According to the eligibility criteria, 549 articles were excluded at the abstract screening phase. Fifty-seven articles proceeded to full-text review. Sixteen were ultimately included in the final synthesis (Table 3).

There was heterogeneity in study design, medical specialty, and career stage focus of the included studies. Five were purely quantitative, with one focusing on tool validation; the others used cross-sectional, often retrospective surveys. Eight were qualitative, involving semi-structured interviews. Three involved mixed-methods evaluation that included either focus groups or open-ended survey data that underwent thematic analysis.

Definition of Sponsorship

All included studies provided a description of sponsorship or acts of sponsorship; however, the definition was not consistently stated at the outset. There was general consensus on three elements unique to sponsorship: (1) Sponsorship is specifically focused on the provision of career advancement opportunities; (2) sponsorship requires the sponsor to hold a position of power or influence; (3) sponsorship involves advocacy by the sponsor for the sponsee. Two articles additionally highlighted the role of a sponsor in protecting their sponsees. 5, 31

Studies varied in their description of the nature of the sponsorship relationship, with some calling it “episodic” or “transactional,” 29, 35 while others focused on more longitudinal elements of the relationship, noting that a sponsee “is distinguished by loyalty to the sponsor” 27 and that sponsorship requires a “reputational risk” to the sponsor through the public commitment of an individual whose talents they are promoting. 35 Mahendran et al. 35 and Hilsabeck 32 highlighted the bi-directional nature of the sponsorship relationship, with both noting the intrinsic satisfaction of seeing a protégé succeed. A precursor to sponsorship appears to be sufficient interpersonal connection for a sponsee’s talent to be recognized. Table 4 provides an overview of sponsorship definitions.

Table 4 Sponsorship DefinitionsOverview of Sponsorship Themes

The data extracted from the analyzed studies revealed salient themes relating to career sponsorship in academic medicine. The most common themes highlighted were the following: significant impact of sponsorship on career success and breaking barriers; enhanced impact on career for women; differences in receipt and delivery of sponsorship for women and UIM individuals; and lack of awareness of sponsorship and how best to seek sponsorship.

Effects of Sponsorship on Career Advancement

Three studies provided definitions or criteria for career advancement. While the others did not explicitly define career advancement, per our inclusion criteria, all mentioned career advancement in association with sponsorship, as either a goal or outcome (Table 5). Ten studies reported that sponsorship was associated with career advancement, often as a critical component 4, 5, 25, 27,28,29, 33,34,35,36.

Table 5 Included Studies’ Definition of Career Advancement and Support for Sponsorship’s RoleGender Differences in Sponsorship

Two of the four quantitative studies that reported on gender differences found that men were more likely to report receiving sponsorship 25 or found a trend towards men receiving more sponsorship. 26 The other two either found no difference 24 or were insufficiently powered to draw conclusions. 28

Of the qualitative studies in our review, women reported a lack of access to sponsorship 30, 35 compared to men who received more sponsorship 33, and earlier in their careers. 29 It was noted that men are more likely to sponsor men 29, and women are less likely to seek out or be identified for sponsorship. 4, 34 Only one qualitative study reported no gender differences. 32

Finally, the mixed-methods studies that included a gender comparison offered a more nuanced understanding of the relationship between gender, career-stage, and sponsorship. In one study, women full professors were significantly more likely to report having received sponsorship to arrive at the leadership position than their male peers 36, while a separate study found no gender differences at the same stage. 5 At the early-career stage, one study found distinct differences in patterns of sponsorship between the early- and mid-career stages, with women receiving more sponsorship than their male peers at the assistant professor level; however, women were significantly less likely than men to receive sponsorship at the associate level. 5

Sponsorship Value for UIM

Two studies, Levine et al. 34 and Williams et al. 5, analyzed the value of sponsorship for UIM individuals. Levine et al. note that among UIM faculty interviewed, there was a sense that sponsorship offered them enhanced external credibility and privileged access to influential networks. Williams et al. delved further into sponsorship experiences and perceptions using a quantitative approach. In that study, the experience of UIM faculty varied by academic rank. Familiarity and receipt of sponsorship was higher among junior UIM faculty compared to their non-UIM peers, while the inverse was true at the associate and full professor levels. Regarding delivery of sponsorship, more full-professor faculty reported serving as sponsors than their non-UIM peers; the same was not true at the assistant level. They also found that among the total faculty sample, a significant proportion perceived inequities in the receipt of sponsorship for UIM faculty members.

Received Training on Sponsorship

Two studies examined the prevalence of sponsorship training. Seehusen et al. 28 reported 26% of their sample had received training on sponsorship and 54% of their sample frequently used sponsorship as a tool for faculty development. Hilsabeck 32 reported that none of their participants had received formal training on sponsorship. However, they identified the most valued and the least desirable sponsee characteristics.

Critical Junctures and Career Stages

Four of the included studies did not identify the career stage of their participants. Of the remaining 12 studies, one focused on early-career faculty 24, two focused on mid- and late-career faculty 30, 32, four on late-career faculty 28, 31, 33 (including some retired faculty 29), and five included participants from across career stages. 4, 5, 34,35,36 One study that did not disclose the career stage of participants reported that respondents considered sponsorship most important at the mid-career stage, and that the importance of sponsorship lasted through late-career stages. 27 One study noted that as faculty advanced in their career, access to sponsorship became more limited. 35 Across studies, a theme that emerged was the importance of having a sponsor who was in a position of power, often someone at a late-career stage.

Included Studies’ Guidance for Addressing Inequities

The included studies proposed multiple avenues for addressing sponsorship inequity (Fig. 2). The most highly endorsed approach was establishing institutional expectations for sponsorship, including metrics for assessing it and expectations around promotion of women. 5, 27, 30, 34, 37 The other most prevalent proposed intervention was implementing sponsorship training programs. 5, 28, 31, 32 Studies advocated for transparency in sponsorship opportunities for women, 5, 30, 33 community building for women in academic medicine to raise awareness of available opportunities, 24 encouraging proactive sponsorship of women, 31, 36 and having sponsees approach upper leadership to ask for sponsorship. 4, 25

Figure 2

Studies’ proposed interventions for addressing inequity in sponsorship.