- Email: [email protected]
The Role of Gender and Distance Mentoring in the Surgical Education Research Fellowship
ORIGINAL REPORTS
The Role of Gender and Distance Mentoring in the Surgical Education Research Fellowship John L. Falcone, MD,*,† Alfred J. Croteau, MD,‡ and Kimberly D. Schenarts, PhD§ Department of Surgery, Owensboro Health, Owensboro, Kentucky; †Department of Surgery, University of Louisville, Louisville, Kentucky; ‡Department of Surgery, University of Vermont, Burlington, Vermont; and § Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska *
OBJECTIVE: The nature of the mentor-mentee relationship is important in the pursuit of successful research projects. The purpose of this study is to evaluate the mentor-mentee relationships in the Surgical Education Research Fellowship (SERF) based on gender and geographical distances regarding program completion. We hypothesize that there are no differences for SERF program completion rates based on gender pairs and distances between pairs. METHODS: This was a retrospective study from 2006 to
2011. Mentor-mentee rosters were retrospectively reviewed for program completion, demographics, and PubMeD indexing. Time zone differences and geographic distances between pairs were found with online applications. Chisquare tests were used for categorical variables and nonparametric statistics were carried out using α ¼ 0.05. RESULTS: Of the 82 individuals accepted into the SERF
program, 43 (52%) completed the SERF program during the study period. There were no differences in program completion rates based on fellow gender and gender pairing (all p 4 0.05). Different-gender pairs that completed the program (n ¼ 17) were indexed more frequently on PubMed than same-gender pairs that completed the program (n ¼ 24) (41% vs 12%, p ¼ 0.04). There were no differences in program completion based on time zone differences (p ¼ 0.20). The median distance between pairs completing the program (n ¼ 35) was greater than that for pairs not completing the program (n ¼ 36) (1741 km [IQR: 895-3117 km] vs 991 km [IQR: 676-2601 km]; p ¼ 0.03). CONCLUSION: Completion of the SERF program was
independent of mentor-mentee gender pairs and time zone differences. There was greater geographical distance separating mentor-mentee pairs that completed the SERF program
Correspondence: Inquiries to John L. Falcone, MD, MS, Department of Surgery, Owensboro Health Surgical Specialists, Owensboro Health, Ridgecrest Medical Park, 2801 New Hartford Road, Owensboro, KY 42303; fax: (270) 683-3797; e-mail: [email protected]
330
compared with pairs that did not complete the program. Distance mentoring is a successful and crucial element of C 2014 Association the SERF program. ( J Surg 72:330-337. J of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: Association for Surgical Education, distance
mentoring, mentee, mentor, surgery, Surgical Education Research Fellowship (SERF) COMPETENCIES:
Professionalism, Communication Skills
Interpersonal
and
INTRODUCTION Research mentoring is a critically important professional need in academia.1-4 It has been suggested that unless an investigator has significant research experience, he or she will not go far without a good mentor.1 Regarding gender differences between mentor-mentee pairs, women and men differ in opinion whether gender congruity between mentor and mentee affects social/professional boundaries. Although 50% of women say that it does, only 12% of men say so.2 As a corollary, having a mentor of the same gender was found to be important to only 8% of resident mentees.5 However, regarding outcomes, studies of mentoring in academic medicine have revealed nothing to suggest that same-sex mentor pairing is superior.3,6-7 One study specifically showed that there were no differences in publications based on gender differences of the mentor-mentee pairs.7 Over time, academic careers in particular have become characterized by mobility and flexibility, where the concept of mentorship has broadened to include relationships between mentors that span distance and institutions.2 As a result, distance mentoring practices are becoming more common.8-9 In long-distance mentoring relationships, there is little or no physical contact between the mentor and the mentee. The mentor is not “down the hall,” so the mentee must be able to exploit other resources and make use of each
Journal of Surgical Education & 2014 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2014.08.009
communication opportunity.8 The newer technology available, such as synchronous communication with video teleconferencing or asynchronous methods of communication, has the potential to improve the nature of distance mentormentee relationships.8-10 Distance does not appear to limit the connecting potential, leading to a meaningful mentoring relationship; rather, it offers possibilities that local mentoring relationships may not.8 However, although most mentors find long-distance mentoring to be less demanding, many also say it is less effective for the mentee and is personally less fulfilling.2 Since 1995, the Association for Surgical Education has offered a Surgical Education Research Fellowship (SERF).11 This program is a 1-year, home-site fellowship designed to equip investigators with the skills and knowledge needed to plan, implement, and report research studies in the field of surgical education.12 Fellows have 2 group didactic sessions approximately 6 months apart in which they learn the fundamentals of educational research. Each fellow is matched with a mentor with similar research interests, as collaboration with a research mentor is a central tenet of the SERF program. Mentors are generally MDs, PhDs, or other surgical educators and are known in the education community. Mentors do receive the expectations of the SERF fellows, but do not receive dedicated training in mentoring. To complete the SERF program, each fellow must attend the required meetings and must submit an abstract or a article to a peer-reviewed forum or journal. Failure of a fellow to collaborate with his or her mentor would result in dismissal from the program.12 Over the first 15 years of the SERF program, the completion rate has been 50.7%.11 The mentorship of the SERF program in relation to program completion has not been evaluated. The purpose of this study is to evaluate the nature of these SERF program mentor-mentee relationships based on gender differences and geographical distances in direct relation to the successful completion of the SERF program. Given that gender differences in mentor-mentee pairs do not seem to affect productivity, we hypothesized that there would be no differences in SERF program completion based on the nature of mentor-mentee gender pairing. In addition, given that there has been an increased focus in the nature of distance mentoring in the setting of the available technology, we also hypothesized that there would be no differences in SERF program completion based on geographic distance between mentor-mentee pairs.
