An online abstract mentoring programme for junior researchersand healthcare professionals

Gurmit Singh*

School of Education, University of Leeds, Leeds, UK

(Received 17 January 2011; final version received 18 February 2011)

Dissemination of findings about the HIV epidemic at international conferenceshas been dominated by researchers from developed countries working in well-resourced and supported institutions. This has led to exclusionary practiceswhere community healthcare workers and practitioners working in under-resour-ced contexts have had limited opportunities to share their own experiences. Alow focus on research in their working contexts and lack of capacity to produce‘acceptable’ research for dissemination at international audiences have exacer-bated the exclusion. This article describes how early career researchers andabstract submitters in resource-limited developing countries, particularly inAfrica, received online help from experienced volunteer mentors in the AbstractMentor Programme (AMP), enabling them to share their work at internationalconferences on the issues of preventing and managing HIV and AIDS.

Keywords: abstract writing; online mentoring; healthcare professional develop-ment; HIV and AIDS; conference presentations

Introduction

Junior researchers, healthcare professionals, community workers, and social counsel-lors involved with HIV/AIDS treatment, prevention, and care working in rural andremote regions in developing countries have a wealth of knowledge of local circum-stances, what works, what doesn’t, and why. Their practical experience, findings,and ideas can be very important for strengthening HIV/AIDS healthcare systems,understandings, and practices (Zewdie, Cahn, McClure, & Bataringaya, 2008).However, their lack of skills in writing academic papers effectively debars themfrom attending international conferences and opportunities for sharing their expertiseand learning from those working in the developed world. The Abstract MentorProgramme (AMP) (International AIDS Society [IAS], 2011b) was designed to helplocal healthcare workers in developing countries achieve the required standards intheir abstracts for international conferences, and seen as a first small but significantstep in this process. The AMP was based upon Siemens’ concept of learning as anecology (2005), an environment that fosters and supports the creation of learningcommunities and networks. It was also conceived as the 3-Os learningmodel – onsite, online, and ongoing. Quite apart from the professional dimensions,it was seen as an important empowering, motivational initiative because, as Couper

*Email: gurmit@3-Os.com

Distance EducationAquatic InsectsVol. 32, No. 2, August 2011, 229–242

ISSN 0158-7919 print/ISSN 1475-0198 online� 2011 Open and Distance Learning Association of Australia, Inc.DOI: 10.1080/01587919.2011.584849http://www.informaworld.com

(2004) observes, in Africa and many parts of the world, healthcare workers arestruggling to cope with the HIV pandemic and inadequate resources, and canbecome very discouraged. Enabling remote and rural healthcare workers to feel thattheir work is being recognized and that they can make a meaningful contribution toresearch and practice in partnership with people in the developed world can behighly motivating.

The challenge

The Geneva-based International AIDS Society (IAS) is a leading global independentassociation of HIV professionals. It convenes highly regarded and influential annualinternational HIV and AIDS conferences, and conferences on HIV pathogenesis,treatment, and prevention. These provide valuable platforms for presenting evi-dence-based responses to HIV, promoting dialogue on appropriate interventions, andbuilding consensus to advance the global fight against HIV and close the gaps inknowledge, expertise, and practice at every level and in every context (IAS, 2011a).

IAS has a worldwide membership of over 14,000, of which 23.3% is fromAfrica and 35.53% from lower- and lower-middle income countries, as classified bythe World Bank. Significantly, in the context of this article, while 17.8% areresearchers, about 33% are healthcare professionals. Further, data on conferenceparticipation show that there are high numbers of delegates from Africa. At the2009 IAS conference in Cape Town, African delegates represented 32% of the14,863 delegates (IAS, 2009), but, perhaps even more surprisingly, at the 2010 con-ference in Vienna, further away from home, they constituted 23% of the 13,841 del-egates (IAS, 2010).

The conferences on HIV pathogenesis, treatment, and prevention are smallerevents, attracting on average about 5000 delegates. Both conferences are organizedin collaboration with UNAIDS (http://www.unaids.org) and other organizationsinvolved in the global response against HIV and AIDS (IAS, 2011d).

