With the publication of this third annual special edition of AUANews with its focus on diversity, equity, and inclusion (DEI), we are reminded of the pivotal role such conversations have had on our personal and professional lives. In our clinical realms, many health care institutions have had a degree of reawakening to the depth and breadth of institutionalized bias and its impact on public health broadly, as well as care delivery closer to home in our hospitals and clinics. For smaller groups, including most of our relatively modest-sized urological departments/divisions/practices, it may not always be apparent how to move forward without any preexisting formal avenues to inform us on this much-needed work. Looking outside of urology to colleagues in other specialties or institutions and even to other professions, and using valuable resources such as this focus issue of AUANews, are critical to learning and improving. Ensuring discussions on DEI and initiating effective group efforts should help our organizations improve communication, which will enhance provider wellness and patient satisfaction to deliver improved quality of care, especially to those most vulnerable. As stated in last year’s focus issue, “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.”¹ The Journal of Urology^® has committed to making DEI a permanent part of our ongoing conversation and resolved that this box will never be checked.

It is naïve to hope that our academic lives are somehow immune to the downstream impacts of systemic bias and discrimination that otherwise influence every other stratum of society. These important discussions around DEI in scientific research are arguably even longer overdue. There is overwhelming evidence highlighting disparities and unfair practices in collaborative research that are the consequence of decades of inattention to the funding for the study of health disparities and the lack of involvement of underrepresented and marginalized groups in science and medicine. Awareness of these problems has recently amplified calls for transparency and commitment to remedy shortfalls in research funding addressing health inequities and foster the recruitment of a more diverse and inclusive workforce.² Although one might assume these issues are less tenacious in the scientific publishing industry, representing a more passive or reactive player in the delivery of research output, lack of diversity of voices that are assessing research work has contributed to well-documented biases in the review processes. Gaps in diversity on editorial boards have been recently highlighted as a paragon of these issues.³ Indeed, diverse representation at the leadership level of academia has a critical role in any solution through role modeling and amplifying the importance of an inclusive research culture.

Last year, we underscored these issues in the AUANews DEI edition as a call to action for The Journal of Urology^® and its editorial board. Herein, we want to report back on our own progress towards more diversity and inclusion within our pages. We have instituted a table of engaged board members to carry on these conversations on issues of health equity and diversity (HEAD Table) in urological publishing. Although our efforts are just beginning and the mandate evergreen, one area of emphasis has been to look carefully at the diversity of the editorial board, as well as the reviewers we invite as external consultants. It is no small feat to try and engage with the voices of contributors and peer reviewers from around the globe, but we are dedicated to asking our team members about their geographical location, self-identified gender/race/ethnicity, and career stage. Examining the diversity of these voices is one step towards assuring we can begin to reflect on the broader spectrum of The Journal’s global readership. This information, alongside our newly instituted open peer review where our reviewers can choose to have their names published alongside their own peer review reports of accepted articles, will hopefully enhance the transparency that we are working toward.

An integral part of our HEAD Table initiatives has been to look outward to best learn from others in the publishing industry to help inform our next steps. Over the last year, we have invited editorial board members to join a regular DEI Leadership webinar series. Although there are excellent scholarly resources available online to promote actions that advance diversity (geographic, gender, racial and ethnic, institutional, cultural, etc),⁵ these recorded sessions have focused on learning from members of the scholarly publishing community about their DEI-related efforts and how we can benefit from their experience. We have made the conscious decision to invite experts outside of urology for a broader exposure to improve our own foundational values.

A few examples from this series include a webinar with Mary Williams, PhD, features editor, The Plant Cell, ASPB (American Society of Plant Biologists). Mary shared with us about ASPB’s efforts to start and expand a robust early career editor program (“assistant features editors”). Their experience mentoring these individuals was very helpful as we reflect on our own freshman class of early career editors at the journal.⁴ Adrianna Borgia, managing editor, ASM (American Society for Microbiology) discussed the ASM’s open call for editorial board members with their focus on purposeful diversification in an extraordinarily broad field of research. Learning about this incredible effort inspired us to announce our own first open call for editorial positions that led to a remarkable number of strong (and unsurprisingly) diverse applications. Opening future application processes will become the rule for us instead of the exception. Jennifer Pesanelli, executive officer, The Biophysical Society, discussed her experience as a Founding Member of C4DISC. The coalition is dedicated to addressing issues of diversity and inclusion within the scholarly communications industry. It serves as a great resource for all publishers and editors, regardless of content. Most recently, we had Miranda Walker, associate director, Medical Journals, Wolters Kluwer and president, SSP (Society for Scholarly Publishing) speak to her work with SSP to develop and implement the core values of the organization. She described a pragmatic and inclusive exercise identifying those core values that support the vision of their organization and continuously inform what is at the heart of their work. The Journal is considering duplicating this effort with our editorial board to provide additional guidance of our own mission in a rapidly evolving landscape.

As a medical journal, we are obliged to continuously evaluate our mandate of serving the needs of the members of the AUA and our global readership, who search for rigorous and accessible clinical and translational evidence to enhance the urological care of their patients. To best serve these care providers, researchers, and patients, we must do better in advancing toward equity and inclusion in our journal-related activities. One of the strengths of our DEI initiatives is that we work hard to reach out and listen rather than simply identify DEI issues. We focus on publications that address DEI issues with solutions in urology, not just accept articles that identify disparities. And the efforts trickle down to inclusive committees. For instance, we have grown our team of online content editors to include a wide spectrum of voices so the content of our journals is widely accessible and consumable. Most importantly, we are intentional about speaking up loudly about DEI in urology, not just silently spectating. We are proud to partner with other urological publishers to unify efforts in a space that should never be competitive. One example is our partnership with the European Urology family of journals to provide learning opportunities at the European Association of Urology and AUA annual meetings to global urologists of all career stages centered on publishing activities, including reviewing, writing, dissemination and promotion of content, and editorial leadership. We look forward to extending these collaborations with other urological organizations and publications.

We still have a long way to go, and a short time to get there—but we are closer than we were this time last year, and we will continue to prioritize DEI in the work that we do.