a b s t r a c t

Background: Studies show that although the presence of women in the medical field has risen, there is a lesser representation of women within Editorial boards of journals. Studies on this subject have mostly been carried out related to the medical field of the researcher. It is not known what position the emergency medicine depart- ment is in this regard compared to other departments. We aimed to investigate whether gender disparity exists within the editors and editorial Board members of medical journals, especially in those related to emergency medicine.

Methods: In the present cross-sectional study, we searched medical journals using the Scimago Journal/Country Rank journal system for comparison. The websites of the journals included in the study were searched, and gen- der data of the editor and editorial board, associate editors, consultant editors, and section editors for each journal were obtained.

Results: The total number of journals examined in this study was 276. The median percentage of female editorial board members (20.8%; 50-100) was lower in emergency medicine journals compared to other branches of medicine (31%; 0-100) (p < .001). The median percentage of female editorial board members and editors was also lower in the emergency medicine field (20.6%; 0-50) (p < .001) than in other branches of medicine. The per- centage of female editorial board members of emergency medicine journals was 19.5% with the third-lowest ranking among 26 branches. When both the editors and editorial board members were considered, the highest female percentage was found in pediatrics (50.7%) followed by geriatric medicine (43.4%).

Conclusion: There is a significant gender disparity within editors and editorial board members in emergency medicine journals. The proportion of women within the editorial board was found to be lower in emergency medicine journals among all the journals included in the study.

(C) 2022

1. Introduction

Academic progress in medicine has been associated with education, management responsibility, the Clinical performance of faculty mem- bers, and the ability to conduct clinical research [1]. In addition, titles such as editor and editorial board member or assistant editor in journals are important for academic prestige [2]. Gender disparity in academic progress and production has previously been the subject of research [3]. Although there have been improvements compared to previous years, the lesser role of females in terms of academic titles and levels of academic productivity has been observed [4]. Similarly, there are studies showing that women are less represented within journal

* Corresponding author at: Sirinevler, Alparslan Cd. No:1, 78200 Karabuk Merkez/ Karabuk, Turkey.

E-mail address: [email protected] (S.E. Atis).

editorship or editorial board membership [5,6]. Eliminating this in- equality is an important step to broaden the clinical perspective, sup- port educational efforts in other fields, and increase the quality of research [7]. Although the number of female authors in the field of emergency medicine has increased, we are still far from achieving equality [8,9].

1. Objective

In our study, we aimed to investigate whether there is a gender dis- parity within the editors and editorial boards in journals published in the field of emergency medicine and the editors and editorial boards in other medical branches. To our knowledge, there is no study assessing the position of the emergency medicine department is in this regard compared to other departments.

https://doi.org/10.1016/j.ajem.2022.01.040

0735-6757/(C) 2022

1. Material and method
   1. Study design

Our study is a cross-sectional study, and no ethics committee ap- proval was required since no human subjects were used, and the data sources were public on the internet.

• 1. Collection of data

The medical journals compared in the study were searched using the Scimago Journal/Country Rank journal system [10]. In the journal finder application in this system, the journals with the word “Emergency” in the journal name and their contents were examined. Journals publish- ing on emergency medicine have been categorized as “Emergency Med- icine” journals (Appendix 1) and top 10 journals (SCImago Journal Rank score) belonging to other medical fields including “Anesthesia; Cardiology-Cardiovascular Surgery; Critical Care; Dermatology; Endo- crinology; Family Medicine; Gastroenterology; Geriatrics; Hematology; Immunology; Infectious Diseases; Internal Diseases; Medicine (unclas- sified); Orthopedics; Neurology; Obstetrics; Oncology; Ophthalmology; Otorhinolaryngology; Psychiatry; Chest Diseases; Radiology; Rheuma- tology; Surgery; and Urology” were included in the study. First, the cur- rent issues of the found journals were examined. They were included in the study if their last issue was not published at the end of 2020 or if they did not publish an issue in 2021. If the same journal is listed twice among these journals, the content of the journal was examined, and the journal was included in the medical field that was more appro- priate. The search for the journals was carried out between February and June 2021. The websites of the journals included in the study were searched, and gender data of the editor and editorial board, asso- ciated editors, consultant editors, and section editors for each journal were obtained. This investigation was based on gender, not biological sex. First names were primarily found to determine the genders of the individuals included in the study. To identify the gender of unisex names for which the gender could not be revealed by examining the journal website, internet data containing photographs and academic ti- tles of individuals obtained from the websites of the institutions or asso- ciations they are affiliated with were used. If there was a photograph of the individuals, the gender was determined. In the absence of a photo- graph, an expression indicating the gender of the individual was sought in the CV. In case the gender could not be found all these efforts, we used the web-based online service genderize.io (https://genderize.io/) to de- termine the gender [11]. Despite all, individuals whose gender could not be distinguished were excluded from the study. Titleholders, coordina- tors, advisory boards, website designers, honor members, advisory board, and founding editors who are not actively involved in the journal were excluded from the study.

