Forward/?_ga=2.254791176.1082814212.1652104550-586689187.1652104550Date accessed: June 23, 2022Google Scholar Herein, we present our experiences, as well as the benefits and lessons learned from participating in the inaugural FORWARD cohort. Mentorship and SponsorshipThe AGA FORWARD Program was structured to provide a team-based approach to mentoring through the following 4 key mechanisms: home institution mentor, AGA FORWARD mentor, executive coach, and academic skills specialist. This structure fostered skills in development, networking, interpersonal insight, and advice (Figure 2). FORWARD scholars and mentors regarded as experts in their respective fields were matched based on areas of mutual interest. Mentor–mentee pairs met in person and virtually at prespecified time points throughout the 2-year program. Mentors received training on how to mentor effectively. The agenda for mentor–mentee meetings was guided by a formal curriculum. In addition to one-on-one mentoring, network mentoring was used during in-person gatherings. FORWARD alumni reported productive structured mentored sessions in which opportunities were provided to discuss challenges in research and guidance on areas of expertise that were otherwise not available within their home institutions.One major benefit of FORWARD was that scholars engaged in both formal and informal peer mentoring.18Cree-Green M. Carreau A.M. Davis S.M. et al.Peer mentoring for professional and personal growth in academic medicine.J Investig Med. 2020; 68: 1128-1134Crossref PubMed Scopus (18) Google Scholar An example of informal peer mentoring is the utilization of a text-messaging group to receive quick feedback regarding clinical, research, or leadership questions. Some FORWARD scholars created a formal writing accountability and peer-mentoring group that meets for 1 hour each weekday. Scholars set goals, discuss progress with writing tasks, and provide advice regarding grant applications. Perhaps more importantly, participation in this writing group has served as a great source of moral support. Participating scholars celebrate each other’s victories and provide guidance and encouragement when roadblocks emerge. Academic medicine can be isolating, especially for UIM faculty who are often the only people of color in their division or department.19Royal K.D. Cannedy A.L. Dent G.A. More on diversity and inclusion in academic medicine: the isolation of Black females.Acad Med. 2016; 91: 896Crossref PubMed Scopus (4) Google Scholar Participation in the FORWARD Program has allowed for fellowship with, and peer mentorship from, others who have similar lived experiences. Increased utilization of teleconferencing during the COVID-19 pandemic provided the necessary infrastructure, making it feasible for scholars scattered throughout the United States to engage regularly. This arrangement has been so beneficial that it is still ongoing and constantly evolving to meet the emerging needs of participants.Recognizing that sponsorship is an important aspect of career development and success, FORWARD embedded mechanisms for promoting the careers of mentees. A sponsor advocates and helps to promote a junior faculty member’s career by facilitating introductions to key experts in the field and invited presentations and leadership opportunities, which are important metrics for promotion. The COVID-19 webinar series is an example of sponsorship; scholars who served as moderators for these sessions were able to work and engage with key society leaders.17AGA UniversityYour hub for GI education.https://agau.gastro.org/diweb/catalog/q/Forging-Forward/?_ga=2.254791176.1082814212.1652104550-586689187.1652104550Date accessed: June 23, 2022Google Scholar In many cases, mentors and mentees continue to meet regularly and alumni continue to benefit from sponsorship and mentorship. The AGA FORWARD Program was structured to provide a team-based approach to mentoring through the following 4 key mechanisms: home institution mentor, AGA FORWARD mentor, executive coach, and academic skills specialist. This structure fostered skills in development, networking, interpersonal insight, and advice (Figure 2). FORWARD scholars and mentors regarded as experts in their respective fields were matched based on areas of mutual interest. Mentor–mentee pairs met in person and virtually at prespecified time points throughout the 2-year program. Mentors received training on how to mentor effectively. The agenda for mentor–mentee meetings was guided by a formal curriculum. In addition to one-on-one mentoring, network mentoring was used during in-person gatherings. FORWARD alumni reported productive structured mentored sessions in which opportunities were provided to discuss challenges in research and guidance on areas of expertise that were otherwise not available within their home institutions. One major benefit of FORWARD was that scholars engaged in both formal and informal peer mentoring.18Cree-Green M. Carreau A.M. Davis S.M. et al.Peer mentoring for professional and personal growth in academic medicine.J Investig Med. 2020; 68: 1128-1134Crossref PubMed Scopus (18) Google Scholar An example of informal peer mentoring is the utilization of a text-messaging group to receive quick feedback regarding clinical, research, or leadership questions. Some FORWARD scholars created a formal writing accountability and peer-mentoring group that meets for 1 hour each weekday. Scholars set