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Medical mentoring is becoming increasingly complex with the evolving needs of trainees and the complexities of their personal and social lives. The Internet is an enabling technology, which increasingly facilitates interaction with multiple people at a distance. Web 2.0 and 3.0 technology shows promise in furthering this facilitation.
The objective of our study was to establish opinions among doctors in postgraduate surgical training regarding mentoring and whether these doctors would readily accept virtual mentoring following a brief experience.
On the 12th of February 2012, an introductory teaching class was arranged by The London Postgraduate School of Surgery for doctors in training. Participants were introduced to a novel virtual mentoring system and asked to complete a questionnaire regarding their opinions before and after the demonstration.
A total of 57 junior doctors attended. Among them, 35 completed questionnaires pre- and postdemonstration. Regarding usefulness of a 3D virtual environment for mentoring, 6/35 (17%) agreed or strongly agreed and 20/35 (57%) were unsure prior to the session. Following 20 minutes using MentorSL, this significantly increased to 14/35 (40%) agreeing or strongly agreeing with 11/35 (31%) unsure (
These data suggest that a short introduction on how to use virtual systems may result in significant participation and use of virtual mentoring systems.
Doctors in postgraduate surgical training often require guidance to overcome hurdles associated with modern-day surgical training. Good mentoring delivered in a timely fashion is a way in which surgical trainees may be helped through these difficulties in a manner compatible with the principles of adult learning.
The Standing Conference on Postgraduate Medical and Dental Education (SCOPME) in the United Kingdom, describes mentoring as:
The process whereby an experienced, highly regarded, empathic person (the mentor) guides another individual (the mentee) in the development and re-examination of their own ideas, learning, and personal and professional development. The mentor, who may or may not work in the same organization or field as the mentee, achieves this by listening and talking in confidence to the mentee [
The mentors have many roles that have previously been reviewed [
It has been previously reported that trainees often do not have mentors or are unaware of the role of the mentor and therefore do not have beneficial meetings with them [
The latest digital technologies may be a key enabler to support these requirements. The Department of Health in the United Kingdom has recently published a “Framework for Technology Enhanced Learning” that advocates the use of e-learning and simulation to enhance learning where there is a clear benefit to patient care [
Virtual worlds including Second Life (SL) by Linden Laboratories [
For the purposes of exploring new methods to support mentoring, a 3D virtual system, MentorSL, was developed [
Doctors in postgraduate surgical training in the London Postgraduate School of Surgery (see
The London Postgraduate School of Surgery is the largest surgical training organization in the world. It is responsible for managing more than 900 trainees. The school offers programs at prestigious teaching centers across the capital city. Doctors in postgraduate training spend an initial 2 years (FY1, FY2) in generic foundation training; this is followed by a further 2 years (CT1, CT2) in core surgical training. Successful competitive progression results in spending an additional 6 years in specialty surgical training (ST3 to ST8) toward award of completion of training.
Photograph from Second Life showing the MentorSL meeting complex. Licensed under Creative Commons Attribution 2.0.
Doctors in postgraduate surgical training were invited to attend a “taster” session introducing virtual mentoring via the online virtual world SL at the London Postgraduate School of Surgery, UK. This session was a subsection of a wider training meeting being held. The trainees were within the first four years of postgraduate training. All participants had previously experience of mentoring as a component of “Foundation Training” which includes appointing of an “Assigned Educational Supervisor” by the training program. A 10-minute presentation on SL and specifically on MentorSL including an “in-world” walk through was given via a large screen projector. SL as a virtual world facilitating interaction of virtual people or avatars was explained. Methods used to navigating and communicate in SL were explained to participants. MentorSL was introduced as a tool to facilitate mentoring in the virtual world of SL. The search mentor facilities in MentorSL and the facilities to arrange and hold meeting within the MentorSL framework were explained and demonstrated. Following a short questions and answers session, participants were able to sit in groups at computer stations running Second Life fitted with multiple headsets. Facilitators in the real world as well as SL were available to help and guide participants.
