Moving ahead

I began writing this editorial exactly 1 week before the U.S. 2020 presidential election. Regardless of man we support at top ticket, are all nervous. Will next president be able to assuage our fears, boost spirits, “round corner” with us and represent? Ultimately, will find solace not by looking them but acting ourselves. This year, country faced crisis, rather than much-anticipated optimism that might accompany a new decade. Focusing on those issues pertaining public health, people lost lives, loved ones, livelihoods virus has shattered collective confidence. We saw (and/or participated in) summer civil unrest after witnessing death Black Americans hands police vigilantes. Asian-Americans, including who members medical communities, have been targets racist attacks due politization COVID-19. African American, Latinx, Native American communities disproportionately affected current coronavirus pandemic. The East coast smoke from wildfires in West, attesting their ferocity complicating management pandemic- associated respiratory disease. In comparison, crisis own vascular community experienced last response an article sought quantify unprofessional behavior young surgeons' social media accounts1Hardouin S. Cheng T.W. Mitchell E.L. Raulli S.J. Jones D.W. Siracuse J.J. et al.RETRACTED: Prevalence content among surgeons.J Vasc Surg. 2020; 72: 667-671Abstract Full Text PDF PubMed Scopus (43) Google Scholar seem minor comparison. Yet, it resonated publicly because critical mass exasperation had reached. Consider following: study design already published thus “sanctioned” least two other surgical journals.2Koo K. Ficko Z. Gormley E.A. Unprofessional Facebook accounts US urology residency graduates.BJU Int. 2017; 119: 955-960Crossref (34) Scholar,3Langenfeld Cook G. Sudbeck C. Luers T. Schenarts P.J. An assessment residents Facebook: warning dangers media.J Surg Educ. 2014; 7: e28-e32Crossref (58) Consent was waived under auspices sponsoring institutional review board, were appropriately approached for guidance. paper survived process, which left vacuum ultimately filled anger, reprehensible against authors, reviewing team, Journal, skewed perspective what outstanding practitioners do every day. Indeed, caught Journal society off guard. retracted lack appropriate permissions, as retracting brought up.4Retraction notice.J 1514Abstract (0) Inarguably, should prudent about post – racist, sexist, homophobic, violent, pornographic material certainly characterize would diminish trust take care people.5Shore R. Halsey J. Shah Crigger B.J. Douglas S.P. Ethical AMACoReport AMA Council Judicial Affairs: professionalism use Clin Ethics. 2011; 22: 165-172PubMed While bikinis mentioned methods specific target report, Results section show “provocative posing bikinis/swimwear” included analysis, sparking, part, response. Growing up, allowed wear bikini. argument both implied explicitly stated girl wears bikini is asking “it”. Asking what, exactly? To disrespected or worse? struck nerve. donned modest tweeted first time ever policing highest priority. One my tweet particularly relevant any discussion around diversity, equity, inclusion (DEI). I'll paraphrase posting #medbikini, George Floyd, better check privilege. no defense. driven experience, think right, whom hurt by, how want healed. craving someone represent fight White, Black, Native, Asian, immigrant, heterosexual, gay, lesbian, transgender, queer, man, woman, nonbinary, disabilities, urban, rural, educated, uneducated, elite, “deplorable”. hospital's tribute kneeling 8 minutes 46 seconds many others protest. Wasn't enough? know not. Who authority decide “professional behavior” medicine? safe definition “set values, behaviours relationships [underpin] doctors” (Royal College Physicians 2005). (6) Currently United States, scientists doctors depends small part one's political affiliation. Also, relates accountability matter debate when pertains doctor's limited personal time.6Pearson D. Walpole Barna Challenges professionalism: Social global environmental change.Med Teach. 2015; 37: 825-830Crossref (21) Additionally, “professionalism” ripe unconscious bias.7Frye V. Camacho-Rivera M. Salas-Ramirez Albritton Deen Sohler N. al.Professionalism: Wrong Tool Solve Right Problem?.Acad Med. 95: 860-863Crossref (7) Scholar,8Bowser K.E. pseudoscience legitimize criticism surgeons reinforce old ways.J 1827-1828Abstract (2) narrow views (traditionally defined white heterosexual men) grant limit access privilege degree, academic advancement, wages. more likely bias, malicious acts discrimination, perpetuates continued disparities healthcare leadership, important consequences follow. According recent Association Medical Colleges (AAMC; freely available AAMC.org reflective data 2018-2019), while number women applying school surpassed men, representation division chief chair positions remains low. Thirty percent chiefs across clinical fields women. Women under-represented medicine groups (URiM) make up only 15% basic sciences. 6.3% General Surgery chairs, third lowest above Otolaryngology (3.5%) Orthopedic (0.8%; https://www.aamc.org/data-reports). Thus, can say embrace diversity if these numbers leadership remain so low? personally won't listen attend another “manel” (all men panel). From director's desk, Dr Francis Collins NIH refused participate one (https://www.nih.gov/about-nih/who-we-are/nih-director/statements/time-end-manel-tradition). As newly appointed Associate Editor Clinical Research focus Diversity, Equity, Inclusion (DEI), thank editors commitment shatter silo. flagship publication reflect population serve surgeons. Even you don't see daily, diverse women, gender permutations willing ready lend discerning eyes process. unprecedented move, JVS increased UriM board; now constitute 27% board and/or (19/69). broadened call diversify reviewer pool. putting forth exciting opportunity engage still training form internship help groom array trainees become reviewers Journal. By being good, consistent, responsive reviewer, eventually join possibly Editor. path. If asked, said yes. asked asked! Don't afraid your ambition, readers! You rewarded. also process transparent, encourage totality readership responsibility society. Guided expertise Elsevier place, evaluating ways improve reporting sex/gender racial variables research. Reviewers comment well parameters addressed, they not, ask rationale. ironic twist, recruit generation bright minds effort. Diversity may good business importantly, students, residents, staff, colleagues it. Harvard Business Review (September-October pp.64-72) recently five-step plan promote equity workplace reflected acronym PRESS (Problem awareness, Root-cause Empathy, Strategy, Sacrifice). article, Robert Livingston identified source failure initiatives complacency. opinion piece New England Medicine, Vanessa Grubbs explained she, African-American leaving seemingly insurmountable role models looked like her path “professorship chiefdom.”9Grubbs That Matter.N Engl J 383: e25Crossref (9) She warned, previous author, believing enough name officer without deeper reflection change inadequate. approach journal necessarily multifaceted. societal enthusiastically supported position, formation DEI committee Society Vascular whole. It noted made big strides space 5 years, testament diversifying its ranks. 2008, Fiemu Nwariaku delivered Academic address Surgical Congress. entitled “Mind Gap: Workforce Disparities.”10Nwariaku F.E. Mind gap: workforce health.J Res. 2009; 154: 304-311Abstract (3) his address, he referenced “He ain't heavy”, famous Gilbert Young painting reaching down wall grab hand another. Surgeons always teachers helped lift up. am confident going lead area workforce, pool, articles, vision. election referendum representation, writing, idea shake out. outcome, momentum here you're heavy.