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Equity: European Journal of Emergency Medicine reflects forward

Lewiss, Resa E.a; Ogle, Kathleen Y.b; Freund, Yonathanc,,d

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European Journal of Emergency Medicine: April 2020 - Volume 27 - Issue 2 - p 77-78
doi: 10.1097/MEJ.0000000000000681
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The year 2020 will be a landmark year. The decade will be a period for change. We are taking a close look at the journal and its role in academic equity. We know that our sibling journals are doing the same.

Historically, we have not done the most commendable job as Editors-in-Chief, as boards, as editors, and as peer reviewers in committing to a safe equitable and dignified environment for all healthcare workers. We are looking at the role we can play in improving representation at all levels. We have only just begun and are off to an active start.

To this end, we are making intentional and transparent changes at the Emergency Journal of Emergency Medicine (EJEM). We have started with the implementation of three initiatives: diversifying the board, diversifying the pool of peer reviewers and analyzing the peer review process, and looking at the voice put forth in journal invited commentaries, editorials, and perspective pieces.

We are turning over our editorial board to allow opportunities for people of different backgrounds. Four board members resigned over the past year (N.B. we wholeheartedly thank them for their work), and four new members were invited to join. Although not yet representative of the geographic and racial diversity we seek, we are proud that 3 women and 1 man have accepted the invitation. This makes the EJEM board 35% women. Our 17 board members represent the countries of France, United Kingdom, Turkey, Spain, Germany, Sweden, Denmark, Belgium and the United States.

We are inspired by the literature on this topic. In 2011, Amrein et al. sought to determine the gender distribution of major medical journal editorial boards. They found that overall, less than 16% of editors-in-chief and only 17.5% of editorial board members were women. There were slightly higher proportions of women, who served in these positions in Internal Medicine, but overall, a paucity of representation [1]. In 2019, Kaji et al. assessed and analyzed the gender distribution at the Annals of Emergency Medicine (AEM) [2]. About 24% of the AEM editorial members were women with 10% at the senior editorial board level. Also in 2019, Harris et al. reviewed the proportion of women in editorial board positions in high impact surgical journals. Although representation had increased over a 20 year period, the proportion of women still fell short at 19% [3]. In the same year, Rynecki et al. reported that women represent 9% of the editorial board members in three of the most widely read orthopedic journals. There were no women Editors-in-Chief [4]. Finally, Ioannidou and Rosania analyzed representation in dental journals. Women comprised 2.5% of the Editors-in-Chief. The overall percentage of women associate Editors-in-Chief over 3000 editorial board members was 16% [5].

When we move our focus from editors to peer reviewers in emergency medicine, there is similarly a documented disparity in the representation of women, that is, there are many fewer women. AEM is addressing this within their journal in many ways: (a) partnering with multiple national women’s emergency medicine organizations to solicit peer reviewers; (b) engaging Association of Academic Chairs of Emergency Medicine to encourage their faculty to participate in the journal; (c) identifying and contacting former women leaders in these organizations asking them to make recommendations regarding other women academicians who should be invited; (d) surveying former AEM resident fellows to elucidate potential barriers and ways in which they can improve processes for inclusion [2]. Interestingly, the Lancet Group is updating their publication submission system to include demographics which will allow for tracking and assessment of gender parity and inclusion of a more diverse editor, reviewer and author population [6].

At EJEM, we have contacted leaders in emergency medicine to suggest and invite traditionally underrepresented reviewers. We have begun tracking this pool of journal contributors.

Finally, we are looking closely at our invited writers. In 2006, Jagsi et al. reviewed 35 years of medical literature to better quantify representation of women physician investigators identified as first or senior authors in six impactful journals. Although they found an increase in women first and senior authors over the years, the proportions of women remained low: 29.3% first authors and 19.3% senior authors [7]. At the time of their review, only 11.4% of NEJM and 18.8% of JAMA guest, that is, invited editorials, were written by women. In Kaji et al’s. 2019 study, they also took particular note of the gender of first authors in commissioned and unsolicited articles [2]. It is a noted area for improvement for AEM.

Based on these findings, editorial boards should be more intentional about inviting women authors for commissioned articles—commentaries, perspective pieces and editorials—to address the disparity. At EJEM, we are committed to this [8–11].

When considering substantive ways in which the academic community can demonstrate commitment to gender equity in publication, we wish to tip our hat to The Lancet Group and the European Association of Science Editors. The Lancet Group made two commitments: ‘The Diversity Pledge’ and a ‘No All-Male Panel Policies.’ These are transparent, clearly articulated modifications to create parity for representation of women, and people of color. This is inclusive of professionals from low and middle-income countries at every level of their journals [6]. The European Association of Science Editors is working on the following solutions: (a) Creation of a ‘Gender Policy Committee’; (b) Developing guidelines to ‘ensure significant representation of women on meeting speaker lists, on editorial boards, and in other significant leadership positions’ [12].

We can do more and we will do more. We are working towards transparency in our peer review, decision editor and invitation for the authorship process. Please e-mail us [email protected] with your suggestions on how we can create a more equitable journal.


R. E. L. is a newly invited Board member of the EJEM. She has no financial disclosures. She is a volunteer founder of TIME’S UP Healthcare, a nonprofit initiative that advocates for safety and equity in healthcare and a volunteer advisor for, a website that supports the careers of women in medicine.

Conflicts of interest

Y.F. is the Editor-in-Chief of the EJEM. There are no conflicts of interest for the remaining authors.


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2. Kaji AH, Meurer WJ, Napper T, Nigrovic LE, Mower WR, Schriger DL, Cooper RJ; Annals of Emergency Medicine Diversity Task Force. State of the journal: women first authors, peer reviewers, and editorial board members at annals of emergency medicine. Ann Emerg Med. 2019; 74:731–735
3. Harris CA, Banerjee T, Cramer M, Manz S, Ward ST, Dimick J, Telem DA. Editorial (spring) board? Gender composition in high-impact general surgery journals over 20 years. Ann Surg. 2019; 269:582–588
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