Participants were invited to fill in an anonymous questionnaire regarding their perceptions both prior to and after the session. The questionnaire consisted of 7 domains: (A) demographic data, (B) perceptions regarding mentoring, (C) perceptions regarding the 3D Web, (D) perceptions regarding the practicalities of MentorSL, (E) perceptions regarding tele- and multiple mentoring, (F) perceptions regarding further enhancements in virtual mentoring, and (G) perceptions regarding future use of MentorSL (see
Statistical analysis was performed using SAS (Cary, USA). Data were presented as ratios and percentages. The chi-square test was used for significance testing.
There were 57 participants in total, median age was 28.1 years (range 24-43). There were 32 females (32/57, 56%) and 25 males (25/57, 44%).
Of the total participants, 1/57 (2%) qualified in 2004, 3/57 (5%) qualified in 2007, 23/57 (40%) qualified in 2008, 13/57 (23%) qualified in 2009, and 17/57 (30%) qualified in 2011. Of the total participants, 20/57 (35%) were in foundation year 1 (FY1), 22/57 (39%) were in core surgical training 1 (CT1), and 15/57 (26%) were in core training 2 (CT2).
Of the 57 participants, 40/57 (70%) participants reported that they had firm plans for which specialty they would like to enter, 3/57 (5%) had no plans as yet, and 14/57 (25%) were unsure of their choice. The response rate for the questionnaire was 35/57 (61%).
In terms of previous experience with the 3D virtual environments, 6/57 (11%) had had previous experience and 51/57 (89%) had no experience or were unsure. Mentee perceptions are described below and summarized in
Stacked bar chart of response to questions pre- (above) and post-experience (below) of the MentorSL system. *Improvement in response;
With regards to having understood of the roles of a mentor, prior to the experience, 3/35 (9%) said they strongly agreed, 19/35 (54%) said they agreed, 12/35 (34%) were unsure, and 1/35 (3%) strongly disagreed. Following the experience, there was a statistically significant improvement toward agreement (
With regards to whether mentoring was thought to be useful, 10/35 (29%) strongly agreed, 21/35 (60%) agreed, and 4/35 (11%) were unsure. Following the experience, there was a statistically significant improvement toward agreement (
When asked whether they thought whether a 3D virtual environment would be useful in mentoring prior to experiencing it, 2/35 (6%) strongly agreed, 4/35 (11%) agreed, 20/35 (57%) were unsure, and 9/35 (26%) disagreed. Following the experience, there was a statistically significant improvement toward agreement (
Prior to experiencing MentorSL, when asked whether voice communication would be useful in the mentoring relationship, 3/35 (9%) strongly agreed, 9/35 (26%) agreed, 18/35 (51%) were unsure, and 5/35 (14%) disagreed. Following experiencing MentorSL, there was a statistically significant improvement toward agreement (
When asked regarding navigation in SL was sufficiently simple to use, 6/35 (17%) strongly agreed, 11/35 (31%) agreed, 14/35 (40%) were undecided, 2/35 (6%) disagreed, and 2/35 (6%) strongly disagreed.
When asked whether the search for mentor facility in MentorSL was sufficiently simple to use, 7/35 (20%) strongly agreed, 6/35 (17%) agreed, 19/35 (54%) were undecided, 2/35 (6%) disagreed, and 1/35(3%) strongly disagreed.
When asked whether the meeting scheduling facility in MentorSL was sufficiently simple to use, 4/35 (11%) strongly agreed, 11/35 (31%) agreed, 18/35(51%) were undecided, and 2/35 (6%) disagreed.
When asked regarding ease of using voice communication in SL, 6/35 (17%) strongly agreed, 10/35 (29%) agreed, and 19/35 (54%) were undecided.
Regarding overall satisfaction with MentorSL, 6/35 (17%) reported very good, 24/35 (69%) reported adequate, 4/35 (11%) reported slightly disappointing, and 1/35 (3%) reported very poor.
Regarding the usefulness of a specialist mentor who may be geographically remote, prior to the experience, 6/35 (19%) strongly agreed, 18/35 (51%) agreed, and 11/35 (31%) were unsure. Following the experience, there was a statistically significant improvement toward agreement (
When asked regarding the perceived benefits of having multiple mentors available for specific mentoring needs, prior to the experience, 8/35 (23%) strongly agreed, 16/35 (46%) agreed, 10/35 (29%) were unsure, and 1/35 (3%) disagreed. Following the experience, there was a statistically significant improvement toward agreement (
When asked whether participants thought that real life facial recognition and animation of avatar facial features would be useful, 2/35 (6%) strongly agreed, 13/35 (37%) agreed, 13/35 (37%) were undecided, and 7/35 (20%) disagreed.
