On manels and manferences in urology

News & VIews SCIENCE AND SOCIETY On manels and manferences in urology Imogen Patterson and Sigrid V. Carlsson Balancing diversity on panels at academic medical conferences demonstrates a commitment to the principles of diversity and inclusion. However, it seems we have a long way to go in urology, where two-thirds of sessions at major urology meetings still consist of all-male speaker panels. Refers to Teoh, J. Y.-C. et al. A quantitative analysis investigating the prevalence of “manels” in major urology meetings. Eur. Urol. https://doi.org/10.1016/j.eururo.2021.05.031 (2021). Urology remains an overwhelmingly male specialty, but the proportion of female uro logists is increasing. According to data from the 2020 American Urological Association census, for the first time in history, women urologists have now surpassed 10% of the urology workforce in the USA1. In addi tion, many academics devoted to urological research are women. However, the increasing female urology workforce is not necessarily reflected in the speakers and panels at aca demic urology meetings. In a recent study in European Urology, Teoh and colleagues2 inves tigated the prevalence of ‘manels’ — the name given to an all-male speaking panel — at uro logical meetings organized by major urolog ical associations and societies over a single year between December 2019 and November 2020. Of 285 urology meeting sessions dur ing that 1-year period, almost two-thirds (64%) were manel sessions. One could argue that inclusion on panels should be based on experience and merits and some amongst the meeting organizers or attendees might believe that participants with those qualifications are more likely to be older, more senior men. However, intriguingly, comparison of male faculty and their female counterparts with similar academic merits, taking into account metrics such as number of publications or H-index, showed that men still participated in more sessions than women in the urological meetings. Simply put: regardless of expertise and merit, men received more opportunities than women2. Women are under-represented in urol ogy and at urology meetings, and the fact that this disparity remains an issue in 2021 is vexing. Lack of gender diversity among panellists sends the wrong message to con ference attendees and limits the perspectives shared with the audience to those of the men on the panel3, which might be disparate and detached from what the audience might expe rience. However, perhaps more importantly, in academic settings, in which national and international recognition and the opportunity to appear at a plenary session or present as an invited speaker counts towards promotion, it could be argued that manels are another form of career discrimination. Dr Francis Collins, Director of the National Institutes of Health (NIH), alluded to this issue in a 2019 state ment declaring that he will no longer accept invitations to participate in manels4. This atti tude has been echoed by many other men on an individual level, within urology and across other professions. Manels and manferences5 — conferences largely dominated by male speakers — are not limited to urology or even academic medicine in general; other specialties and professions have come to the same conclusion about the persistence of this imbalance in their specialty conferences, as Teoh et al.2 rightly point out. The financial industry has reported simi lar findings, but here the burgeoning evi dence demonstrates that gender diversity on boards or amongst startup founders leads to improved company performance6–8. A 2018 Boston Consulting Group report found that diverse leadership leads to improved inno vation 6, and a Harvard Business Review study revealed that firms with more women Nature Reviews | Urology 0123456789();: To promote positive change, we must work together as organizers, panellists and audiences in senior positions are more profitable than those without 7. This evidence has led to improvements in recruitment and promo tion of women within many companies to improve shareholder returns and stock mar ket performance8. Taking into account these data illustrating the benefits of gender diver sity, it is, therefore, perplexing that the fail ure to include or promote women in urology conferences and panels continues. Many explanations have been proposed for the lack of female representation on speaker panels at conferences with traditionally lower proportions of women. To inject some humour into the debate, public health spe cialist Dr Mary E. Black created a 25-square ‘manel bingo card’ covering common excuses and misperceptions used to ‘justify’ exclud ing women from conference panels9. These unfounded excuses include “there aren’t enough qualified female speakers”, “you can’t kick out a male speaker just to fit a woman in there” and “all the women were probably busy”. The COVID-19 pandemic has further eroded the list of potential excuses for includ ing women, as many meetings now have a vir tual component. Video teleconferencing can obviate the need for every panellist to travel, thereby removing another tired excuse that women prefer not to travel because of fam ily commitments — not to mention the fact that many men have families too. The rapid adoption of video teleconferencing during the pandemic has demonstrated the capabil ity of urologists to expedite change and do away with eons of ‘tradition’ when necessary, making it even more unfortunate that manels have persisted for so long in our field despite the evidence that shows that the majority of urologists are able to accept change when it is forced upon us. So, what can we all do to raise awareness of the problem of under-representation of women at academic medical conferences? Much like the declaration by NIH Director Collins4, or the recent diversity statement and commitment to change by the Royal College of Surgeons of England, which set gender NeWS & VieWS 3 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4 Credit: Getty Images/Oleg Prikhodko ✉e-mail: https://doi.org/10.1038/s41585-021-00508-7 American Urological Association. 2020: The State of Urology Workforce and Practice in the United States (AUA, 2020). 2. Teoh, J. Y.-C. et al. A quantitative analysis investigating the prevalence of “manels” in major urology meetings. Eur. Urol. https://doi.org/10.1016/j.eururo.2021. 05.031 (2021). 3. Kibbe, M. R. & Kapadia, M. R. Underrepresentation of women at academic medical conferences — “manels” must stop. JAMA Netw. Open 3, e2018676 (2020). 4. Collins, F. S. Time to end the manel tradition. NIH https://www.nih.gov/about-nih/who-we-are/nih-director/ statements/time-end-manel-tradition (2019). 5. Else, H. How to banish manels and manferences from scientific meetings. Nature 573, 184–186 (2019). 6. Lorenz (...truncated)