South Africa has hosted two of these conferences: the 13th International AIDSConference in 2000 in Durban and the 5th IAS Conference on HIV Pathogenesis,Treatment and Prevention in 2009 in Cape Town (IAS, 2011d). These events areattended by scientists, healthcare providers, political, community, and business lead-ers, journalists, government, non-governmental, and intergovernmental representa-tives, and people living with HIV and AIDS. However, important voices were notbeing heard – those of the junior researchers and workers in varied and sometimesremote community settings.

Addressing the problem

IAS was committed to the idea of supporting junior researchers and healthcareworkers in developing countries write of academic papers and presentations. It rec-ognized that these frontline workers had valuable tacit and explicit knowledge, butstruggled to express themselves through academic genres and discourses. Time andhuman resources were limited, so it was only possible to focus on the abstract writ-ing rather than full-paper development, a task that would have been unmanageablegiven the numbers of abstracts involved. However, this was an entirely appropriateapproach since in the case of both conferences, acceptance depended not upon thequality of full papers, but the quality of the abstracts. Consequently, in 2004, IAS

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began experimenting with a small-scale online mentoring service for noviceresearchers to gain assistance with preparing their abstracts for the 15th Interna-tional AIDS Conference in that year. This introductory offer of online abstract men-toring was aimed at two-way communication and feedback between the mentor andthe abstract submitter. In the beginning of the programme, abstract submitters uti-lized the small number of mentors available to send email queries about their writ-ing and topics, and how to develop their abstracts.

An initial pool of mentors was recruited. These mentors had to be capable ofhelping the junior researchers and healthcare workers grow into a community ofpractice (Wenger, 1998). They had to be capable of providing feedback, clarifyingmisunderstandings, sharing perspectives, and helping novice researchers, profession-als, and paraprofessionals become more confident in their writing, and in the rele-vance and value of their experience. Mentors were identified from among HIVresearchers on the IAS board and abstract submitters who had won scholarships andprizes at previous conferences.

Other resources were provided for AIDS 2008 in addition to the toolkit, includ-ing frequently asked questions (FAQs), the five main reasons for abstracts beingrejected, and examples of good and poor abstracts (IAS, 2011b; Singh, 2010, p.21). However, it was found that these were insufficient. The submitters desired dia-logue with people who had gone through the process before, who could read theirdrafts, and who could help them construct their stories into effective abstracts thatwould be recognized internationally.

A cross-department project team was formed to address this problem. This com-prised staff from the IAS conference programme, professional development, and ITdepartments – people who usually spoke different languages and worked in silos.Discussions resulted in agreement on how to move from a web page/email approachthat had been adopted in 2008 to a more structured online abstract mentoring sys-tem with a dedicated structured query language (SQL) database. This moreadvanced system was launched to coincide with the abstract submission period ofthe IAS 2009 conference, from November 2008 to February 2009. Using the tem-plate shown in Figure 1, abstract submitters could type in their drafts following thestep-by-step guide.

To support writing their drafts, abstract submitters were given access to a down-loadable abstract writing toolkit (Miller, 2009). This toolkit, which is in five lan-guages, expands the online mentoring service by providing writers with access tolearning resources to develop an abstract prior to review by a mentor. The toolkitcomprises ‘a conceptual checklist, a writing guide, probing questions, and oral andposter presentation drafting templates’ (Singh, 2010, p. 21) and was designed tohelp novice researchers understand the processes of abstract writing, submission,and selection. Page 9 of this toolkit showing the checklist to guide abstract writersis shown in Figure 2.

The mentors provided feedback on the draft abstracts using collaborativelydeveloped guidelines. An example of a mentor’s feedback on an abstract from ahealth professional in Malawi is given in Figure 3. In this case, the mentor madecorrections to the construction, language, wording, and organization of the abstract,as well as further recommendations regarding the content and presentation.

The online AMP was incorporated into the IAS website (IAS, 2011c) (Figure 4).It was also widely promoted through networks of HIV professionals and researchersand at conferences with flyers (Figure 5).

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Figure 1. The template of the online AMP used for IAS 2009, AIDS 2010, and IAS 2011conferences (IAS, 2011d).