• 1. Statistical analysis

To summarize data obtained from this study descriptive statistics for continuous variables were given as mean +- standard deviation or me- dian, minimum, and maximum according to the distribution. Categori- cal variables were summarized as frequency and percentage. The normality of numerical variables was checked with Shapiro-Wilk, Kolmogorov-Smirnov, and Anderson-Darling tests. The Mann- Whitney U test was used for the comparison of two independent groups when numerical variables didn’t show normal distribution. The Kruskal-Wallis H test was used for the comparison of more than two in- dependent groups when numerical variables didn’t have a normal dis- tribution. Dwass-Steel-Critchlow-Fligner test was used for the differences between the groups for non-parametric tests. Statistical an- alyzes were performed with Jamovi project (2021), Jamovi (Version 1.8.1.0) [Computer Software] (Retrieved from https://www.jamovi.

org) and JASP (Version 0.14.1.0) (Retrieved from https://jasp-stats. org) software; p-value of 0.05 indicated statistical significance.

1. Results

The total number of journals examined in this study was 276. Ten journals were included from each of the medical departments. Also, there were 26 journals from Emergency Medicine and 10 Medicine (un- classified) journals. We excluded 33 (0.22%) individuals due to not dis- tinguishing their gender.

The department which had journals with the highest percentage of female editors was family medicine which had a percentage of 60%. This was followed by infectious diseases which had a female editor ratio of 46.2%. The female editor ratio of Emergency Medicine journals was 17.2% and it was 14th among 26 branches. Considering the editorial boards, the journal with the highest ratio of female members was pedi- atrics (51.1%). This was followed by geriatric (44.2%). The percentage of female editorial membership of emergency medicine journals was 19.5% with the third-lowest ranking among 26 branches. The highest percentage of male board membership was in orthopedics (83.8%) followed by urology (80.8%). When both the editors and board mem- bers were considered, the highest female percentage was found in pedi- atrics (50.7%) followed by geriatric medicine (43.4%). Emergency medicine had the second-lowest rate in this category with 19.4% after orthopedics which had a rate of 16% (Table 1).

The median percentage of female board members (20.8%; 50-100) was lower in the emergency medicine journals compared with the other journals (31%; 0-100) (P < .001) The median percentage of fe- males as board members plus editors was also lower in the Emergency Medicine journals (20.6%; 0-50) (P < .001) compared with the other journals (Table 2).

The ratio of male and female board members was different among the medicine specialties (P < .001 for each). The branch with the highest male ratio was urology (86.3%; 0-91.9). This was followed by orthope- dics (85.4%; 52.8-95.6). (Table 3).

The ratio of male and female editors + editorial board members was different among the journals (P < .001 for each). The branch with the highest male ratio was urology (86.5%; 0-2). This was followed by or- thopedics (86%; 53.3-96.5). The branch with the highest female ratio was pediatrics (48.8%; 19.1-100) (Table 4).

1. Discussion

In an article examining the American Medical Association Physician Masterfile dataset, the Female gender in the emergency medicine de- partment was found to be 28% [12]. In the field of emergency medicine, women occupy less academic and management positions and have fewer years of work [13]. Despite an increase in average wages, women still earn less than men [14]. Similarly, although there has been an increase in the proportion of academic publications by women over the years, the women’s academic publishing rate is lower than that of men [9]. This is similar within the editorial and editorial boards of the journals in the field of emergency medicine. In a study conducted in 2021, 16 emergency medicine journals with an impact fac- tor higher than 1 were examined and it has been found that the propor- tion of females within the editorial board and female editors were 12.7%, and 6.6%, respectively [15]. Gottlieb et al. have found that the rate of women within the editorial board was 16.3% and the rate of fe- male editors was 8.7% [16]. In an earlier study by Miro et al., the propor- tion of females within the editorial board and female editors were 13.2% and 3.6%, respectively [17]. In our study, these rates were found to be 17.2% and 19.5%, respectively. Compared to other studies, the rate of the female within the editorial board and female editors was found to be higher in our study. This difference is due to the journal selection criteria and the difference in the number of journals included in the study. Considering both our study and other studies, although it is

