Background: As more early career scientists enter into diverse career pathways, visiting local companies or organizations can support their exploration of these paths. As an efficient way to facilitate this, we developed a collaborative regional site visit program: theEnhancingLocalIndustryTransitions throughExploration (ELITE) Consortium.  Consortium members arrange half-day visits to local industry sites, thus providing companies and trainees the opportunity to meet and identify potential professional and career opportunities. Three different training institutions worked cooperatively in the development and maintenance of the program. The ELITE Consortium was developed with eight phased steps; guidelines and operating procedures were created for each of these steps and are provided along with sample materials for institutions interested in building similar programs.Methods: Prior to fully developing the program, trainee interests were evaluated via questionnaire. During program implementation and thereafter, program directors tracked attendance and collected career outcome data from publicly available sources to identify first job positions after training. Regression analyses and chi-squared analyses were used to examine site visit matches and career outcome data.Results: Analyses suggest a positive impact of site visits on postdoctoral and graduate trainees’ career outcomes at companies or institutions that match a similar sector  and type . Despite a small sample size, evidence suggests an especially positive impact on trainees who organize site visits to companies compared with those who simply participate.Conclusions: The ELITE Consortium was successful in helping trainees explore and identify a multitude of career paths. Trainees attained employment either directly or in related companies and institutions visited by ELITE participants. The joint, three-institution, flexible nature of the ELITE Consortium positively impacts the program’s sustainability and reach. The toolkit provided here will help other institutions to replicate and adapt the program with minimal effort. It is widely known that the number of tenure-track positions remains relatively flat while the number of PhD-holders increases —meaning To address this gap in career preparation, experiential learning has recently been applied more broadly in graduate education  Consortium. The mission of the ELITE Consortium is to connect companies that hire PhDs with PhD students and postdocs from the National Institute of Environmental Health Sciences (NIEHS), the University of North Carolina: Chapel Hill (UNC), and Duke University (Duke). ELITE helps trainees explore industry career options through site visits to leading Research Triangle Park, NC, life-science companies, and to other employers beyond the traditional tenure-track . Site visits allow trainees to learn about the different types of industry jobs open to PhDs and how best to prepare for them. These visits also provide an excellent opportunity to network with industry professionals, and to experience company culture first-hand. ELITE also benefits participating companies, who can gain positive exposure among PhD trainees and identify talent for future hiring.The focus of this manuscript is a company site visit program termed thehttps://www.fredhutch.org/en/research/education-training/office-of-scientific-career-development.html); the Explore On Site (ExPOSE) program at the National Cancer Institute (https://events.cancer.gov/cct/expose); the Bridges to Biotech multi-institutional partnership program in Maryland (https://open.maryland.gov/blog/bridges-to-biotech-preparing-tomorrows-workforce-today/); the Industry Bridge Program at Scripps (https://www.scripps.edu/about/campus-resources/working-at-scripps-research/campus-interest-groups/society-of-fellows/industry-bridge-program); and others. This sharp rise in new experiential site visit programs is a testament to the growing interest of training institutes and academic institutions in programs of this type.The concept of having trainees visit local companies and industries has previously been established as good practice at several other institutions. The industry site visit program developed by postdoctoral scholars at Massachusetts General Hospital in 2010  are examhttps://www.niehs.nih.gov/careers/research/fellows/involvement/committees/elite/index.cfm) was created to enhance the synergy from each of our three institutions’ pre-existing site visit programs and efforts, and was structured around the single-institution-based ELITE program that NIEHS initiated and formed in 2015.Building directly upon the Massachusetts and Berkeley industry site visit program models, here we describe a variation on an industry site visit program that is a joint effort between three institutions: the NIEHS’ Office of Fellows’ Career Development (OFCD), the Duke University Office of Postdoctoral Services, and the Training Initiatives in Biomedical & Biological Sciences (TIBBS) at UNC. The unique three-institution ELITE site visit Consortium , guidelines, and sample materials that other institutions could directly adapt and use. We also describe the preliminary career outcomes of ELITE consortium participants in an effort to determine whether the program impacted their career decisions and outcomes. Our purpose in providing a toolkit along with preliminary outcomes is to demonstrate initial program effectiveness and lessons learned in order to inspire development of experiential opportunities at other institutions.The ELITE program at NIEHS was originally modeled after successful programs in San Francisco, Boston, and Seattle. Briefly, attendees completed a biosketch and indicated interest in a site visit, the NIEHS Program Director selected attendees, attendees were required to attend a preparatory meeting, and NIEHS provided transportation to the site visit. UNC TIBBS also piloted a "Program for Industry Exploration" (PIE) prior to joining ELITE, and Duke was informally visiting companies about once per year. While these parallel institutional site visit programs were either modeled after others’ programs or developed in-house, we found that key adaptations were needed for continued success in our local environment. One of the most impactful adaptations involved inter-institutional collaboration. With this adaptation, all three institutions  joined together to form the ELITE Consortium; we share the work of organizing visits, and an equal number of trainees from all three institutions may attend each site visit, regardless of the organizer that month. Besides decreasing the burden on any particular institution to plan all of the site visits, it enabled us to have a critical mass of attendees, which made better use of the company’s time, and thus increased their interest in hosting such an event since they could reach a more diverse audience—in short, because the program was explicitly a joint effort, companies were quicker to say “yes” to hosting a visit.https://medschool.vanderbilt.edu/career-development/aspire-on-the-road/#:~:text=ASPIRE%20on%20the%20Road%20is,make%20well%2Dinformed%20career%20decisions) and the University of Chicago’s Trek Program (https://careeradvancement.uchicago.edu/student-opportunities/treks) have also adopted cover letters as part of their application process.Another key adaptation involved the way in which trainees apply to attend a site visit. NIEHS began the original ELITE program in a manner similar to UC Berkeley’s Postdoc Industry Exploration Program  which inThus far, we have described some basics of the ELITE Consortium site visit program, as well as key adaptations that have made this joint program successful. Next, we describe the finer details of how the program works—including program variations at each member institution. Our goal is to provide a detailed framework that other institutions can use in order to seamlessly replicate, adapt, and/or expand this program for their trainees.Underlying Data S1 , we provide a detailed framework for how to identify contacts within a company, and we recommend doing so approximately 4–6 months prior to an anticipated site visit date. Additional considerations include confidentiality and liability. While rare, companies have occasionally requested that attendees sign non-disclosure agreements; thus we suggest that organizers coordinate with the company and check with institutional subject matter experts  to ensure compliance with institutional guidelines. In case of questions from the company about liability, it is also important for institutions to clarify the extent of their coverage . Each of our institutions’ coverage extended to trainees while off campus and one should check their own institutions’ local policy.Institutional variations: NIEHS’ program was originally designed by trainees, and the organizing committee consists of staff within the Office of Fellows’ Career Development as well as a committee of trainees. For any particular site visit, an individual trainee can volunteer to be the lead organizer of a site visit; the SOP was originally written for trainees since their time at an institution is limited. The SOP helps to consolidate knowledge and best-practices, and it simplifies, streamlines and de-mystifies the process for trainee volunteers. Trainee volunteers also receive a sample ‘first contact’ letter template (seeExtended Data: S2) to assist them in communicating with company representatives. Sample Agendas , that trainees are not involved in the selection process and do not see the letters submitted. Before the selection process begins, institutions take note of the number of spots available for the site visit in question. Depending on what a company can accommodate, site visits typically include 15–50 participants, with the vast majority of visits hosting 20–25 participants. Keeping these numbers small allows for a smaller attendee-to-company-scientist ratio which could provide a more engaging learning and networking environment. The available spots are divided evenly among Duke, UNC, and NIEHS, regardless of the institution that is planning that particular site visit. As part of the selection process, cover letters are evaluated on the degree to which they are tailored to the company being visited. Typically, the number of cover letters submitted per institution allows us to accommodate all applicants by sharing open, extra spots across institutions if there are more applicants at one institution versus another. Once we begin to reach capacity, program directors make every attempt to accommodate all applicants—they often release their own designated spots to trainees, and they may contact the company host to ask whether the company can accommodate additional participants. In the rare instances in which capacity is reached, we may prioritize trainees who are more senior in their training fellowship (or nearing graduation). We may also prioritize attendance for those who have participated in the NIEHS ELITE organizing committee or those who have demonstrated other leadership involvement. Another point to note—since a trainee organizes the site visits at NIEHS, the organizer automatically reserves a spot to attend. Extended Data: S8 , preparatory meeting , UNC identifies a location and time where participants gather well in advance of the site visit time. Trainees may volunteer to drive the program office’s van. For those who choose to drive individually or arrange carpooling among themselves, UNC instructs individuals to arrive to the site visit no later than 15 minutes before the site visit start time. Because Duke does not have institutional vehicles available to reserve, participants drive their personal