INTRODUCING THE STROKE EDITOR TRAINING PROGRAM (ETP) FOR UNDERREPRESENTED IN MEDICINE SCHOLARS

Opportunities to truly realize health equity for all, will require not just the purposeful involvement of key stakeholders in the conduct and dissemination of health equity research,¹ but also the prioritization and implementation of other activities, including diversifying the biomedical research workforce.² Unfortunately, there is an established dearth of certain racial/ethnic groups in medicine generally, and in academic medicine in particular,^3–6 and these are the same groups more likely to experience relatively unfavorable health outcomes. Explanations for the lower frequency of these groups in academia include possible structural racism, implicit bias, and lack of mentorship.^7–11 Groups underrepresented in medicine (UIM) with notable health dispartities,¹² include African-Americans, Latinx, Native Americans (i.e. American Indians, Alaska Natives, and Native Hawaiians) and mainland Puerto Ricans.^13–16 Achieving the goals of sustainable change that will effectively address the under representation of certain groups in academic medicine requires action. Enhancing the number of these groups in medical research conduct and dissemination may help better highlight questions and discoveries of high relevance to underserved areas and vulnerable populations.²

As the primary conduits for underscoring research gaps and disseminating progress in clinical sciences and health care, as well as boosting career growth in academic medicine, medical journals could play an important role in mitigating healthcare disparities and bridging health inequities.¹⁷ Scholars from racial/ethnic minorities and other historically marginalized groups are disproportionately underrepresented on editorial boards and in editorial leadership.¹⁷ Increasing numbers of UIMs on editorial boards, and in senior editor positions might make issues of health equity and workforce diversity more prominent than they currently are, and provide avenue to attract and retain UIMs in academic medicine.¹⁷ A well-trained workforce of UIM scholars is a critical component of research to reduce disparities in cerebrovascular disease outcomes that affect underserved and/or low-income communities, as well as a major factor in minority participation in clinical trials, especially given the changing demographics in the United States.¹⁸

Several medical journals have Editorial Fellowships, which provide a great opportunity for early career individuals to obtain insight into the peer review process by shadowing experienced journal editors. During these programs, Editorial Fellows participate in all of a Journal’s editorial processes, reading assigned manuscripts, selecting appropriate reviewers, evaluating quality of the reviews, and helping to make decisions. Successful fellows are later invited to join the Editorial Boards of these journals. If journals could make a concerted effort to recruit more UIMs to these fellowships, thereby creating a pipeline of qualified and capable individuals to later join editorial boards and eventually editor teams. A side benefit of these fellowships is that fellows become better readers and, subsequently better writers of manuscripts and grants.

Recognizing that few trainees or junior faculty are formally exposed to editorial processes, especially UIM, Stroke aims to fill this opportunity gap through the launch of an Editor Training Program (ETP) for UIM scholars. Objectives of the ETP are: 1) to offer a pathway for UIM early career scholars to gain the mentorship, experience and professional skills that will support their effective participation in the editorial process through acting as junior editors under the mentorship of members of our editorial leadership team; 2) to address that gap by providing mentored experiences in all aspects of the journal publication process; 3) to facilitate the ability of diverse scholars to produce their own manuscripts that will be successful in navigating the professional journal review process; and 4) although not guaranteed, to provide an experience that will allow successful Trainee Editors to later go on to be reviewers, and possibly editorial board members for Stroke. Table 1 provides an overview of various activities in the ETP.

Table 1.

Overview of the Stroke Editor Training Program (ETP) for Underrepresented in Medicine Minority Scholars