goals, discuss progress with writing tasks, and provide advice regarding grant applications. Perhaps more importantly, participation in this writing group has served as a great source of moral support. Participating scholars celebrate each other’s victories and provide guidance and encouragement when roadblocks emerge. Academic medicine can be isolating, especially for UIM faculty who are often the only people of color in their division or department.19Royal K.D. Cannedy A.L. Dent G.A. More on diversity and inclusion in academic medicine: the isolation of Black females.Acad Med. 2016; 91: 896Crossref PubMed Scopus (4) Google Scholar Participation in the FORWARD Program has allowed for fellowship with, and peer mentorship from, others who have similar lived experiences. Increased utilization of teleconferencing during the COVID-19 pandemic provided the necessary infrastructure, making it feasible for scholars scattered throughout the United States to engage regularly. This arrangement has been so beneficial that it is still ongoing and constantly evolving to meet the emerging needs of participants. Recognizing that sponsorship is an important aspect of career development and success, FORWARD embedded mechanisms for promoting the careers of mentees. A sponsor advocates and helps to promote a junior faculty member’s career by facilitating introductions to key experts in the field and invited presentations and leadership opportunities, which are important metrics for promotion. The COVID-19 webinar series is an example of sponsorship; scholars who served as moderators for these sessions were able to work and engage with key society leaders.17AGA UniversityYour hub for GI education.https://agau.gastro.org/diweb/catalog/q/Forging-Forward/?_ga=2.254791176.1082814212.1652104550-586689187.1652104550Date accessed: June 23, 2022Google Scholar In many cases, mentors and mentees continue to meet regularly and alumni continue to benefit from sponsorship and mentorship. Academic and Research SkillsA critical aspect in the development of future leaders in gastroenterology and hepatology is fostering a strong foundation in academic and research skills. To address disparities in NIH funding,20Valantine H.A. Lund P.K. Gammie A.E. From the NIH: a systems approach to increasing the diversity of the biomedical research workforce.CBE Life Sci Educ. 2015; 15: fe4Crossref Scopus (55) Google Scholar,21Bernard M.A. Johnson A.C. Hopkins-Laboy T. et al.The US National Institutes of Health approach to inclusive excellence.Nat Med. 2021; 27: 1861-1864Crossref PubMed Scopus (6) Google Scholar FORWARD partnered with an independent consulting firm. Through this partnership, scholars engaged in structured modules focused on the following key components of academic and research skills: research leadership development, grantsmanship, and manuscript development. In preparation for the transition to independence, scholars gained skills in laboratory team management and team-based science. Markers of success included 135 manuscripts since the cohort’s inception and 40 articles published in high-impact journals. FORWARD scholars were also able to translate their research goals into successful early career grant applications—since beginning the program, 2 have received funding from the Mentored Clinical Scientist Research Career Development Award (K08/K23), 1 is funded by an institutional KL2 Award, and 2 are funded by academic societies and/or foundations. One scholar received an early-career, new principal investigator award for an NIH R01. In addition to these grants, scholars also successfully competed for institutional pilot awards and industry-sponsored grants. In total, FORWARD scholars received notices of awards for 18 of the 30 grant applications submitted since the program’s inception. Two have been promoted to assistant professor and 3 have been promoted to associate professor. A critical aspect in the development of future leaders in gastroenterology and hepatology is fostering a strong foundation in academic and research skills. To address disparities in NIH funding,20Valantine H.A. Lund P.K. Gammie A.E. From the NIH: a systems approach to increasing the diversity of the biomedical research workforce.CBE Life Sci Educ. 2015; 15: fe4Crossref Scopus (55) Google Scholar,21Bernard M.A. Johnson A.C. Hopkins-Laboy T. et al.The US National Institutes of Health approach to inclusive excellence.Nat Med. 2021; 27: 1861-1864Crossref PubMed Scopus (6) Google Scholar FORWARD partnered with an independent consulting firm. Through this partnership, scholars engaged in structured modules focused on the following key components of academic and research skills: research leadership development, grantsmanship, and manuscript development. In preparation for the transition to independence, scholars gained skills in laboratory team management and team-based science. Markers of success included 135 manuscripts since the cohort’s inception and 40 articles published in high-impact journals. FORWARD scholars were also able to translate their research goals into successful early career grant applications—since beginning the program, 2 have received funding from the Mentored Clinical Scientist Research Career Development Award (K08/K23), 1 is funded by an institutional KL2 Award, and 2 are funded by academic societies and/or foundations. One scholar received an early-career, new principal investigator award for an NIH R01. In