Husmann DA, Terris MK, Lee CT et al: The American Board of Urology: in pursuit of diversity, equity, and inclusion. Urol Pract 2021; 8: 583.

To seek equity in the practice of medicine demands that diversity is reflected within the composition of the board members that lead our specialties. Why? Diverse management teams have been documented to foster innovation, understanding and empathy, increase effective communication and significantly improve governance in ways that are lacking within a homogeneous environment.^1,2 These benefits far exceed the window dressing of a diverse membership used to enhance the public reputation and serve as a buffer against external pressures.^1,2In this regard, the American Board of Urology (ABU) desires to point out that the practice of diversity and inclusion has been a cornerstone of our values for years; however, we acknowledge that although progress has been made, there is more to be done. The article in the September issue of Urology Practice® briefly outlines the current processes we employ and those we intend to pursue.³

The ABU consists of 3 major committees: the Trustees of the Board, and the Written and Oral Exam Committees. Yearly, before selecting new members to these committees, a gap analysis is performed to evaluate for discrepancies between the committee structure and the constituents we serve. The selection of new committee members is based on both the individual’s merit and an attempt to match or supersede the diversity ratios described within the most current National Census conducted by the American Urological Association.⁴ The diversity ratios we evaluate include gender, race, ethnicity, geography and subspecialty areas.

This year’s evaluation revealed our committee structure consisted of 85% (98/115) male and 15% (17/115) women: National Census 90% and 10%, respectively. Regarding race and ethnicity, White nonHispanic: 74% (85/115) compared to 81% (National Census); Hispanic: 1% (1/115) compared to 4%; Asian: 22% (25/115) compared to 12%; Black/African American: 3% (4/115) compared to 2%. Regarding evaluating the physician’s region of practice, we assess the percentage of U.S. urologists practicing within an AUA section and attempt to have the ABU committee structure be equivalent to or within 1–4 percentage points. It is also noteworthy that we carefully evaluate the percentage of individuals representing a subspecialty within the ABU committee structure. However, we have deliberately increased numbers of individuals who practice Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and Pediatric Urology above the national percentiles due to the expertise required to construct test items for subspecialty examinations.

The ABU recognizes that the evaluation of ratios with attempts to match our committee structure to our constituency is an excellent initial step to establish diversity. However, the establishment of ratios has not substantially changed societal behavior or attitudes and may have significant negative unintended consequences.^5–9 The actual establishment of diversity and inclusion practices is about much more than a numbers game. Rather, the path we desire to pursue to establish diversity must eventually modify the mindset of individuals, societies and ultimately national cultures.^5–9 To reach our eventual long-term goal, we must include educational efforts that inform our diplomates and committee members regarding the benefits of diversity. In this regard, the ABU is pursuing multiple specific aims: 1) Development of an implicit bias educational course that all ABU staff and committee members will participate in either at its inception or at the time of hiring or initial ABU committee appointment. 2) We desire to evaluate our examinations to see if any bias exists due to an individual’s primary language, race, ethnicity or gender. To accomplish this goal, it will be necessary for the ABU to voluntarily request that individuals record this information at the time of the examination. Historically, we have not captured these data due to concerns that candidates may have been apprehensive that information could negatively impact their certification process. Unfortunately, our failure to record this information significantly impairs our ability to evaluate potential implicit bias. Lack of knowledge also prevents our ability to correct any disparities that could exist. 3) We plan to formally establish an ABU subcommittee onDiversity, Equity and Inclusionthat will monitor and mentor diversity within the ABU committee structure.

The ABU would like to acknowledge that establishing and maintaining diversity within any governing board is an imperative that needs to be valued, incessantly evaluated and, when necessary, amended to reflect the values and principles of the public we serve and the diplomates we govern.