MATERIALS AND METHODS This was a retrospective study from the 2006 to 2007 academic year to the 2011 to 2012 academic year. The earliest academic year with data available online (20062007) was chosen as the starting year for the study period. The latest academic year (2011-2012) was chosen as the
study period ending year because it allowed for at least 2 full years after completion of the SERF program for peer-review publication. All data were obtained through the Association for Surgical Education website. Permission to use these publically available data for research purposes was confirmed by the SERF Program Director and the Executive Director for the Association for Surgical Education. The SERF fellow and faculty mentor rosters across academic years were obtained from the Association for Surgical Education website.13-18 The main outcome variable of the study was successful completion of the SERF program by the paired fellow and mentor. This was determined from the roster of SERF fellow and faculty members that completed the SERF program electronically obtained from the Association for Surgical Education website.19 Because of the importance of the mentormentee pairing, we define completion of the program from the standpoint of a dyad as opposed to completion from the standpoint of the individual effort of a fellow. Besides gender, the main demographic evaluated for research fellows was career status. The career status for each research fellow: trainee (resident/surgery fellow) or faculty surgeon and the home institution of each fellow and mentor were obtained. Important demographic characteristics for mentors, besides gender, included the type of degree(s) held, previous experience as a SERF mentor, and research experience as evidenced by the number of peer-reviewed articles indexed in PubMed. To evaluate peer-reviewed articles, PubMed was searched using the mentor’s first and last name in conjunction with the “[Author]” PubMed search variable.20 The total number of articles and the number of first-author articles, last/senior-author articles, and middle-author articles were found. Mann-Whitney U tests were performed to evaluate authorship differences based on SERF program completion. For mentors with multiple mentees, outcomes for all subsequent mentormentee relationships were evaluated. The secondary outcome variable of the study was if pairs that completed the SERF program had published a peerreviewed article that was indexed in PubMed. To do this, PubMed was searched using the fellow’s last name and the Boolean operator “AND” followed by the mentor last name.20 Search results were evaluated by content analysis to determine if any peer-reviewed article had been published that was related to the title of the SERF project. The journal of publication was recorded. For each mentor-mentee pairing, the geographic distance between cities in kilometers was determined using an online program powered by Google Maps Api.21 The difference in time zones between mentor-mentee pair cities was determined using an online program.22 SERF fellows who had more than one listed mentor were excluded from these analyses. Program completion was used to evaluate gender differences in fellow performance and with regard to mentor-
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TABLE 1. The Number and Outcome of Fellows Accepted Into the SERF Program From 2006-2012 Academic Year 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Fellows who completed SERF Fellows who did not complete SERF Total
2 (25%)
6 (50%)
8 (53%)
8 (50%)
10 (63%)
9 (60%)
43 (52%)
6 (75%)
6 (50%)
7 (47%)
9 (50%)
6 (37%)
6 (40%)
39 (48%)
8
12
15
16
16
15
82
mentee pairings with chi-square tests. Chi-square tests were also used to compare outcomes based on PubMed status, same or different institution pairing, domestic or international pairing, short-distance or long-distance mentorship, and by absolute time zone differences. The distance used to physically distinguish short-distance from long-distance mentorship was arbitrarily chosen to be 100 km. To evaluate outcomes by the nature of long-distance mentoring relationships, the Mann-Whitney U test was performed between pairs that completed the SERF program and pairs that did not complete the SERF program. Owing to the distribution of the data, nonparametric statistics were performed. All statistical tests were performed with Stata 13 statistical software (StataCorp, College Station, TX), using α ¼ 0.05.
RESULTS Over the study period, 82 fellows were accepted into the SERF program. Table 1 shows the number of fellows that were accepted and the proportion that completed the SERF program. Simple linear regression of the data showed that the number of fellows accepted into the SERF program over time was increasing during the study period (p ¼ 0.047) (graph not shown). A chi-square test of outcomes across the study period indicated that there were no significant outcome ratio differences across years (p ¼ 0.61). Simple linear regression, given in Figure 1, showed that the percentage of fellows who completed the SERF program was increasing over time (p ¼ 0.04). The Pearson correlation coefficient between academic year and annual SERF completion rate was 0.84. Overall, 39 (48%) women and 43 (52%) men were accepted into the SERF program. Of the fellows, 43 (52%) completed the SERF program during the study period. Of the fellows included in the analyses, 51 (62%) had career status available for review. There were 80 (98%) single mentor-mentee pairs identified. In addition, 43 unique SERF mentors were identified. Of these, 24 (56%) were mentors for 1 SERF fellow and 19 (44%) were mentors for more than 1 SERF fellow. For mentors with previous SERF experience, the median number of fellows mentored was 332
Total
3 (interquartile range [IQR]: 2-3, range: 2-5). For the completion of the SERF program by fellow demographics, mentor demographics, mentor-mentee gender pairs, and geographic differences between mentor-mentee pairs are exhibited in Table 2. There were no gender or demographic differences in relation to completion of the SERF program (all p 4 0.05). The 43 mentors were indexed in PubMed 1470 times: 460 times as first authors, 356 times as last/senior authors, and 654 times as middle authors. These mentors had a median instance of total authorship of 26 times (IQR: 14-46), first authorship of 7 times (IQR: 4-12), last/senior authorship of 5 times (IQR: 2-10), and middle authorship of 13 times (IQR: 7-21). There were no differences in the following SERF outcomes between mentors who completed the program and those who did not do so: Median total authorship (30 times [IQR: 15-47] vs 28 times [IQR: 14-46], p ¼ 0.89), first authorship (7 times [IQR: 4-17] vs 6 times [IQR: 3-10], p ¼ 0.32), last/senior authorship
FIGURE 1. Simple linear regression showing the percentage of fellows (n ¼ 82) completing the SERF program over 6 consecutive academic years.