vehicles and are encouraged to carpool. Carpooling is often discussed at the prep meeting. As at UNC, the option for personal vehicle use or carpooling is necessitated by the fact that many participants are spread out across large campuses. Trainees are encouraged to arrive at least 10 minutes early.The fact that each of our three institutions have varied transportation models ranging from group-to-individual-transportation demonstrates that a site visit program can be successful with any of these models, and institutions should adopt the one that best suits trainees in their institutional environment.Site visit day. A site visit typically lasts three hours, and may involve a variety of activities , which differ based on the type of company visited—for example, whether bench- or office-based. A site visit frequently begins with a company overview presentation in order to provide participants with a basic understanding of what a company does. Site visits also often include a panel discussion with scientists working in a variety of positions across the company so that participants can learn about the different types of positions. Participants have found it informative to learn from both those in more senior roles as well as those who recently made the transition from academia to industry. Site visits may also include presentations from Human Resources representatives, and they may include an informal networking session to give participants a chance to mingle with company representatives. If the visit is to a company that primarily conducts bench research, participants are often provided a detailed tour of the company’s facilities.Follow-up. After a site visit, institutions follow-up in various ways. Participants are encouraged to immediately send an email thanking the company host and any company representatives that they connected with during the site visit. Participants are also encouraged to connect with company representatives on LinkedIn using a tailored invitation. Trainees may further follow-up via informational interviews with company representatives over coffee, lunch, or the phone. Some institutional program staff maintain a collection of thank-you cards; trainees are encouraged to sign and send a group snail-mail card to the company host. Some institutions may choose to send a gift basket or other token of appreciation to the company host (government funds are not used for these purposes). Once we organized the site visits, we identified key metrics to record each site visit in order to assess the program’s success. To maximize sample size, data from all three institution’s attendees were pooled and we standardized data collection criteria. Program participants’ career outcomes were evaluated by collecting publicly available career outcomes from the internet. Career outcome data were then grouped into taxonomic tiers jointly agreed upon by the authors, particularly those corresponding to Tier 1 of the commonly used PhD Career Outcomes Taxonomies , and being hired at a company sharing the same Tier 1 coding . MS Excel logic functions were used to create variables that quantified matching pairs . We recorded if the participants attended a site visit, if they were hired at the visited company, if they were hired at a company of the same type , and if they were hired at a Tier 1 match  by checkmark. We converted the Boolean checkmarks to binary 1’s and 0’s, and applied IF ELSE statements to the columns to simplify analysis. We compared the visited categories to the hired categories for each attendee. For example, IF attendee visit equals 1 (true), check the hire location to see if it matches the visit location and record 1 (true) for hired at site visit, ELSE record 0 . The same logic was applied to the type of company and tier one category of company. Due to not offering governmental site or teaching-intensive university site visits, the Sector (Tier 1) match analysis specifically compared For-Profit matches, but did not count other matches  because there were few site visits that fell into any of the latter three categories; hence only for-profit matches were included in the match count.Program summaries. Site visits included in this summary were held between 2015-2019, including 30 total site visits with 24 unique sites/companies total (https://www.niehs.nih.gov/careers/research/fellows/involvement/committees/elite/index.cfm contains full list), and 250 unique ELITE participants split approximately equally across the three institutions. We limited our career outcomes data analyses to those that graduated or were hired since attending an ELITE site visit  through January 2020. Among those who participated and are now in their first position post-training, postdoctoral trainees (n=79) constituted 63% of the sample while doctoral students (n = 46) constituted the other 37%.Participants. On average, ELITE participants who have since been hired into a first position attended 1–2 visits total , Biotech , and Pharma ; a small percent were affiliated with academic institutions and did not clearly fit into any of these categories and were hence coded as “not applicable” N/A .Planned analyses. Summary statistics are provided to represent program participation for trainees and companies/organizations. Differences in career outcomes for graduate vs. postdoctoral trainees were tested using Chi-Squared analyses . Logistic regression was used to test the hypothesis that attending more site visits was associated with a greater chance of being hired at a site visit company (or in that sector). IBM SPSS v26 was used to run analyses.not the stated goal of these site visits (and this is repeatedly emphasized to trainees in the mandatory prep visits), when hiring opportunities arose organically, they were a beneficial outcome for both the trainee and the company. While only 8% (n=10) were hired at a specific company they visited . Furthermore, by definition, all of these were also company-type matches. This may indicate that an in-depth, meaningful interaction with company representatives while organizing site visits results in a stronger personal connection; it provides trainees an ability to demonstrate planning/organizational skills and professionalism; and it also offers an extended opportunity to connect and network beyond introductory levels. Furthermore, a person’s character and passion for the company may better shine through during prolonged planning interactions.The large number (n=82) of participants hired into a similar company type (and even a few into the specific companies) suggests that attending site visits is helping the trainee find and/or display a good fit with the company, type, or industry. While we can’t isolate a single mechanism, it seems likely that trainees may have been able to confirm or deny their interest in a particular type and sector of company/organization, and perhaps these visits impact their interest and confidence in applying; knowledge of the roles and responsibilities of different positions; ability to create competitive application materials using appropriate industry terms; and networking connections within the industry. Further research is needed to tease apart the specific route(s) by which the site visits made a difference in trainee job searches and application processes.https://www.ncbiotech.org/about/history-of-biotechnology-north-carolina#panel6).Of ELITE participants hired at a matching company type, 57% (n=47) were hired at CSOs, 23% (n=19) at Biotech, and 20% (n=16) at Pharma. Participants from our sample were hired into CSOs at a high rate (at about twice the number compared with each of the other categories), which is not surprising given that the local job market is highly saturated with this type of organization. In fact, North Carolina has the greatest concentration of Contract Research Organizations in the world =.26,p=.88). Although more postdocs were hired into positions across all three categories, there were more postdoc participants in the sample, so this did not differ from variations expected by chance based on the sampling distribution.Overall, there were no differences in being hired into a specific company type when comparing postdoctoral and graduate trainees =10.29,p=.001) favored postdocs in for-profit positions, with a split roughly equally for graduate students in for-profit and other sectors compared with postdocs in other sectors = 9.18,p=.002); however, the 2×2 Chi-Squared did not indicate a proportional difference from chance for the combined effect of postdoc vs. graduate student into for-profit vs. other sectors = 1.90,p=0.17, NS). Hence, while a slightly greater proportion of postdocs entered for-profit directly compared with graduate students, the combined effect was not significant. This could partially be explained by the higher incidence of graduate students entering into postdoctoral training whereas a natural next step for a postdoc is full-time employment  were compared between doctoral and postdoctoral trainees. For-profit vs. other  = .03,p= 0.87, NS). Hence, any differences in postdoctoral versus graduate hiring rates seem to be accounted for by rates of continued training being more prevalent in graduate student populations than for postdoctoral trainees .To better understand if there was any effect for postdocs or graduate students transitioning into for-profit roles, we ran a further post-hoc analysis and removed trainees who entered into training positions as their next step . When trainees who entered into a subsequent training role were removed from the sample, 67% of graduate students vs. 69% of postdoctoral trainees constituted matches on tier 1 sector for-profit hires . Site visit participation continues to show a significant positive impact when controlling for graduate/postdoc status ; there was no significant difference between graduate or postdoctoral status . In other words, attending more site visits made one more competitive as a future hire, regardless of whether one was a graduate student or postdoc.Some of this effect could be driven by the fact that site visit organizers tended to attend more than others see; nonetheOverall, the ELITE program was successful in its mission: to help trainees explore industry career options through site visits in Research Triangle Park, NC and to other employers beyond the traditional tenure-track. We saw significant numbers of both graduate students and postdocs hired at companies that match the type of company they visited, and several successful hires at the same sites visited. The visits were succinct and effective, even under the time constraints of a half-day visit. The program identified trainees looking for a variety of career options and companies looking for new talent, and coordinated the two fairly and representatively. Not all effects achieved significance which may be in part due to the limited sample size; nonetheless, emergent trends were identified.In summary, there are different institutional models for a site visit program’s operation, and they can each work to meet the needs of the institution while still allowing for collaboration and serving to benefit the overall ELITE Consortium. It is important to figure out the optimal attendance capacity for visits and optimal frequency for each set of institutions and partners in your area, but it is also common to have trial and error while working out the ideal size.The benefits and challenges of collaboration are varied. Benefits include less time per institution for planning; companies are more interested in hosting because they can reach multiple institutions simultaneously; and hosts have a guaranteed critical mass to make it worth the company’s time with