key: cord-0072690-oogdh8si
authors: Pickering, Ashley; Patiño, Andrés; Garbern, Stephanie C.; Abu‐Jubara, Dania; Digenakis, Alexandra; Rodigin, Anthony; Banks, Michaela; Herard, Kimberly; Chamberlain, Stacey; DeVos, Elizabeth L.
title: Building a virtual community of practice for medical students: The Global Emergency Medicine Student Leadership Program
date: 2021-12-29
journal: J Am Coll Emerg Physicians Open
DOI: 10.1002/emp2.12591
sha: 9077d0b770c7735c0d06d8445f2335aa4b82f416
doc_id: 72690
cord_uid: oogdh8si

Virtual communities of practice (VCoPs) facilitate distance learning and mentorship by engaging members around shared knowledge and experiences related to a central interest. The American College of Emergency Physicians and Emergency Medicine Residents’ Association's Global Emergency Medicine Student Leadership Program (GEM‐SLP) provides a valuable model for building a VCoP for GEM and other niche areas of interest. This VCoP facilitates opportunities for experts and mentees affiliated with these national organizations to convene regularly despite barriers attributed to physical distance. The GEM‐SLP VCoP is built around multiple forms of mentorship, monthly mentee‐driven didactics, academic projects, and continued engagement of program graduates in VCoP leadership. GEM‐SLP fosters relationships through (1) themed mentoring calls (career paths, work/life balance, etc); (2) functional mentorship through didactics and academic projects; and (3) near‐peer mentoring, provided by mentors near the mentees’ stage of education and experience. Monthly mentee‐driven didactics focus on introducing essential GEM principles while (1) critically analyzing literature based on a journal article; (2) building a core knowledge base from a foundational textbook; (3) applying knowledge and research to a project proposal; and (4) gaining exposure to training and career opportunities via mentor career presentations. Group academic projects provide a true GEM apprenticeship as mentees and mentors work collaboratively. GEM‐SLP mentees found the VCoP beneficial in building fundamental GEM skills and knowledge and forming relationships with mentors and like‐minded peers. GEM‐SLP provides a framework for developing mentorship programs and VCoPs in emergency medicine, especially when niche interests or geographic distance necessitate a virtual format.

www.icmje.org). The authors have stated that no such relationships exist. literature based on a journal article; (2) building a core knowledge base from a foundational textbook; (3) applying knowledge and research to a project proposal; and (4) gaining exposure to training and career opportunities via mentor career presentations.

Group academic projects provide a true GEM apprenticeship as mentees and mentors work collaboratively. GEM-SLP mentees found the VCoP beneficial in building fundamental GEM skills and knowledge and forming relationships with mentors and likeminded peers. GEM-SLP provides a framework for developing mentorship programs and VCoPs in emergency medicine, especially when niche interests or geographic distance necessitate a virtual format. VCoP for fostering GEM mentorship for medical students.

CoPs form as individuals with a common interest exchange knowledge and experience, allowing for mutual learning amongst members and ultimately for members to apply new knowledge to their own practice. 1 

Globally, there is a profound need for emergency medicine. In low-and middle-income countries, it is estimated that 24 million lives are lost each year as a result of injuries and illnesses that could be effectively treated with prehospital and emergency care. 8 GEM seeks to assist in building acute care health systems and emergency care capacity in low-resource settings. The scope of GEM is broad and includes emergency medicine development, delivery of acute care in resourcelimited settings, and disaster and humanitarian response. 9 Interest in GEM is growing rapidly among medical students and trainees. Although GEM fellowship opportunities are increasing, there are limited opportunities for GEM mentorship, education, and career guidance for medical students. This gap is partly attributed to limited numbers of trained GEM faculty members and uneven distributions of these faculty members between institutions. 10, 11 Several national societies have addressed the need for increased This framework illustrates how different groups actively engaged with the VCoP, both learning from and transforming the community.

Apprenticeship allowed participants at all levels the opportunity to transition to VCoP leadership roles through active engagement in VCoP activities spectives. The community's practice-or shared activities, discussions, and resources-consisted of mentoring calls, didactics, and mentored academic projects as illustrated in Table 1 and Figure 1 .