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TABLE 2. SERF Program Outcomes Based on Fellow Gender, Fellow and Mentor Demographics, Gender Relationships With Mentors, and Geographic Differences Between Mentor-Mentee Pairs Demographic Characteristics Fellow gender Woman Man Fellow career stage Resident or surgical fellow Surgical staff member Type of mentorship Single mentor Dual mentor Type of single mentor degree PhD MD MD/education degree MD/PhD Education degree Type of mentor experience Previous mentor Not a previous mentor Multiple mentor experience First SERF fellow Second SERF fellow Third SERF fellow Fourth SERF fellow Fifth SERF fellow Mentor-mentee pairs Same gender Different gender For female SERF fellows Female mentor Male mentor For male SERF fellows Female mentor Male mentor Mentor-mentee pairs Same city Different city Mentor-mentee pairs Same country Different country Mentor-mentee pairs Short distance (r100 km) Long distance (4100 km)
Completed SERF (n, [%])
Did Not Complete SERF(n, [%])
Total
21 (54) 22 (51)
18 (46) 21 (49)
39 43
9 (50) 17 (52)
9 (50) 16 (48)
18 33
41 (51) 2 (100)
39 (49) 0 (0)
80 2
20 14 3 2 2
27 7 3 2 0
(57) (33) (50) (50) (0)
47 21 6 4 2
28 (50) 11 (46)
56 24
11 10 6 0 1
(58) (53) (55) (0) (33)
19 19 11 4 3
24 (56) 17 (46)
19 (44) 20 (54)
43 37
10 (53) 10 (53)
9 (47) 9 (47)
19 19
6 (35) 15 (60)
11 (65) 10 (40)
17 25
5 (63) 36 (50)
3 (38) 36 (50)
8 72
33 (50) 8 (57)
33 (50) 6 (43)
66 14
6 (67) 35 (49)
3 (33) 36 (51)
9 71
p* 0.81 0.92 0.17 0.26
(43) (67) (50) (50) (100)
0.81 28 (50) 13 (54)
0.29 8 9 5 4 2
(42) (47) (45) (100) (67)
0.38 40.99 0.12 0.50 0.63 0.33
*Results of a chi-square test between characteristics and SERF program outcome.
(5 times [IQR: 3-10] vs 5 times [IQR: 2-11], p ¼ 0.93), and middle authorship (14 times [IQR: 7-22] vs 17 times [IQR: 7-23], p ¼ 0.36). There were no authorship differences between mentors of 1 SERF fellow and mentors of more than 1 SERF fellow (all p 4 0.05) (data not shown). Overall, 10 (23%) SERF program mentor-mentee pairs had a peer-reviewed article indexed in PubMed that included both the SERF fellow and mentor as authors. Of the SERF program completers, 4 (19%) women and 6 (27%) men had published articles. The journals in which these articles were published are shown in Table 3. Gender did not have any association with the publication status qof the SERF fellows (p ¼ 0.52). For SERF program
TABLE 3. The Peer-Reviewed Journals Indexed in PubMeD in Which SERF Projects Were Published For Research Fellows (n ¼ 10) From 2006-2012 Journal American Journal of Surgery Academic Medicine Annals of Surgery Journal of Surgical Education Journal of Surgical Research Journal of Trauma and Acute Care Surgery Medical Education
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Frequency (%) 3 2 1 1 1 1 1
(30%) (20%) (10%) (10%) (10%) (10%) (10%) 333
complete the SERF program (p ¼ 0.03). This comparison is shown graphically in Figure 2.
TABLE 4. PubMeD Publications For Single-Mentor SERF Program Completers (n ¼ 41) by Mentor-Mentee Gender Differences Mentor-Mentee Genders Same PubMeD publication No PubMeD publication Total
Not the Same
DISCUSSION
Total (p ¼ 0.04)*
3
7
10
21
10
31
24
17
41
The purpose of this study was to explore the relationship between mentor-mentee pairs, both from the perspectives of gender and distance, in relation to the completion of the SERF program. The overall rate of SERF program completion in this study is approximately 50%. This may appear low but is representative of the completion rate of the SERF program over its first 15 years.11 The SERF program is a very unique program, and there are no other known comparable surgical education research programs; SERF is a certificate program and not a degree-bearing program. However, even though the SERF program is not a basic science/clinical fellowship, its completion rate is comparable to degree-bearing graduate research programs based in biomedical sciences.23 The most common historical reasons for failure to complete the program include lack of time to work on the SERF project and lack of institutional support.11 We found that the number of SERF fellows participating during the study period significantly increased over time. There is currently a limit of 16 fellows per year, thus future increases in trends will not occur if the limit and acceptance rates stay the same.12 Interestingly, not only are there increases in the number of fellows per year, but the percentage of fellows who complete the program is also increasing in a significant fashion based on the linear regression analysis in Figure 1. This finding is an exciting one for the SERF program, and it suggests that the program is marketable and that internal improvements to the program may be improving fellow performance. We are hopeful that program completion rates will continue to increase over time. There is a fairly low peer-reviewed publication rate of mentor-mentee pairs indexed on PubMed. We feel that the actual publication rate is likely higher, as some studies may still be in press, in the peer-review process, or article preparation phases. In addition, while one would assume that the mentor would be listed as a coauthor, this is not always the case and is not a requirement of the SERF
*Results of a 2 2 chi-square test between gender differences and publication outcomes.
completers, there were no differences in PubMed indexing rates across years (p ¼ 0.85). Published outcomes for pairs that completed the SERF program based on mentormentee gender pairing are shown in Table 4. The median time zone difference from mentees to mentors was 0 hours (IQR: 1 to þ1 hour) (range: 8 to þ6 hours). The median absolute time zone difference from mentees to mentors was 1 hour (IQR: 0-2 hours, range: 0-8 hours). The outcomes of mentor-mentee pairs across absolute time zone differences are shown in Table 5. Chi-square analyses showed that there were no time zone cutoff points that resulted in outcome differences of mentor-mentee pairs (all p 4 0.05) (data not shown). The median distance between all mentor-mentee pairs was 1108 km (IQR: 640-2729 km, range: 0-7915 km). There were 9 of 80 (11%) pairs that were considered short-distance pairs (r100 km), with a median distance of 0 km (IQR: 0-0 km, range: 0-14 km). There were 71 of 80 (89%) pairs that were considered long-distance pairs (4100 km), with a median distance of 1294 km (IQR: 769-2931 km, range: 299-7915 km). On evaluating long-distance mentor-mentee pairs only (n ¼ 71), the median distance between long-distance pairs that completed the SERF program (n ¼ 35) was 1741 km (IQR: 895-3117 km, range: 376-7915 km). The median distance between long-distance pairs that did not complete the SERF program (n ¼ 36) was 991 km (IQR: 676-2601 km). A Mann-Whitney U test showed that the median distance between pairs that completed the SERF program was greater than the median distance between pairs that did not
TABLE 5. The Outcome Of Mentor-Mentee Pairs (n ¼ 80) in the SERF Program From 2006-2012 Based on Absolute Time Zone Differences Absolute Time Zone Differences (h) 0
1
2
3
4
5
6
7
8
Pairs that completed SERF (n, %) 14 (47) 14 (52) 5 (50) 3 (50) 1 (100) 1 (33) 2 (100) 0 (0) 1 (100) Pairs that did not complete 16 (53) 13 (48) 5 (50) 3 (50) 0 (0) 2 (67) 0 (0) 0 (0) 0 (0) SERF (n, %) Total 30 27 10 6 1 3 2 0 1 334
Total (p ¼ 0.20)* 41 (51) 39 (49) 80 (100%)
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FIGURE 2. Comparison of mentor-mentee pair distances (n ¼ 71) based on SERF program completion.