Table 1

The Frequencies and Percentages of Males and females as Editors, Board Members, or Both

Editor Editorial board Editorial + Board

			Number of males	Number of females	Total editor	Male %	Female %		Number of males	Number of females	Board total	Male %	Female %		Number of males	Number of females	Board total	Male %	Female %
	Emergency Medicine		24	5	29	82.8%	17.2%		720	174	894	80.5%	19.5%		744	179	923	80.6%	19.4%
	Pediatrics		6	4	10	60.0%	40.0%		129	135	264	48.9%	51.1%		135	139	274	49.3%	50.7%
	Geriatrics		11	1	12	91.7%	8.3%		317	251	568	55.8%	44.2%		328	252	580	56.6%	43.4%
	Family Medicine		4	6	10	40.0%	60.0%		153	107	260	58.8%	41.2%		157	113	270	58.1%	41.9%

Obstetrics and Gynecology

9

3

12

75.0%

25.0%

293

213

506

57.9%

42.1%

302

216

518

58.3%

41.7%

Unclassified	9	1	10	90.0%	10.0%	87	66	153	56.9%	43.1%	96	67	163	58.9%	41.1%
Dermatology	7	3	10	70.0%	30.0%	422	291	713	59.2%	40.8%	429	294	723	59.3%	40.7%
Infectious Diseases	7	6	13	53.8%	46.2%	100	60	160	62.5%	37.5%	107	66	173	61.8%	38.2%
Hematology	13	2	15	86.7%	13.3%	297	181	478	62.1%	37.9%	310	183	493	62.9%	37.1%
Psychiatry	11	0	11	100.0%	0.0%	172	104	276	62.3%	37.7%	183	104	287	63.8%	36.2%
Rheumatology	9	2	11	81.8%	18.2%	367	191	558	65.8%	34.2%	376	193	569	66.1%	33.9%
Endocrinology	7	3	10	70.0%	30.0%	244	114	358	68.2%	31.8%	251	117	368	68.2%	31.8%
Internal Medicine	6	4	10	60.0%	40.0%	193	84	277	69.7%	30.3%	199	88	287	69.3%	30.7%
Ophthalmology	12	0	12	100.0%	0.0%	327	150	477	68.6%	31.4%	339	150	489	69.3%	30.7%
Immunology	9	2	11	81.8%	18.2%	222	97	319	69.6%	30.4%	231	99	330	70.0%	30.0%
Oncology	7	4	11	63.6%	36.4%	368	156	524	70.2%	29.8%	375	160	535	70.1%	29.9%
Anesthesia	10	1	11	90.9%	9.1%	393	147	540	72.8%	27.2%	403	148	551	73.1%	26.9%
Neurology	9	2	11	81.8%	18.2%	345	120	465	74.2%	25.8%	354	122	476	74.4%	25.6%
Chest Diseases	10	2	12	83.3%	16.7%	442	153	595	74.3%	25.7%	452	155	607	74.5%	25.5%
Surgery	10	1	11	90.9%	9.1%	583	192	775	75.2%	24.8%	593	193	786	75.4%	24.6%
Hepatology	11	2	13	84.6%	15.4%	526	163	689	76.3%	23.7%	537	165	702	76.5%	23.5%
Intensive care	9	1	10	90.0%	10.0%	465	143	608	76.5%	23.5%	474	144	618	76.7%	23.3%
Otorhinolaryngology	8	2	10	80.0%	20.0%	532	137	669	79.5%	20.5%	540	139	679	79.5%	20.5%

Cardiovascular Surgery-Cardiology

9

1

10

90.0%

10.0%

1159

280

1439

80.5%

19.5%

1168

281

1449

80.6%

19.4%

Urology	8	2	10	80.0%	20.0%	598	142	740	80.8%	19.2%	606	144	750	80.8%	19.2%
Orthopedics	12	0	12	100.0%	0.0%	832	161	993	83.8%	16.2%	844	161	1005	84.0%	16.0%

thought that there is a rise in the rate of female gender in emergency medicine journals over the years, it has been found in a study that this increase was not statistically significant [18]. In the above-mentioned study, the proportion of women within the editorial boards of emer- gency medicine journals has been found to be lower compared to the journals in the field of Surgery, Obstetrics, Pediatrics, General Medicine, and Internal Medicine [18]. In our study, emergency medicine journals had a lower proportion of women in the editorial board compared to other medical fields. Similarly, the proportion of women within the ed- itorial boards of emergency medicine journals was found to be lower compared to the four medicine fields mentioned above. Our study showed that the field of emergency medicine ranked third from the last in terms of the proportion of females within the editorial board among all fields. Pediatric journals have the highest proportion of fe- males within the editorial board. To the best of our knowledge, our study is the most comprehensive study comparing Emergency Medicine journals with those in other medical fields.

