Introducing the EAU Equality, Diversity, Inclusion Taskforce

Dr. Silvia Proietti Member, EAU Equality, Diversity and Inclusion Taskforce San Raffaele Hospital Milan (IT)

proiettisil@gmail.com

A continuous hot topic for vivid discussions remains the disproportional representation of male physicians in various medical disciplines, in which urology is no exception. These debates on gender imbalance have triggered the EAU to critically review the level of inclusivity of its own organisation. This resulted in a strong ambition to actively act upon the underrepresentation of all minorities in terms of gender, country of origin, religion, age, social and ethnic backgrounds within its community. A special taskforce has been established to make this happen. In a series of articles, different aspects of the EDI strategy will be covered, starting with this first article focussing on gender imbalance.

Why is EDI important? An environment that includes, respects, promotes and values individual differences along varying dimensions is of paramount importance in any organisation, but especially in a scientific organisation that is active across borders and is considered a networking hub for many different nationalities. Research has shown that inclusive organisations are more innovative and make better decisions in both clinical and scientific circumstances.

“The European Association of Urology (EAU), as a leader in the urological field, is convinced that by promoting Equality, Diversity, and Inclusion, urological care will be improved.”

With the growing need for more urologists, the recruitment of medical students is essential in lowering the workload. Young physicians are more likely to be alienated from the organisation if they do not see themselves represented within an organisation. By expanding opportunities to teach, speak and lead to the wider urological community, the aim is not only to widen the urological talent pool, but also to foster belonging and to strive for continued unbiased excellence.

Gender balance in Europe Over the last couple of years, the number of women in the medical and urological workforce has considerably increased and it is expected that this number will rise at a rapid pace. Recent analysis of data from 9 European countries indicates that women currently make up 63% of all medical students, 48% of all urology residents and 24% of all urology consultants. (See Fig. 1)

Analysis of diversity in EAU The EAU currently has over 19,000 members of whom the majority (14,000 members) practice in Europe. (See Fig. 3) Over 3,200 (17%) of the total membership database are female, most of them are under the age of 40 years. Although the recent years have shown an increase in female representation among EAU members, the speed is not the same as the increase seen in some of the European countries.

“Over the last couple of years, the number of women in the medical and urological workforce has considerably increased and it is expected that this number will rise at a rapid pace.”

When looking at various EAU activities, the increasing feminisation of urology is currently not reflected within its ranks. Up until 2021 women presented less than 20% of all posters, chaired less than 10% of the scientific sessions and made up around 12% of the faculty at the Annual EAU Congress was female. (See Fig. 2) While the situation is changing (this year the first female board member was appointed, as chair of the Guidelines Office), still some EAU Offices and Sections only consist of male members. In terms of future membership and development of the association this is certainly something that needs to be considered and transformed.

EAU EDI Task Force The European Association of Urology (EAU), as a leader in the urological field, is convinced that by promoting Equality, Diversity, and Inclusion, urological care will be improved. With the establishment of the EDI Task Force with special focus on gender, EDI should be further encouraged and established within the EAU. The members of the Task Force were selected in open competition, based on their experience with leadership, teamwork, and diversity-related advocacy. The first team, focussing on gender imbalance, consists of 8 core members including female and male urologists at various levels of seniority in both academic and institutional service roles. The team is led by Associate Professor Tamsin Greenwell (UK). The other Task Force members are: Dr. Ekaterina Laukhtina (Austria), Dr. Laura Mertens (the Netherlands), Dr. Carmen Mir (Spain), Dr. Saskia Morgenstern (Germany), Dr. Fardod O’ Kelly (Ireland), Dr. Idir Ouzaid (France) and Dr. Silvia Proietti (Italy).

After an initial audit to assess the current situation on EDI in the urological community, the task force has commenced developing strategies and formulating potential solutions to identified issues. This resulted in the following aims & objectives of the EAU-EDI Task Force: 1. To provide similar opportunities and the same future career perspectives to our EAU members 2. To eliminate barriers in terms of gender (identity), ethnicity, country of origin, disability, and sexuality without reducing the quality of the clinical practice and educational output of the

EAU 3. To create an inclusive environment dedicated to change within the EAU 4. To turn attention and resources toward structural and systemic interventions aimed to develop all and foster the development of minority members within the EAU In the next 5-10 years these objectives should lead to the implementation of a diverse and inclusive structural urological framework with 5 concrete actions initially planned:

1. A demographic and unconscious bias survey: to capture and analyse the current situation within the EAU and establish a benchmark upon which to measure the success of the strategies to enhance EDI 2. Establish a mentorship programme to provide career, academic and pastoral support for EAU members – initially this will be for younger members and via application in open competition. 3. Establish a diverse speaker panel to ensure equality in speaker and faculty opportunities and to attract young and diverse talented urologists.