program. This study also did not evaluate peer-reviewed journals outside those indexed on PubMed, nor were we able to identify national forums in which work may have been presented. Table 3 shows that the most frequent publication is in the American Journal of Surgery, which is the official journal of the Association for Surgical Education.24-25 Interesting further studies into the SERF programmatic variables that may affect program completion are warranted. Regarding gender specifically, there were no differences in gender regarding SERF program acceptance, and fellow outcomes. There were also no differences in SERF program completion rates for same-gender and different-gender mentor-mentee pairs. These findings are consistent with our first study hypothesis, as these findings are also consistent with other studies on gender differences in mentoring.3,6-7 In direct contrast to these prior studies on mentoring, interestingly, Table 4 shows a surprising finding. From Table 4, we conclude that for mentor-mentee pairs, there is a higher association of publication if the mentor and mentee are of opposite gender. The reasons behind this finding are unclear, and further study into some variables involving mentor-mentee gender pairing is warranted. Based on the findings in Table 2, there are other demographics of fellows and mentors that do not seem to affect the SERF program completion rate. The career stage of the fellow is not associated with SERF program completion. The degrees of the mentors and being a multiple fellow SERF mentor are also not associated with SERF
program completion. The percentage of success with subsequent mentorship does increase but not in a statistically significant fashion. Moreover, mentor experience, as defined by authorship of peer-reviewed articles indexed in PubMed, is not associated with SERF program completion. We would recommend that the SERF program should consider formal mentorship/leadership training to the pool of mentors. Regarding distance, we found a very broad spectrum of time zone differences and geographic distances between mentor-mentee pairs. These ranges in distance and time speak to the diverse nature of the SERF program, where interest in surgical education research spans not only across the United States but also across the globe. We found that there were no differences in program completion based on time zone differences. This suggests that time zone differences are not associated with success of the mentormentee relationship. This may imply that electronic communication between mentor-mentee pairs across long distances was more heavily favored to being in similar time zones. We did not find any differences between outcomes for short-distance and long-distance mentor pairs, although some smaller numbers of short-distance pairs greatly increase the chance of a type II error. These findings were consistent with the second study hypothesis. However, in direct contrast with this hypothesis, we found it most interesting that the distances between long-distance mentor-mentee pairs for SERF program completers were statistically and significantly greater than those distances between
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mentor-mentee pairs that did not complete the SERF program. This suggests that distance is truly not a barrier to success. There was 1 mentor-mentee pair that completed the program from a distance of 7915 km (more than 4900 miles) and with an 8-hour time zone difference between the pair. The reasons behind this finding are likely related to personal characteristics of the mentor and mentee regarding motivation, goal-sharing, and compatibility. Further studies on the process of matching a mentor to a mentee, and the subsequent interpersonal dynamics would be fascinating and might be able to explain the finding that success is proportional to distance when the inverse relationship may be more intuitive. There are some limitations to this study. First, given that all of the data were obtained from online sources, we assume that the nature of reporting is accurate and current. However, it is conceivable that changes may have occurred that were not electronically updated on the website. Second, it is important to note that the SERF program had different leadership during the study period. So, although criteria for program completion remained constant, the curricula did vary and the experience by the fellows was not uniform. Third is the relative power of the study. Although all of the available electronic data were used, the relatively low numbers overall, and especially with comparisons involving published outcomes and time zone differences, and the low power would allow for a higher chance of a type II error. However, we feel that the sample size was representative, as program pass rates of the sample are consistent with those over the first 15 years of the SERF program. Next, this study did focus on peer-reviewed publication indexing in PubMed. It is possible that the fellows published without listing the mentor as an author; however, that scenario was not studied, as the focus of this project was on collaboration. And, although PubMed indexing is a measurable outcome, there are other measures of success such as abstract presentation in poster/plenary form, SERF program completion, and other nontangible outcomes such as collaboration and ongoing friendships/professional relationships that are meaningful to success in surgical education. Finally, this study evaluates gender and geographic demographics. However, it does not study any other important characteristics between mentor-mentee pairs such as goalsetting, personality differences, career trajectory, or the nature of the interaction and dynamic. Distance mentoring was found to be successful, but the variables attributing to this success were not able to be evaluated in this study design. These variables are very importance to the milieu of mentor-mentee pairings. These important pairing characteristics should be studied further in the future. There are some strengths to this study. Given that the data were available online, it could easily be repeated. Some of the outcome variables reported were likely conservative, as there were numerous individuals who were accepted into the program but dropped out before the first SERF meeting. 336
Therefore, another strength to this study is that it functioned more as an intention-to-treat analysis, likely yielding more conservative outcome measures. Moreover, the comparisons are relatively straightforward in nature. This is the first known study to evaluate the nature of nonclinical longdistance mentoring, and it is also the first known study to evaluate the success of the SERF program. It is very interesting that longer distances were associated with higher SERF program completion rates. Overall, we found that completion of the SERF program does not depend on fellow gender, gender disparities between mentor-mentee pairs, fellow career stage, mentor degree, or mentor experience in the SERF program. Dissimilar gender for SERF program completers was associated with a higher publication rate as measured by articles indexed through PubMed. Additionally, although no international boundaries or time zone differences were associated with SERF program outcomes, a greater physical distance between mentor-mentee pairs was associated with a higher completion rate in the SERF program. There appear to be meaningful benefits to distance mentoring; distance mentoring should remain an important element of the SERF program. Future studies on the pairing process and the dynamics between mentormentee pairs should be explored to see which other important factors may improve success in the SERF program.
