Longitudinal program evaluation of an inter-institutional mentorship network for pediatric rheumatology using a quality improvement framework

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Nigrovic, Kelly A. Rouster-Stevens, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3717708/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background: The American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology. Initial program evaluation indicated increased mentorship access. Given the small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was a potential threat to the longevity of the network. Our aims were to: (i) describe the sustainability of AMIGO over the period 2011-2018, (ii) highlight ongoing benefits to participants, and (iii) describe challenges in the maintenance of a mentorship network. Methods: A mixed-methods approach centered on a quality improvement framework was used to report on process and outcomes measures associated with AMIGO annual cycles. Results: US and Canada Pediatric rheumatology workforce surveys identified 504 possible participants during the time period. As of fall 2018, 331 unique individuals had participated in AMIGO as a mentee, mentor or both for a program response rate of 66% (331/504). Survey of mentees indicated high satisfaction with impact on general career development, research/scholarship and work-life balance. Mentors indicated increased sense of connection to the community and satisfaction with helping mentees despite minimal perceived benefit to their academic portfolios. Based on AMIGO’s success, a counterpart program, Creating Adult Rheumatology Mentorship in Academia (CARMA), was launched in 2018. Conclusions: Despite the challenges of a limited workforce, AMIGO continues to provide consistent access to mentorship opportunities for the pediatric rheumatology community. This experience can inform approaches to mentorship gaps in other academic subspecialties. mentorship workforce educational quality improvement Figures Figure 1 Figure 2 Figure 3 Introduction The American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is a novel subspecialty-wide inter-institutional mentorship program developed to target mentorship gaps within pediatric rheumatology. 1 This network pairs fellows and junior faculty with more senior faculty mentors at outside institutions based on career interests and goals. 2 , 3 Surveys after the initial program implementation revealed increased access to mentorship beyond the home institution and perceived benefits including impact on career development, scholarship, work-life balance, and connectedness to the pediatric rheumatology community for mentees. 3 Maintaining and growing the mentorship pipeline was the next challenge for the network. Mentorship during fellowship training and junior faculty years is critical to the development of a successful academic career. 4 In pediatric rheumatology, the majority of graduating fellows enter into academic positions. 5 With only approximately 400 practicing board-certified pediatric rheumatologists in the United States and Canada, most programs contain relatively few faculty and the current supply is insufficient to meet clinical demands. Given this workforce shortage, faculty time is often constrained by heavy clinical, research and administrative duties. Local access to senior mentors for fellowship trainees and junior faculty is often limited. 2 , 5 The problem of limited access to mentorship is not unique to pediatric rheumatology. In particular, the literature indicates local mentorship resources may be limited for women in certain subspecialties 6 , 7 and under-represented minorities 8 – 10 . Throughout academic medicine there has been a call to develop more formal mentorship programs due to increased awareness of the value of extended mentorship networks to provide diverse insight and expertise. 11 – 13 Educational Challenge: Based on the success of an initial pilot, AMIGO was formally sponsored by the ACR in 2011. Given the relatively small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was foreseen as a potential threat to the longevity of the network. In particular, there exists a ‘bimodal’ age distribution in the pediatric rheumatology workforce with larger numbers of practitioners either at the ending or beginning of their careers and a relatively smaller ‘mid-career’ population; 32% of current Pediatric or Med/Peds Rheumatologists are expected to retire within 10 years. 14 , 15 Despite these ‘supply’ challenges, the AMIGO network thrived over these 7 years. Our specific aims are to: (i) describe the sustainability of the AMIGO mentoring network between 2011–2018, (ii) highlight ongoing benefits to mentees and mentors, and (iii) describe limitations and challenges in the maintenance of a mentorship network. This information will be informative for other subspecialties interested in development of longitudinal mentorship programs. Methods A mixed methods approach was used, drawing on both educational evaluation as well as quality improvement theory. 16 , 17 Specifically, the SQUIRE-EDU guidelines was used as a framework. 18 We used the Kirkpatrick Evaluation Model to report on participant reactions, behaviors and benefit to the organization as a whole 16 These responses are situated as process and outcome measures associated with AMIGO annual cycles. Context: Program Description Development and implementation of the AMIGO program has already been reported. 2 Subsequent to the pilot program, network leadership has been provided by two rotating pediatric rheumatology faculty Co-Chairs. One chair is nominated from the ACR Pediatric Rheumatology Subspecialty Committee, and one is the elected CARRA Early Investigator Committee Vice Chair. The Co-chairs serve three-year terms and are responsible for oversight of the annual matching process, exit surveys, and design, implementation and evaluation of faculty development and networking sessions held during bi-annual scientific rheumatology meetings. ACR staff provides administrative assistance with emails, administration and tabulation of evaluations and surveys and event planning. The ACR also stores survey and evaluation data and maintains the AMGIO website which houses mentorship and professional development resources ( https://www.rheumatology.org/Get-Involved/Mentoring/AMIGO ). A Microsoft Excel algorithm was used to generate mentee-mentor pairings based on mentee and mentor responses to an annual electronic survey. Demographic information, mentee preferences for career path, research interests, experience and level of mentor seniority were used to generate a list of top matches per mentee. Subsequently, a larger group of volunteer AMIGO committee members conducedt a phone conference to review and adjust algorithmically generated results and ensure the best dyad fit. Dyads were officially followed by the AMIGO program for a three-year period. Participants were sent an anonymous exit survey at the end of the three-year term to obtain more detailed information on utilization of and satisfaction with the program. Interventions AMIGO Co-Chairs and evaluation committee members reviewed data from networking events, email check-ins and the overall program exit evaluations at least semi-annually. Results were used to adjust content and format of educational programing events and to monitor for successful or problematic matches. Starting in 2016 networking events were structured to increase interaction between as well as within dyads attending events to promote extended mentorship networks and informal peer mentorship opportunities. Measures and Analysis: ACR database and surveys were used to obtain data. End of program exit surveys were available from years 2016–2018 reflecting the experience of mentors and mentees who had entered the program in 2012 to 2015 (Kirkpatrick level 1- Reactions). Certain mentors had more than one mentee over the time period and were asked to fill out a separate response for each mentee with whom they were matched. In terms of process measures , we report the number of annual mentee and mentor applications, total active program participants, number of substantive meetings between dyads, and attendance at bi-annual in-person networking events (Kirkpatrick level 3-Behaviors). Outcome measures include: perceived benefit to mentee in specific domains (research/scholarship, teaching, clinical work, career development, negotiating current position or salary, work-life balance), mentee and mentor ratings of dyad ‘goodness of fit’, satisfaction with biannual networking meetings (Kirkpatrick Level 1-Reactions) and number of mentees who return to the network as mentors in subsequent cycles (Kirkpatrick level 3- Behavior). With our interest in mentor sustainability, we also collected additional outcome and potential balancing measures (reported impact on mentor’s promotion portfolio, perceived ability to help mentee, and sense of connectedness to the larger pediatric rheumatology community [Kirkpatrick Level 1-Reactions]). To measure impact on the community as a whole (Kirkpatrick level 4- Results/impact) we report on cumulative number of participants in the network relative to the number of fellows and board certified pediatric rheumatologists in the US and Canada, the community served by the program. Descriptive statistics are used; given the small sample sizes and variable survey response rates, rigorous statistical comparisons were not performed. We were unable to correlate dyad responses or to determine exact denominators for the mentor cohort due to the anonymity of the exit survey. Ethical Considerations: The project was granted exempt status by the Institutional Review Board at Seattle Children’s Hospital (STUDY00000772) as non-human subjects research. Results Process Measures: Mentee-Mentor dyads : Fig. 1 demonstrates the growth of the network over time. In 2012, the AMIGO program was launched at scale after the initial limited pilot program and thus a large number of mentees joined the program. Subsequently, the annual number of mentee applicants has reached a steady state (median 26; range 20–57) closely paralleling the number of entering US pediatric rheumatology fellows per year (median: 28; range: 23–39) over the time period. 