When asked whether hand gesture recognition and animation of avatar would be useful, 2/35 (6%) strongly agreed, 12/35 (34%) agreed, 14/35 (40%) were undecided, and 7/35 (20%) disagreed.
When asked whether participants would use MentorSL in the future, 4/35 (11%) strongly agreed, 15/35 (43%) agreed, 10/35 (29%) were undecided, 4/35 (11%) disagreed, and 2/35 (6%) strongly disagreed.
This study demonstrates that doctors in postgraduate surgical training are willing to “buy-in” to a virtual mentoring system in SL. The most well-received facilities were those of tele- and multiple mentoring and that of voice communication. The implication of these findings is that this mentoring system may be able to deliver mentoring to this group of doctors in a manner commensurate with their needs.
The response rate of 61% (35/57) in this study, seemingly low and a limitation of the study, is commensurate with other studies in this population [
It the context of team training for triage of mass casualties, it has been demonstrated that trainees quickly adapt to a virtual environment and find it an experience that is beneficial to their professional development [
Despite the all-pervasive nature of the Internet in today’s society, 89% (51/57) of participants had no significant previous experience of 3D Web 3.0 technology. Despite this, we found that only 17% (6/35) of participants disagreed or strongly disagreed, following a short introduction, with using the system in the future.
Central to the provision of a virtual “just-in-time” mentoring system is the mentee perceiving the need for being mentored. At outset, only 21/35 (60%) participants agreed or strongly agreed that they understood the concept of mentoring; this improved to 31/35 (89%). In addition, the initial high agreement with the usefulness of mentoring was maintained following the introduction (31 predemonstration vs 32 postdemonstration).
The specific use of the 3D virtual world for mentoring is perhaps the most contentious issue to be assessed in the confines of a short introduction. More formed decisions will most likely require the on-going usage of the system by mentees. This seems to be reflected in that 14/35 (40%) were positive regarding the system, and 11/35 (31%) were unsure.
Importantly, the more immediate and apparent facilitatory benefits of the system seemed to be well received by the participants. This was reflected by the strong performance in the voice communication, tele-, and multiple-mentoring domains. Indeed, the voice communication domain showed a large increase in agreement from 4/35 (11%) to 16/35 (46%). The user-friendliness of the voice communication was found to have a major impact in acceptance of a SL training program for nurses [
There may be barriers to the adoption of these new technologies for medical mentoring. Hansen et al recalled Roger’s diffusion of innovation theory in explaining attributes of a new technology affecting an individual’s decision to adopt [
With regards to future developments in the MentorSL, equivalent numbers were positive regarding animation of the avatars facial features and hand gestures to improve the experience.
We have demonstrated that the MentorSL system has the potential to be well accepted by mentees. This may be a reflection of the rapidly acquired understanding of the role of a mentor and the feeling of need for mentoring. Junior surgical trainees are able to rapidly familiarize with this novel communication modality and seem interested in further expansion of the virtual mentoring experience using facial and gesture recognition and avatar animation technology. Further work is required to evaluate utilization of this virtual mentoring facility when made available to doctors in postgraduate surgical training and to establish benefit. We are currently establishing a pilot study to trial medical mentoring using MentorSL in a cohort of surgical trainees in the London Postgraduate School of Surgery.
Questionnaire.
core surgical training 1
core surgical training 2
foundation year 1
foundation year 2
Second Life
three-dimensional
We would like to acknowledge statistical support from Jonathan Alsop, statistician at Numerus, UK. The development of the mentoring environment was supported by small grants from the NANIME charitable trust and the London Postgraduate School of Surgery.
UJ conceived the idea, helped develop the software, and wrote the manuscript. NS is guarantor, and critically appraised the design and manuscript. NWJ critically appraised the manuscript and was involved with design.
None declared.