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The Role of Gender and Distance Mentoring in the Surgical Education Research Fellowship John L. Falcone, MD,*,† Alfred J. Croteau, MD,‡ and Kimberly D. Schenarts, PhD§ Department of Surgery, Owensboro Health, Owensboro, Kentucky; †Department of Surgery, University of Louisville, Louisville, Kentucky; ‡Department of Surgery, University of Vermont, Burlington, Vermont; and § Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska *
OBJECTIVE: The nature of the mentor-mentee relationship is important in the pursuit of successful research projects. The purpose of this study is to evaluate the mentor-mentee relationships in the Surgical Education Research Fellowship (SERF) based on gender and geographical distances regarding program completion. We hypothesize that there are no differences for SERF program completion rates based on gender pairs and distances between pairs. METHODS: This was a retrospective study from 2006 to
2011. Mentor-mentee rosters were retrospectively reviewed for program completion, demographics, and PubMeD indexing. Time zone differences and geographic distances between pairs were found with online applications. Chisquare tests were used for categorical variables and nonparametric statistics were carried out using α ¼ 0.05. RESULTS: Of the 82 individuals accepted into the SERF
program, 43 (52%) completed the SERF program during the study period. There were no differences in program completion rates based on fellow gender and gender pairing (all p 4 0.05). Different-gender pairs that completed the program (n ¼ 17) were indexed more frequently on PubMed than same-gender pairs that completed the program (n ¼ 24) (41% vs 12%, p ¼ 0.04). There were no differences in program completion based on time zone differences (p ¼ 0.20). The median distance between pairs completing the program (n ¼ 35) was greater than that for pairs not completing the program (n ¼ 36) (1741 km [IQR: 895-3117 km] vs 991 km [IQR: 676-2601 km]; p ¼ 0.03). CONCLUSION: Completion of the SERF program was
independent of mentor-mentee gender pairs and time zone differences. There was greater geographical distance separating mentor-mentee pairs that completed the SERF program
Correspondence: Inquiries to John L. Falcone, MD, MS, Department of Surgery, Owensboro Health Surgical Specialists, Owensboro Health, Ridgecrest Medical Park, 2801 New Hartford Road, Owensboro, KY 42303; fax: (270) 683-3797; e-mail: [email protected]
330
compared with pairs that did not complete the program. Distance mentoring is a successful and crucial element of C 2014 Association the SERF program. ( J Surg 72:330-337. J of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.) KEY WORDS: Association for Surgical Education, distance
mentoring, mentee, mentor, surgery, Surgical Education Research Fellowship (SERF) COMPETENCIES:
Professionalism, Communication Skills
Interpersonal
and
INTRODUCTION Research mentoring is a critically important professional need in academia.1-4 It has been suggested that unless an investigator has significant research experience, he or she will not go far without a good mentor.1 Regarding gender differences between mentor-mentee pairs, women and men differ in opinion whether gender congruity between mentor and mentee affects social/professional boundaries. Although 50% of women say that it does, only 12% of men say so.2 As a corollary, having a mentor of the same gender was found to be important to only 8% of resident mentees.5 However, regarding outcomes, studies of mentoring in academic medicine have revealed nothing to suggest that same-sex mentor pairing is superior.3,6-7 One study specifically showed that there were no differences in publications based on gender differences of the mentor-mentee pairs.7 Over time, academic careers in particular have become characterized by mobility and flexibility, where the concept of mentorship has broadened to include relationships between mentors that span distance and institutions.2 As a result, distance mentoring practices are becoming more common.8-9 In long-distance mentoring relationships, there is little or no physical contact between the mentor and the mentee. The mentor is not “down the hall,” so the mentee must be able to exploit other resources and make use of each
Journal of Surgical Education & 2014 Association of Program Directors in Surgery. Published by 1931-7204/$30.00 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jsurg.2014.08.009
communication opportunity.8 The newer technology available, such as synchronous communication with video teleconferencing or asynchronous methods of communication, has the potential to improve the nature of distance mentormentee relationships.8-10 Distance does not appear to limit the connecting potential, leading to a meaningful mentoring relationship; rather, it offers possibilities that local mentoring relationships may not.8 However, although most mentors find long-distance mentoring to be less demanding, many also say it is less effective for the mentee and is personally less fulfilling.2 Since 1995, the Association for Surgical Education has offered a Surgical Education Research Fellowship (SERF).11 This program is a 1-year, home-site fellowship designed to equip investigators with the skills and knowledge needed to plan, implement, and report research studies in the field of surgical education.12 Fellows have 2 group didactic sessions approximately 6 months apart in which they learn the fundamentals of educational research. Each fellow is matched with a mentor with similar research interests, as collaboration with a research mentor is a central tenet of the SERF program. Mentors are generally MDs, PhDs, or other surgical educators and are known in the education community. Mentors do receive the expectations of the SERF fellows, but do not receive dedicated training in mentoring. To complete the SERF program, each fellow must attend the required meetings and must submit an abstract or a article to a peer-reviewed forum or journal. Failure of a fellow to collaborate with his or her mentor would result in dismissal from the program.12 Over the first 15 years of the SERF program, the completion rate has been 50.7%.11 The mentorship of the SERF program in relation to program completion has not been evaluated. The purpose of this study is to evaluate the nature of these SERF program mentor-mentee relationships based on gender differences and geographical distances in direct relation to the successful completion of the SERF program. Given that gender differences in mentor-mentee pairs do not seem to affect productivity, we hypothesized that there would be no differences in SERF program completion based on the nature of mentor-mentee gender pairing. In addition, given that there has been an increased focus in the nature of distance mentoring in the setting of the available technology, we also hypothesized that there would be no differences in SERF program completion based on geographic distance between mentor-mentee pairs.
