Leading medical textbook achieves editorial gender balance

Strength in diversity

As Professor of Medicine at the University of California San Francisco with more than 40 years’ experience, Dr Broaddus  had witnessed the serious and continued push for diversity from her institution. For Murray & Nadel’s Textbook of Respiratory Medicine to maintain its status as the gold standard in the field of pulmonary medicine, she believed, improved diversity among contributors was a critical goal:

I’m a firm believer that diversity makes for excellence. Diversity is strength. It allows for more balanced views and inputs.

Gender bias in the medical profession, particularly in senior roles, is an ongoing cause for concern. In the United States, more than half of medical school students are female, but research suggests this balance is still not filtering to leadership positions, places on editorial boards or authorship of publications.

In an editorial context, gender bias has the potential to translate into a narrower range of approaches. This is a factor Dr Broaddus is conscious of in the medical sphere. For example, it is possible that male contributors may lean towards intervention-based recommendations vs non-surgical solutions. She noted the influence of a more gender-balanced perspective on the revised book:

One of the new topics in this edition is sleep and the chapter on treatment for sleep apnea has all sorts of recommended non-surgical approaches. We hadn’t had anything like that before. If you have a range of outlooks, you can present a more balanced view of the field.

Seizing opportunity for editorial gender balance

Pursuing editorial gender balance raises pragmatic questions, particularly in a field where male editors and authors predominate. Dr Broaddus is quick to give due credit to past contributors:

I have had the good fortune to run into excellent men throughout my career, who have become important mentors. These include the late John Murray, who invited me to be an editor for this textbook. Male contributors have helped bring the book to its height. But to have a balanced view, the more inputs the better.

One key lesson from production of the previous edition was that practical barriers cannot be overcome through talk alone. That was Dr Broaddus’s first stint as Editor-in-Chief in which gender balance was raised but ultimately not reached:

We discussed improving diversity for the 6th edition. We were all well-meaning, but when it came down to it, the authors suggested continued to be predominantly male. We ended up with only 17% of contributors being women. I realized talk can be cheap, and we had not really achieved our good intentions.

Off the back of this, a different approach was pursued for the 7th edition, including seizing opportunity the moment it presented itself. The book was undergoing its biggest reorganization since the first edition in 1988. Major changes to the structure and content necessitated an additional editor. Additionally, two past editors were retiring. Dr Broaddus explained that her wish for these new positions was specific and clear:

I wasn't going to be nuanced this time; now it was about being direct. I wanted to make good on the gender balance of our editorial board before asking for the authorship to change. I was able to fill our open editorial positions with qualified, up-and-coming women. Before I knew it, we were 50:50 on our editorial board.

Pursuing concrete targets

The appointment of new female editorial board members created a tipping point. With a fresh outlook and diverse areas of expertise, the opportunity was ripe to reach for an ambitious 50% female authorship goal:

I was very clear that we wanted more women authors. I put a concrete, measurable goal in place of 50%. Then I kept raising the subject at every opportunity. It is important to be brave with targets and then continually pursue them.

A gender-balanced editorial board proved a great indicator of credibility to demonstrate the seriousness of the 50% author target. There was then work to do to shift traditional editorial and author mindsets. When seeking contributors, the natural tendency is to default to existing networks. This limited circle can lead to persistent bias. Research has certainly shown this to be the case for invited editorials by journals.

Uncovering excellent new contributors required continually prompting to look beyond existing networks. Dr Broaddus explained:

It’s tough in the beginning as the instinct is to approach your closest networks. You must put in work to turn up names of new authors. I would constantly be asking the editorial team and any authors who were on board, ‘Do you know any qualified women who could take this on? Who do you know?’ As soon as some good authors come through, it developed its own momentum. As a result I’ve learned about some great people in the field who hadn’t written for a textbook before.

A mutual opportunity

For potential authors, while contributing to a leading textbook can be perceived as a time-consuming activity, Dr Broaddus believes it can add great value to career and personal goals:

Anyone writing a chapter is seen as the world’s expert in that subject and a true citizen. If you contribute to this textbook, you are bettering the field for the next generation of pulmonary practitioners. It’s made my life easier that when we ask someone to write a chapter, we almost never have anyone decline.

Ambition for the future

The final figure of 32% female authors fell slightly off the 50% target. But by almost doubling the number of women’s voices compared to the previous edition, it represents an enormous step forward, Dr Broaddus said:

I am proud of what we’ve achieved — not for myself but for the book. This was a positive and joyful thing that we could do for the book.

For a profession that maintains under-representation at the senior end of the profession, visibility of female voices in leading textbooks might be one way to chip away at existing gender bias, she said:

We can’t fix the whole situation, but bringing more female voices to light with this edition was something that we could have more control over. That gave us a sense of accomplishment in what we were able to do.

From this landmark point, her next goal is to bring in even more underrepresented voices from around the world:

The more we can push diversity, the less likelihood of bias. For example, it has been discovered that oximeters, which measure oxygen pressure via your finger, can give a faulty reading on someone of dark skin color. Luckily, we now have that in the chapter on oximetry. Diversity of authors can help ensure the work is evidence-based. The whole goal is to be authoritative, comprehensive, and balanced. It’s a worthy goal.