The Issue

The February 23, 2016 issue of the Journal of the American Medical Association (JAMA) devoted to critical care is a major achievement. However, we were disappointed to see that the Sepsis-3 consensus panel, convened with the support of major national and international critical care societies to formulate a new definition for sepsis, included no women, no under-represented minority members, and no members from developing countries.(1) This panel came on the heels of another invited consensus group convened a few years ago to address the definition of the Acute Respiratory Distress Syndrome that included only one woman out of 15 Task Force members, and lacked representation from countries beyond North America and Western Europe.(2)

There are presently many accomplished academic intensivists who are women and/or underrepresented minorities, and who work outside of Europe and North America; however, it is unclear if intensivists with these demographics were considered in the formation of the Sepsis-3 consensus panel. Importantly, diversity does not, and should not, come at the expense of academic excellence. But the willingness to look beyond traditional circles for expertise is a necessity in 2016.

A Solution

Consensus panels convened by invitation have a unique opportunity to ensure inclusive leadership that is representative of the whole community within critical care. Moreover, extensive research has demonstrated that with diversity of participants comes diversity of ideas, enhanced innovation, and improved group performance (3,4)--something any expert panel should welcome. We suggest that societies sponsoring such panels ensure a transparent selection process to ensure that diversity is valued and relative homogeneity is explained.

With an increasing number of medical school graduates now women and minorities,(5) critical care can and must attract the very best of these groups to the field to retain relevance. To look at the recent JAMA publications may very well leave talented women and minorities feeling they cannot see a career path within critical care, resulting in their selecting other specialties; this would be a huge loss. Invitation-only consensus panels are well-positioned to actively cultivate diversity, and explicitly mentor rising investigators into leadership roles. We encourage professional organizations and academicians to pro-actively engage in a larger conversation directed at finding ways for the field of critical care to open its doors and provide a face to the world promoting diversity.

This letter was written on behalf of the American Thoracic Society’s Working Group of Women in Critical Care and the Subcommittee on Health Equality and was published on July 26, 2016 in JAMA.(6) Over 60 individuals in academic critical care have given their support for it already. Please show your support for diversity in Critical Care Medicine by signing this statement with us.

Supporters

Raolat M. Abdulai, MD; Harvard Medical School-Brigham and Women's Hospital, USA

Kathleen Akgun, MD MS; Yale School of Medicine, USA

Rebecca Aslakson, MD PhD; Johns Hopkins University, USA

Becky Baron, MD; Brigham and Women's Hospital, USA

Julie Bastarache, MD; Vanderbilt University, USA

Estaban G. Burchard, MD MPH; University of California, San Francisco, USA

Ellen Burnham, MD MS; University of Colorado School of Medicine, USA

Carolyn S. Calfee, MD; University of California, San Francisco, USA

Shannon Carson, MD; University of North Carolina, USA

Juan C. Celedon, DrPH, MD; University of Pittsburgh, Children's Hospital of Pittsburgh, USA

Jason Christie, MD MS; University of Pennsylvania, USA

Geoffrey Connors, MD; Yale School of Medicine, USA

Colin Cooke, MD MS; University of Michigan, USA

Christopher E. Cox, MD MPH; Duke University, USA

Janet Diaz, MD; California Pacific Medical Center, USA

Ivor Douglas, MD; University of Colorado School of Medicine, USA

E. Wesley Ely, MD MPH; Vanderbilt University, USA

Elisa Estessoro, MD; Hospital Interzonal de Agudos San Martin, La Plata, BA Argentina

Laura E. Evans, MD MSc; NYU School of Medicine, Bellevue Hospital Center, USA

Thomas W. Ferkol Jr., MD; Washington University, USA

Simon Finfer, MD; University of Sydney, Australia

Joe N.G. (Skip) Garcia, MD; University of Arizona Health Sciences, USA

Allan Garland, MD MA; University of Manitoba, Canada

Hayley B. Gershengorn, MD; Albert Einstein College of Medicine, Montefiore Medical Center, USA

Timothy Girard, MD; Vanderbilt University, USA

Antonio Gomez, MD; University of California, San Francisco, USA

Michelle N. Gong, MD MS; Albert Einstein College of Medicine, Montefiore Medical Center, USA

David Gozal, MD MBA; University of Chicago, USA

Jesse R. Hall, MD; University of Chicago, USA

Scott Halpern, MD PhD; University of Pennsylvania, USA

John Hansen-Flaschen, MD; University of Pennsylvania, USA

Nicholas Hart, MRCP MBBS PhD; St Thomas' Hospital, UK

Shyoko Honiden, MD; Yale School of Medicine, USA

Aluko A. Hope, MD; Albert Einstein College of Medicine, Montefiore Medical Center, USA