MATERIALS AND METHODS This was a retrospective study from the 2006 to 2007 academic year to the 2011 to 2012 academic year. The earliest academic year with data available online (20062007) was chosen as the starting year for the study period. The latest academic year (2011-2012) was chosen as the
study period ending year because it allowed for at least 2 full years after completion of the SERF program for peer-review publication. All data were obtained through the Association for Surgical Education website. Permission to use these publically available data for research purposes was confirmed by the SERF Program Director and the Executive Director for the Association for Surgical Education. The SERF fellow and faculty mentor rosters across academic years were obtained from the Association for Surgical Education website.13-18 The main outcome variable of the study was successful completion of the SERF program by the paired fellow and mentor. This was determined from the roster of SERF fellow and faculty members that completed the SERF program electronically obtained from the Association for Surgical Education website.19 Because of the importance of the mentormentee pairing, we define completion of the program from the standpoint of a dyad as opposed to completion from the standpoint of the individual effort of a fellow. Besides gender, the main demographic evaluated for research fellows was career status. The career status for each research fellow: trainee (resident/surgery fellow) or faculty surgeon and the home institution of each fellow and mentor were obtained. Important demographic characteristics for mentors, besides gender, included the type of degree(s) held, previous experience as a SERF mentor, and research experience as evidenced by the number of peer-reviewed articles indexed in PubMed. To evaluate peer-reviewed articles, PubMed was searched using the mentor’s first and last name in conjunction with the “[Author]” PubMed search variable.20 The total number of articles and the number of first-author articles, last/senior-author articles, and middle-author articles were found. Mann-Whitney U tests were performed to evaluate authorship differences based on SERF program completion. For mentors with multiple mentees, outcomes for all subsequent mentormentee relationships were evaluated. The secondary outcome variable of the study was if pairs that completed the SERF program had published a peerreviewed article that was indexed in PubMed. To do this, PubMed was searched using the fellow’s last name and the Boolean operator “AND” followed by the mentor last name.20 Search results were evaluated by content analysis to determine if any peer-reviewed article had been published that was related to the title of the SERF project. The journal of publication was recorded. For each mentor-mentee pairing, the geographic distance between cities in kilometers was determined using an online program powered by Google Maps Api.21 The difference in time zones between mentor-mentee pair cities was determined using an online program.22 SERF fellows who had more than one listed mentor were excluded from these analyses. Program completion was used to evaluate gender differences in fellow performance and with regard to mentor-
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TABLE 1. The Number and Outcome of Fellows Accepted Into the SERF Program From 2006-2012 Academic Year 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 Fellows who completed SERF Fellows who did not complete SERF Total
2 (25%)
6 (50%)
8 (53%)
8 (50%)
10 (63%)
9 (60%)
43 (52%)
6 (75%)
6 (50%)
7 (47%)
9 (50%)
6 (37%)
6 (40%)
39 (48%)
8
12
15
16
16
15
82
mentee pairings with chi-square tests. Chi-square tests were also used to compare outcomes based on PubMed status, same or different institution pairing, domestic or international pairing, short-distance or long-distance mentorship, and by absolute time zone differences. The distance used to physically distinguish short-distance from long-distance mentorship was arbitrarily chosen to be 100 km. To evaluate outcomes by the nature of long-distance mentoring relationships, the Mann-Whitney U test was performed between pairs that completed the SERF program and pairs that did not complete the SERF program. Owing to the distribution of the data, nonparametric statistics were performed. All statistical tests were performed with Stata 13 statistical software (StataCorp, College Station, TX), using α ¼ 0.05.
RESULTS Over the study period, 82 fellows were accepted into the SERF program. Table 1 shows the number of fellows that were accepted and the proportion that completed the SERF program. Simple linear regression of the data showed that the number of fellows accepted into the SERF program over time was increasing during the study period (p ¼ 0.047) (graph not shown). A chi-square test of outcomes across the study period indicated that there were no significant outcome ratio differences across years (p ¼ 0.61). Simple linear regression, given in Figure 1, showed that the percentage of fellows who completed the SERF program was increasing over time (p ¼ 0.04). The Pearson correlation coefficient between academic year and annual SERF completion rate was 0.84. Overall, 39 (48%) women and 43 (52%) men were accepted into the SERF program. Of the fellows, 43 (52%) completed the SERF program during the study period. Of the fellows included in the analyses, 51 (62%) had career status available for review. There were 80 (98%) single mentor-mentee pairs identified. In addition, 43 unique SERF mentors were identified. Of these, 24 (56%) were mentors for 1 SERF fellow and 19 (44%) were mentors for more than 1 SERF fellow. For mentors with previous SERF experience, the median number of fellows mentored was 332
Total
3 (interquartile range [IQR]: 2-3, range: 2-5). For the completion of the SERF program by fellow demographics, mentor demographics, mentor-mentee gender pairs, and geographic differences between mentor-mentee pairs are exhibited in Table 2. There were no gender or demographic differences in relation to completion of the SERF program (all p 4 0.05). The 43 mentors were indexed in PubMed 1470 times: 460 times as first authors, 356 times as last/senior authors, and 654 times as middle authors. These mentors had a median instance of total authorship of 26 times (IQR: 14-46), first authorship of 7 times (IQR: 4-12), last/senior authorship of 5 times (IQR: 2-10), and middle authorship of 13 times (IQR: 7-21). There were no differences in the following SERF outcomes between mentors who completed the program and those who did not do so: Median total authorship (30 times [IQR: 15-47] vs 28 times [IQR: 14-46], p ¼ 0.89), first authorship (7 times [IQR: 4-17] vs 6 times [IQR: 3-10], p ¼ 0.32), last/senior authorship
FIGURE 1. Simple linear regression showing the percentage of fellows (n ¼ 82) completing the SERF program over 6 consecutive academic years.