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In light of overwhelming demand for abstract mentoring in the 2009 pro-gramme, two key changes were made to balance mentee demands with the availableresources for AIDS 2010 (IAS, 2010):

� more mentors were recruited and database management was improved to cate-gorize their expertise by scientific field and region of work

� submitters were provided the option of two rounds of mentoring with thesame mentor to maintain continuity and contiguity in feedback.

As these experiences demonstrated that abstract mentoring is a significant con-tributor to the success of international AIDS conferences, other abstract writinginterventions were also introduced with IAS partner institutions. For example, in2008, IAS supported the Society of AIDS in Africa in organizing the 15th Inter-national Conference on AIDS and Sexually Transmitted Infections in Africa (ICA-SA) held in Dakar, Senegal, from 3 December to 7 December 2008. At thisconference, a workshop on abstract writing was facilitated by editors-in-chief ofThe Journal of the International AIDS Society (JIAS), in which delegates wereshown how to use the online AMP to prepare for the next ICASA conference(IAS, 2008). IAS has also partnered with the Health[e]Foundation, which offers ascientific writing e-learning course authored by the editors of the JIAS. The firstmodule, on abstract writing, is freely available online (IAS & JIAS, n.d.).

Evaluating the outcomes

It was important that having made all this effort, the team should ascertain whetherthis approach was appropriate, and where and how it might be improved. Thisinvolved gaining the views of the various stakeholders. Three types of data weregathered using three different methods (Table 1).

Figure 2. Checklist in the conference abstract and presentation toolkit (Miller, 2009, p. 16).

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Table 2 shows the outcomes of the programme over three years. The figures for2008 and 2009 have been reported previously (Singh, 2010, p. 25), and there isnew data from 2010 (IAS, 2010, p. 26).

Data in Table 2 indicate that the mentoring system increased the chance ofabstract submitters with little prior experience being accepted. For AIDS 2008, 80%

BACKGROUNDThe Ministry of Health X (MOH) has implemented the Prevention of Mother to Child Transmission of HIV (PMTCT) program in 1998 amongfor all women attendingreceiving government antenatal services since .1998.Towards strengthening and improving the program, aWe conducted a qualitative evaluation on the uptake of the program was conducted through a collaborative project by in collaboration withthe University Y, the MOH and UNICEF XThe objective of this research wasto examine the women’s perspectives and experiences inof women utilizing the PMTCT program inX.

METHODOLOGYA qualitative research involvingWe conducted 12 focus group discussions and 36 open-ended questionnaires interviews with key informants consisting of antenatal women and HIV-infected mothers from urban and rural districts in three states in X was conducted from November 2006 until August 2007.Information of key areasunder the PMTCT services was coded and thematic content analysis was done using NVIVO software.

RESULTS•Respondents have showndemonstrated good basic knowledge of HIV/AIDS butmoderatelyon awareness to of the PMTCT program.•Respondents were found to be plagued with some kinds of complaints ranging fromlacking inreported that they lacked basic information in the PMTCT guidelines and alsocounselling service from the healthcare providers.•Practical problem in bBreast feeding amongby poor HIV-infected mothers, particularlyamongin the poor of both urban and rural areas also was problematic, was also arise..•Limited counseling and coping assistance services for HIV-infected mothers, includingcounselling and coping assistance, were compounded by socio-cultural and economicissues, especially social stigma attached to HIV-infected people

CONCLUSIONThis qualitative evaluation was able to increase the improve understandingon of issues surrounding the uptake of PMTCT services among the women or usersof the program. There is an urgent need to carry out measuresfrom the government and other agencies to maximize the program benefit and its health and social impacts.

1. Can you describe the areas or domains of interest concisely and specifically here?2. I would advise against the bulleted format and recommend changing to complete

sentences in paragraph form. Other specific comments are embedded.3. How was this measured? Whatis the cut off for ‘good’?4. Do you mean that fewer were aware of the PMTCT program? Can you provide

numbers?5. Describe your findings. What did they not like about the counselling service? Was the

service not available, i.e., lacking? Or did the providers mistreat them?6. Recommend substituting this sentence with an explanation of how understanding

increased. Can you summarize the major issues which need to be addressed?7. Rather than call for urgent measure, you might suggest what these measures might

be. Suggest ones that will address the issues you discovered in the study, i.e., what can be done about stigma. Also there is new evidence presented at CROI 2008 that nevirapine given once daily to breast-feeding infants from 8 to 42 days old decreased by almost half the rate of HIV transmission via breast-feeding at six weeks of age, See http://www.siteweb.com/releases/

Figure 3. Example of mentor feedback to abstract submitter (reprinted with permission ofmentor).