higher attendance. Challenges include the additional complexity of coordination across multiple sites  such as establishing common date decisions, number of trainee acceptances, etc. While collaboration means there is the drawback of fewer overall spots per institution, a benefit is that when a particular host company is less popular at one institution, critical mass can still easily be reached. However, on occasion a host company may be popular across all three institutions, in which case less attendees per institution can be accommodated than if each had arranged separately. One other potential pitfall for institutions with trainees organizing the visits is that program leadership may need to educate trainee committee members on business etiquette in order to avoid any potentially negative interactions that could damage either the image of the Consortium or an individual’s professional image. To date, we have not experienced this pitfall, but it is a potential risk to consider – especially if early-stage trainees are involved in planning a site visit. In our experience, trainee involvement in planning has been a tremendous benefit, and having planners across sites has balanced-out responsibilities for planning well. However, it does require close interactions and real-time communication during the trainee site selection/ organization process, so working closely with colleagues across all institutions is important.To better understand the time-associated benefits and/or challenges of collaborating with trainees and other institutions to organize a site visit, we estimated the amount of time it would take a program director to organize a site visit in different scenarios. Organized independently, it requires ~12.5 hours for a program director to organize a single site visit from start to finish—including all steps from identifying and contacting companies through attending the site visit itself and following-up afterwards. If a program director alone were to organize and attend one site visit per month for a year (12 visits/year), this would amount to an average of ~150 hours spent in a year. Collaborating with a trainee at one’s institution would reduce a program director’s hours by 20%. Extending this further to collaborate with two other institutions in the model described here reduces the total time spent per year to about 96 hours, which amounts to ~2.5 weeks of FTE time. These estimated hours all suppose that a program director is also attending each site visit, which takes up a significant portion of the time. If they choose not to attend the site visits, then the amount of time spent organizing in the collaborative model is further reduced to 36 hours per year. As illustrated, depending on the time constraints of the program director and needs of the institution, one can adjust their level of time commitment by using a program model that best fits their needs—whether by collaborating with more institutions and/or adjusting the number of site visits planned in a year.We have also observed a multitude of benefits for trainees. For the institution with trainee-organized visits especially, the postdoc leadership experience, professional communication experience, and networking opportunities have provided valued benefits. In addition to our data that suggests benefits to trainees who may be future applicants in the for-profit sector or to a particular company type, we learned anecdotally that some trainees were hired specifically because they demonstrated outstanding communication skills while organizing an ELITE site visit on behalf of the Consortium. We surmise that the trainee/company interactions may allow company representatives to observe trainees in action, thus allowing employers to unofficially evaluate them as potential future colleagues. Other benefits include cover letter practice writing, learning about a variety of companies, and networking between postdocs and graduate students across all three institutions in the Consortium—besides the obvious benefit of networking with company professionals. This benefit was manifest in a number of ways, one of which included the fact that some company HR representatives voluntarily offered to prioritize ELITE participant job applications for review. Furthermore, a larger pool of program alumni from the Consortium has created contacts for future site visits, resulting in a synergistic effect which can then lead to future trainees being hired and/or learning more about company types through informational interviews, etc.Anecdotally, some representative comments about participation benefits included the following:Thank you for selecting me as one of the applicants to attend the [Company] site visit. It was a great experience, and I enjoyed learning about the company culture and what it is like to work for a contract development/manufacturing organization. I think the ELITE program is a great way to help us postdocs make local industry contacts, and I hope to be able to participate in future site visits.” – ELITE Participant“The site visit to [Company] was awesome. Such exposure to industry is invaluable to Postdocs like me. Thanks for helping coordinate that visit.” – ELITE Participant“I love the environment of [the organization]. Thank you very much for your time and the previous chance of visiting [the organization]! Hopefully, I can naturally transfer to the clinical research field as you.” – ELITE Participant“The cover letter application is a good technique for applications and the actual site visit was excellent!” – ELITE Participant“What I most liked about the [Company] visit was] the ability to hear from employees at varying stages of their career. The mix of hearing from early/newer employees all the way up to the VP and CEO was really great. Really enjoying the small group discussion/networking session opportunities to ask more questions!” – ELITE Participant“, have you changed your mind about the career path you plan to take?” (47 yes); “If YES, asked “Please explain the factors that contributed to your change in career interest.”While we do not have conclusive data, it seems likely that at least some of the many trainees who didFurthermore, in response to the question: “Please list any suggestions for additional events or workshops that [we] should offer:” one respondent indicated that “[they] wish[ed] there were more options for ELITE site visits- the past few have seemed like they're all geared towards bench science careers in industry that are very specific to a certain area of research that I feel like only a few graduate students would be qualified for... So maybe something a little more generalized.” Hence, a future direction would be to create site visits to a broader range of companies, perhaps even outside the scope of science-specific companies.https://www.nsf.gov/statistics/srvydoctorates/#tabs-2), show that the percentage of life scientists that report entering postdoctoral training ranged from 59–65%. While this data is not conclusive, it at least suggests that there may be merit for further investigation. This is an issue that has long been a concern of the biomedical workforce , only 24% (n=10) continued on to postdoctoral positions whereas 76% (n=36) continued to permanent employment. In comparison, national results from the NSF Survey of Earned Doctorates between 1998–2018  so I’m happy to be able to pay it forward now.” - Alumni/Employer“Anecdotally, the ELITE program has resulted in additional employer engagement opportunities outside of site visits. In one example, a site visit resulted in a company representative volunteering to present a separate session at one of the ELITE Consortium member institutions, in which the representative explained the company’s career path options and trajectories to a broader audience. Fellows really appreciated the company representative explaining what the position titles meant, and explaining the career ladder progression at the company.It was great to see you here at [Company] and to interact with the fellows who came with you. I’m happy to help out as much as I can with answering questions and providing advice, so please feel free to keep using me as a resource for fellows who are interested in patent law. And if anyone sees something here at [our company] that they are interested in applying for, or if they want to speak with someone here about work in a particular field , you can certainly reach out to me and I can put them in touch with the right person.” - Employer“It was a pleasure meeting all of you – there are so many opportunities available, whether you stay in academia or go to industry or government. Kudos for seeking out information to make the best decision for you (and extra kudos for the follow-up e-mail – it matters more than you might think). Happy to connect on LinkedIn, or chat further if you have additional questions.” - Employer“A variety of limitations should be considered in the context of this study. One such limitation includes the potential for self-selection bias in that those individuals who apply to participate in this program may be more likely to already have career exploration experience and/or experience writing cover letters. We also recognize that preparation and understanding of career development processes may not be equitably accessed, which could influence site visit participation. Another potential limitation includes lack of a formal negative control comparison group. This is a common challenge in observational studies in which it may be unethical and/or impractical to deprive or delay participants’ access to professional development at crucial points in their training. Furthermore, in order to compare sector or company type matches, one would need an indicator, which in this case was attending an ELITE site visit in a particular sector/company type match. Hence there wasn’t an analogous ‘match/no match’ dataset for non-participants. Furthermore, intent to pursue additional training  may influence immediate career decisions and could impact first-destination outcomes. The current study did not account for intent to pursue additional training and future studies should account for this intent versus intent to directly enter the workforceFuture directions could also involve exploring different binnings of company type as well as how interest, exposure, and first job match is related to specific roles . Our site visits covered a multitude of roles within each company type and hence career outcomes for specific roles could not be matched at this level of granularity. In addition, studies should explore other ways to define matches to include entrance surveys for whole populations assessing career interests which could be matched for participants versus non-participants at the end of their training. Furthermore, to complement quantitative analysis of career outcome matches, a comprehensive qualitative evaluation could provide more robust insight about the benefits of participating in the ELITE program. In addition, it will be important for future work to replicate this program using the toolkit at other institutions and evaluate its effectiveness, and/or to collaboratively conduct cross-site evaluations with similar existing programs.Additional limitations included the lack of ability to examine demographic influences, unknown generalizability beyond life sciences, and reliance on a geographic convenience sample of companies. First, we were unable to examine career outcomes by demographics, such as gender, race/ethnicity, international status, etc. It will be important for these variables to be examined in future research in order to identify who is participating  as well as whether there are career outcome