15 After the initial pilot years, the majority of mentees applicants were fellows, however, some junior faculty members continued to apply to the network (Table 1 ). Table 1 Demographics for AMIGO annual mentor-mentorship dyad matching process over time Match/Entry Year 2011 2012 2013 2014 2015 2016 2017 2018 Mentee Applications (N) 20 57 38 23 25 26 29 26 Gender Female (%) 70 82.5 76 83 80 77 79 77 Nationality Canadian (%) 0 9 8 4 4 4 3 12 Academic Rank Fellows (%) 85 82 97 100 84 92 93 92 Jr. faculty * (%) 15 18 3 0 16 4 7 4 Sr. faculty ** (%) 0 0 0 0 0 0 0 0 Unknown (%) 0 0 0 0 0 4 0 4 Mentor Applications (N) 20 57 38 27 25 36 35 43 Gender Female (%) 70 58 58 59 60 61 71 63 Nationality Canadian (%) 10 8.8 5.3 0 4 2.8 8.6 0 Academic Rank Jr. faculty * (%) 15 16 45 52 40 58 60 56 Sr. faculty ** (%) 60 30 47 48 60 39 40 40 Unknown (%) 30 54 8 0 0 3 0 5 Mentor application numbers remained steady and in certain years exceeded the number of mentee applications. Mentee-Mentor contact : Exit Survey response rates were variable (for Mentees: 49% [28/57] in 2016; 24% [9/38] in 2017 and 39% [9/23] in 2018; for Mentors: 109% [62/57] in 2016; 53% [20/38] in 2017 and 104% [24/23] in 2018. The greater than 100% response rate observed in mentors was attributed to certain mentors responding separately for multiple mentees who had different dyad starting years.) However, responses indicate that utilization of the AMIGO mentorship network was high. The cohort surveys indicate that dyads connected by phone, email and in-person. Ninety-three percent (43/46) of mentee respondents reported meeting with their mentor at least 2–3 times since the initial match and 72% (33/46) indicated greater than 3 substantive meetings. Biannual conferences Attendance at in person networking events held at ACR and CARRA scientific conferences was high and sustained over time. Table 2 indicates number of respondents to session evaluations which underestimates total attendance at these sessions as not all participants submitted evaluations. Outcome measures: Career development sessions Table 2 also provides highlights from participant evaluations of the biannual networking sessions. Detailed evaluation questions varied between sessions over time. Responses indicating aggregate participant reactions to that day’s overall program or the AMIGO network are included and indicate high ratings for participant satisfaction. Table 2 AMIGO biannual faculty development and networking session attendance and participant overall ratings Meeting: AMIGO Event Title Evaluation Question(s) Rating (scale 1–5)* Respondents (n) ** 2014 CARRA Session ⋅ Potential value of the AMIGO program? 1.6 * 57 2015 CARRA Session: “Promotions Bootcamp” ⋅ Understanding of promotion domains after session? 4.3 43 ⋅ Grasp of career development documentation after session? 4.1 43 2015 ACR breakfast: “Mentorship Resource Fair” ⋅ Value of today’s mentorship resource fair? 4.7 33 ⋅ Value of encouraging mentorship networks? 4.8 33 2016 CARRA session: “Mentorship 360 o” ⋅ Talk: “Mentoring 360 o ” 4.7 43 ⋅ Potential value of a mentoring program as envisaged by AMIGO? 4.8 43 2016 ACR breakfast: “Building Your Academic Career” ⋅ Value of today’s mentorship talk? 4.7 12 + ⋅ Value of encouraging mentorship networks? 4.8 12 + 2017 CARRA/PRYSM: “Peer mentorship” ⋅ Value of AMIGO’s current vertical mentorship program? 4.7 36 ⋅ Value of a potential Peer/Horizontal mentorship program? 4.3 36 2017 ACR Breakfast: “‘GROW # ’ your mentorship network” ⋅ Value of today’s mentorship resource fair? 4.8 37 ⋅ Value of encouraging mentorship networks? 4.8 37 2018 CARRA Breakfast ⋅ Value of today’s networking session? 4.8 32 2018 ACR Breakfast ⋅ Value of today’s networking session? 4.8 40 ⋅ Value of encouraging mentorship networks? 4.8 40 *5 = Strongly agree except for 2014 where 1 = strongly agree **Responses from session attendees, sessions were open to AMIGO participants and non−participants +Actual attendance estimated at 35–40 participants (author KH observation) however, evaluations were sent electronically after the event and only 12 responses were received # GROW: Goal Reality Options Will Mentorship Model Mentee Perceptions Mentees cited ‘General career development’ as the professional development domain in which AMIGO either ‘helped very much’ or ‘helped somewhat’ (89% [41/46]). The AMIGO relationship was also rated as beneficial in the domains of ‘Research/Scholarship’ (70% [32/46]) and ‘Work-Life Balance’ for most respondents (59% [27/46]). The impact in other specific domains such as ‘Obtaining your current position’ and ‘Negotiating a salary’ was more variable; certain respondents reported the network helped very much (13% [6/46] and 9% [4/46]) while the majority indicated the AMIGO dyad made no difference or these domains were non-applicable to their experience (50% [23/46], 74% [34/46], respectively). Approximately a third of respondents indicated AMIGO ‘helped very much’ or ‘helped somewhat’ for the areas of Clinical work (37% [17/46]) and Teaching (35% [16/46]). Mentee-Mentor fit Results for mentee and mentor perception of ‘goodness of dyad fit’ from cohort surveys are presented in Fig. 2 . In general, mentees tended to rate the goodness of fit of the dyad as slightly higher than mentors (most responses “Excellent” or “Good”) however, overtly problematic matches were infrequent over the 3 years. Due to small numbers/variable response rate there was no attempt to perform rigorous comparisons between groups or across years. Mentee to Mentor Transition As of fall 2018, 25% (40/163) of former mentee participants had returned to the network as mentors in a subsequent cycle. Mentor Perceptions/Balancing measures Figure 3 indicates aggregate mentor responses for all years 2016–2018 (n = 106) to exit survey questions regarding benefits or opportunity costs associated with participation in the network. Most respondents had positive perceptions of their ability to help their mentees and an improved sense of connection to the community, however, the majority also indicated neutral to doubtful benefit for their own academic portfolios. Results/Impact on the community As of fall 2018, 331 unique individuals had participated in AMIGO as mentees, mentors or both. The 2017–2018 American Board of Pediatrics Workforce Survey identified 357 pediatric rheumatologists with active board certification and 96 pediatric or medicine-pediatrics rheumatology fellows. 15 A 2015 Canadian workforce survey indicates approximately 51 pediatric rheumatologists. 19 Thus, the total number of possible participants during this time is estimated at 504 individuals. Participation in AMIGO has reached almost 66% (331/504) of the US/Canadian pediatric rheumatology community. Discussion This paper updates our initial reports of an inter-institutional career mentorship program for pediatric rheumatologists. 2 , 3 Similar models have now been reported within the pediatric hematology/oncology and trauma surgery communities. 20 – 22 Several program evaluations 12 , 23 , 24 and systematic reviews of mentorship models in academic medicine have also been published. 4 , 25 , 26 However, this paper provides the first longitudinal evaluation of an inter-institutional mentorship program over an extended period. We also are unique in the application of an educational quality improvement framework for our evaluation in parallel with classic Kirkpatrick levels of evaluation. Our findings demonstrate that the AMIGO network was able to sustain stable entry rates and high levels of utilization of and satisfaction. Mentee exit surveys indicate highest levels of satisfaction with impact on domains of General Career Development, Research/Scholarship and Work-Life Balance. In general, both mentees and mentors indicated good-to-excellent ‘fit’ for their match over time. Attendance at and satisfaction with semi-annual networking meetings has been robust. The networking sessions have cultivated an informal environment where participants are able to meet face to face within their assigned dyads as well as to interact with other attendees. In particular, the focus of sessions in 2016–2018 was to promote connections across mentorship dyads in order to foster informal peer mentorship relationships and to grow networks of mentees and mentors with similar interests. One of the most critical factors important to the long-term success of any mentorship program is sustained access to engaged mentors. In spite of potential supply issues in the senior pediatric rheumatology workforce, the AMIGO network has consistently provided access to all interested mentees, with the number of annual mentor applications exceeding the mentee applications in some years. In part, this is due to certain committed senior mentors who agree to mentor multiple mentees or who consistently reapply after the end of a 3-year cycle. Importantly however, we found that 40 mentee graduates of the program returned to the program as mentors to incoming mentees in subsequent years. This ‘mentee turned mentor’ phenomenon is perhaps one of the key indicators of participant satisfaction with the network and has been critical to sustaining ongoing mentorship access in AMIGO. In terms of using this experience to replicate mentorship networks in other specialty situations, it will be important to pay attention to cultivation of mentees as future mentors as well as factors that will encourage the recognition and retention of faculty mentors. Interestingly although mentors reported high satisfaction with their participation in the network, there was little perception of benefit towards their academic promotions. Given the competing demands on mid-career faculty, identifying additional ways to increase the tangible impact on mentors’ academic careers will be an important consideration for long term success of these networks. Fortunately, earlier studies within AMIGO had found that the time commitment required for mentors was small, typically a less than 3 hours per year, helping to explain why mentors as well as mentees retain strongly overall satisfaction with AMIGO. 3 One of the major limitations of our study was the exit survey response rates. This could be attributed to several factors including survey fatigue in our community as well as change in email contact information, particularly for fellow participants who were likely to have graduated and changed institutions over the three-year time-period. Respondents unhappy with or less invested in the program may have been less likely to respond to the surveys. We have retained the anonymity of the exit survey process in an attempt to obtain honest, unbiased feedback on the program, however, this feature also limits our ability to identify non-respondents or to conduct more detailed analyses regarding factors associated with the dyad matching process or the program. Another potential limitation to the generalizability of our approach is the matching process itself. The initial mentorship dyad matches are created with the use of a Microsoft Excel spreadsheet algorithm, curated through subsequent committee review to ensure face validity of the pairings and revise matches in case of any algorithm failures. This feature is relatively feasible within the pediatric rheumatology community given the small size and close-knit nature of our specialty. Reproducibility within a different or larger community might be more difficult. Lastly, but importantly, this study took place during the pre-pandemic era. Although the AMIGO network continued during the COVID-19 pandemic, both the ACR and CARRA annual meetings were converted to remote formats, which limited opportunities regular for face-to-face interactions are required restructing of the netowork. Additional study will be important to determine how the network and inter-institutional mentorship relationships have been affected by these changes and the increased reliance on virtual connections in the post-pandemic setting. ACR sponsorship has been a key facet to the sustainability of the AMIGO network. Administrative support in particular has been crucial to the ongoing operation of the network, which would otherwise be solely dependent upon volunteer time from physician leadership. A key indicator of the success of the network is the launch of a parallel network, Creating Adult Rheumatology Mentorship in Academia (CARMA), by the ACR in 2018 to address the burgeoning need for inter-institutional mentorship in adult academic rheumatology. 27 A parallel program targeted to postdoctoral fellows has been developed within the NIH-funded Joint Biology Consortium research infrastructure https://www.jbcwebportal.org/jbc-mentorship-program/ . The ACR is also developing a structured mentorship program for division directors within the organization (M. Klein-Gitelman, personal communication, 7/21/2020). Replication in other settings would likely require identification of a similar funding or sponsorship agency. Conclusion Over the span of seven years, AMIGO has provided much-needed access to inter-institutional mentorship for pediatric rheumatologists across the United States and Canada. More than 66% of the Pediatric Rheumatology community has been involved in this program with a high proportion of program graduates returning to the network in a mentorship role. Future ideas for improvement include optimizing exit survey response rates, expanding access to diversity mentorship and exploring the impact of peer mentorship in addition to the more formal vertical mentorship structure. We hope our process and learning can facilitate the development of other programs to improve access to mentorship within underserved pediatric communities. Abbreviations ACR: American College of Rheumatology CARRA: Childhood Arthritis and Rheumatology Research Alliance (CARRA) AMIGO: American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group SQUIRE-EDU: Standards for QUality Improvement Reporting Excellence in Education GROW: Goal Reality Options Will Mentorship Model Declarations Ethics approval: The project was granted exempt status by the Institutional Review Board at Seattle Children’s Hospital (STUDY00000772) as non-human subjects research Consent for publication: not applicable Availability of data and materials: The data that support the findings of this study are available from the American College of Rheumatology (ACR) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the ACR. Competing interests: All authors have served as either AMIGO founders (PN, EM, LM) or Co-chairs (KR, AG, KH, LH, KA). AG is a member of the ACR Research Committee. Authors EM and LH are members of the ACR Annual Meeting Planning Committee (AMPC). The authors have no financial conflicts of interest relevant to this article to disclose. Funding: ACR provides support for the AMIGO program. PAN was supported by NIH P30 AR070253. Author’s contributions: Hayward and Moorthy conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Muscal, Nigrovic and Rouster-Stevens designed data collection instruments including initial matching algorithm, network evaluation and program surveys, and reviewed and revised the manuscript. Drs. Grom, Ardalan and Hiraki coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Acknowledgements: The authors wish to thank ACR staff Jillianne Jewell, Sarah Osbourne and Julie Anderson for tireless support of the AMGIO program and assistance with data acquisition and review. We also thank Marissa Klein-Gitelman for shepherding the paper through the ACR publication approval process. The authors wish to acknowledge CARRA and the ongoing Arthritis Foundation financial support of CARRA. References American College of Rheumatology Early Career Investigator Subcommittee of the Committee on Research. https://www.rheumatology.org/Get-Involved/Mentoring/AMIGO . Nigrovic PA, Muscal E, Riebschleger M, et al. AMIGO: a novel approach to the mentorship gap in pediatric rheumatology. J Pediatr. 2014;164(2):226–7. e221-223. Moorthy LN, Muscal E, Riebschleger M, et al. Efficacy of an Interinstitutional Mentoring Program Within Pediatric Rheumatology. 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Sambunjak D, Straus SE, Marusic A. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J Gen Intern Med. 2010;25(1):72–8. Kashiwagi DT, Varkey P, Cook DA. Mentoring programs for physicians in academic medicine: a systematic review. Acad Med. 2013;88(7):1029–37. Ogdie A, Sparks JA, Angeles-Han ST, et al. Barriers and Facilitators of Mentoring for Trainees and Early Career Investigators in Rheumatology Research: Current State, Identification of Needs, and Road Map to an Inter-Institutional Adult Rheumatology Mentoring Program. Arthritis Care Res (Hoboken). 2018;70(3):445–53. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3717708","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":258241720,"identity":"3aad3bc3-66c6-4276-be17-c42f5cd36491","order_by":0,"name":"Kristen Hayward","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-6562-029X","institution":"Seattle Children's Hospital and University of Washington School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Kristen","middleName":"","lastName":"Hayward","suffix":""},{"id":258241721,"identity":"0c24a5a7-2bc6-4736-aa02-17e5b5e96f2c","order_by":1,"name":"Alexi Grom","email":"","orcid":"","institution":"CCHMC: Cincinnati Children's Hospital Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Alexi","middleName":"","lastName":"Grom","suffix":""},{"id":258241722,"identity":"f64e47a6-ec74-4d96-bfab-a170c3468b13","order_by":2,"name":"Eyal Muscal","email":"","orcid":"","institution":"BCM: Baylor College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Eyal","middleName":"","lastName":"Muscal","suffix":""},{"id":258241723,"identity":"d3ee2d4c-df8d-4d36-b064-b935993b5ddf","order_by":3,"name":"Peter A. Nigrovic","email":"","orcid":"","institution":"Boston Children's Hospital Division of Immunology","correspondingAuthor":false,"prefix":"","firstName":"Peter","middleName":"A.","lastName":"Nigrovic","suffix":""},{"id":258241724,"identity":"354c27c8-b312-4264-ad2c-9e0a1dea05c0","order_by":4,"name":"Kelly A. Rouster-Stevens","email":"","orcid":"","institution":"Emory University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Kelly","middleName":"A.","lastName":"Rouster-Stevens","suffix":""},{"id":258241725,"identity":"b3064e5d-5f17-4cb9-bc8b-02b4e2a360dc","order_by":5,"name":"Kaveh Ardalan","email":"","orcid":"","institution":"Duke-NUS Medical School","correspondingAuthor":false,"prefix":"","firstName":"Kaveh","middleName":"","lastName":"Ardalan","suffix":""},{"id":258241726,"identity":"e8f0e49f-da04-4824-be81-cce646329d23","order_by":6,"name":"Linda Hiraki","email":"","orcid":"","institution":"SickKids: The Hospital for Sick Children","correspondingAuthor":false,"prefix":"","firstName":"Linda","middleName":"","lastName":"Hiraki","suffix":""},{"id":258241727,"identity":"0026bd20-6cc7-4317-9dff-6422e3729cd4","order_by":7,"name":"L. Nandini Moorthy","email":"","orcid":"","institution":"UMDNJ RWJMS: Rutgers Robert Wood Johnson Medical School","correspondingAuthor":false,"prefix":"","firstName":"L.","middleName":"Nandini","lastName":"Moorthy","suffix":""}],"badges":[],"createdAt":"2023-12-07 02:05:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3717708/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3717708/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":48074827,"identity":"12e41b12-240d-4162-a602-e826fc7bb5c4","added_by":"auto","created_at":"2023-12-12 15:53:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":44323,"visible":true,"origin":"","legend":"\u003cp\u003eGrowth of AMIGO mentorship network over time\u003c/p\u003e","description":"","filename":"Figure1.NumberAmigoParticipants.Time.png","url":"https://assets-eu.researchsquare.com/files/rs-3717708/v1/80f250f7f06737508f338d73.png"},{"id":48074825,"identity":"329a0823-99e7-4613-9e80-a343fad2d69f","added_by":"auto","created_at":"2023-12-12 15:53:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":42999,"visible":true,"origin":"","legend":"\u003cp\u003eAverage rating of ‘goodness of fit’ of mentorship dyad over time by participant status\u003c/p\u003e","description":"","filename":"Figure2.AMIGO.Goodness.of.png","url":"https://assets-eu.researchsquare.com/files/rs-3717708/v1/f345ac54ca9243aff548c24e.png"},{"id":48074824,"identity":"5ed08085-532d-4d3f-b20c-652eef0895d4","added_by":"auto","created_at":"2023-12-12 15:53:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28683,"visible":true,"origin":"","legend":"\u003cp\u003eWhat’s in it for mentors? Aggregate mentor responses to benefit/balancing measures 2016-2018 (n=106)\u003c/p\u003e","description":"","filename":"Figure3.WhatsForMentors.png","url":"https://assets-eu.researchsquare.com/files/rs-3717708/v1/ff4e2fd1db5dbf36c3c8accc.png"},{"id":48074871,"identity":"564a84bd-b329-4d8d-8b44-4e0b24007263","added_by":"auto","created_at":"2023-12-12 15:53:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":746582,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3717708/v1/26bd3b91-a25e-4471-84bf-66808c82bd53.pdf"}],"financialInterests":"","formattedTitle":"Longitudinal program evaluation of an inter-institutional mentorship network for pediatric rheumatology using a quality improvement framework","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is a novel subspecialty-wide inter-institutional mentorship program developed to target mentorship gaps within pediatric rheumatology.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e This network pairs fellows and junior faculty with more senior faculty mentors at outside institutions based on career interests and goals.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Surveys after the initial program implementation revealed increased access to mentorship beyond the home institution and perceived benefits including impact on career development, scholarship, work-life balance, and connectedness to the pediatric rheumatology community for mentees.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Maintaining and growing the mentorship pipeline was the next challenge for the network.\u003c/p\u003e \u003cp\u003eMentorship during fellowship training and junior faculty years is critical to the development of a successful academic career.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e In pediatric rheumatology, the majority of graduating fellows enter into academic positions.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e With only approximately 400 practicing board-certified pediatric rheumatologists in the United States and Canada, most programs contain relatively few faculty and the current supply is insufficient to meet clinical demands. Given this workforce shortage, faculty time is often constrained by heavy clinical, research and administrative duties. Local access to senior mentors for fellowship trainees and junior faculty is often limited.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe problem of limited access to mentorship is not unique to pediatric rheumatology. In particular, the literature indicates local mentorship resources may be limited for women in certain subspecialties\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e and under-represented minorities\u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Throughout academic medicine there has been a call to develop more formal mentorship programs due to increased awareness of the value of extended mentorship networks to provide diverse insight and expertise.\u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eEducational Challenge:\u003c/h3\u003e\n\u003cp\u003eBased on the success of an initial pilot, AMIGO was formally sponsored by the ACR in 2011. Given the relatively small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was foreseen as a potential threat to the longevity of the network. In particular, there exists a \u0026lsquo;bimodal\u0026rsquo; age distribution in the pediatric rheumatology workforce with larger numbers of practitioners either at the ending or beginning of their careers and a relatively smaller \u0026lsquo;mid-career\u0026rsquo; population; 32% of current Pediatric or Med/Peds Rheumatologists are expected to retire within 10 years.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Despite these \u0026lsquo;supply\u0026rsquo; challenges, the AMIGO network thrived over these 7 years.\u003c/p\u003e \u003cp\u003eOur specific aims are to: (i) describe the sustainability of the AMIGO mentoring network between 2011\u0026ndash;2018, (ii) highlight ongoing benefits to mentees and mentors, and (iii) describe limitations and challenges in the maintenance of a mentorship network. This information will be informative for other subspecialties interested in development of longitudinal mentorship programs.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eA mixed methods approach was used, drawing on both educational evaluation as well as quality improvement theory.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Specifically, the SQUIRE-EDU guidelines was used as a framework.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e We used the Kirkpatrick Evaluation Model to report on participant reactions, behaviors and benefit to the organization as a whole \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e These responses are situated as process and outcome measures associated with AMIGO annual cycles.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eContext: Program Description\u003c/h2\u003e \u003cp\u003eDevelopment and implementation of the AMIGO program has already been reported.