Abstract
The rapid proliferation of consensus statements has created an urgent need for guidance on developing frameworks that govern the production of future consensus statements. This satire reflects on the process involving steering committees, oversight committees, external validation panels, and multiple Delphi rounds. An international expert group formulated ten recommendations addressing committee structures, consensus methodology, evidence utilization, international representation, acronym generation, infographic deployment, and transparency practices. These satiric guidelines aim to standardize the consensus-development ecosystem while ensuring sufficient ambiguity to justify future updates, additional Delphi exercises, and subsequent consensus statements.
Executive summary
The explosive rise of consensus statements has transformed modern academia from a pursuit of knowledge into a carefully moderated sequence of Zoom calls. While clinical uncertainty once prompted research, it now more appropriately triggers the formation of a steering committee, followed by at least three Delphi rounds and strongly worded infographics.
This document seeks to establish best practices for generating future consensus statements, particularly those intended to regulate the production of additional consensus statements.
The recommendations below were developed through a rigorous process involving: 14 steering committee members, 9 oversight committee members, 3 external validation panels, 2 methodology consultants and 1 exhausted statistician who eventually stopped replying to emails. Agreement exceeding 83.7% was considered consensus; nobody remembers why.
Recommendation 1: Establish a steering committee immediately
No academic problem should ever be addressed directly. Even straightforward issues such as ‘Should drains be used?’ must first be escalated into a multinational governance ecosystem involving experts from at least four continents and one person described only as a ‘stakeholder representative’. The steering committee's primary responsibility is to create additional committees.
Recommendation 2: Every committee must have an oversight and external validation committee
Unchecked committees may accidentally make decisions. Premature evidence generation without committee oversight may lead to clarity. 1 Oversight committees ensure procedural integrity by carefully monitoring whether steering committees are adhering to previously established frameworks for future framework development. Subcommittees should also be considered to oversee inclusivity within oversight structures.
External validation panels are strongly recommended because experts who generated the recommendations may be biased by having generated the recommendations. External validators should ideally know at least two steering committee members, have co-authored prior consensus statements and describe the methodology as ‘robust’ without elaboration. True independence remains aspirational.
Recommendation 3: Conduct a minimum of three Delphi rounds
One Delphi round reflects opinion. Two rounds reflect emerging consensus. Three rounds create the illusion of destiny. By Round 3, nobody should remember who originally proposed the project. 2 A fourth round may be necessary if agreement rates are insufficiently impressive for publication.
Importantly, all statements should gradually evolve toward maximum vagueness. Example:
Round 1: ‘Procedure X should be abandoned’. Round 3: ‘Procedure X may be considered in appropriately selected settings where institutionally relevant contextual expertise exists’.
Consensus achieved: 94%.
Recommendation 4: Ensure international representation
Nothing strengthens a guideline more than adding authors who did not attend the meetings. 3 True international collaboration requires: one European professor, one North American keynote speaker, one perpetually jet-lagged Australian and at least three individuals from Asia and Africa attending at 2:30 AM local time while muted. This diversity ensures the final recommendations remain universally noncommittal.
Recommendation 5: Evidence is helpful but not essential
Historically, guidelines relied excessively on data. Modern consensus methodology recognises that expert opinion, repeated often enough in PowerPoint presentations, acquires an almost evidence-adjacent quality. Hence, low-quality evidence should never prevent strong recommendations, particularly when the panel feels ‘collectively optimistic’. 4
Recommendation 6: Develop consensus statement proliferation disorder criteria
Diagnostic features include recurrent Delphi exercises, unexplained steering committees, guideline reproduction without replication, persistent urge to create flowcharts and inability to publish without the phrase ‘international expert panel’. 5
Recommendation 7: Use acronyms aggressively
No recommendation framework should exist without an acronym that sounds vaguely military. Examples include: CONSENSUS-AID, GLOBAL-CORE, EXPERT-MAP, GUIDE-X, HARMONY and DELPHI-PLUS. Ideally, the acronym should require greater methodological explanation than the clinical topic itself.
Recommendation 8: Publish methodology papers with infographics before producing results while emphasising transparency
The modern academic lifecycle now proceeds as follows: Publish rationale paper → Publish protocol paper → Publish methodology paper → Publish stakeholder engagement paper → Publish modified methodology update → Publish consensus statement → Publish explanatory infographic → Publish corrigendum correcting committee affiliations. Actual scientific discovery is optional.
No consensus statement is complete without infographics with circular arrows, pyramids of evidence and at least one icon of people shaking hands. Complexity should be converted into a downloadable PDF with reassuring gradients.
Transparency should be emphasised repeatedly, preferably in bold. This is particularly important when committee selection criteria remain unclear, voting thresholds are adjusted midway or authorship exceeds the seating capacity of the conference room. Transparency is primarily achieved through supplementary appendices nobody reads.
Recommendation 9: Include deadpan statements of great importance
Every consensus document should contain at least one sentence so obvious that it becomes spiritually profound. Examples:
‘Further high-quality studies are needed’. ‘Patient-centred care remains important’. ‘Clinical judgement should be exercised’.
These statements reassure readers that wisdom was generated despite limited evidence and 17 hours of breakout-room discussions.
Recommendation 10: Never resolve anything completely
Consensus is often misunderstood as agreement among experts. In reality, it refers to the point at which dissenting panelists become too tired to continue answering survey emails. This phenomenon is formally described as Consensus Fatigue Equilibrium. 6 Absolute clarity threatens future publication opportunities. Recommendations must identify emerging gaps requiring additional consensus, which justify future updates every 18 months. 7 The cycle must continue. The consensus ecosystem depends on it.
Footnotes
Funding
The author received no financial support for the research, authorship and/or publication of this article.
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.