Catherine L. Hough, MD MSc; University of Washington, USA

S. Jean Hsieh, MD; Albert Einstein College of Medicine, Montefiore Medical Center, USA

May Hua, MD; Columbia University Medical College, USA

T. Jack Iwashyna, MD PhD; University of Michigan, USA

Meshell D. Johnson, MD; University of California, San Francisco, USA

Jeremy Kahn, MD MS; University of Pittsburgh, USA

Kirsten Kangelaris, MD; University of California, San Francisco, USA

Meeta Kerlin, MD MSCE; University of Pennsylvania, USA

Nita Khandelwal, MD; University of Washington, USA

Vladimir Kvetan, MD; Albert Einstein College of Medicine, Montefiore Medical Center, USA

Meghan Lane-Fall, MD MSHP; University of Pennsylvania, USA

Abbey Lara, MD; University of Colorado School of Medicine, USA

Joe Levitt, MD MS; Stanford University, USA

Janice Liebler, MD; University of Southern California, USA

Kathleen Liu, MD; University of California, San Francisco, USA

Sarah M. Lyon, MD MSCE; University of Pennsylvania, USA

Aline Maddux, MD; University of Colorado School of Medicine, USA

Atul Malhotra, MD; University of California, San Diego, USA

Michael Matthay, MD; University of California, San Francisco, USA

Richard Matthay, MD; Yale University, USA

Nuala J. Meyer, MD; University of Pennsylvania, USA

Smita Pakhale, MD MSc FRCPC; Ottawa Hospital, Canada

Pratik Pandharipande, MD; Vanderbilt University, USA

Hallie C. Prescott, MD MSc; University of Michigan, VA Ann Arbor, USA

Kristin A. Riekert, PhD; Johns Hopkins University, USA

Katherine Rivera-Spolijaric, MD; Washington University, USA

William Rodriguez, MD; VA San Juan, USA

Jesse Roman-Rodriguez, MD FACP FACCP; University of Louisville, USA

Kari L. Rosbeck; Tuberous Sclerosis Alliance, USA

Kathy Rowan, PhD MSc; Intensive Care National Audit & Research Centre, UK

Jonathan M. Samet, MD MS; University of Southern California, USA

Dean E. Schraufnagel, MD; University of Illinois College of Medicine, USA

Dean Sheppard, MD; University of California, San Francisco, USA

Mark Siegel, MD; Yale School of Medicine, USA

Kerri A. Smith, MD; University of Pennsylvania, USA

Renda Soylemez Wiener, MD MPH; Boston University School of Medicine, USA

H. Thomas Stelfox, MD PhD FRCPC; University of Calgary, Canada

Eleanor Summerhill, MD; Lahey Hospital and Medical Center, MD

Alvin V. Thomas Jr., MD; Howard University Hospital, USA

Dona J. Upson, MD MA; University of New Mexico School of Medicine, USA

Lisa K. Vande Vusse, MD MSc; University of Washington, USA

Adrian Velasquez, MD MPH; Newport Hospital, USA

Allan J. Walkey, MD MSc; Boston University School of Medicine, USA

Angela Wang, MD; Scripps Clinic, USA

Lorraine Ware, MD; Vanderbilt University, USA

Ann Weinacker, MD; Stanford University, USA

Douglas B. White, MD MAS; University of Pittsburgh, USA

Jeanine P. Wiener-Kronish, MD; Massachusetts General Hospital, USA

Jennifer Wilson, MD; University of California, San Francisco, USA

Hannah Wunsch, MD MSc; University of Toronto, Canada

Guy A. Zimmerman, MD; University of Utah, USA

 

 

References

1. Singer M, Deutschman CS, Seymour C, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801---810.

2. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. Jun 20 2012;307(23):2526---2533.

3. Dezso CL, Ross DG. Does female representation in top management improve firm performance? A panel data investigation. Strat Manage J. 2012; 33 (9): 1072---89.

4. Richard OC. Racial diversity, business strategy, and firm performance: A resource--- based view. Acad Manage J. 2000; 43(2): 164---77.

5. AAMC. Diversity in the Physician Workforce: Facts & Figures 2014. Washington, DC: Association American Medical Colleges;2014.

6. Burnham EL and Roman J. JAMA. 26 Jul 2016;(316(4):460-1.