This will permit nomination (including selfnomination) of new talent. Application will be via a designated form and submission of a short recorded talk. 4. To establish a series of educational activities like webinars, podcasts around EDI and personal development to inspire and energise all urologists 5. A tailor-made monitoring framework will be developed for the EDI Task Force Strategy to monitor progress towards its objectives.

In conclusion, the vision outlined in this article is ambitious and long-term, but it represents an important starting point to make the EAU urological community more diverse (and hence representative), equitable and inclusive which will ensure, undoubtedly, its bright future!

What is EDI?

The term EDI stands for Equality, Diversity, and Inclusion.

• Equality is the state of being equal, especially in status, rights, or opportunities. • Diversity is the practice or quality of including or involving people from a range of different social and ethnic backgrounds and of different ages, gender and sexual orientation. • Inclusion is the action or state of including or of being included within a group or structure.

The EAU Equality, Diversity and Inclusion Taskforce

Ms. Tamsin Greenwell Chair, EAU EDI Taskforce Consultant Urological Surgeon, UCLH Honorary Assoc. Professor, UCL London, United Kingdom

Dr. Ekhaterina Laukhtina Research Fellow, Dept. of Urology Comprehensive Cancer Center Medical University of Vienna, Austria

Dr. Laura Mertens Fellow Oncologic Urology Antoni van Leeuwenhoek, Netherlands Cancer Institute Amsterdam, The Netherlands

Dr. M. Carmen Mir Consultant Urological Surgeon IVO Foundation Valencia, Spain Dr. Saskia Morgenstern Consultant Urological Surgeon Agaplesion Markus Hospital Frankfurt, Germany

Dr. Fardod O’Kelly Consultant Paediatric Urologist Beacon Hospital Dublin, Ireland

Dr. Idir Ouzaid Consultant Urological Surgeon, Groupe Hospitalier Bichat-Claude Bernard Paris, France

Dr. Silvia Proietti Consultant Urological Surgeon San Raffaele Hospital Milan, Italy

Other sources on EDI

1. https://www.aamc.org/news-insights/press-releases/ majority-us-medical-students-are-women-new-datashow 2. Accreditation Council for Graduate Medical Education:

Data Resource Book, Academic Year 2019–2020.

Chicago: Accreditation Council for Graduate Medical

Education 2020. Accessed May 9, 2021. Available at https://www.acgme.org/ About-Us/Publications-and-

Resources/ 3. American Urological Association: Census Results.

Available at https://www.auanet. org/research/ research-resources/aua- census/census-results.

Accessed April 28, 2021. 4. Richter KP, Clark L, Wick JA, Cruvinel E, Durham D, Shaw

P, Shih GH, Befort CA, Simari RD. Women Physicians

and Promotion in Academic Medicine.N Engl J Med. 2020; 383(22):2148-2157. 5. Bailey EL.Br Women in medicine: increasing in number but not regard.

J Gen Pract. 2020;70(695):296. 6. Capella C, Schlegel L, Shenot P, Murphy A.Female

Representation at High-profile Urology Conferences, 2014-2019: A Leadership Metric.Urology. 2021;150:72-76. 7. T Adesoye , C Mangurian, EK Choo , C Girgis , H

Sabry-Elnaggar , E Linos, Physician Moms Group Study

Group. Perceived Discrimination Experienced by

Physician Mothers and Desired Workplace Changes: A

Cross-sectional Survey. JAMA Intern Med 2017; 177(7):1033-1036. 8. Gomez LE, Bernet P.Diversity improves performance and outcomes. J Natl Med Assoc. 2019;111(4):383-392.

% Female

female

male

undefined Gender 2015 2016 2017 2018 2019 2020 2021

2,110 2,197 2,608 2,763 2,828 3,045 3,224

13,277 13,448 14,719 14,474 14,556 14,470 15,487

575 465 579 587 546 419 346

Fig. 3: EAU members by gender from 2015 until 2021

30

25 % Female

20

15

10

5