Mentorship was at the core of the GEM-SLP VCoP for mentees and junior members of the leadership team. Mentor-mentee relationships were fostered through multiple avenues, the most prominent of which These speed-mentoring calls leveraged the following 2 main strengths: (1) allowing multiple, short-term relationships that provided varied perspectives and goal-directed advice and (2) assisting mentees in identifying mentors with whom they might develop a long-term relationship. 13 As GEM mentors are not available at all institutions and mismatches in mentor-mentee relationships have been shown to lead to a failure of support, this method maximized the opportunity to meet multiple mentors. 14 

The program held monthly didactic sessions, offering an opportunity for peers, mentors, and leaders to interact. These monthly discussions were structured around rotating fundamental GEM themes (eg, ethics of humanitarian work, sustainability in global health). These sessions also provided opportunities for ACEP International Section fringe members to engage in the VCoP. Many didactic participants later became mentees, mentors, and GEM-SLP leaders. Leadership "The leadership of the program was excellent-the mentorship coordinators and journal club leaders never demanded more enthusiasm from participants than they brought themselves, so their attitude toward the group sessions really helped make the program feel meaningful."

Mentorship components "I found [GEM-SLP] very thorough and it was one of the best mentorship experiences I've had in terms of how many of the mentors I had a chance to speak with and connect with." "[My mentor was] instrumental in helping me navigate a future in global EM. Through our discussions about partnership, I have a better appreciation for reciprocal learning opportunities and the importance of local project ownership."

Didactic components "I liked having dedicated global health time each month during didactics and meeting all of the mentors & mentees." "I think that discussions are the real opportunity for learning during the monthly mentee-driven didactics, and I never thought the projects were as interesting or thought-provoking as some of the articles and book chapters. I think if more time were reserved for discussion, didactics would be even more interesting." "The reading topics covered essential global health concepts, but the most fruitful aspect was the conversations about real-world examples with GEM colleagues around the world." Multiple-mentor model "I know there needs to be a good match between mentor and student, which can be hard to determine, but it often felt like I was repeating my interests without having much forward momentum call to call. That said, I did appreciate getting so many different perspectives from mentors, so I'm not sure how to balance these."

Peer collaboration "I think it would be great to develop a better relationship with the cohort. It is certainly easier said than done, but I think having a strong cohort that interacts with each other would be incredibly valuable as we are all in the same 1-2 year window of our training and would feel more comfortable reaching out to each other and collaborating." Table 1 .

Mentees worked with mentors on GEM academic projects to build practical skills and a GEM network in the mentees area of interest. The GEM-SLP VCoP community was notably important to mentees.

Mentees ranked the program highly in terms of networking with peers interested in GEM. Mentees also noted the value of having dedicated core members of the VCoP, as expressed through qualitative feedback in Table 2 . Mentees appreciated the variety of academic projects available due to the diverse GEM work of VCoP mentors. However, many recognized the limitations of completing projects within an academic

year and planned to continue to work on their projects after program completion ( Table 2) . journal articles discussed were either moderately or very helpful. Every mentee also felt that speed-mentoring calls were either moderately or very helpful, with 65% ranking this element as very helpful. Qualitative mentee feedback on both components is included in Table 2 ( Figure 3 ).

Initially, the GEM-SLP VCoP paired mentors and mentees 1-to-1. The pairs met at the ACEP International Section Ambassador Conference, an annual 1-day preconference event at the ACEP Scientific Assembly, for an in-person orientation to the program. Mentor-mentee relationships were strengthened through phone and virtual meetings throughout the year. However, varying levels of engagement were noted by some mentees and mentors, leading to diverse experiences. This feedback prompted the evolution from dyad mentor-mentee pairing to the multiple-mentor model used currently.

The multiple-mentor model fully leverages the benefits of a VCoP including access to expanded GEM networks, multiple mentor perspectives, increased mentor recruitment, and increased peer collaboration through group projects. However, the need to balance the opportunity to meet multiple mentors and build long-term mentor relationships was highlighted by mentee feedback (Table 2) . To address this, we transitioned to flexible mentoring opportunities, allowing for mentee personal preference and mentor-mentee fit. Mentees used published biographic information to identify mentors with similar GEM focus and regional interests, and multiple VCoP members contributed to new member mentorship.