differences across groups. Second, our sample of trainees and companies were both life-science heavy by virtue of the population of participants served by the founding program directors and the high concentration of life science companies in this area. Third, we acknowledge that geographic location may influence concentration of available companies for site visits, especially given that Research Triangle Park is a major life science hub. However, future directions could explore virtual options as well as TREKs . We believe virtual site visits will become increasingly pivotal for creating experiential learning opportunities for trainees interested in exploring industry, especially given the need for alternative options created by the global pandemic. Future directions should continue to explore the efficacy of virtual visits and other types of digital collaborations and connections between universities and companies.Given the potential need for virtual visits now and into the future, we are currently exploring opportunities to pivot these types of programs into a virtual space, as it seems likely that this will be an area of future growth. In fact, leaders in graduate education have issued calls for a greater focus on preparing trainees for broader career options especially due to the implications of COVID-19 on a global economy . AnsweriOur data suggests that a minimal amount of professional development time has shown significant positive impacts on career outcomes. Because this program has the potential to help many other graduate students and postdoctoral scholars, we wanted to reduce the barriers for other institutions to replicate such a program. Therefore, we have included a toolkit for developing a site visit program with local industry that can be adapted for single- or multi-institutional programs. The SOPs contain sample communications, marketing materials, policies, presentations, and program structure recommendations. We share lessons learned to create a robust, sustainable program. Furthermore, given resource scarcity, site visits can provide exceptionally effective professional development programming with minimal cost. In our experience, however, there is still a demonstrated necessity for including staff oversight and coordination time to develop a program that can run efficiently and consistently while ensuring professional business etiquette with industry – whether or not the staff take the role of the primary planners or as coordinators with a trainee planning committee.This activity was determined to constitute Non-Human Subjects Research (NHSR) as part of the NIH BEST Consortium under the auspices of the University of North Carolina IRB (IRB Number 14-0544). For the student surveys referenced herein, information sheets were provided to trainees, along with additional consent information for any who elected to complete surveys in which case they consented by continuing the voluntary survey. Summary: The article describes the conceptualization, implementation and preliminary evaluation of a career development program termed Enhancing Local Industry Transitions through Exploration (ELITE) that is aimed at postdoctoral researchers and senior graduate students in three research institutions  in and around the Research Triangle Park, North Carolina. As the number of PhD holders keeps increasing while the number of tenure-track positions remains constant, there is an increasing need for trainees at research centers to explore industry opportunities. The ELITE program was established to facilitate site-visits to local industries that provide networking opportunities between the candidate and the company. Unlike other student/trainee driven career programs, at ELITE the institutional staff of the participating institutes serve as lead organizers. The authors provide  (i) a detailed toolkit, including standard operating procedures (SOP) for initiating first contact with company partners, selecting appropriate candidates from the application pool, organizing transportation and logistics for travel as well as fostering, and maintaining future relationships with the company partner organizations after the site visit.  (ii) an analysis of how successful the ELITE trainees are in finding jobs in the industry. The toolkit illustrates a framework with a detailed standard operating processes (SOP) for initiating first contact with company partners, selecting appropriate candidates from the application pool, organizing transportation and logistics for travel as well as fostering, and maintaining future relationships with the company partner organizations after the site visit. The toolkit and SOP are bound to be a useful resource for trainees at various research institutions wanting to organize site visits to local industries.  The framework is beneficial for all stake-holders, for the trainees, it provides a platform to learn writing cover-letters, business etiquette and conducting background research on companies before the site-visit. For the company partners it provides activity templates for conducting a successful site-visit.  The article reports that several of the trainees successfully transitioned to the industry of their choice and that many ex-alumni of the program have anecdotally praised it. In conclusion, considering the limited opportunities to find an academic position, the article supports an important point about the necessity of career development avenues for postdoctoral researchers.General Comments: Minor comments:For the data collected for the manuscript, mention the years or months for which the ELITE program was operational, and comment on how representative the data is across the different years / institutions.Figure 3 is unnecessary. Figure 4, 5 and 6 can be condensed to panels of a single figure, or a table.Use “graduate students” in place of the colloquial “grad students”. Pages 10,13. Minor clarification:If possible, is there data available on how many candidates of the ELITE program that successfully transitioned to the industry were international candidates? And how many industrial partners were willing to sponsor work visas?Does the program only focus on life sciences related industries? Do other non-life science candidates benefit from the ELITE program?Is the work clearly and accurately presented and does it cite the current literature?YesIf applicable, is the statistical analysis and its interpretation appropriate?YesAre all the source data underlying the results available to ensure full reproducibility?YesIs the study design appropriate and is the work technically sound?YesAre the conclusions drawn adequately supported by the results?YesAre sufficient details of methods and analysis provided to allow replication by others?YesReviewer Expertise:NeuroscienceWe confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Response to 1: Thank you for this suggestion, we have now included additional information to clarify this. Data includes all site visits from program inception (2015) through December 2019 and accepted job offers and/or start dates reflecting the same period. Excluding 2015, in which the program was just beginning to be formed, approximately 6 site visits per year were conducted. Participants were split approximately equally from all three institutions . Please refer to the “Program summaries” section under “Methods” where we have modified the text to include this additional information.Response to 2: Thank you for noting this; while Figure 3 doesn’t present data, it was provided as an example of program branding for institutions who may want to replicate their own site visits so we have chosen to retain it.Response to 3: Thank you for pointing out that these figures could be consolidated. However, they were developed to help convey information through individual visualizations in order to highlight specific findings and better engage the reader. Because of the distinct purpose of each figure, we have elected to have them remain separate.Response to 4: Thank you for pointing that out; we have modified the article and changed all incidents of “grad” to “graduate.”Response to minor clarification 1: We acknowledge that this information would be especially informative for international students considering their career possibilities. While we do not have access to that data in the current sample, we agree that this is an interesting area to consider in future studies. We have now added a comment in the new limitations and future directions section: “Additional limitations included the inability to limit career outcomes by demographics, such as gender, race/ethnicity, international status, etc. It will be important for these variables to be examined in future research in order to identify who is participating as well as whether there are career outcome differences across groups.” Response to minor clarification 2. For the ELITE program, site visit participation was not explicitly limited to those in the life sciences, but we acknowledge that there is a strong representation of life science trainee participants based on the composition of those that program directors marketed the program to via listservs. Likewise, the ELITE program site visits were not strictly limited to life sciences by design--nonetheless, life sciences companies are very common in the Research Triangle Park area. We have added additional text within the new limitations and future directions section: “Second, our sample of trainees and companies were both life-science heavy by virtue of the population of participants served by the founding program directors and the high concentration of life science companies in this area.” In this article, the authors describe the development, implementation, and results of their “Enhancing Local Industry Transitions through Exploration (ELITE) Consortium,” a multi-institution industry site visit program designed to provide career exploration, company culture exposure, professional etiquette practice, and networking for biomedical graduate students and postdoctoral scholars in the Research Triangle region of North Carolina. They provide a detailed toolkit for other institutions to use in order to implement and execute their own site visit programs, and they discuss benefits for both the program participants and the employers visited. Additionally, the authors convey the career outcomes of program alumni in terms of their employment at contract research organizations, biotech companies, or pharmaceutical companies – the types of companies visited in this program. Specifically, the authors state that trainee site visit participation is positively correlated with being hired to the company visited, or to one of these three company types. In their cohort, this effect was significant for those who attended more than one site visit, namely trainees who organized the industry site visits, but not significant when these individuals were excluded from the analysis. The strength of this article is it provides a toolkit to establish this type of collaboration and program. The article, and the included toolkit, is a facilitators guide that includes timelines, standard operating procedures, communications, agendas, and data collection tools. Historically, a limitation of these types of programs is that their feasibility relies on geographic location – a university located in or near a pharmaceutical and biotechnology hub, like Research Triangle Park, will have a greater ability to form the partnerships required for such a program, simply due to proximity. However, as the authors note in their discussion of future directions, these programs can be adapted from a physical to a virtual space, utilizing technologies that are