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Subsequent to the pilot program, network leadership has been provided by two rotating pediatric rheumatology faculty Co-Chairs. One chair is nominated from the ACR Pediatric Rheumatology Subspecialty Committee, and one is the elected CARRA Early Investigator Committee Vice Chair. The Co-chairs serve three-year terms and are responsible for oversight of the annual matching process, exit surveys, and design, implementation and evaluation of faculty development and networking sessions held during bi-annual scientific rheumatology meetings. ACR staff provides administrative assistance with emails, administration and tabulation of evaluations and surveys and event planning. The ACR also stores survey and evaluation data and maintains the AMGIO website which houses mentorship and professional development resources (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rheumatology.org/Get-Involved/Mentoring/AMIGO\u003c/span\u003e\u003cspan address=\"https://www.rheumatology.org/Get-Involved/Mentoring/AMIGO\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). A Microsoft Excel algorithm was used to generate mentee-mentor pairings based on mentee and mentor responses to an annual electronic survey. Demographic information, mentee preferences for career path, research interests, experience and level of mentor seniority were used to generate a list of top matches per mentee. Subsequently, a larger group of volunteer AMIGO committee members conducedt a phone conference to review and adjust algorithmically generated results and ensure the best dyad fit. Dyads were officially followed by the AMIGO program for a three-year period. Participants were sent an anonymous exit survey at the end of the three-year term to obtain more detailed information on utilization of and satisfaction with the program.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInterventions\u003c/h2\u003e \u003cp\u003e AMIGO Co-Chairs and evaluation committee members reviewed data from networking events, email check-ins and the overall program exit evaluations at least semi-annually. Results were used to adjust content and format of educational programing events and to monitor for successful or problematic matches. Starting in 2016 networking events were structured to increase interaction between as well as within dyads attending events to promote extended mentorship networks and informal peer mentorship opportunities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMeasures and Analysis:\u003c/h2\u003e \u003cp\u003eACR database and surveys were used to obtain data. End of program exit surveys were available from years 2016\u0026ndash;2018 reflecting the experience of mentors and mentees who had entered the program in 2012 to 2015 (Kirkpatrick level 1- Reactions). Certain mentors had more than one mentee over the time period and were asked to fill out a separate response for each mentee with whom they were matched.\u003c/p\u003e \u003cp\u003eIn terms of \u003cb\u003eprocess measures\u003c/b\u003e, we report the number of annual mentee and mentor applications, total active program participants, number of substantive meetings between dyads, and attendance at bi-annual in-person networking events (Kirkpatrick level 3-Behaviors). \u003cb\u003eOutcome measures\u003c/b\u003e include: perceived benefit to mentee in specific domains (research/scholarship, teaching, clinical work, career development, negotiating current position or salary, work-life balance), mentee and mentor ratings of dyad \u0026lsquo;goodness of fit\u0026rsquo;, satisfaction with biannual networking meetings (Kirkpatrick Level 1-Reactions) and number of mentees who return to the network as mentors in subsequent cycles (Kirkpatrick level 3- Behavior). With our interest in mentor sustainability, we also collected additional outcome and \u003cb\u003epotential balancing measures\u003c/b\u003e (reported impact on mentor\u0026rsquo;s promotion portfolio, perceived ability to help mentee, and sense of connectedness to the larger pediatric rheumatology community [Kirkpatrick Level 1-Reactions]). To measure impact on the community as a whole (Kirkpatrick level 4- Results/impact) we report on cumulative number of participants in the network relative to the number of fellows and board certified pediatric rheumatologists in the US and Canada, the community served by the program.\u003c/p\u003e \u003cp\u003eDescriptive statistics are used; given the small sample sizes and variable survey response rates, rigorous statistical comparisons were not performed. We were unable to correlate dyad responses or to determine exact denominators for the mentor cohort due to the anonymity of the exit survey.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations:\u003c/h2\u003e \u003cp\u003eThe project was granted exempt status by the Institutional Review Board at Seattle Children\u0026rsquo;s Hospital (STUDY00000772) as non-human subjects research.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eProcess Measures:\u003c/h2\u003e \u003cp\u003e \u003cem\u003eMentee-Mentor dyads\u003c/em\u003e: Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates the growth of the network over time. In 2012, the AMIGO program was launched at scale after the initial limited pilot program and thus a large number of mentees joined the program. Subsequently, the annual number of mentee applicants has reached a steady state (median 26; range 20\u0026ndash;57) closely paralleling the number of entering US pediatric rheumatology fellows per year (median: 28; range: 23\u0026ndash;39) over the time period.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e After the initial pilot years, the majority of mentees applicants were fellows, however, some junior faculty members continued to apply to the network (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics for AMIGO annual mentor-mentorship dyad matching process over time\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMatch/Entry Year\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMentee Applications (N)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanadian (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Rank\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFellows (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJr. faculty\u003csup\u003e*\u003c/sup\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. faculty\u003csup\u003e**\u003c/sup\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMentor Applications (N)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanadian (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic Rank\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJr. faculty\u003csup\u003e*\u003c/sup\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. faculty\u003csup\u003e**\u003c/sup\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMentor application numbers remained steady and in certain years exceeded the number of mentee applications.\u003c/p\u003e \u003cp\u003e \u003cem\u003eMentee-Mentor contact\u003c/em\u003e: Exit Survey response rates were variable (for Mentees: 49% [28/57] in 2016; 24% [9/38] in 2017 and 39% [9/23] in 2018; for Mentors: 109% [62/57] in 2016; 53% [20/38] in 2017 and 104% [24/23] in 2018. The greater than 100% response rate observed in mentors was attributed to certain mentors responding separately for multiple mentees who had different dyad starting years.) However, responses indicate that utilization of the AMIGO mentorship network was high. The cohort surveys indicate that dyads connected by phone, email and in-person. Ninety-three percent (43/46) of mentee respondents reported meeting with their mentor at least 2\u0026ndash;3 times since the initial match and 72% (33/46) indicated greater than 3 substantive meetings.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBiannual conferences\u003c/strong\u003e \u003cp\u003eAttendance at in person networking events held at ACR and CARRA scientific conferences was high and sustained over time. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e indicates number of respondents to session evaluations which underestimates total attendance at these sessions as not all participants submitted evaluations.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eCareer development sessions\u003c/strong\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e also provides highlights from participant evaluations of the biannual networking sessions. Detailed evaluation questions varied between sessions over time. Responses indicating aggregate participant reactions to that day\u0026rsquo;s overall program or the AMIGO network are included and indicate high ratings for participant satisfaction.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAMIGO biannual faculty development and networking session attendance and participant overall ratings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeeting:\u003c/p\u003e \u003cp\u003eAMIGO Event Title\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluation Question(s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRating\u003c/p\u003e \u003cp\u003e(scale 1\u0026ndash;5)*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRespondents (n)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2014 CARRA Session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003ePotential value of the AMIGO program?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.6\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2015 CARRA Session:\u003c/p\u003e \u003cp\u003e\u0026ldquo;Promotions Bootcamp\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eUnderstanding of promotion domains after session?