According to data of the Association of American Medical Colleges,

similar proportions of men and women graduate from medical schools each year, and the rate of female academics in medical faculties is cur- rently 41% and this rate drops to 21% in professorship positions. The

Table 2 The Comparison of the sex of editors, and board members of emergency medicine journals and other journals

rate of female academicians in the emergency medicine community was found to be 33% [13,19]. Although similar proportions of men and women have graduated from medical school, the rate of female acade- micians is low, may be due to the lack of mentorship, preference to teach rather than academic publishing, being young and at the begin- ning of their academic careers [20]. In addition, the burden of domestic responsibilities of women such as childcare, pregnancy, housework, etc. contributes to delaying professional careers [21]. Interestingly, the term of science is often more associated with the male gender than with women, interfering objective judgment or selection, and may have an impact on editorial board acceptance and peer-Review processes [22]. Various task forces have been established to prevent gender inequality in emergency medicine. It was thought that expanding the scope of ac- tivity of these task forces or the emergence of similar initiatives could help to eliminate gender inequality [15]. Emergency medicine journals can review their editorial boards and take independent steps in this re- gard. Instead of face-to-face mentoring, mentorship websites can be es- tablished, where women can support each other online. Emergency Medicine associations worldwide can organize panels in meetings to raise awareness about gender inequality.

In conclusion, there is a significant gender disparity within editors and editorial board members in emergency medicine journals. The pro- portion of women within the editorial board was found to be lower in emergency medicine journals among all the journals included in the study. It has been determined that journals in the field of emergency

medicine had the editorial board with the third-lowest women propor-

	Emergency	Other	p?
Board
Male %	79.2 [50-100]	69.1 [0-100]	<0.001
Female %	20.8 [0-50]	31 [0-100]	<0.001
Board + Editor
Male %	79.4 [50-100]	68.6 [0-100]	<0.001
Female%	20.6 [0-50]	31.4 [0-100]	<0.001

tion among all fields. This should be prevented with various initiatives and awareness.

• 1. Limitations

Descriptive Statistics were given as median, minimum, and maximum depending on the distribution of numerical variables.

* . The Mann-Whitney U test was used.

Although attention is paid to the field-specific selection of the journals included in our study, there is no definitive method for selecting a field-specific journal. There may be emergency medicine journals that fall outside the journal selection criteria, have just started

Table 3

The comparison of the ratios of male and female editorial board members among the journals

Table 4

The comparison of the ratios of male and female editors + editorial board members among the journals

	Male %	p?	Female %	p?			Male %	p?	Female %	p?
Emergency Medicine	79.2 [50-100]	<0.001	20.8 [0-50]	<0.001		Emergency Medicine Anesthesia	79.4 [50-100] 75 [18.2-96]	<0.001	20.6 [0-50] 25 [4-81.8]	<0.001

Anesthesia

74.6 [20-95.7]	25.4 [4.4-80]	Family medicine	60.6 [13.3-75.4]	39.4 [24.6-86.7]
62.3 [13.8-76.8]	37.7 [23.2-86.2]	Surgery	76.1 [56,1-93.3]	23.9 [6.7-43.9]
77 [55-93.1] 49.3 [0-80] 59.3	23 [6.9-45] 50.7 [20-100] 40.7	Pediatrics Dermatology	51.2 [0-81] 59.7 [31.7-76.6]	48.8 [19.1-100] 40.3 [23,4-68.3]
[30-76.2] 67.4 [44.4-100] 72.3 [0-87]	[23.8-70] 32.6 [0-55.6] 27.7 [13-100]	Endocrinology Chest diseases Hematology	66.7 [33.3-100] 73.2 [0-87.5] 62.6 [0-94]	33.3 [0-66.7] 26.8 [12.5-100] 37.4 [6-100]
62.2 [0-93.8] 79.9 [50-100] 73.9 [54.8-100] 61.5 [0-80.3]	37.8 [6.3-100] 20.1 [0-50] 26.1 [0-45.2] 38.5 [19.7-100]	Hepatology Internal Medicine Immunology Infectious Diseases Obstetrics and	74.9 [60-88.6] 73.7 [53.1-79,3] 64.1 [0-80.5] 60.3 [33.3-100] 57.9	25.1 [11.4-40] 26.3 [20.7-46.9] 35.9 [19.5-100] 39.7 [0-66.7] 42.1
50 [25-73.8]	50 [26.2-75]	Gynecology	[26.2-74.6]	[25.4-73.8]
57.5	42.5	Otorhinolaryngology	76.3 [50-88.7]	23.7 [11.3-50]
[26.8-74.1]	[25.9-73.2]	Cardiovascular Surgery	77.9 [50-91.8]	22.1 [8.2-50]
75.6	24.4	Neurology	71.2 [20-80.3]	28.8 [19.7-80]
[52.4-90.3]	[9.7-47.6]	Ophthalmology	70.7 [50-93.3]	29.3 [6.7-50]
77.8	22.2	Oncology	67.8 [0-100]	32.2 [0-100]
[33.3-91.8]	[8.2-66.7]	Orthopedics	86 [53.3-95.6]	14 [4.4-46.7]