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of mentored abstracts were accepted (Singh, 2010, p. 24). For IAS 2009, anincreased number of abstracts were submitted, mentored, and accepted. Further,89% of those mentored and 93% of those accepted came from low- or middle-income countries (Singh, 2010, p. 24). The demand for mentoring for AIDS 2010was so overwhelming that it was not possible to recruit sufficient mentors in time.Many submitters were denied help to avoid overwhelming the pool of mentors whowere volunteering their time. While only half of the mentees received at least oneround of mentoring, 50% of the submitted abstracts were accepted. The level ofdemand showed that more extensive and extended mentoring and funding support

Figure 4. Promotion of the AMP on the IAS website (IAS, 2011c).

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would be needed if this approach to open-access distance capacity building is to bescaled up sustainably.

One positive feature of the programme was the persistence of the mentors fromthe time of the AIDS 2008 programme. Despite being unpaid volunteers, theyoffered their services again for the IAS 2009 and AIDS 2010 programme. As anindicator of their continuing commitment, half of the 46 mentors completing thesurvey for AIDS 2010 had mentored abstracts in previous years and half of thesehad mentored more than five abstracts. Mentors’ suggestions for improving the pro-gramme included ‘giving more attention to abstract writers for whom English is nota first language and those from non-scientific backgrounds’ as well as facilitatingongoing ‘collaboration between mentors and abstract writers’ (Singh, 2010, p. 26).However, limited funding and time precluded this.

Reflecting on the outcomes, it was possible to conclude that:

� There had been an improvement in the quality and acceptance rates of juniorresearchers’ abstracts that might otherwise have been eliminated during theblind peer review. However, with hindsight, the quality and acceptance ratesmight have been even better had abstracts first gone through the peer reviewprocess, and then been worked through with the mentors.

� There was a widening of access, with more abstracts from low- and middle-income countries successfully accepted.

Figure 5. Flyer for the AMP (IAS, 2011c).

Table 1. Data and methods for evaluating the AMP.

Data Method

Quantity and quality of abstractsmentored

Weekly logs of online activity with SQL back-officeand email

Perceptions of the mentees andmentors

Online questionnaire surveys

Perceptions of the project team Meetings and dialogue

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� User participation in co-design of the digital learning tool enabled continuousimprovements to be made to deliver value-added services year on year.

� The programme overcame deficit discourses about junior health professionalsfrom Africa as ‘not able to do research’ and empowered them as contributorsto collaborative knowledge building on HIV and AIDS issues.

� Costs were controlled as no additional budget was provided for this initiative.

Survey findings established that African healthcare professionals who participatedin the programme benefitted from:

� the flexible, anytime, anywhere mentoring that did not take them away fromtheir clinics

� access to free downloadable learning resources for self-study, expertise thatwas not available locally, and specific information, opinion, and advice whenrequired

� mentoring tailored to their immediate and practical concerns� anonymity and confidentiality

Table 2. Outcomes of the AMP, 2008, 2009, and 2010.

Indicator AIDS 2008 IAS 2009 AIDS 2010

No. of mentors 42 signed up, ofwhom 26reviewed at leastone abstract

63 signed up, of whom 43reviewed at least oneabstract

80 signed up, ofwhom 65reviewed at leastone abstract

No. of abstractsubmitters (note:some submittedseveral abstracts formentoring)

66 95 346

No. of abstractsreceived formentoring

80 118 Over 900

No. of abstractsreviewed by mentors

78 118 500

No. of mentoredabstracts submittedfor the conference

59 73 459

No. of mentoredabstracts accepted forthe conference

47 46 22930 posterdisplays

2 poster displays 42 posterdisplays

1 posterdiscussionsession

18 poster discussionsessions

5 posterdiscussionsessions

1 poster back-up 25 CD-ROMs 73 CD-ROMs2 oralpresentations

1 oral presentation 9 oralpresentations

13 CD-ROMs 3 authors had more than 1abstract accepted; 2 authorsfrom non-scientificbackgrounds had theirabstracts accepted

6 authors hadmore than oneabstract accepted

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� increased connections and meaningful interactions between learners, peers,and experts.