addition to these grants, scholars also successfully competed for institutional pilot awards and industry-sponsored grants. In total, FORWARD scholars received notices of awards for 18 of the 30 grant applications submitted since the program’s inception. Two have been promoted to assistant professor and 3 have been promoted to associate professor. LeadershipDespite the increase in individuals who are UIMs matriculating in medical school, UIMs continue to be underrepresented in higher academic ranks and senior leadership positions across the board.22Lee T.H. Volpp K.G. Cheung V.G. et al.Diversity and inclusiveness in health care leadership: three key steps. NEJM Catalyst Innovations in Care Delivery. Published June 7, 2021.https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0166Date accessed: June 29, 2022Google Scholar Leadership is a critical component of physician competence, yet existing leadership curricula in graduate medical education is limited and the best approaches to developing leadership skills for physicians remain undefined. Medical students have expressed the need for structured leadership training programs,23Quince T. Abbas M. Murugesu S. et al.Leadership and management in the undergraduate medical curriculum: a qualitative study of students' attitudes and opinions at one UK medical school.BMJ Open. 2014; 4e005353Crossref PubMed Scopus (36) Google Scholar and residents are not prepared for informal or formal leadership roles after graduation.12Baird D.S. Soldanska M. Anderson B. et al.Current leadership training in dermatology residency programs: a survey.J Am Acad Dermatol. 2012; 66: 622-625Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar,24Blumenthal D.M. Bernard K. Bohnen J. et al.Addressing the leadership gap in medicine: residents' need for systematic leadership development training.Acad Med. 2012; 87: 513-522Crossref PubMed Scopus (161) Google Scholar The need to foster leadership development for physicians in training, particularly for UIMs, has been widely recognized. As part of its strategic plan, AGA FORWARD addressed the gap of leadership development. During individual meetings with the career coach, scholars polished leadership skills with tailored strategies, enhancing the scholars’ overall potential as a future leader in academia.FORWARD leadership training included critical content areas, such as self-awareness, emotional intelligence, and conflict resolution, which are pivotal for becoming a successful leader. Scholars completed an in-depth 360-degree assessment in which they received candid performance feedback from their peers, supervisors, and direct reports. In one-on-one executive coaching sessions, scholars used this feedback to leverage their strengths and plan strategies to develop areas of weakness. Participation in such structured career and leadership coaching is pivotal for junior faculty, who often juggle multiple research and clinical responsibilities and struggle with producing meaningful outputs in these roles. Scholars benefited greatly from dedicated and tailored leadership advice from exceptional AGA leaders who shared their experiences and insights on becoming a successful leader. As a result of the program, FORWARD scholars excelled in their current leadership positions—5 achieved new leadership roles at the departmental, institutional, or national level. As FORWARD scholars continue to lead, they will draw from the lessons and strategies learned and will continue to inspire medical students, residents, and fellows of color interested in gastroenterology and hepatology. Despite the increase in individuals who are UIMs matriculating in medical school, UIMs continue to be underrepresented in higher academic ranks and senior leadership positions across the board.22Lee T.H. Volpp K.G. Cheung V.G. et al.Diversity and inclusiveness in health care leadership: three key steps. NEJM Catalyst Innovations in Care Delivery. Published June 7, 2021.https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0166Date accessed: June 29, 2022Google Scholar Leadership is a critical component of physician competence, yet existing leadership curricula in graduate medical education is limited and the best approaches to developing leadership skills for physicians remain undefined. Medical students have expressed the need for structured leadership training programs,23Quince T. Abbas M. Murugesu S. et al.Leadership and management in the undergraduate medical curriculum: a qualitative study of students' attitudes and opinions at one UK medical school.BMJ Open. 2014; 4e005353Crossref PubMed Scopus (36) Google Scholar and residents are not prepared for informal or formal leadership roles after graduation.12Baird D.S. Soldanska M. Anderson B. et al.Current leadership training in dermatology residency programs: a survey.J Am Acad Dermatol. 