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TABLE 2. SERF Program Outcomes Based on Fellow Gender, Fellow and Mentor Demographics, Gender Relationships With Mentors, and Geographic Differences Between Mentor-Mentee Pairs Demographic Characteristics Fellow gender Woman Man Fellow career stage Resident or surgical fellow Surgical staff member Type of mentorship Single mentor Dual mentor Type of single mentor degree PhD MD MD/education degree MD/PhD Education degree Type of mentor experience Previous mentor Not a previous mentor Multiple mentor experience First SERF fellow Second SERF fellow Third SERF fellow Fourth SERF fellow Fifth SERF fellow Mentor-mentee pairs Same gender Different gender For female SERF fellows Female mentor Male mentor For male SERF fellows Female mentor Male mentor Mentor-mentee pairs Same city Different city Mentor-mentee pairs Same country Different country Mentor-mentee pairs Short distance (r100 km) Long distance (4100 km)
Completed SERF (n, [%])
Did Not Complete SERF(n, [%])
Total
21 (54) 22 (51)
18 (46) 21 (49)
39 43
9 (50) 17 (52)
9 (50) 16 (48)
18 33
41 (51) 2 (100)
39 (49) 0 (0)
80 2
20 14 3 2 2
27 7 3 2 0
(57) (33) (50) (50) (0)
47 21 6 4 2
28 (50) 11 (46)
56 24
11 10 6 0 1
(58) (53) (55) (0) (33)
19 19 11 4 3
24 (56) 17 (46)
19 (44) 20 (54)
43 37
10 (53) 10 (53)
9 (47) 9 (47)
19 19
6 (35) 15 (60)
11 (65) 10 (40)
17 25
5 (63) 36 (50)
3 (38) 36 (50)
8 72
33 (50) 8 (57)
33 (50) 6 (43)
66 14
6 (67) 35 (49)
3 (33) 36 (51)
9 71
p* 0.81 0.92 0.17 0.26
(43) (67) (50) (50) (100)
0.81 28 (50) 13 (54)
0.29 8 9 5 4 2
(42) (47) (45) (100) (67)
0.38 40.99 0.12 0.50 0.63 0.33
*Results of a chi-square test between characteristics and SERF program outcome.
(5 times [IQR: 3-10] vs 5 times [IQR: 2-11], p ¼ 0.93), and middle authorship (14 times [IQR: 7-22] vs 17 times [IQR: 7-23], p ¼ 0.36). There were no authorship differences between mentors of 1 SERF fellow and mentors of more than 1 SERF fellow (all p 4 0.05) (data not shown). Overall, 10 (23%) SERF program mentor-mentee pairs had a peer-reviewed article indexed in PubMed that included both the SERF fellow and mentor as authors. Of the SERF program completers, 4 (19%) women and 6 (27%) men had published articles. The journals in which these articles were published are shown in Table 3. Gender did not have any association with the publication status qof the SERF fellows (p ¼ 0.52). For SERF program
TABLE 3. The Peer-Reviewed Journals Indexed in PubMeD in Which SERF Projects Were Published For Research Fellows (n ¼ 10) From 2006-2012 Journal American Journal of Surgery Academic Medicine Annals of Surgery Journal of Surgical Education Journal of Surgical Research Journal of Trauma and Acute Care Surgery Medical Education
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Frequency (%) 3 2 1 1 1 1 1
(30%) (20%) (10%) (10%) (10%) (10%) (10%) 333
complete the SERF program (p ¼ 0.03). This comparison is shown graphically in Figure 2.
TABLE 4. PubMeD Publications For Single-Mentor SERF Program Completers (n ¼ 41) by Mentor-Mentee Gender Differences Mentor-Mentee Genders Same PubMeD publication No PubMeD publication Total
Not the Same
DISCUSSION
Total (p ¼ 0.04)*
3
7
10
21
10
31
24
17
41
The purpose of this study was to explore the relationship between mentor-mentee pairs, both from the perspectives of gender and distance, in relation to the completion of the SERF program. The overall rate of SERF program completion in this study is approximately 50%. This may appear low but is representative of the completion rate of the SERF program over its first 15 years.11 The SERF program is a very unique program, and there are no other known comparable surgical education research programs; SERF is a certificate program and not a degree-bearing program. However, even though the SERF program is not a basic science/clinical fellowship, its completion rate is comparable to degree-bearing graduate research programs based in biomedical sciences.23 The most common historical reasons for failure to complete the program include lack of time to work on the SERF project and lack of institutional support.11 We found that the number of SERF fellows participating during the study period significantly increased over time. There is currently a limit of 16 fellows per year, thus future increases in trends will not occur if the limit and acceptance rates stay the same.12 Interestingly, not only are there increases in the number of fellows per year, but the percentage of fellows who complete the program is also increasing in a significant fashion based on the linear regression analysis in Figure 1. This finding is an exciting one for the SERF program, and it suggests that the program is marketable and that internal improvements to the program may be improving fellow performance. We are hopeful that program completion rates will continue to increase over time. There is a fairly low peer-reviewed publication rate of mentor-mentee pairs indexed on PubMed. We feel that the actual publication rate is likely higher, as some studies may still be in press, in the peer-review process, or article preparation phases. In addition, while one would assume that the mentor would be listed as a coauthor, this is not always the case and is not a requirement of the SERF
*Results of a 2 2 chi-square test between gender differences and publication outcomes.
completers, there were no differences in PubMed indexing rates across years (p ¼ 0.85). Published outcomes for pairs that completed the SERF program based on mentormentee gender pairing are shown in Table 4. The median time zone difference from mentees to mentors was 0 hours (IQR: 1 to þ1 hour) (range: 8 to þ6 hours). The median absolute time zone difference from mentees to mentors was 1 hour (IQR: 0-2 hours, range: 0-8 hours). The outcomes of mentor-mentee pairs across absolute time zone differences are shown in Table 5. Chi-square analyses showed that there were no time zone cutoff points that resulted in outcome differences of mentor-mentee pairs (all p 4 0.05) (data not shown). The median distance between all mentor-mentee pairs was 1108 km (IQR: 640-2729 km, range: 0-7915 km). There were 9 of 80 (11%) pairs that were considered short-distance pairs (r100 km), with a median distance of 0 km (IQR: 0-0 km, range: 0-14 km). There were 71 of 80 (89%) pairs that were considered long-distance pairs (4100 km), with a median distance of 1294 km (IQR: 769-2931 km, range: 299-7915 km). On evaluating long-distance mentor-mentee pairs only (n ¼ 71), the median distance between long-distance pairs that completed the SERF program (n ¼ 35) was 1741 km (IQR: 895-3117 km, range: 376-7915 km). The median distance between long-distance pairs that did not complete the SERF program (n ¼ 36) was 991 km (IQR: 676-2601 km). A Mann-Whitney U test showed that the median distance between pairs that completed the SERF program was greater than the median distance between pairs that did not
TABLE 5. The Outcome Of Mentor-Mentee Pairs (n ¼ 80) in the SERF Program From 2006-2012 Based on Absolute Time Zone Differences Absolute Time Zone Differences (h) 0
1
2
3
4
5
6
7
8
Pairs that completed SERF (n, %) 14 (47) 14 (52) 5 (50) 3 (50) 1 (100) 1 (33) 2 (100) 0 (0) 1 (100) Pairs that did not complete 16 (53) 13 (48) 5 (50) 3 (50) 0 (0) 2 (67) 0 (0) 0 (0) 0 (0) SERF (n, %) Total 30 27 10 6 1 3 2 0 1 334
Total (p ¼ 0.20)* 41 (51) 39 (49) 80 (100%)
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FIGURE 2. Comparison of mentor-mentee pair distances (n ¼ 71) based on SERF program completion.