The evaluation of the IAS conference held in Cape Town in 2009 indicated thatAfrican submitters had benefitted from mentoring, judging by the number ofabstracts submitted and those that were accepted as reflected in Figure 6 (IAS,2009, p. 30). In contrast, when limited support was provided to abstract submitterstwo years earlier at the IAS 2007 conference, abstracts were submitted only fromUganda and Nigeria (IAS, 2008).

The evaluation report emphasizes that the majority of the mentees were inAfrica and the Asia-Pacific region. This is an important finding in regard toequity since ‘submitters from other regions were more likely to be successful inhaving their abstract selected for the conference programme’ (IAS, 2009, p. 30).At the 2007 IAS conference in Sydney, Uganda and Nigeria were among the topfive countries for abstract submission, with 167 and 228 abstracts, respectively.Australia, India, and the USA were also ranked as the top five countries inabstract submission. However, a comparison of top five countries for abstract sub-mission and top five countries for accepted abstracts revealed that Nigeria andUganda had fallen off the top five list of countries with accepted abstracts (IAS,2008). Yet the USA, India, and Australia had retained their top five spots (IAS,2008, p. 13). Thus, compared to what they had submitted, the two African coun-tries had failed to get a substantial number of their abstracts accepted. The dis-crepancy between submitted and accepted abstracts in that year, for abstractsubmitters from these countries, could be attributed to the lack of targeted supportfor abstract submitters. In 2007, despite the fact that Nigeria and Uganda had 395abstracts between them, only 27 abstracts, not necessarily from Uganda and

Figure 6. Comparison of submitted abstracts and those accepted after intervention of theAMP for IAS 2009 conference (IAS, 2009, p. 30).

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Nigeria, in total were submitted for mentoring (IAS, 2008). This suggests anunderutilization of the AMP, to the detriment of abstract submitters who riskedrejection of their abstracts without mentor support. The evaluation also showedthat most of the questions asked were not relevant. This finding led to developinga structured approach a year later.

The mentors see the programme as valuable. A mentor from Uganda commented:

The few healthcare professionals employed in the system are responsible for runninglarge-scale HIV treatment programmes. The need for well-educated professionals withresearch skills increases with the new WHO treatment guidelines that recommendstarting treatment earlier, which will increase the number of patients we serve. Manyof my junior researchers need targeted practice and lack the opportunities to connectwith experts to share their problems and discuss ideas. There is no mentoring cultureor much funding for regular writing workshops. With rapid anonymous feedback, sub-mitters increase their confidence and overcome [sic] their fear of losing face. The men-toring also takes some of the burden off us, knowing we can rely on the volunteerspirit of our overseas colleagues. This is a well-structured and organized initiative thatbrought significant benefits to African healthcare professionals engaging in research.(Dr Mantera, personal communication, April 2010)

Judged to be a success by IAS, the online mentoring programme was includedin the new IAS five-year strategic plan as a key strategy for healthcare profes-sional development (IAS, n.d.). The Scientific Program Committee of the AIDS2010 Conference also adopted it as a tool to improve abstract quality. The pro-gramme has now completed a fourth cycle at the IAS 2011 conference (IAS,2011b).

