Introduction

…Minerva came close up to him in the likeness and with the voice of Mentor. "Telemachus," said she, "if you are made of the same stuff as your father you will be neither fool nor coward henceforward, for Ulysses never broke his word nor left his work half done. If, then, you take after him, your voyage will not be fruitless…

Homer, The Odyssey[1]

Chances in cardiovascular research for fellows, graduate students and for aspiring physician-scientists have never been so exciting as now. The information revolution has revolutionized the flow of biomedical knowledge concerning cardiovascular disease similarly to what the Gutenberg press broadly did in the Renaissance.[2] However, the milieu of cardiovascular research has also become more competitive than in the past.[3] For a young investigator considering the hypothesis of a career in cardiovascular research many challenges have to be overcome, first of all the financial one. In addition, a career combining substantial clinical activities with the concurrent management of a basic, translational or outcome research remains difficult.[4]

Indeed, adequate mentorship and institutional support are key to safely navigate the conundrum represented by concomitant clinical, educational and research activities. Mentorship relies upon the mentor-mentee relationship and it is clearly affected by features of both components.[5] The process of mentoring requires devotion, including generous investment of time, energy, as well as ample resources.[6–9] Yet, it remains poorly studied and evidence of how best to provide mentorship is limited. Given these premises, and aiming at gauging the current stance of both mentees and mentors worldwide toward cardiovascular research training, we designed a survey study.

Methods

Results

Respondents were mainly men (68.4%), aged between 31 and 40 years (49.8%), and half of them were from Mediterranean countries (57.9%) ("Table 1"). Mentees were 152 (61.5%), those in training were 68 (28.2%), and full-time researchers accounted for 70 (28.3%) subjects (Table 2). Additional analyses are disclosed in S1–S5 Tables.

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Table 1. Characteristics of participants to the survey.

https://doi.org/10.1371/journal.pone.0131900.t001

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Table 2. Survey results: overall and distinguishing mentees and mentors.

https://doi.org/10.1371/journal.pone.0131900.t002

In particular, age was not associated with any significant difference in replies (all P>0.05) (S1 and S5 Tables). Conversely, several gender-related differences were identified (S1 and S5 Tables; Fig 1). In particular, bivariate and multivariable analyses showed that female respondents were less satisfied with their career path, reported less support from tutors, and disclosed less commonly the possibility to pursue their preferred field of research (all P<0.05).

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Fig 1. Key differences in replies according to age of respondents.

https://doi.org/10.1371/journal.pone.0131900.g001

Geographic area of origin was also associated at bivariate and multivariable analysis with a number of significant differences (S2 and S5 Tables). In particular, those who originated from North America or Northern/Continental Europe disclosed more often that their institution was a proactive one, with adequate facilities, and that tutors were helpful in finding an appropriate appointment (all P<0.05) (Fig 2A). Accordingly, they were more satisfied than other respondents with their career path, and were more likely to choose the same geographic area to pursue further training (both P<0.05) (Fig 2B).

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Fig 2. Key differences in replies according to geographic area of origin of respondents (panel A and panel B).

https://doi.org/10.1371/journal.pone.0131900.g002

The only feature which appeared statistically significant between respondents in training and post-training was that those belonging to the former group acknowledge less opportunities than those post-training (P = 0.009) (S3 and S5 Tables; Fig 3). Comparison of those working full-time in research versus those with a lower commitment highlighted that full-time researcher status was associated a higher likelihood of replying that tutors were often available to mentees and that they provided formal training in grant writing (both P<0.05) (S4 and S5 Tables). Conversely, detailed bivariate analysis for mentee versus mentor status did not disclose any significant difference in replies (with the notable exclusion of an obvious lower likelihood of having defined already a preferred field of research among mentees [P = 0.006]) (Table 2).

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Fig 3. Key differences in replies according to phase of training of respondents.

https://doi.org/10.1371/journal.pone.0131900.g003

Discussion

This work build upon other surveys on training in cardiovascular research or practice have recently been published.[3,9–12]. In particular, our results highlighting a potential bias in cardiovascular research training towards women in unprecedented.

Gender may indeed play a complex role on the interaction between institutions, mentors, and trainees.[9,13] The delicate issue concerning a possible differential attitude of mentors towards male or female mentees has been evidenced by the differentially perceived frequency of mentors availability for consultations. Although this may also arise from highest expectations and demands from female trainees compared to their male colleagues, nevertheless it can be considered as a sign of lower satisfaction for early career women in the field. Moreover, different perspectives among men and women towards the quality of the research mentorship they are offered have not been reported before.[10,11,14] Thus, caution must be exercised in interpreting and using them for policy making, until they can be confirmed independently.[15] However, there is already evidence that men are more satisfied of their clinical training in general surgery and consider more rarely to leave it, with women reporting less commonly support from the program, less access to faculty members when having difficulties, less respect from the attending, and less solidarity from peers.[16] Similar findings have been reported for allied health care personnel.[17] In addition, supporting data have been provided in a careful analysis of authors and peer reviewers of a scholarly journal.[18] Finally, sex-related bias may operate at several levels, even after a faculty appointment, with women obtaining less opportunity to promotion or being relegated to non-leadership positions.[19]

The other significant predictors of replies are also important, in particular the one depending on geographic area of origin, and those correlated with training phase and full-time researcher status. It is clear that there are major disparities in the quality with which cardiovascular research and training is provided in different countries. Moreover, it is not unexpected to recognize discrepancies in the responses on cardiovascular research training when comparing those post-training and/or working as full-time researchers versus those in training or doing research only as part-time occupation. Yet, these differences should as well call for reasonable but integrated efforts at ameliorating the current situation including the well-known brain drain phenomenon.

Indeed, how can things be improved? First, diversity should be encouraged and open access to researcher networks and facilities should be provided. Training should include in the core curriculum grant writing. In addition, flexible programs may be set already at the undergraduate level to improve confidence, satisfaction, productivity and collaboration.[20] Other measures can also be implemented. However, the first step in addressing existing bias is recognizing them and quantifying them appropriately.

This work has several limitations, which include the observational cross-sectional design, reliance only on closed-ended questions, and risk of false answers. In addition, the international features of our survey possibly limit its validity for country-specific or region-specific situations. In addition, we invited both mentees and mentors, limiting our chance to pose position-specific questions. However, this choice was pursued as it would have enabled comparison of perspectives stemming from these two groups of people. In addition, sample size and validity could have been boosted if two separate surveys had been performed. Most importantly, however, every mentor has been a mentee in the past, and we wish most mentees to become mentors in the future.[21] Thus, it is not so easy to cross a borderline and distinguish the two groups and some of their opinions may be interpreted at both pooled and stratified level. In addition, we did not inquire in detail on number of publications or grants accepted, to verify the real academic standing of the participants. Further surveys are thus clearly warranted to address the crucial mentee versus mentor comparison, as well as the correlation between publications and grants with responses to surveys similar to our own. Finally, we performed several bivariate analyses on top of our descriptive overall analysis. Accordingly, the risk of multiplicity and type I error inflation in such unadjusted analyses should be carefully borne in mind.

Supporting Information

Acknowledgments

GF, ECa, AA and UB are PLOS ONE Editorial Board members. This does not alter our adherence to PLOS ONE Editorial policies and criteria. BZ was, at the time of the preparation of this manuscript, the Congdon Visiting Scholar at the VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, USA. The authors are grateful to Fondazione Roma, Rome, Italy, for all efforts and support provided toward the education and training of our students. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.