program. This study also did not evaluate peer-reviewed journals outside those indexed on PubMed, nor were we able to identify national forums in which work may have been presented. Table 3 shows that the most frequent publication is in the American Journal of Surgery, which is the official journal of the Association for Surgical Education.24-25 Interesting further studies into the SERF programmatic variables that may affect program completion are warranted. Regarding gender specifically, there were no differences in gender regarding SERF program acceptance, and fellow outcomes. There were also no differences in SERF program completion rates for same-gender and different-gender mentor-mentee pairs. These findings are consistent with our first study hypothesis, as these findings are also consistent with other studies on gender differences in mentoring.3,6-7 In direct contrast to these prior studies on mentoring, interestingly, Table 4 shows a surprising finding. From Table 4, we conclude that for mentor-mentee pairs, there is a higher association of publication if the mentor and mentee are of opposite gender. The reasons behind this finding are unclear, and further study into some variables involving mentor-mentee gender pairing is warranted. Based on the findings in Table 2, there are other demographics of fellows and mentors that do not seem to affect the SERF program completion rate. The career stage of the fellow is not associated with SERF program completion. The degrees of the mentors and being a multiple fellow SERF mentor are also not associated with SERF
program completion. The percentage of success with subsequent mentorship does increase but not in a statistically significant fashion. Moreover, mentor experience, as defined by authorship of peer-reviewed articles indexed in PubMed, is not associated with SERF program completion. We would recommend that the SERF program should consider formal mentorship/leadership training to the pool of mentors. Regarding distance, we found a very broad spectrum of time zone differences and geographic distances between mentor-mentee pairs. These ranges in distance and time speak to the diverse nature of the SERF program, where interest in surgical education research spans not only across the United States but also across the globe. We found that there were no differences in program completion based on time zone differences. This suggests that time zone differences are not associated with success of the mentormentee relationship. This may imply that electronic communication between mentor-mentee pairs across long distances was more heavily favored to being in similar time zones. We did not find any differences between outcomes for short-distance and long-distance mentor pairs, although some smaller numbers of short-distance pairs greatly increase the chance of a type II error. These findings were consistent with the second study hypothesis. However, in direct contrast with this hypothesis, we found it most interesting that the distances between long-distance mentor-mentee pairs for SERF program completers were statistically and significantly greater than those distances between
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mentor-mentee pairs that did not complete the SERF program. This suggests that distance is truly not a barrier to success. There was 1 mentor-mentee pair that completed the program from a distance of 7915 km (more than 4900 miles) and with an 8-hour time zone difference between the pair. The reasons behind this finding are likely related to personal characteristics of the mentor and mentee regarding motivation, goal-sharing, and compatibility. Further studies on the process of matching a mentor to a mentee, and the subsequent interpersonal dynamics would be fascinating and might be able to explain the finding that success is proportional to distance when the inverse relationship may be more intuitive. There are some limitations to this study. First, given that all of the data were obtained from online sources, we assume that the nature of reporting is accurate and current. However, it is conceivable that changes may have occurred that were not electronically updated on the website. Second, it is important to note that the SERF program had different leadership during the study period. So, although criteria for program completion remained constant, the curricula did vary and the experience by the fellows was not uniform. Third is the relative power of the study. Although all of the available electronic data were used, the relatively low numbers overall, and especially with comparisons involving published outcomes and time zone differences, and the low power would allow for a higher chance of a type II error. However, we feel that the sample size was representative, as program pass rates of the sample are consistent with those over the first 15 years of the SERF program. Next, this study did focus on peer-reviewed publication indexing in PubMed. It is possible that the fellows published without listing the mentor as an author; however, that scenario was not studied, as the focus of this project was on collaboration. And, although PubMed indexing is a measurable outcome, there are other measures of success such as abstract presentation in poster/plenary form, SERF program completion, and other nontangible outcomes such as collaboration and ongoing friendships/professional relationships that are meaningful to success in surgical education. Finally, this study evaluates gender and geographic demographics. However, it does not study any other important characteristics between mentor-mentee pairs such as goalsetting, personality differences, career trajectory, or the nature of the interaction and dynamic. Distance mentoring was found to be successful, but the variables attributing to this success were not able to be evaluated in this study design. These variables are very importance to the milieu of mentor-mentee pairings. These important pairing characteristics should be studied further in the future. There are some strengths to this study. Given that the data were available online, it could easily be repeated. Some of the outcome variables reported were likely conservative, as there were numerous individuals who were accepted into the program but dropped out before the first SERF meeting. 336
Therefore, another strength to this study is that it functioned more as an intention-to-treat analysis, likely yielding more conservative outcome measures. Moreover, the comparisons are relatively straightforward in nature. This is the first known study to evaluate the nature of nonclinical longdistance mentoring, and it is also the first known study to evaluate the success of the SERF program. It is very interesting that longer distances were associated with higher SERF program completion rates. Overall, we found that completion of the SERF program does not depend on fellow gender, gender disparities between mentor-mentee pairs, fellow career stage, mentor degree, or mentor experience in the SERF program. Dissimilar gender for SERF program completers was associated with a higher publication rate as measured by articles indexed through PubMed. Additionally, although no international boundaries or time zone differences were associated with SERF program outcomes, a greater physical distance between mentor-mentee pairs was associated with a higher completion rate in the SERF program. There appear to be meaningful benefits to distance mentoring; distance mentoring should remain an important element of the SERF program. Future studies on the pairing process and the dynamics between mentormentee pairs should be explored to see which other important factors may improve success in the SERF program.
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