now more commonplace due to the COVID-19 pandemic, such as Zoom or Remo. Despite this strength, we are concerned that the two conclusions stated by the authors – that site visit participation is correlated positively with being hired at one of these company types, and that site visit participation helped trainees explore industry culture and careers – are not supported conclusively by the data provided in the article.There is a lack of a control group for comparison. Inclusion of a local control, or comparison to national career outcome data for biomedical trainees, would help indicate whether the outcomes for this cohort differ from those who did not attend a site visit, or from national trends.Selection biases and equity are not addressed. For example, is there a self-selection bias of program participants among trainees who may have already intended to apply for roles at a contract research organization, biotech company, or pharmaceutical company? Is the application process itself a barrier to entry for people in earlier stages of career exploration? Is there a selection bias for applicants who were more skilled at writing a mock cover letter, opposed to selection based on whether their intended goals aligned with those of the program? Since exclusion criteria are not detailed in the article, we wonder what criteria were used to evaluate how well a cover letter was tailored. Secondarily, the authors include only anecdotal evidence for several claims pertaining to the success of their program. Statements, such as those below, seem overreaching given the limited data. “…our data suggests that positive benefits can arise with as little as 4–12 hours of time invested in professional development, networking, and experiential immersion during site visit activities.”  “Thus, while site visits did not necessarily act as direct career pipelines, they did allow for attendees to gain a sense of the culture within a particular company type and sector, allowing for them to have a more confident match in their future careers.”   These statements would be strengthened by inclusion of data pertaining to how these variables  were evaluated, and how the success of the program was evaluated overall.  Primarily, we feel it is overreaching for the authors to claim a causal relationship, significant or otherwise, between site visit participation and career outcome, given the data provided. We’re specifically concerned about the following:  To improve the authors’ conclusions with the data they have, we think a stronger case could be made by separating the program description, toolkit, and benefits from the story about career outcomes, allowing each to stand on their own.  For the program, toolkit and benefits story, addition of program evaluation criteria would benefit not only the toolkit for someone who wishes to emulate the program, but also strengthen the conclusions made about the benefits and impacts to the cohort studied here. Additionally, we suggest the authors investigate more the qualitative data from their program. It seems that they have quite a few written testimonials from both employers and participants; perhaps these responses could be coded, and further conclusions drawn that would flesh out the program benefits and could support the quantitative career outcomes data.  It would also allow for a more in-depth analysis of their program in context of the current literature. For example, how does the ELITE program compare with other research into internships, job simulations, and other kinds of career exploration activities, and can you draw some conclusions about how site visits provide some of the same benefits in a shorter amount of time? Or do they provide additional benefits, such as employer engagement, not offered by traditional career exploration activities?  For the career outcomes story, we feel that, aside from addressing our concerns stated above, studying a larger cohort is necessary in order to strengthen evidence that a positive correlation exists between site visit attendance and being hired at a company. To do so, the authors might consider partnering with another entity who runs a similar program. For example, the Society of Fellows, the postdoctoral association at The Scripps Research Institute, runs a long-standing industry site visit program, much like that at NIEHS. Not only would this increase the size of the cohort, but would also strengthen the authors’ most compelling evidence that being a site visit organizer significantly increases the likelihood of being hired in industry, as Scripps’ organizers are postdoctoral scholars.Is the work clearly and accurately presented and does it cite the current literature?YesIf applicable, is the statistical analysis and its interpretation appropriate?I cannot comment. A qualified statistician is required.Are all the source data underlying the results available to ensure full reproducibility?YesIs the study design appropriate and is the work technically sound?PartlyAre the conclusions drawn adequately supported by the results?PartlyAre sufficient details of methods and analysis provided to allow replication by others?YesReviewer Expertise:career counseling, career development, program development and evaluation, career education researchWe confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above. Response to 1: We agree that this is a methodological limitation; more detail is addressed in our response to Reviewer 1Q4 who raised the same concern. Please note that we also address this concern in the newly added "Limitations and future directions" section of the manuscript.Response to 2: Minimizing biases and ensuring equity during the selection process are important considerations for any program. We address a similar concern about selection criteria in our response to Reviewer 1Q1, and note that we also included discussion in the newly added "Limitations and future directions" section to address this. Equity and access issues have also been acknowledged and the following sentence has been added to the "Limitations and future directions" section of the manuscript: “We also recognize that preparation and understanding of career development processes may not be equitably accessed, which could influence site visit participation.” We also acknowledge that additional inequities exist . The ELITE program could help to explicitly overcome this by expanding networks and connecting to individuals primed to take action to assist in job seeking at the company.Response to 3: Thank you for raising these issues. Reviewer 1 had the same concerns which we address in our response to R1Q4 and R1Q7. Additionally, we added text to the new Limitations and future directions section of the manuscript as indicated above. Response to next statement about separating the manuscript: The purpose of this study was to assess initial program outcomes and to provide a toolkit to help facilitate the adoption of site visits by other institutions. We feel that it is important to include initial program outcomes alongside the toolkit in order to provide an initial preview of the potential benefits of such a program. In the future, it will be interesting to conduct additional studies to better ascertain the mechanism(s) and the degree to which site visits may help trainees make more informed career decisions. We have modified text in the Introduction to include the following statement: “Our purpose in providing a toolkit along with preliminary outcomes is to demonstrate initial program effectiveness and lessons learned in order to inspire development of experiential opportunities at other institutions.” Furthermore, to acknowledge the importance of replicating the toolkit, we included the following statement in the new Limitations and Future Directions section: “It will be important for future work to replicate this program using the toolkit at other institutions and evaluate its effectiveness.” Response to the next statement about evaluation: We thank the reviewer for their feedback and agree that further research would allow us to better assess all of the benefits of conducting site visits. These will be important topics to pursue in future directions; we should note that all of the testimonials from employers resulted from unsolicited feedback and subsets of trainee self-report survey data . We did not systematically collect qualitative data for a comprehensive evaluation and we agree this would provide a rich data source for future studies. The following statement has been added to the new Limitations and future directions section of the manuscript: “Furthermore, to complement quantitative analysis of career outcome matches, a comprehensive qualitative evaluation could provide more robust insight about the benefits of participating in the ELITE program.”Response to next statement about cohort size: This is a fantastic idea and we agree it would provide not only a greater sample size but allow for additional multi-site comparisons of program success. Examples of great potential collaboration opportunities include but are not limited to the variety of program examples we included in the manuscript. We also modified the article to include Scripps’ Society of Fellows Industry Bridge Program. Thank you for bringing this to our attention. We also modified the text within the Limitations and future directions section to include the cross-site evaluation recommendation: “...to collaboratively conduct cross-site evaluations with similar existing programs.” Methods were thoroughly written and a great idea for SOPs to involve multiple-institutional collaboration. Here are some points which should be addressed. 1) Site visits are valuable, but the authors should address other variables which could have contributed to the hiring of these graduates, such as their professional development before or after these site visits. What other factors may have contributed to the hiring of these graduates? The authors should state these in their discussion  - as just having a site visit is not the only factor in the hiring of these graduates. a) Selection of attendees was by cover letters which already skews the pool of attendees who are deeply invested in their own career development, who had already perhaps attended cover letter-writing training. b) The selection process also used "leadership involvement" which selects for students who are driven in their career development already. 2) Under joint program development: students were asked for their interests in R & D, pharma and CROs - some of these overlap, as all of these categories can contain R & D. This is related to point 5. 3) Site visits - were there any liability waivers which the trainees had to sign? Just a question which could be a supplemental form in the future. 4) Methods - data collection to "assess the program's success" - what defines success here? Career outcomes of participants? The proper negative control would be to collect employment data from a group of graduates who did not attend site visits, or even better, if the control group did not attend site visits, but had simliar interests, academic productivity and similar leadership experience. If this control was not collected, this has to be addressed in the discussion, as being a limitation of this study. 