We've Got a Long Way to Go, and a Short Time to Get There

By: D. Robert Siemens, MD, FRCSC | Posted on: 01 Apr 2022

For most readers of this special edition of AUANews, a focus on diversity, equity and inclusion (DEI) has become an important part of our clinical, educational and/or leadership roles. Reflecting on DEI-related issues in my own life, I keep coming back to a song from Smokey and the Bandit. (For the astute reader, this late ‘70s classic movie reference would confirm that, yes, I am obviously an older, privileged, white male who has remotely coveted a black Trans-Am). Although the movie is unlikely to hold up in 2022, the earwig line from Jerry Reed’s song “East Bound and Down,”1 borrowed here for the title of this article, speaks to me as anthemic. Although a bit reductive, it reminds me that DEI needs to be central in our leadership and organizational conversations. These conversations can lead to swift, meaningful change, but at the same time we need to understand that DEI efforts are not simply a problem we need to solve. We must acknowledge that a box cannot be checked to show that we have satisfied some requirements. We must continually work to be better. The time to be better is now.

In my role as Editor-in-Chief of The Journal of Urology® (JU), I am acutely aware that DEI advancements of The Journal must be emphasized as an overarching goal. The role of an editorial board of a premier medical journal is multi-fold, beyond assuring timely and insightful peer review: acting as ambassadors of the profession, reflecting seriousness and quality, and identifying transformative trends in the specialty. Variety of experience, insight and opinion is therefore paramount. Furthermore, the lack of diversity of urologists in academic leadership positions is a strong driver of the well-documented disparity in our field.2 Involvement on editorial boards of academic journals has been shown to have a lasting impact on career development and trajectory. It is likely not surprising then to readers that we have much room for improvement. As just 1 example, a recently published review of gender disparity on editorial boards of major urology journals shows that only about 12% of editors in 2020 were women.3 The authors identified some encouraging trends since 2015 so that at least currently these rates approximate the percentage of U.S. women urologists. However, a much higher representation of all equity-deserving groups in academic leadership positions such as editorial boards is required to fortify efforts in bridging the current diversity gaps of our specialty. I take this responsibility as an honor and understand that we have a lot of work to do.

How are we on the JU Editorial Board, with the full support of the AUA and our Editorial Office, working together to improve the flagship journal in its approach to DEI? The Editorial Board composition of members itself is an obvious area for ongoing scrutiny. Working with Dr. Joseph A. Smith, Jr. over the last year, we have selected individuals to replace outgoing Editors who are diverse in terms of areas of specialty, geographical location, gender, race and age. In 2022, we invited 6 Early Career Editors to join the Board. Four of them are assigned to work with the adult urology Associate Editors, 1 of them is assigned to the pediatrics team and 1 is assigned to the Online Content Editors group. They review papers, assist in decision making and will attend various meetings of the Board. This opportunity is intended to offer early editorial training and mentorship and support these individuals to become leading senior editors in the future.

Beyond the diversity of the Editorial Board itself, another initiative envisioned by Dr. Smith is adoption of open peer review.4 Research needs to be evaluated by a diverse pool of reviewers in order to provide a comprehensive and contextual assessment. We need to constantly find ways to engage and train peer reviewers and, relevant to this conversation on DEI, we need to be intentional about including previously under-represented groups. Furthermore, processes such as opening up peer review, despite some potential drawbacks, should help facilitate a wider, transparent and more inclusive discussion during the complex curation of academic work.5 Beginning with the April issue, you will see the online publication of these peer review reports for all accepted papers. The reports will include the names of all contributing editors, statisticians and consenting reviewers in aggregate. I worked with Dr. Smith on this for the year before I assumed my role of Editor-in-Chief, and our goals for launching this initiative were simple but clear: transparency, fairness, quality. In the few short months since beginning open peer review, our reviewer decline rates have remained steady, a high percentage of our reviewers are agreeing to the publication of their names and only a handful of reviewers have reached out with concern. Another hope is that these reviews will be used as learning tools to allow early career researchers to understand the process that led to successful publication.

The accessibility of journal content is something I think about frequently. JU offers open access publishing licenses for our authors, and we know that these articles, by virtue of their permanent space in front of the paywall, are accessed much more often. In January 2023, JU will be very supportive of the newest member of the AUA publications family, JU Open Plus. This Gold Open Access journal’s content will be accessible to any reader across the globe. This access includes patients, doctors in other specialties, the press–anyone who wants to read our content. Because of its similar scope, an author who submits to JU or Urology Practice® will have the opportunity to port their submission easily to JU Open Plus. Furthermore, another peer-reviewed journal allows more authors to have their work seen and heard within the AUA portfolio and its power of dissemination.

Initiatives such as this AUANews focus issue that offer open platforms for honest discussion are also key to moving forward. I invite our valued readers to engage with us about how JU can continue to improve. I encourage you to write Letters to the Editor, have in-person conversations with me at the upcoming AUA2022 annual meeting or email me so we can engage about where we are missing the mark. Although we do have a long way to go, and a short time to get there, I know our community is ready to put in the hard work so that Urology is as inclusive and accessible as it can be.

  1. Reed J and Feller D: East Bound and Down. Hori Pro Entertainment Group, Universal Music Publishing Group 1977.
  2. Han J, Stillings S, Hamann H et al: Gender and subspecialty of urology faculty in department-based leadership roles. Urology 2017; 110: 36.
  3. Nguyen AX-L, Zorigtbaatar A, Bouhadana D et al: Gender disparity on editorial boards of major urology journals. Can Urol Assoc J 2022; http://dx.doi.org/10.5489/cuaj.7690.
  4. Smith JA Jr: The next chapter in a good story. J Urol 2021; 206: 1356.
  5. Pros and cons of open peer review. Nat Neurosci 1999; 2: 197.
Top 300x250:
Bottom 300x250: