Flexman, Alana M

Smith, Martin

Théard, Marie Angèle

English

UCL Discovery

Accepted version 1 J Neurosurg Anesthesiol 2020; 32: 283-284. doi: 10.1097/ANA.0000000000000711. 2  3  4 Diversity, Inclusion and Equity in the Journal of Neurosurgical Anesthesiology: a look to the 5 future 6 Théard MA, Flexman AM, Smith M. 7  8  9 I can tell you, without diversity, creativity remains stagnant 10 Edward Enninful, OBE 11  12 The Journal of Neurosurgical Anesthesiology (JNA) has been, and continues to be, committed to 13 publishing the most creative, innovative and highest quality perioperative neuroscience research.1 14 Commensurate with this mission is a dedication to support the growth and development of all editorial 15 aspects of the Journal: authors who submit their work, reviewers who provide timely and expert 16 commentary, Editorial Board members, and the Editor-in-Chief who is responsible for journal policy and 17 governance. To date, ample evidence supports diversity, inclusion, and equity as advantageous to the 18 organizational structure of a number of different societal establishments, and medical journals are no 19 exception.  20  21 From financial performance in business to reducing health disparities, a diverse workforce is increasingly 22 identified as essential for success.   While diversity refers to the differences in experiences and 23 perspectives within a group, inclusion ensures that all members have equal access to opportunities, and 24 equity is defined by parity in processes and policies. In an analysis of over 2 million published articles, 25 those published in higher impact journals had a more diverse authorship and were cited more often.2  In 26 addition, diversity within the healthcare workforce has been demonstrated to increase communication, 27 patient satisfaction, patient compliance and overall health outcomes.3 Heterogeneous groups with a 28 variety of ethnicities, perspectives and experiences have also been shown to increase accuracy and 29 innovation in finance.4, 5 Despite these proven benefits, a lack of gender and racial diversity in academic 30 anesthesiology has been highlighted as a persistent issue6, 7, perpetuated by entrenched societal biases 31 and institutionalized racism.  32  33 The Journal of Neurosurgical Anesthesiology is an international journal which serves as the official 34 journal of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC), itself an 35 organization with a diverse international member base. In 2019, JNA received submissions from authors 36 in 35 countries and all continents, with a readership extending to 72 countries.  The Editor-in-Chief 37 supported by the Editorial Board has an obligation to ensure that JNA content reflects a full range of 38 ideas, perspectives, and approaches to scientific inquiry. Peer review, in particular, serves as a critical 39 gatekeeper tasked with upholding the highest level of scientific rigor and quality of research published in 40 JNA.8  41  42 The Editor-in-Chief recently reviewed the demographics of the JNA Editorial Board and Board of 43 Reviewers over three time-points during the last two decades (2006, 2012 and 2019; Figure 1). In 2006, 44 93% of Editorial Board members were based in the United States; this fell to 63% in 2019 with the other 45 37% of members representing 11 countries from all continents. Moreover, 40% of manuscript reviews 46 are now provided by colleagues outside the United States compared with only 16% in 2006. Over the 47 time period examined, women were underrepresented on the Editorial Board, making up only 20% of its 48 members, similar to other journals in Anesthesiology.9, 10 Encouragingly, there has been a small but 49 steady increase in the proportion of women providing peer review for JNA over time, increasing from 50 17% in 2006 to 29% in 2019.  51  52 The diversity of the neuroanesthesia and perioperative neuroscience community as a whole is not well-53 defined. A glimpse into the demographics of SNACC’s international membership, however, reveals a 54 group that is more reflective of today’s majority white, male medical establishment in the United States. 55 A 2018 survey conducted to better understand the demographics and experiences of SNACC members 56 revealed that the majority of respondents were from the United States (76% vs. 24% non-US) and were 57 male (63%).11 Regarding race/ethnicity, most of the men and women respondents self-identified as 58 white (67% and 63%, respectively). These findings are consistent with a previous analysis demonstrating 59 a relative lack of racial and gender diversity in Anesthesiology as a specialty in the United States.6 These 60 findings compel serious consideration of the systemic barriers to more equitable representation in 61 physician workforce, medical education, medical societies, medical research, and medical journals. 62 Targeted initiatives such as highlighting the work of minority groups and mentorship may be beneficial 63 in improving diversity. Several of these initiatives have been employed by SNACC12, similar to many 64 medical societies around the world. 65  66 Overall, while JNA has made progress towards increasing geographic diversity and gender 67 representation amongst peer reviewers, there is room for improvement going forward, particularly with 68 regard to Editorial Board membership. Furthermore, the evolution over the past two decades occurred 69 in the absence of a formal diversity and inclusion policy, an absence which we intend to address. 70 Increasing diversity and inclusion is complex and requires a sustained and intentional approach to 71 addressing many disparities. The first step is to systematically collect and analyze data, both to inform 72 strategy and inform progress going forward. Next, we need to understand the obstacles to participation 73 in neuroscience research, publishing and peer review. Finally, this information should be used to 74 develop strategies to minimize systematic barriers and increase the inclusion of members of 75 underrepresented groups. We look forward to a bright future for JNA as we strive to achieve a broader 76 more diverse platform for the publication of perioperative neuroscience research. 77  78 References 79 1. Smith M. The Old and the New: An Enhanced Vision for JNA. J Neurosurg Anesthesiol 2018;30: 80 287. 81 2. Freeman R, Huang W. Collaborating with People Like Me: Ethnic Coauthorship within the United 82 States. Journal of Labor Economics 2015;33: S289-S318. 83 3. LaVeist TA, Pierre G. Integrating the 3Ds--social determinants, health disparities, and health-care 84 workforce diversity. Public Health Rep 2014;129 Suppl 2: 9-14. 85 4. Nathan M, Lee N. Cultural Diversity, Innovation, and Entrepreneurship: Firm-level Evidence from 86 London. Economic Geography 2013;89: 367-394. 87 5. Levine SS, Apfelbaum EP, Bernard M, et al. Ethnic diversity deflates price bubbles. Proc Natl 88 Acad Sci U S A 2014;111: 18524-9. 89 6. Nafiu OO, Leis AM, Wang W, et al. Racial, Ethnic, and Gender Diversity in Pediatric 90 Anesthesiology Fellowship and Anesthesiology Residency Programs in the United States: Small 91 Reservoir, Leaky Pipeline. Anesth Analg 2020, Mar 27: doi:10.1213/ANE.0000000000004765. 92 Epub ahead of print 93 7. Toledo P, Duce L, Adams J, et al. Diversity in the American Society of Anesthesiologists 94 Leadership. Anesth Analg 2017;124: 1611-1616. 95 8. Smith M. JNA Editorial - July 2018. J Neurosurg Anesthesiol 2018;30: 199. 96 9. Miller J, Chuba E, Deiner S, et al. Trends in Authorship in Anesthesiology Journals. Anesth Analg 97 2019;129: 306-310. 98 10. Lorello GR, Parmar A, Flexman AM. Representation of women on the editorial board of the 99 Canadian Journal of Anesthesia: a retrospective analysis from 1954 to 2018. Can J Anaesth 100 2019;66: 989-990. 101 11. Theard M, Flexman A, Aglio L. Diversity and Perspectives of the Society for Neuroscience in 102 Anesthesiology and Critical Care Membership: A Survey. J Neurosurg Anesth 2019;31: 491-492. 103 12. Théard MA, Aglio LS. Diversity and Inclusion, Here and Now – SNACC Reaches Out to All Its 104 Members. ASA Monitor 2018;82: 52-54. Available  at: 105 https://monitor.pubs.asahq.org/article.aspx?articleid=2695441 (accessed 12 June 2020) 106  107 Marie Angèle Théard MD 108 Vice-chair, SNACC Diversity and Inclusion Committee 109 theard@ohsu.edu 110  111 Alana M. Flexman MD FRCPC 112 SNACC Representative to the JNA Editorial Board and SNACC Secretary/Treasurer 113 alana.Flexman@vch.ca 114  115 Martin Smith MBBS FRCA FFICM 116 Editor-in-Chief, Journal of Neurosurgical Anesthesiology 117 martin.smith@ucl.ac.uk 118  119 The authors have no conflicts of interest to disclose.   120 FIGURE LEGEND 121  122 Figure 1 123 Gender and geographic representation of Editorial Board members and peer reviewers: 2006-124 2019 125  126  127 

Diversity, Inclusion and Equity in the Journal of Neurosurgical Anesthesiology: A Look to the Future

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Diversity, Inclusion and Equity in the Journal of Neurosurgical Anesthesiology: A Look to the Future

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