5) The cutoff of 20,000 or less employees for biotech and 20,000+ for Pharma seems random - the type of career which the graduate enters should be assessed by their specific role. i.e. R & D, Medical Affairs, Business Development - regardless of the title/type of organization. Both biotech and pharma hold all of these roles. A more detailed analysis would be to see if the graduate obtained a job in the area of interest they had expressed prior/during site visit. Most students who are interested in R&D go into R&D, regardless if it is in biotech, pharma, non-profit government, CRO. This would affect the statement in the Results "Thus, while site visits did not necessarily act as direct career pipelines, they did allow for attendees to gain a sense of the culture within a particular company type and sector, allowing for them to have a more confident match in their future careers." If authors do not have this data , this should be addressed in the discussion. 6) Under program summaries, the authors state n=126 but the total number in figure 4 is 141. 7) "Hence, our data suggests that positive benefits can arise with as little as 4–12 hours of time invested in professional development, networking, and experiential immersion during site visit activities." With the caveat that a negative control group does not exist here. 8) The sample number of organizing trainees (n=5) is too small to make any conclusion. Although yes, the numbers who were hired by the company 3/5 is 60% - probably best to leave it as just the number and not a percentage. 9) Fig 6: What are the numbers of graduates these companies hired who did not participate in the ELITE program? This would be a control group. If authors cannot obtain this data, this would be a discussion point. 10)  "In one institution’s sample of ELITE participants (n=46 graduate students), only 24% (n=10) continued on to postdoctoral positions whereas 76% (n=36) continued to permanent employment." Trainees attending these site visits are more likely to be the ones who have decided to not pursue a postdoc. Maybe an intake question for the next site visit. 11) Another factor which could have been discussed is geography. Research Triangle Park is a research hub - how many of these graduates are employed by these institutations because they live here? How many of these ELITE students left NC area with what type of career outcome? These points should be addressed in the discussion and/or future directions to make this publication a more thorough report and study.Is the work clearly and accurately presented and does it cite the current literature?YesIf applicable, is the statistical analysis and its interpretation appropriate?I cannot comment. A qualified statistician is required.Are all the source data underlying the results available to ensure full reproducibility?YesIs the study design appropriate and is the work technically sound?PartlyAre the conclusions drawn adequately supported by the results?PartlyAre sufficient details of methods and analysis provided to allow replication by others?YesReviewer Expertise:Graduate professional development, industry collaborations, graduate curriculum, site visits, mentorshp, career outcomes of graduate students.I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Response to 1-a & b: We made every effort to accommodate nearly all applicants for each site visit--including asking the companies if they could accommodate a few extra people when the applicant pool was high, and including giving up ‘program director’ seats to trainees. We acknowledge that writing a cover letter requires effort and planning, and at the same time we do not expect that this creates an insurmountable barrier for graduate and postdoctoral trainees. While we acknowledge that some self-selection bias may occur, the process of practicing cover-letter writing and thus researching the company will help strengthen their job application skills and thus competitiveness on the job market. In addition, we acknowledge that many factors may influence the hiring of graduates into these companies. Self-selection bias has now been acknowledged in a new limitations and future directions section added to the manuscript.Response to 2: We agree that there is some overlap between R&D, pharma, and CRO; the pre-interest questionnaire allowed respondents to select from a wide variety of career categories and they could select interest in more than one. These distinctions were based on a convenience sample representative of the type of industries most common in our area, and we recognize that this could differ in other regions.Response to 3: Regarding legal liabilities, such as if an accident were to happen--this is an important consideration for organizing a site visit. In our experience, trainees participating in an institutionally-organized site visit would typically be covered by the institution’s existing worker’s compensation policy. Site visit organizers should refer to their own institutions’ worker’s compensation policies to determine accident liability. In addition to accident liabilities, another common question that arises concerns confidentiality agreements. Companies occasionally requested that attendees sign confidentiality agreements stating that they would not divulge proprietary information learned during the visit. We have added the following text to the “Identifying and contacting companies” section: “Additional considerations include confidentiality and liability. While rare, companies have occasionally requested that attendees sign non-disclosure agreements; thus we suggest that organizers coordinate with the company and check with institutional subject matter experts  to ensure compliance with institutional guidelines. In case of questions from the company about liability, it is also important for institutions to clarify the extent of their coverage . Each of our institutions’ coverage extended to trainees while off campus and one should check their own institutions’ local policy.”  Response to 4: The purpose of this study was to assess initial program outcomes and to provide a toolkit to help facilitate the adoption of site visits by other institutions. We agree that obtaining a negative control would be a cleaner test of the hypothesis. At the same time, we also acknowledge that there is always some element of self-selection bias in career development participation; hence, it is difficult to define a true negative control. One approach could be to compare these results to national or institutional career outcome averages, yet there are inherent difficulties in obtaining a representative sample that is truly comparable to a site visit participant comparison sample. Nonetheless, future studies could attempt to establish a baseline measurement of career outcomes pre- and post- introduction of site visit programs, while acknowledging that this method could also be confounded by economic and programmatic changes over time. This is beyond the scope of the current study but we agree that this is an interesting question which merits further attention across the career development field as a whole in identifying promising practices for effectively evaluating programs. We have acknowledged this limitation in the new limitations and future directions section of the manuscript.Response to 5: Regarding company type, we searched the company website, LinkedIn, or the NC Biotechnology company directory to determine how to categorize a company based on their own self-identification. In rare cases where the self-identification was not made, company size was used as a factor in determining biotech versus pharma. The definition of these two has morphed over time, with size now being a commonly used factor toward distinguishing between the two  and we used LinkedIn’s automatic company size designations as a cutoff which is now indicated in the manuscript. Regarding specific roles, thank you for pointing out that R & D may be a common career interest. It will be interesting to note for future analysis how company size and type factors into career choices relative to roles within a company. We also would like to point out the nuance that company cultures can vary quite a bit between large and small companies, and also between those that identify as contract research organizations relative to biotech or pharma, even across common R & D roles. We have acknowledged this in the new limitations and future direction section of the manuscript by adding the following text: “Future directions could look at different binnings of company type as well as how interest, exposure, and first job match is related to specific roles . Our site visits covered a multitude of roles within each company type and hence career outcomes for specific roles could not be matched at this level of granularity.” Response to 6: We understand that the figure may be confusing. The total number hired at a different company type (44) plus the number hired at a matching company type (82) is equal to 126. The number hired at a specific company visited  is still part of the 82 hired at a company type; extra description was added to clarify the relative proportion of the 82 company type matches that involved being hired at a specific company visited. To clarify these distinctions, we have modified the figure legend. The following text modified to say the following: “The majority of ELITE attendee alumni were hired at a company type that matched those they visited ). Of those 82, ten were hired at the specific company visited, and 3 of those 10 were trainee site visit organizers.”Response to 7: Thank you for pointing this out. We have addressed this in our response to point 4 above. Response to 8: We agree that results should be interpreted with caution because in some cases the “N” is small. Because of that, we chose to include both the “N”s as well as the percentages so that it would be informative for the reader and also allow for comparisons of differing proportions in order to highlight patterns.Response to 9: This is a great area for future discussion and outside the scope of the current study. We have added a paragraph on limitations and future directions in which we address the need for a control group, including non-participant career outcomes (second paragraph). We acknowledge that this is an important area of future consideration.Response to 10: We agree that this is a key area of consideration, and it will be important to examine whether site visits are simply selecting for those who otherwise would not do a postdoc, or whether they are facilitating quicker transitions into permanent employment. It will be interesting to further pursue these questions and adjust our intake questionnaires accordingly in future studies. The following has been added to limitations and future directions section: “Furthermore, intent to pursue additional training  may influence immediate career decisions and could impact first-destination outcomes. The current study did not account for intent to pursue additional training and future studies should account for this intent versus intent to directly enter the workforce.”Response to 11: A large percentage of ELITE attendees are employed in NC; as more institutions are reporting their career outcomes, it is becoming apparent that geography indeed plays a role--increasing evidence demonstrates a strong correlation between the location in which someone trained and the location in which they became employed. For instance, the top job location for all ELITE institutions with publicly available location information was North Carolina . Examples of collated institutional career outcome information can be found by exploring the Graduate Career Consortium’s database of member institution outcomes (https://osf.io/28dn6/), or the Coalition of Next Generation of Life Sciences’ member institution outcomes . The following has been added to the article in the Limitations and Future Directions Section: “Third, we acknowledge that geographic location may influence concentration of available companies for site visits, especially given that Research Triangle Park is a major life science hub. However, future directions could explore virtual options as well as TREKs  for those institutions with fewer companies in close proximity.” Response to last statement: We have addressed these points by adding a Limitations section in the manuscript and have expanded upon the Future Directions section.  Thank you for thoughtful feedback; we believe that this has significantly strengthened the manuscript.