2012; 66: 622-625Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar,24Blumenthal D.M. Bernard K. Bohnen J. et al.Addressing the leadership gap in medicine: residents' need for systematic leadership development training.Acad Med. 2012; 87: 513-522Crossref PubMed Scopus (161) Google Scholar The need to foster leadership development for physicians in training, particularly for UIMs, has been widely recognized. As part of its strategic plan, AGA FORWARD addressed the gap of leadership development. During individual meetings with the career coach, scholars polished leadership skills with tailored strategies, enhancing the scholars’ overall potential as a future leader in academia. FORWARD leadership training included critical content areas, such as self-awareness, emotional intelligence, and conflict resolution, which are pivotal for becoming a successful leader. Scholars completed an in-depth 360-degree assessment in which they received candid performance feedback from their peers, supervisors, and direct reports. In one-on-one executive coaching sessions, scholars used this feedback to leverage their strengths and plan strategies to develop areas of weakness. Participation in such structured career and leadership coaching is pivotal for junior faculty, who often juggle multiple research and clinical responsibilities and struggle with producing meaningful outputs in these roles. Scholars benefited greatly from dedicated and tailored leadership advice from exceptional AGA leaders who shared their experiences and insights on becoming a successful leader. As a result of the program, FORWARD scholars excelled in their current leadership positions—5 achieved new leadership roles at the departmental, institutional, or national level. As FORWARD scholars continue to lead, they will draw from the lessons and strategies learned and will continue to inspire medical students, residents, and fellows of color interested in gastroenterology and hepatology. ConclusionsThe AGA FORWARD Program represents a model of success for professional organizations and academic institutions interested in developing targeted programs aimed at increasing academic, research, and leadership skills in groups who have historically been UIM. The intensive 2-year experience was constructed to equip future leaders in gastroenterology, hepatology, and academic medicine with many of the tools needed to succeed. Historically, marginalized groups have limited awareness of, and access to, such transformational opportunities. The FORWARD Program has been successful because it was tailored to fit the needs of its participants. In a preprogram AGA survey and focus group meetings, UIM respondents indicated that lack of knowledge about how to become an investigator, lack of mentorship and sponsorship, and lack of visibility in national organizations were barriers to success and advancement. Programs looking to emulate the success of FORWARD should initiate the process by engaging with stakeholders and conducting a needs assessment to ensure that the subsequent program is responsive to the needs of prospective participants.The AGA FORWARD Program could be improved by further tailoring content to the needs and academic goals of participants. In our cohort, all participants worked on developing academic skills synchronously; however, it may be more beneficial for some to focus on developing manuscripts and others to focus on grants, depending on existing skills, career stage, and goals.Due to significant attrition of UIM faculty in academic medicine, fellows and junior faculty from UIM groups may experience difficulty identifying role models and mentors. The AGA FORWARD Program engaged and prepared allies in methodologies to fill the mentor gap, which enabled scholars to achieve success. The partnership of mentors and allies is an important component of the program and ensured that mentors have the skills needed to provide guidance to mentees who likely have had very different lived experiences as UIMs navigating academic medicine. Pipeline programs are proposed as a solution to increase the number of UIM physician-scientists, and by extension may improve health disparities and incrementally advance us toward achievement of health equity. However, simply increasing the number of UIM scholars without implementing systems of support is unlikely to achieve the intended goal. The beauty of the AGA FORWARD Program was its multifaceted approach, which ensured that scholars would benefit from one component or another, depending on their individual needs. As the pipeline expands, similar programs could be piloted at the society, departmental, or institutional level, and could be the key to overcoming decades of structural barriers to success. The FORWARD Program is a critical step toward achieving a vision of inclusive leadership in medicine that reflects the diversity of our population and patients. The AGA FORWARD Program represents a model of success for professional organizations and academic institutions interested in developing targeted programs aimed at increasing academic, research, and leadership skills in groups who have historically been UIM. The intensive 2-year experience was constructed to equip future leaders in gastroenterology, hepatology, and academic medicine with many of the tools needed to succeed. Historically, marginalized groups have limited awareness of, and access to, such transformational opportunities. The FORWARD Program has been successful because it was tailored to fit the needs of its participants. In a preprogram AGA survey and focus group meetings, UIM respondents indicated that lack of knowledge about how to become an investigator, lack of mentorship and sponsorship, and lack of visibility in national organizations were barriers to success and advancement. Programs looking to emulate the success of FORWARD should initiate the process by engaging with stakeholders and conducting a needs assessment to ensure that the subsequent program is responsive to the needs of prospective participants.