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eGrasp of career development documentation after session?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2015 ACR breakfast:\u003c/p\u003e \u003cp\u003e\u0026ldquo;Mentorship Resource Fair\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of today\u0026rsquo;s mentorship resource fair?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of encouraging mentorship networks?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2016 CARRA session:\u003c/p\u003e \u003cp\u003e\u0026ldquo;Mentorship 360\u003csup\u003eo\u0026rdquo;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eTalk: \u0026ldquo;Mentoring 360\u003c/em\u003e\u003csup\u003eo\u003c/sup\u003e\u003cem\u003e\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003ePotential value of a mentoring program as envisaged by AMIGO?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2016 ACR breakfast:\u003c/p\u003e \u003cp\u003e\u0026ldquo;Building Your Academic Career\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of today\u0026rsquo;s mentorship talk?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of encouraging mentorship networks?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2017 CARRA/PRYSM:\u003c/p\u003e \u003cp\u003e\u0026ldquo;Peer mentorship\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of AMIGO\u0026rsquo;s current vertical mentorship program?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of a potential Peer/Horizontal mentorship program?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2017 ACR Breakfast:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u0026lsquo;GROW\u003csup\u003e#\u003c/sup\u003e\u0026rsquo; your mentorship network\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of today\u0026rsquo;s mentorship resource fair?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of encouraging mentorship networks?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2018 CARRA Breakfast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of today\u0026rsquo;s networking session?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2018 ACR Breakfast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of today\u0026rsquo;s networking session?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026sdot; \u003cem\u003eValue of encouraging mentorship networks?\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e*5 = Strongly agree except for 2014 where 1 = strongly agree\u003c/sup\u003e \u003c/p\u003e \u003cp\u003e\u003csup\u003e **Responses from session attendees, sessions were open to AMIGO participants and non\u0026minus;participants\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003csup\u003e+Actual attendance estimated at 35\u0026ndash;40 participants (author KH observation) however, evaluations were sent electronically after the event and only 12 responses were received\u003c/sup\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003e#\u003c/sup\u003eGROW: Goal Reality Options Will Mentorship Model\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMentee Perceptions\u003c/strong\u003e \u003cp\u003eMentees cited \u0026lsquo;General career development\u0026rsquo; as the professional development domain in which AMIGO either \u0026lsquo;helped very much\u0026rsquo; or \u0026lsquo;helped somewhat\u0026rsquo; (89% [41/46]). The AMIGO relationship was also rated as beneficial in the domains of \u0026lsquo;Research/Scholarship\u0026rsquo; (70% [32/46]) and \u0026lsquo;Work-Life Balance\u0026rsquo; for most respondents (59% [27/46]). The impact in other specific domains such as \u0026lsquo;Obtaining your current position\u0026rsquo; and \u0026lsquo;Negotiating a salary\u0026rsquo; was more variable; certain respondents reported the network helped very much (13% [6/46] and 9% [4/46]) while the majority indicated the AMIGO dyad made no difference or these domains were non-applicable to their experience (50% [23/46], 74% [34/46], respectively). Approximately a third of respondents indicated AMIGO \u0026lsquo;helped very much\u0026rsquo; or \u0026lsquo;helped somewhat\u0026rsquo; for the areas of Clinical work (37% [17/46]) and Teaching (35% [16/46]).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMentee-Mentor fit\u003c/strong\u003e \u003cp\u003eResults for mentee and mentor perception of \u0026lsquo;goodness of dyad fit\u0026rsquo; from cohort surveys are presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. In general, mentees tended to rate the goodness of fit of the dyad as slightly higher than mentors (most responses \u0026ldquo;Excellent\u0026rdquo; or \u0026ldquo;Good\u0026rdquo;) however, overtly problematic matches were infrequent over the 3 years. Due to small numbers/variable response rate there was no attempt to perform rigorous comparisons between groups or across years.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMentee to Mentor Transition\u003c/strong\u003e \u003cp\u003eAs of fall 2018, 25% (40/163) of former mentee participants had returned to the network as mentors in a subsequent cycle.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMentor Perceptions/Balancing measures\u003c/strong\u003e \u003cp\u003eFigure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e indicates aggregate mentor responses for all years 2016\u0026ndash;2018 (n\u0026thinsp;=\u0026thinsp;106) to exit survey questions regarding benefits or opportunity costs associated with participation in the network. Most respondents had positive perceptions of their ability to help their mentees and an improved sense of connection to the community, however, the majority also indicated neutral to doubtful benefit for their own academic portfolios.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eResults/Impact on the community\u003c/h2\u003e \u003cp\u003eAs of fall 2018, 331 unique individuals had participated in AMIGO as mentees, mentors or both. The 2017\u0026ndash;2018 American Board of Pediatrics Workforce Survey identified 357 pediatric rheumatologists with active board certification and 96 pediatric or medicine-pediatrics rheumatology fellows.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e A 2015 Canadian workforce survey indicates approximately 51 pediatric rheumatologists.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Thus, the total number of possible participants during this time is estimated at 504 individuals. Participation in AMIGO has reached almost 66% (331/504) of the US/Canadian pediatric rheumatology community.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis paper updates our initial reports of an inter-institutional career mentorship program for pediatric rheumatologists.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Similar models have now been reported within the pediatric hematology/oncology and trauma surgery communities.\u003csup\u003e\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e Several program evaluations\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e and systematic reviews of mentorship models in academic medicine have also been published.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e However, this paper provides the first longitudinal evaluation of an inter-institutional mentorship program over an extended period. We also are unique in the application of an educational quality improvement framework for our evaluation in parallel with classic Kirkpatrick levels of evaluation.\u003c/p\u003e \u003cp\u003eOur findings demonstrate that the AMIGO network was able to sustain stable entry rates and high levels of utilization of and satisfaction. Mentee exit surveys indicate highest levels of satisfaction with impact on domains of General Career Development, Research/Scholarship and Work-Life Balance. In general, both mentees and mentors indicated good-to-excellent \u0026lsquo;fit\u0026rsquo; for their match over time. Attendance at and satisfaction with semi-annual networking meetings has been robust. The networking sessions have cultivated an informal environment where participants are able to meet face to face within their assigned dyads as well as to interact with other attendees. In particular, the focus of sessions in 2016\u0026ndash;2018 was to promote connections across mentorship dyads in order to foster informal peer mentorship relationships and to grow networks of mentees and mentors with similar interests.\u003c/p\u003e \u003cp\u003eOne of the most critical factors important to the long-term success of any mentorship program is sustained access to engaged mentors. In spite of potential supply issues in the senior pediatric rheumatology workforce, the AMIGO network has consistently provided access to all interested mentees, with the number of annual mentor applications exceeding the mentee applications in some years. In part, this is due to certain committed senior mentors who agree to mentor multiple mentees or who consistently reapply after the end of a 3-year cycle. Importantly however, we found that 40 mentee graduates of the program returned to the program as mentors to incoming mentees in subsequent years. This \u0026lsquo;mentee turned mentor\u0026rsquo; phenomenon is perhaps one of the key indicators of participant satisfaction with the network and has been critical to sustaining ongoing mentorship access in AMIGO.