After receiving intensive medical treatment; individuals with eating disorders often require ongoing care to maintain their recovery, build social networks, and reduce risk of relapse.To address this important transition period, a six-month peer mentoring program was developed and piloted in Melbourne, Australia. Twelve adults with a past history of an eating disorder (mentors) were paired with 14 individuals with a current eating disorder (mentees). Pairs met for thirteen mentoring sessions in community settings. Throughout the program mentees and mentors completed reflective questions online. Upon completion of the program, qualitative interviews were conducted. Both online reflections and interviews explored themes relating to perceived benefits and challenges of participation in the peer mentoring program, and the differences between mentoring and traditional treatment.Thematic analysis identified several benefits for mentees; including hope, reconnection with others, and re-engaging with the world. The majority of mentees described their mentor as uniquely supportive due to their past experience of an eating disorder. Mentors reported experiencing benefits such as increased connection with self and others, and indicated that the experience helped them positively reframe their past experience of an eating disorder. Ending the relationship at the completion of the program was a significant challenge for both groups, and managing boundaries was deemed a main challenge by mentors.Overall, results indicated that this mode of informal support may be worthy of further investigation as an adjunct to clinical treatment programs for this population.ACTRN12617001412325 - Date of registration – 05/10/2017 (Retrospectively registered)Australian and New Zealand Clinical Trials registration number -  Individuals recovered from an eating disorder (‘mentors’) and individuals currently with an eating disorder (‘mentees’) participated in a peer mentoring program. Thirteen mentoring sessions occurred in community settings. Participants were asked to complete online reflections at three time-points: after session one, at the half-way point of the program, and at the completion of mentoring sessions. At the completion of the program, semi-structured interviews were conducted. The research identified many positive aspects relating to the experience of participation, as well as aspects of the program that could be refined in the future. Mentees noted that the support of their mentor allowed them to gain renewed hope in their recovery and helped them to re-engage socially, whilst mentors experienced benefits such as increased connection with self and others, and noted the experience helped them appreciate the wisdom they had gained from their past eating disorder. Ending the relationship at the completion of the program was a significant challenge for both groups, and managing boundaries was deemed a main challenge by mentors. Overall, the results are encouraging, but further research is required to extend and expand our knowledge about the role of peer support in the recovery journey of people with an eating disorder.Eating disorders are typically chronic  and diffRecovered individuals have reported that social support is particularly pertinent after undergoing intensive treatments such as inpatient programs –13. DeveOne framework which emphasises building social support is the peer-mentoring model of mental health care . This moPrevious research has identified both benefits and risks for mentors who are providing such services. Meta-syntheses of research describing existing peer mentoring programs for mental health conditions have identified benefits including enhanced self-esteem and confidence , improveN = 270), with only two of these  twenties”, which she had previously assumed would be characterised by illness and isolation. Another participant, Michelle, stated: “I think it was just inspiring that no, actually this is a life that maybe I do want more than I want to be sick.”Theme one describes the benefits that mentees received from participation in the program and is broken down into four subthemes. First, Motivation and agency describes an increased readiness for action. Margie described: “My brain is starting to recognise that healthy, happy, is actually worth something.” Mentees reported that their involvement with mentoring motivated them to commit to recovery-focused actions, included self-care activities, social eating challenges and reaching out to friends. Michelle offered: “It was nice to have someone to…go and do activities with and kind of give things a go and have a laugh along the way.” Nicole reported: “I got in touch with one of my really close friends who doesn’t live too far away and…[asked], you know, ‘If I could… if I need to talk to someone, could I talk to you?’”re-engaging with the world and others. Mentees typically described their illness as profoundly isolating. Mentoring provided a bridge to support the transition back to a more connected and “normal” life. The mentoring sessions were an opportunity to socialise free of the imperative to pretend they were well, and a chance to increase tolerance for leaving the house and exploring being out and about. Jasmine said: “I just have anxiety around crowded restaurants…and at the start we’d be like, let’s go somewhere else, but now I can just deal with it.”The next subtheme is barriers to benefiting from the program. Despite being prompted to reflect on negative aspects of the program, few barriers or challenges were identified by participants. However, not all mentee experiences were positive; three mentees withdrew from the current program before completion. Taken together, the stated reasons (reported above) draw attention to two main factors. The first is the importance of a natural and complementary connection in the mentoring relationship, which is explored further under Theme three: The relationship. The second factor was the importance of a certain level of readiness for participation, including a minimum wellness level, ability to make time and space for the program, and adopting realistic expectations. Julia blamed herself for not benefiting from the program due to her self-reported high expectations, commenting: “It was probably more because of me that I didn’t get much out of it...I went in thinking that this person could give me a road map [for recovery]”. Another withdrawn participant (Sarah) reported enjoying the program, but stated an exacerbation of her social anxiety made it too difficult to attend. Helen reported struggling to juggle work, medical, and mentoring commitments. Two participants who completed the program reflected that they could imagine participation at an acute stage of the illness would not be helpful, due to that stage being characterised by an unwillingness to explore alternative ways of being.The final subtheme explored the perceived mentor’s own experience of an eating disorder emerged as the foundational feature that allowed the mentor’s other qualities (described in subsequent subthemes) to be effective. Nicole reported: “I believe these silly little rules, and…[my mentor] could really properly understand it all.” This concept was endorsed by all but one (withdrawn) participant, who reported she didn’t see value in her mentor’s past experience of an ED. Second, the mentor’s willingness to show imperfection offered permission for the mentee to do the same, thus promoting openness and trust. Michelle stated: “My mentor was extremely upfront and honest and…just really real as well.” Relatedly, the mentor displayed acceptance of wherever the mentee was “at” in their illness, and this acceptance facilitated provision of unconditional encouragement. Rene commented: “It’s just so nice to talk to someone who wasn’t going to judge you, and just accepted it, and if you had a bad week, that’s ok, you know, keep moving forward, keep going.” Margie appreciated that her mentor “really pointed out things that I was doing well.”Most mentees described their mentors in a spirit of great admiration and enthusiasm. The key aspects of the mentoring role are described through four sub-themes. First, the passing on valuable knowledge about the nature of recovery. They offered practical strategies and provided helpful perspectives on life and relationships more generally. Michelle said: “My mentor gave me some sayings and things to do when those [difficult] times came up, and even book suggestions.” In contrast, Julia, who withdrew from the program, reported she received impractical advice from her mentor, such as “listen to your body”. She commented: “[It was] not very specific advice, or concrete I guess. It was a lot more about feelings and emotions, and that wouldn’t really help me.” She reflected this may have been due to her mentor forgetting the finer details and practical tips that helped her in her own recovery. However, the majority of mentees reported their mentor’s advice and support was valuable. The following quote embodies the descriptions of mentors acting as a guide on their mentee’s recovery journey.It was like she’d come down the mountain a little and throw me a rope, and it would pull me up a little bit every time… then the next time she didn’t have to come as far down the mountain…It was almost like we were getting to a point of meeting in the middle. But the middle wasn’t actually the middle of the mountain, it was closer to her top than to my bottom. –Margie.Mentees described their mentor in a role akin to a teacher or guide, Most mentees described their mentor as someone who offered permission to be just as they were, whilst simultaneously helping them move forward. Maintaining this delicate balance facilitated the mentee opening to new knowledge and perspectives about recovery and life in general.the relationship formed with their mentor as being vital to their engagement in the program. The third theme has four associated subthemes. Successful pairings maintained this connection through reciprocity  as illustrated by Jackie: “It’s a two-way street thing…I did find [it] comforting to deal with I guess, not feeling so spotlighted, not feeling like centre stage and…we did share a…lot of personal things.” Having personal similarities as well as appreciation for differences was also important. Jasmine said: “I was surprised we had a lot in common, we spoke a lot about, like environmental things like feminism and politics and stuff. It was nice”. Michelle commented: “The way [my mentor] thinks about things is almost the polar opposite to me, so that was quite helpful.” Unsuccessful dyads either did not appear to have many similarities, or there was a lack of perceived value in the differences between them. One of the three withdrawn participants, Julia, stated the relationship didn’t flow: “just because we were different people I guess–we didn’t really seem to connect.” A mutual understanding and respect of roles and boundaries was identified as crucial to a successful pairing. Andrea commented: “I think [my mentor] had really good boundaries in terms of the types of things they talked about.”Mentees explained the quality of ending of the relationship, which was commonly experienced by mentees as a difficult and sad separation, heralding the loss of an