Activity	Description
Highlights	Working remotely, Editors-in-Training will spend at least one year working closely with a mentor who is a member of the Stroke Editorial Team (i.e., the Editor in Chief or one of the Associate Editors), learning to shepherd submissions through the entire peer review process including screening submissions, identifying reviewers, making and communicating editorial decisions and editing manuscripts to export for publication Editorship is unpaid and part-time, approximately 2–3 hours per week; most work is online and by conference call. Editors-in-Training will work from their own locations and will not relocate. Editors-in-Training will participate in manuscript decisions, strategic planning for the journal, editorial team conference calls, and the journal’s annual Editorial Board meeting. Editors-in-Training will be assigned a Senior Editor who will act as their mentor for the duration of their appointment. The Senior Editor will help the Fellow seek the best referees and coach them on how to analyze referees’ reports and make a recommendation on acceptability. Name(s) of the Editors-in-Training will appear next to that of the Senior Editor handling the paper and will be published alongside the final accepted paper. Editors-in-Training will be listed on the Stroke masthead as such. Monthly consultation calls with the mentor will be held in order to ensure that goals are achieved and the Editors-in-Training professional development needs are being met. Upon successful completion of the year-long fellowship, Editors-in-Training will become members of the Stroke Editorial Board, following which, if an Assistant Editor position becomes available, they may become candidates for consideration to take on an such a role.
Eligibility	Membership in American Heart Association (at the time editorship begins, if not currently) Identification with a historically underrepresented in medicine group (i.e., related to race, ethnicity). Blacks or African Americans, Hispanics or Latinos, American Indians or Alaska Natives, Native Hawaiians and other Pacific Islanders.19 In post-doctoral training or within five years of first academic faculty appointment Stroke Reviewer Trainee Pool members to be invited to apply From any profession or discipline including basic sciences Have a record of at least three peer review publications (at least of which as first author) in reputable journal(s) on a topic in stroke. Have served as a reviewer for at least two (2) manuscripts at any peer-reviewed journals, along with a track record of commitment to cerebrovascular disease research. Be willing to not accept appointments or serve on the editorial boards of any other journals during the period of the Editor Training Program.
Application	A cover letter, addressed to Ralph Sacco, M.D., M.S., Editor-in-Chief, describing your objectives in applying for the fellowship, why you are suited for this position, and what you believe you might gain from this experience and training, and how you will use the fellowship to advance your career and/or impact your program/department A current curriculum vitae Completed conflict of interest form Completed confidentiality form A sample of your writing (i.e. a manuscript that you have submitted or published. Draft manuscripts will NOT be circulated and will only be used to assess writing style and interests) A written sample of a recent manuscript review you have performed would be a plus (it will NOT be circulated and only be used to gauge current level of reviewing skill) Letter of recommendation (< 2 pages) from the Academic Home Division Chief, Program director, or Department Chair. A statement of protected time to perform the functions outlined is desirable. Letter of recommendation (< 2 pages) from a Fellow of the AHA Stroke Council (distinct from academic leader letter).
Selection	Application review by Stroke Editors Interviews of top candidates by designated Stroke Editorial Mentors Editor-in-Training selection by designated Editorial Mentors The name(s) of the selected individual(s) will be announced at the ISC meeting. Editor Training Program to begin during the International Stroke Conference meeting
Expectations	There will be no more than 3–5 Editors-in-Training at any given time Participate in bi-weekly Editor conference calls. Each Editor-in-Training will be expected to advance twelve to fifteen papers over the year through the editorial process from submission to review to publication decision. Editors-in-Training may have more than one assigned Senior Editor mentor during the training period. Editor-in-Training will be expected to write at least one editorial or other article type for Stroke (with supervision). Editor-in-Training may also contribute to the journal’s social media presence Editors-in-Training will be encouraged (where feasible) to carry out mentored research projects that investigate issues pertinent to peer review and academic communication. Editors-in-Training will participate (when appropriate) in outreach to particular readers, commenters, and knowledge user groups Stroke will evaluate Fellows’ progress and adjust program to specific needs in annual ISC meeting(s) or conference call(s) with the Editor-in-Chief. Editors-in-Training will serve for at least 1 year, with the option of renewing annually for up to 3 years.
Miscellaneous	Consideration will be given in future years to creating two tracks of Editors-in-Training Junior Editors-in-Training (fellows, very early career faculty (≤3 years), those with relatively less reviewer/editorial/publishing experience) Senior Editors-in-Training (late early career faculty (4–5 years), those with relatively more reviewer/editorial/publishing experience) Consideration will be given in future years to creating one slot for a promising international Editor-in-Training candidate from a low- to middle income country

In conclusion, gaps in the pipeline for UIMs are well established.^20–22 While gratifyingly there has been some progress for women advancing in the biomedical sciences, UIMs so far are not making much headway.^{23, 24} There is considerable room for improvement to enhance involvement of UIM racial/ethnic minority individuals in the decision-making and leadership of prominent medical journals. Stroke has decided to act. A year-long Editor Training Program offering diverse early career individuals an opportunity to be involved in editorial activities that they would not normally be exposed to until much later in their careers could be a right step in the right direction.