\u003c/p\u003e \u003cp\u003eIn terms of using this experience to replicate mentorship networks in other specialty situations, it will be important to pay attention to cultivation of mentees as future mentors as well as factors that will encourage the recognition and retention of faculty mentors. Interestingly although mentors reported high satisfaction with their participation in the network, there was little perception of benefit towards their academic promotions. Given the competing demands on mid-career faculty, identifying additional ways to increase the tangible impact on mentors\u0026rsquo; academic careers will be an important consideration for long term success of these networks. Fortunately, earlier studies within AMIGO had found that the time commitment required for mentors was small, typically a less than 3 hours per year, helping to explain why mentors as well as mentees retain strongly overall satisfaction with AMIGO.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOne of the major limitations of our study was the exit survey response rates. This could be attributed to several factors including survey fatigue in our community as well as change in email contact information, particularly for fellow participants who were likely to have graduated and changed institutions over the three-year time-period. Respondents unhappy with or less invested in the program may have been less likely to respond to the surveys. We have retained the anonymity of the exit survey process in an attempt to obtain honest, unbiased feedback on the program, however, this feature also limits our ability to identify non-respondents or to conduct more detailed analyses regarding factors associated with the dyad matching process or the program.\u003c/p\u003e \u003cp\u003eAnother potential limitation to the generalizability of our approach is the matching process itself. The initial mentorship dyad matches are created with the use of a Microsoft Excel spreadsheet algorithm, curated through subsequent committee review to ensure face validity of the pairings and revise matches in case of any algorithm failures. This feature is relatively feasible within the pediatric rheumatology community given the small size and close-knit nature of our specialty. Reproducibility within a different or larger community might be more difficult. Lastly, but importantly, this study took place during the pre-pandemic era. Although the AMIGO network continued during the COVID-19 pandemic, both the ACR and CARRA annual meetings were converted to remote formats, which limited opportunities regular for face-to-face interactions are required restructing of the netowork. Additional study will be important to determine how the network and inter-institutional mentorship relationships have been affected by these changes and the increased reliance on virtual connections in the post-pandemic setting.\u003c/p\u003e \u003cp\u003eACR sponsorship has been a key facet to the sustainability of the AMIGO network. Administrative support in particular has been crucial to the ongoing operation of the network, which would otherwise be solely dependent upon volunteer time from physician leadership. A key indicator of the success of the network is the launch of a parallel network, Creating Adult Rheumatology Mentorship in Academia (CARMA), by the ACR in 2018 to address the burgeoning need for inter-institutional mentorship in adult academic rheumatology.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e A parallel program targeted to postdoctoral fellows has been developed within the NIH-funded Joint Biology Consortium research infrastructure \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.jbcwebportal.org/jbc-mentorship-program/\u003c/span\u003e\u003cspan address=\"https://www.jbcwebportal.org/jbc-mentorship-program/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. The ACR is also developing a structured mentorship program for division directors within the organization (M. Klein-Gitelman, personal communication, 7/21/2020). Replication in other settings would likely require identification of a similar funding or sponsorship agency.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Over the span of seven years, AMIGO has provided much-needed access to inter-institutional mentorship for pediatric rheumatologists across the United States and Canada. More than 66% of the Pediatric Rheumatology community has been involved in this program with a high proportion of program graduates returning to the network in a mentorship role. Future ideas for improvement include optimizing exit survey response rates, expanding access to diversity mentorship and exploring the impact of peer mentorship in addition to the more formal vertical mentorship structure. We hope our process and learning can facilitate the development of other programs to improve access to mentorship within underserved pediatric communities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n\u003cli\u003eACR: American College of Rheumatology\u003c/li\u003e\n\u003cli\u003eCARRA: Childhood Arthritis and Rheumatology Research Alliance (CARRA)\u003c/li\u003e\n\u003cli\u003eAMIGO: American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group\u003c/li\u003e\n\u003cli\u003eSQUIRE-EDU: Standards for QUality Improvement Reporting Excellence in Education\u003c/li\u003e\n\u003cli\u003eGROW: Goal Reality Options Will Mentorship Model\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n\u003cli\u003e\u003cstrong\u003eEthics approval: \u003c/strong\u003eThe project was granted exempt status by the Institutional Review Board at Seattle Children\u0026rsquo;s Hospital (STUDY00000772) as non-human subjects research\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eConsent for publication: not applicable\u003c/strong\u003e\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAvailability of data and materials: \u003c/strong\u003eThe data that support the findings of this study are available from the American College of Rheumatology (ACR) but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the ACR.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eCompeting interests: \u003c/strong\u003eAll authors have served as either AMIGO founders (PN, EM, LM) or Co-chairs (KR, AG, KH, LH, KA). AG is a member of the ACR Research Committee. Authors EM and LH are members of the ACR Annual Meeting Planning Committee (AMPC). The authors have no financial conflicts of interest relevant to this article to disclose.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eFunding: \u003c/strong\u003eACR provides support for the AMIGO program. PAN was supported by NIH P30 AR070253.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions: \u003c/strong\u003e\u003cem\u003e Hayward and Moorthy conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript.\u003c/em\u003e\u003cem\u003e Drs. Muscal, Nigrovic and \u003c/em\u003e\u003cem\u003eRouster-Stevens designed data collection instruments including initial matching algorithm, network evaluation and program surveys, and reviewed and revised the manuscript. Drs. Grom, Ardalan and Hiraki coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. \u003c/em\u003e\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eAcknowledgements: \u003c/strong\u003eThe authors wish to thank ACR staff Jillianne Jewell, Sarah Osbourne and Julie Anderson for tireless support of the AMGIO program and assistance with data acquisition and review. We also thank Marissa Klein-Gitelman for shepherding the paper through the ACR publication approval process. The authors wish to acknowledge CARRA and the ongoing Arthritis Foundation financial support of CARRA.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican College of Rheumatology Early Career Investigator Subcommittee of the Committee on Research. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.rheumatology.org/Get-Involved/Mentoring/AMIGO\u003c/span\u003e\u003cspan address=\"https://www.rheumatology.org/Get-Involved/Mentoring/AMIGO\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNigrovic PA, Muscal E, Riebschleger M, et al. AMIGO: a novel approach to the mentorship gap in pediatric rheumatology. J Pediatr. 2014;164(2):226\u0026ndash;7. e221-223.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoorthy LN, Muscal E, Riebschleger M, et al. Efficacy of an Interinstitutional Mentoring Program Within Pediatric Rheumatology. Arthritis Care Res (Hoboken). 2016;68(5):645\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeraci SA, Thigpen SC. A Review of Mentoring in Academic Medicine. Am J Med Sci. 2017;353(2):151\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatwardhan A, Henrickson M, Laskosz L, Duyenhong S, Spencer CH. Current pediatric rheumatology fellowship training in the United States: what fellows actually do. Pediatr Rheumatol Online J. 2014;12:8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVoytko ML, Barrett N, Courtney-Smith D, et al. Positive Value of a Women's Junior Faculty Mentoring Program: A Mentor-Mentee Analysis. J Womens Health (Larchmt). 