important support person.The completion of the program brought with it the All participants endorsed mentoring as a qualitatively different experience from clinical treatment. Many of the four subthemes described here overlap with previously discussed themes. It was nonetheless considered useful to create a separate theme specifically to delineate the ways in which mentees characterised mentoring and clinical treatment differently, because there is little literature published on this topic.equal power dynamic. Talia reported: “I felt like I didn’t have any power [in treatment] because it was that weird dynamic between a doctor so it was nice to do something that’s supposed to be therapeutic, but it could be more of a friend, equal.” Mentoring was described as being more relaxed with a lack of pressure. Rene commented: “There was none of that pressure [compared to clinical treatment], and I felt really good about that – because it actually made me want to try harder the next time.” Mentoring was characterised as being more integrated into normal life. Jordan stated: “You can do a lot of things [in mentoring]. You can’t just go…for example grocery shopping with a psychologist.” Finally it was described as having more impact due to the mentor’s shared experience of an eating disorder. Jasmine described that advice “has a different kind of impact coming from some one who has been through it.”Most mentees described mentoring as allowing a more collaborative and comparison between the two modalities, it was acknowledged by several mentees that the two complement each other, and both had a unique and necessary role to play in supporting them through recovery. Michelle said: “I know a peer mentor is not considered treatment in the normal sense, but it complements treatment and I think it’s one of the best things I’ve done.”Of note, whilst discussions around this theme tended to be framed by mentees in terms of a Five key themes emerged from the online mentor evaluation forms and the qualitative interviews. Each theme is presented with corresponding subthemes in Fig. sense of community as one of the cornerstones of the positive mentoring experience, with many expressing the power of “just getting 15 or so people who’d been through EDs in the same room” . The power was attributed to the fact that many mentors had not knowingly met another recovered individual before and were now doing so with a sense of purpose and positivity – “It was great to meet a lot of other people who had recovered” (Tanya). Most mentors considered the unique aspect of mentoring to be a shared understanding; or “not feeling like you have to explain [your experience] or explain yourself” (Kate). Through this shorthand, mentors believed they were able to” connect on a really authentic level” (Kate) and build rapport quickly. Five mentors noted that the PMP experience allowed them to better connect with themselves, stating that “there is an integration of your own self that happens [in the process of mentoring]” (Jamie) through self-reflection and meeting others who are similar in certain ways – “Before you even go through the door you know you’ve got something in common, there’s a shared connection there” (Sandy). This integration of self was also intertwined with (and reliant on) a sense that being honest with myself and others was essential in the mentoring process; Kim pointed out that “the more you admit that [you’re not perfect], the more everyone gets from it”.The first theme captures the sense of connection with self and others within the ED community that was ubiquitous across all 12 mentors. Mentors emphasised a reframe the eating disorder experience from negative to positive, determining their experience to be “valuable now…actually worth something, other than just suffering and confusion” (Jamie). Mentors also noted that the PMP unexpectedly resulted in improvements in their own recovery though a process of reciprocity, with Kim commenting that “the more I give, the healthier I am, like the less I think about myself is the healthiest place for me”,and Steph noting “[the PMP reinforces] everything you learn in recovery”. The mentoring process meant that there was a need for mentors to face their eating disorder, which for some led to the realisation that “[a] veneer…had grown between me and those experiences…I just [had] this wall…and I couldn’t have that when I was mentoring”(Rory). Through this confrontation of their ED, some mentors built confidence in their own recovery, experiencing “a big relief…thinking that I can still…reframe this…like I’m not just going to live my whole life fearing…it” (Tanya). One of the greatest benefits of the program was reported to be a chance “to reflect on how incredibly far I have come” (Jamie) through an increase in perspective on the ED journey, which also led to revelations that “there’s never really 100% recovery - it’s always 95 and there’s the 5% that you…keep trying to improve” (Taylor).The second theme details the recurring sense that mentors were able to explore their own recovery through the PMP. Most mentors considered that the PMP had allowed them to can I really do this? with skills-based concerns that “I wouldn’t have enough to say and do the right things” (Kim)” and more personal worries including “if someone [triggers me]-how do I deal with that” (Sandy). Sandy also reported that although communication received from EDV at this stage was sufficient to placate any concerns about their competency, there was “anxiety as to whether I would be paired up with anybody”, which was also echoed by another mentor who withdrew at this stage who reflected that had they been matched faster, they may have remained in the program. Mentors also felt the weight of responsibility at times, with Jordan commenting that a decline in their mentee’s functioning left her “questioning whether or not [she] had done enough”. Fortunately, early anxiety over inexperience, skills, and the emotional weight of mentoring were mitigated in the first instance via pre-program training, allowing mentors to “mentally prepare for who we would be working with” (Jules). This continued later through group supervision with other mentors, which was found to be “really valuable, just to…get…ideas-and…understand certain situations” (Rowan). Training and supervision were critical factors in mentors developing a sense of I can do this, and also resulted in the opening of new doors, both personally and professionally as mentors gained “experience and confidence in the [mentoring] role” (Jules) with “opportunities to learn… and build skills” (Kate).The third theme captures the common reports of self-doubt in the early stages of the PMP, followed by an increase in confidence as the program went on. Before training and through early mentoring sessions, most mentors wondered get involved and give back, seeing the program as “a great way to share my experience and help other people” (Rowan). Whilst some mentors had spent many years avoiding anything to do with EDs until “something clicked…and I just felt ready to bring [my experience] back into my life” (Tanya), others felt they had “wanted for quite a long time…for there to be…some platform in which I could use my experiences to…help someone else” (Steph). When considering the personal impact of the program, mentors commented on the intrinsic sense of satisfaction of helping others to thrive, whereby they walked away from their sessions “[feeling] like [I am] making a difference…having a positive influence on somebody else” (Tanya) as well as the opportunity “to just be free and to be able to just discuss whatever and not be afraid of being judged” (Taylor). Mentors also expressed their surprise at how much they gained from their time with their mentee, considering many reported coming into the program for mostly altruistic reasons. Reports of inspiration, empowerment, and reward were common, with frequent accounts of “feeling really inspired by my mentee” (Kate).The fourth theme details the mentors’ hopes before commencing their role, and the often-surprising gains which occurred during the PMP. When discussing their reasons for applying for the PMP, almost all (10) mentors cited a desire to Defining the mentor role was considered by many to be a significant challenge due to the task of “finding a balance between…necessary detachment…and [striving for] the equally-necessary intimacy created by and needed for a solid connection” (Rory). For most mentors, part of the role-delineation process involved defining and managing boundaries and building of “open conversation, respect, understanding, and appropriate support” (Rory). Aspects of training found to be most helpful by mentors included “learning…how to say “no”” (Jamie) and EDV’s emphasis that mentoring was ““only in business hours”…"only…through [certain methods of contact]”” (Rory). The final–and ultimate–test of boundary management for most mentors was almost unanimously considered to occur before the goodbye, during the final mentoring session. Reasons for this difficulty ranged from trying to balance sending a firm message of ““this is 13 sessions, [it] is what it is”, and making sure that didn’t come across as a rejection” (Steph), and the possibility that “after ending the mentoring relationship [a…mentee’s] condition may decline” (Jules). Findings indicate that mentors dealt with these difficulties using EDV’s support to “[guide] me through that process of how to end that relationship…talking about…ways to potentially discuss it with my [mentee]” (Kate), and through “[reminding] myself that my participant has the strengths and skills to continue with…recovery without the mentoring program” (Jules).The fifth and final theme captures some of the most commonly identified challenges of the program for mentors. This qualitative study aimed to investigate the benefits and challenges experienced by mentees and mentors in a peer-mentoring program for individuals in early recovery from an eating disorder. The secondary aim was to explore (from the mentees’ perspective) the experiential difference between receiving support through peer mentoring as opposed to clinical treatment modalities.Hope, which is closely linked to motivation , has beeMentoring was consistently perceived by mentees as a more relaxed form of recovery support than clinical treatment. The elements of spontaneity and fun reported by mentees in the current evaluation was also found in Lippi’s  study. TEchoing results found in the current study, mentors in Ramjan et al.’s study  reportedMentors in the current study experienced an increase in eating disorder symptoms across the program (reported in the quantitative data ), whereaThe most commonly reported challenge of participation reported by both mentees and mentors was the sadness and loss due to separating from their mentor at program completion. Previous mentoring literature noted that there can be difficulties with ending the mentoring relationship due to the bond that often develops . The difMuch of the research on peer-mentoring emphasises the importance of supervision and training of mentors , 52, 53 social desirability response bias , future efforts should include a controlled trial using a This study contributes to the small and growing body of evidence suggesting value in pursuing peer mentoring as one part of a comprehensive approach to eating disorder treatment. Results indicate that peer mentoring has the potential to provide unique and beneficial support to complement clinical treatment, warranting further research efforts and program development.Additional file 1: Appendix A. Online Reflection Questions.Additional file 2: Appendix B. Interview Schedule.