Mentorship has long been recognized as one of the most powerful determinants of professional development, career satisfaction, and scholarly productivity in academic medicine. Yet despite more than four decades of research documenting the benefits of mentoring relationships, academic medicine continues to face persistent inequities in recruitment, retention, advancement, and well-being, particularly among individuals who occupy marginalized or multiply marginalized social positions. This paradox suggests that mentorship cannot be fully understood or optimized without attention to broader social, cultural, and structural forces that shape how mentoring relationships are formed, enacted, and experienced. Drawing on a comprehensive body of scholarship on mentoring in academic medicine and integrating it with contemporary theories of intersectionality, cultural humility, cultural safety, and health equity, this article develops an original, theoretically unified, and empirically grounded framework for understanding mentorship as both a professional development mechanism and a site of power, identity negotiation, and institutional reproduction.

Using an integrative narrative synthesis approach grounded in the foundational mentoring literature of Roch, Palepu and colleagues, Pololi and colleagues, Allen and colleagues, Cameron and Blackburn, and others, alongside the intersectionality and equity-focused work of Collins, Crenshaw, Bowleg, Jones, Braveman, Curtis, Hook, and Wilkins, this study moves beyond a narrow focus on dyadic mentor–mentee relationships. Instead, it conceptualizes mentorship as a multilayered social process embedded within historically structured systems of race, gender, class, professional hierarchy, and institutional culture. The methodology involves a theoretically informed qualitative synthesis in which mentoring functions, roles, and outcomes identified in the medical education literature are reinterpreted through an intersectional lens to illuminate how advantages and disadvantages are differentially distributed.

The results of this analysis demonstrate that while mentorship consistently produces positive career outcomes, including increased productivity, career clarity, and professional confidence, these benefits are not evenly accessible. Informal mentoring networks, which are often the most powerful sources of sponsorship and career advancement, disproportionately favor those who already resemble institutional norms of authority and legitimacy. At the same time, mentees from marginalized backgrounds often experience mentoring relationships that are simultaneously supportive and constraining, shaped by cultural misunderstanding, implicit bias, and unequal power dynamics. The integration of cultural humility and cultural safety frameworks reveals that effective mentorship in diverse academic environments requires not only technical guidance but also a reflexive, justice-oriented orientation toward difference, power, and historical context.

In discussion, the article argues that mentorship must be reconceptualized as a form of institutional practice rather than merely an interpersonal relationship. Such a reconceptualization carries profound implications for faculty development, leadership training, and organizational accountability. By embedding intersectionality and equity into the design, evaluation, and everyday practice of mentoring, academic medical centers can transform mentorship from a mechanism that often reproduces inequality into one that actively disrupts it. The article concludes by outlining a set of theoretically grounded and empirically supported principles for building mentoring systems that promote both excellence and justice in academic medicine.