2018;27(8):1045\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRetrouvey M, Keefe B, Kotsenas A, McGinty G, Patel AK. Women in Radiology: Creating a Global Mentorship Network Through Social Media. J Am Coll Radiol. 2018;15(1 Pt B):229\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLewellen-Williams C, Johnson VA, Deloney LA, Thomas BR, Goyol A, Henry-Tillman R. The POD: a new model for mentoring underrepresented minority faculty. Acad Med. 2006;81(3):275\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeech BM, Calles-Escandon J, Hairston KG, Langdon SE, Latham-Sadler BA, Bell RA. Mentoring programs for underrepresented minority faculty in academic medical centers: a systematic review of the literature. Acad Med. 2013;88(4):541\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePachter LM, Kodjo C. New Century Scholars: A Mentorship Program to Increase Workforce Diversity in Academic Pediatrics. Acad Med. 2015;90(7):881\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCommittee on Pediatric R. Promoting education, mentorship, and support for pediatric research. Pediatrics. 2014;133(5):943\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen MM, Sandborg CI, Hudgins L, Sanford R, Bachrach LK. A Multifaceted Mentoring Program for Junior Faculty in Academic Pediatrics. Teach Learn Med. 2016;28(3):320\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeary JC, Schainker EG, Leyenaar JK. The Unwritten Rules of Mentorship: Facilitators of and Barriers to Effective Mentorship in Pediatric Hospital Medicine. Hosp Pediatr. 2016;6(4):219\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRheumatology AC. \u003cem\u003eAmerican College of Rheumatology (2015) 2015 Workforce study of rheumatology specialists in the United States.\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePediatrics ABo. \u003cem\u003ePediatric Physicians Workforce Databook.\u003c/em\u003e 2017\u0026ndash;2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirkpatrick DL. Evaluation of training. In: L. CR, ed. \u003cem\u003eTraining and development handbook: A guide to human resource development.\u003c/em\u003e 2nd ed ed. New York: McGraw-Hill; 1976:301\u0026ndash;319.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRooholamini SS, Hayward S, Colson K, Smith E. Using Quality Improvement Concepts to Improve Educational Curricula. In: Morgenstern BZ, Sr HKL, Ledford C, Manthey D, Olasky J, Power DV, Pradhan A, Vaidya N, Beck Dallaghan GL, editors. Alliance for Clinical Education Guidebook for Clerkship Directors. 5th ed. ed. Syracuse, NY: Gegensatz Press; 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgrinc G, Armstrong GE, Dolansky MA, Singh MK, Davies L. SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in Education): Publication Guidelines for Educational Improvement. Acad Med 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarber CE, Jewett L, Badley EM, et al. Stand Up and Be Counted: Measuring and Mapping the Rheumatology Workforce in Canada. J Rheumatol. 2017;44(2):248\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevy AS, Pyke-Grimm KA, Lee DA, et al. Mentoring in pediatric oncology: a report from the Children's Oncology Group Young Investigator Committee. J Pediatr Hematol Oncol. 2013;35(6):456\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBadawy SM, Black V, Meier ER et al. Early career mentoring through the American Society of Pediatric Hematology/Oncology: Lessons learned from a pilot program. Pediatr Blood Cancer 2017;64(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZakrison TL, Polk TM, Dixon R, et al. Paying it forward: Four-year analysis of the Eastern Association for the Surgery of Trauma Mentoring Program. J Trauma Acute Care Surg. 2017;83(1):165\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStraus SE, Johnson MO, Marquez C, Feldman MD. Characteristics of successful and failed mentoring relationships: a qualitative study across two academic health centers. Acad Med. 2013;88(1):82\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRagsdale JR, Vaughn LM, Klein M. Characterizing the adequacy, effectiveness, and barriers related to research mentorship among junior pediatric hospitalists and general pediatricians at a large academic institution. Hosp Pediatr. 2014;4(2):93\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSambunjak D, Straus SE, Marusic A. A systematic review of qualitative research on the meaning and characteristics of mentoring in academic medicine. J Gen Intern Med. 2010;25(1):72\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKashiwagi DT, Varkey P, Cook DA. Mentoring programs for physicians in academic medicine: a systematic review. Acad Med. 2013;88(7):1029\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgdie A, Sparks JA, Angeles-Han ST, et al. Barriers and Facilitators of Mentoring for Trainees and Early Career Investigators in Rheumatology Research: Current State, Identification of Needs, and Road Map to an Inter-Institutional Adult Rheumatology Mentoring Program. Arthritis Care Res (Hoboken). 2018;70(3):445\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-rheumatology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"proj","sideBox":"Learn more about [Pediatric Rheumatology](http://ped-rheum.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/proj/default.aspx","title":"Pediatric Rheumatology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"mentorship, workforce, educational quality improvement","lastPublishedDoi":"10.21203/rs.3.rs-3717708/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3717708/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe American College of Rheumatology (ACR)/Childhood Arthritis and Rheumatology Research Alliance (CARRA) Mentoring Interest Group (AMIGO) is an inter-institutional mentorship program launched to target mentorship gaps within pediatric rheumatology. Initial program evaluation indicated increased mentorship access. Given the small size of the pediatric rheumatology workforce, maintaining a consistent supply of mentors was a potential threat to the longevity of the network. Our aims were to: (i) describe the sustainability of AMIGO over the period 2011-2018, (ii) highlight ongoing benefits to participants, and (iii) describe challenges in the maintenance of a mentorship network.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA mixed-methods approach centered on a quality improvement framework was used to report on process and outcomes measures associated with AMIGO annual cycles.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eUS and Canada Pediatric rheumatology workforce surveys identified 504 possible participants during the time period. As of fall 2018, 331 unique individuals had participated in AMIGO as a mentee, mentor or both for a program response rate of 66% (331/504). Survey of mentees indicated high satisfaction with impact on general career development, research/scholarship and work-life balance. Mentors indicated increased sense of connection to the community and satisfaction with helping mentees despite minimal perceived benefit to their academic portfolios. Based on AMIGO’s success, a counterpart program, Creating Adult Rheumatology Mentorship in Academia (CARMA), was launched in 2018.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Despite the challenges of a limited workforce, AMIGO continues to provide consistent access to mentorship opportunities for the pediatric rheumatology community. This experience can inform approaches to mentorship gaps in other academic subspecialties.\u003c/p\u003e","manuscriptTitle":"Longitudinal program evaluation of an inter-institutional mentorship network for pediatric rheumatology using a quality improvement framework","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-12-12 15:52:57","doi":"10.21203/rs.3.rs-3717708/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2023-12-29T14:28:43+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2023-12-11T02:49:01+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-12-10T17:14:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-12-07T02:21:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Rheumatology","date":"2023-12-05T16:14:15+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-rheumatology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"proj","sideBox":"Learn more about [Pediatric Rheumatology](http://ped-rheum.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/proj/default.aspx","title":"Pediatric Rheumatology","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a24c3057-3c97-4194-9946-d5095df8a89f","owner":[],"postedDate":"December 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-05-13T12:13:56+00:00","versionOfRecord":[],"versionCreatedAt":"2023-12-12 15:52:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3717708","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3717708","identity":"rs-3717708","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}