Certain GEM-SLP VCoP mentors have been strongly academic, whereas others have been more involved in program administration or clinical care globally. This diversity offered much to the VCoP. However, a limitation of the dyad matching was that, at times, mentees were paired with a mentor whose area of focus was poorly aligned with the mentees' goals. Some clinically focused mentors also found providing an academic project burdensome. This was rectified in the multiplementor VCoP model by allowing mentors to self-select into leading a group academic project rather than requiring them to provide a project for a mentee.

There was a strong, initially underrecognized, desire for peer collaboration among the GEM-SLP mentees, as expressed in a mentee feedback in Table 2 

Our primary goal for the GEM-SLP VCoP is to continue to increase and diversify our membership. To date, we have recruited mentors solely from the ACEP International Ambassador Program. We expanded our mentor recruitment to all attending and fellow ACEP International Section members to increase our mentor pool and allow mentees to learn from GEM experts working in more diverse regions and focus areas and additional mentors working primarily outside of the United

States. Integrating GEM fellows will provide additional perspectives on pathways to formal GEM training programs for mentees. Fellows will gain mentorship and leadership experience. Furthermore, we will continue to expand our mentee group focusing on prioritizing medical students training outside the United States to better support the bilateral exchange that is important in GEM learning. 18 In addition, we have started a blog and plan to build strategic partnerships with international emergency medicine organizations to broaden the VCoP's reach.

As the GEM-SLP program is both unique in its aims and fairly new, the leadership team is continuously engaged in quality improvement.

We obtain feedback from both the GEM-SLP mentees and mentors through informal conversations and formal year-end written feedback.

To further improve the program, assessment of its impact on mentee knowledge and skills across GEM domains is needed. To date, there are few defined competencies and assessment tools to gauge the effectiveness of GEM learning experiences. 19, 20 To address this need, the Global Emergency Medicine Think Tank Education Working Group developed the Global Health Milestones

Tool for learners in emergency medicine. This is a yet unvalidated assessment tool that rates trainee competency across 11 domains essential to work in GEM, including global burden of disease, social and environmental determinants of health, capacity strengthening, and program management. 10 Starting in the 2020/2021 program year, we began to use the tool for programmatic quality improvement as a pre/post mentee self-assessment. Although this specific tool is not applicable outside of GEM, there is a strong likelihood that similar tools may be available and of use in building VCoP for trainees within other emergency medicine interest areas.

The relevance and applicability of this model to GEM specifically and for medical education more broadly is clear. It provides a framework to foster mentorship, peer networking, and community, despite distance. A well-cultivated VCoP typically includes educational content and discussion, mentoring, member engagement and ownership, credibility achieved through expert oversight, and lastly, the energy needed to nurture the community over time. 21 The GEM-SLP VCoP model addresses each of these key areas. Furthermore, a successful VCoP allows for varying levels of engagement based on the interest, availability, and experience of each member. However, they also ensure all-from newcomers to core members-are included and gain benefits from participation leading to intrinsic motivation to contribute to the CoP. 3 We believe that the GEM-SLP VCoP achieves these goals, benefiting all mentors, mentees, and the ACEP International Section, leading to continued community engagement. Similar engagement could be replicated in broader applications of the model.

The GEM-SLP VCoP is a model for GEM mentorship of medical students within the structure of a national specialty society. GEM-SLP mentees found the program beneficial in building fundamental GEM skills and knowledge as well as relationships with mentors and a likeminded peer cohort. The GEM-SLP framework can be used in developing mentorship programs and VCoPs in emergency medicine, especially when niche interests or geographic distance necessitate a virtual format.

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The authors thank the mentors, mentees, and leadership team without whom the Global Emergency Medicine Student Leadership Program Community of Practice would not be possible.

The authors declare no conflicts of interest.

Ashley Pickering MD, MPH https://orcid.org/0000-0001-5606-2479