Family Medicine Surgery Pediatrics

Dermatology Endocrinology Chest Diseases Hematology Hepatology Internal Medicine

Immunology Infectious Diseases

Obstetrics and Gynecology

Otorhinolaryngology

Cardiovascular Surgery-cardiology

Neurology 70.5

[25-80.2]

29.5

[19.8-75]

Psychiatry 64,6

[54,3-78,8]

35.5

[21,2-45.7]

Ophthalmology 70.2

[47.4-92.9]

29.8

[7.1-52.6]

Rheumatology 63,2 [0-79,5] 36.8

[20.6-100]

Oncology 70.3 [0-100] 29.7 [0-100]

Unclassified 46,4 [0-76,1] 53.6

Orthopedics 85.4

[52.8-95.6]

Psychiatry 60.1

14.6

[4.4-47.2]

39.9

[23.9-100]

Urology 86,5 [0-92] 13.5 [8-100]

Geriatrics 64,1 [26-86.5] 35.9 [13.5-74] [50-78.1] [21.9-50]

Intensive Care 80,1

19.9 [5.6-36.5]

Rheumatology 62.4 [0-79.2] 37.6

[20.8-100]

Unclassified 38.1 [0-75.6] 61.9

[24.4-100]

Urology 86.3 [0-91.9] 13.7

[8.1-100] [63.5-94.4]

Descriptive statistics for numerical variables were given as median, minimum, and maxi- mum according to the distribution.

* . The Kruskall Wallis H test was used.

Geriatrics 63.4

[26.3-85.3]

Intensive Care 79.3

[63.3-94.3]

36.6

[14.7-73.7]

20.7

[5.7-36.7]

Writing - review & editing, Validation, Methodology, Formal analysis, Data curation, Conceptualization. Yusuf Mistik: Data curation, Concep- tualization.

Descriptive statistics for numerical variables were given as median, minimum, and maxi- mum according to the distribution.

* . The Kruskall Wallis H test was used.

to be published, and are not yet searched based on our search criteria. Despite all efforts, the gender of some individuals could not be deter- mined. This situation may have caused minor deviations in the statisti-

Declaration of Competing Interest

Authors report there is no conflict of interest.

Appendix 1

Emergency Medicine.

cal analysis. In addition, in our study, no data on biological sex was

obtained, all data were designed based on gender.

Funding

Authors declare there is no financial support.

CRediT authorship contribution statement

Seref Emre Atis: Writing - review & editing, Writing - original draft, Methodology, Formal analysis, Data curation, Conceptualization. Oner Bozan: Writing - review & editing, Validation, Methodology, Data curation. Busra Bildik: Visualization, Data curation. Bora Cekmen:

1. Academic Emergency Medicine
2. Annals of Emergency Medicine
3. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
4. prehospital emergency care
5. Emergency Medicine Journal
6. European Journal of Emergency Medicine
7. Western Journal of Emergency Medicine
8. American Journal of Emergency Medicine
9. BMC Emergency Medicine
10. EMA - Emergency Medicine Australasia
11. Canadian Journal of Emergency Medicine
12. International Journal of Emergency Medicine
13. Journal of Emergency Medicine
14. Pediatric Emergency Care
15. Emergencias
16. Open Access Emergency Medicine
17. African Journal of Emergency Medicine
18. Bulletin of Emergency and Trauma
19. Clinical and Experimental Emergency Medicine
20. Turkish Journal of Emergency Medicine
21. Emergency Medicine International
22. Journal of Emergency Medicine, Trauma and Acute Care
23. Clinical Pediatric Emergency Medicine
24. Hong Kong Journal of Emergency Medicine
25. Visual Journal of Emergency Medicine
26. Akademik Acil Tip Olgu Sunumlari Dergisi

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