Conclusion

The World Health Organization (WHO, 2006) evidences a critical shortage of well-trained, adequate, and available healthcare workers to meet pressing health needsacross the globe. As an indicator of the educational need, there are only 0.8 healthworkers per 1000 in Africa (WHO, 2006). This figure is in stark contrast to similarfigures for developed countries – 10 health workers per 1000 in Europe (WHO,2006). Yet African countries carry 24% of the global disease burden and have only3% of the healthcare workers (WHO, 2006). Educators committed to healthcareprofessional development are all too familiar with the rhetoric – the calls for a sys-tems approach (de Savigny & Adam, 2009), changing mindsets (WHO, 2010), andnurturing a culture of inquiry (Bhutta et al., 2010). A recent response to the LancetGlobal Commission report calling for a transformation of health professionaleducation raised the idea of ‘global learning systems’ that can ‘empower resource-poor settings’ and exploit ‘innovative and promising information and communica-tion technologies’ (Stigler, Duvivier, Weggemans, & Salzer, 2010, 1877–1878). Atthe Second Global Forum on Human Resources for Health, the need to empowerhealth workers for health outcomes was stressed in the outcomes statement (WHO,2011). None of these policy declarations, however, made any mention of the needfor global strategic alignment of health, education, and technology to realize thelofty vision of healthcare for all, demonstrating the lack of interdisciplinary thinkingin today’s endeavours to reduce the disease burden in Africa.

The online AMP for junior and community healthcare professionals described inthis article was a modest intervention on a shoestring budget. But it enabled busy,

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previously disempowered healthcare professionals in the field to learn online howto improve their abstracts through practical, targeted tasks and thereby achieve theirpersonal and professional goals. Research into online healthcare professionaldevelopment indicates that healthcare professionals need the ‘acquisition of tacitknowledge and skills that are often organization related and only acquired throughsocial interaction and negotiation’ (McPherson, Nunes, Sandars, & Kell, 2008, p.298). Effective professional development also calls for fostering social participation(Guan, Tregonning, & Keenan, 2008) and ensuring that the learning is context-appropriate (Sandars, Langlois, & Waterman, 2007) and practice-based (Burrows,2003). Improving the skill of scientific writing required not only ‘explicit knowl-edge,’ empirically formulated and disseminated top-down or centre–periphery in theguise of ‘best practices’ or toolkits – the kind that is generalizable but may notalways be replicated easily by others – but also the sharing of tacit knowledge(Polanyi, 1967). Experts and mentors have valuable tacit knowledge, which is muchharder to detail, copy, and distribute as ‘evidence’ but can be located, leveraged,and applied to support others. To learn, professionals have to actively reflect ontheir experience, rather than passively receive disembodied knowledge in workshopsor online training. Besides, writing workshops are more expensive and less effectivein improving practice unless they are intensive courses for small groups of people,which are becoming more difficult with the current financial climate and cutbacksin training budgets. Through the online AMP, learners gained tacit knowledgethrough immersion in the practice of online writing, and used it to integrate bothexplicit and tacit knowledge to co-construct new knowledge, improve their skills,and to achieve changes in practice.

The online mentoring programme led to a gradual but conscious process ofimprovement over three years. Not all of the tools or human resources were availableat the outset, but this was not taken as a barrier to envisioning or embarking onchange. By enabling busy healthcare professionals to access and participate in collab-orative learning dealing with the actual and immediate problems they face, the con-cern was for the learners’ circumstances as well as their needs. It empowered them byincreasing their affective engagement, a precursor to their wanting to explore change.

This experience prompts the question: rather than developing more and morede-contextualized modular courses or discussion boards for online independent orgroup study, why not let busy healthcare professionals learn online with peersthrough practical, targeted tasks on solving their problems, and thus contribute tochanged practices through collaboration and interaction without leaving the commu-nities where they are needed?

AcknowledgementsThe author who, as the coordinator of education and professional development for theInternational AIDS Society, led this project, thanks all International AIDS Society staff whoparticipated in the programme review, design, implementation, monitoring, and evaluation –Emily Blitz, Shirin Heidari, Helena Mansson, Joris Bruchet, Helen von Dadelszen,Annabelle Jolivalt, Laetitia Leinart, Nadia Kharoua, and Betsy Muia. Thanks are also due tothe Coalition for Children Affected by AIDS for providing the abstract writing toolkit, andthe mentors who volunteered their time to review and provide feedback to the abstractsubmitters for the AIDS 2008, IAS 2009, and AIDS 2010 conferences. This article containsthe views of the author only and does not represent the decisions or the stated policies ofthe International AIDS Society.

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Notes on contributorGurmit Singh is a teacher and researcher. His goal is to empower students to network,collaborate, learn, and share with global open access to education.

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