E152: Assessing Attitudes and Perceptions of Unconscious Bias Experienced by Surgical Oncology Fellows

Introduction: Barriers to diversity and inclusion are well documented including financial support, lack of mentorship, and high attrition rates. There is increasing awareness of the role of racial discrimination in the training of surgical residents, but little is known about the experience of discrimination at the surgical fellowship level. The goal of our study was to assess attitudes and perceptions of unconscious bias experienced by surgical oncology fellowship trainees.

Methods: All graduates in the department of surgery at a single tertiary care center from 2016-2021 were eligible to participate. Graduates were contacted via their last known email address to complete an electronic survey. The survey included de novo multiple choice, Likert scale, and free response questions developed by the authors to identify experiences related to unconscious bias.

Results: 273 graduates were contacted with a response rate of 26% (n=72). Responders self-identified as White (72%), Asian (21%), and Black (1%), with 5% not reporting their race. This is similar to overall demographics of fellows from 2016-2021, with 62% White, 24% Asian, and 1.6% Black. Majority of responders were male (60%), parents completed a bachelor’s degree or higher (61%), and had an annual household income of $75,000 or more growing up (68%). Although 93% reported not feeling unfairly treated as a result of their race, 25% witnessed someone else being unfairly treated and 20% felt racial discrimination was an issue at the institution. Further, 10% of responders felt their race affected interactions with patients. 47% and 49% agreed that there was an increased need for diversity amongst trainees and faculty respectively. Free text responses demonstrated clear examples of micro- and macroaggressions related to gender identity and ethnicity. Graduates identified lack of current diversity, recruitment strategies, and the need for more cultural awareness as barriers to diversity and inclusion in medicine.

Conclusions: In our survey of recent graduates, we found disparities in the racial and ethnic diversity of surgical trainees similar to existing literature; despite this, graduates reported witnessing racial discrimination and 10% felt like their race affected interactions with patients. Assessment of institutional culture and the experience of trainees is a necessary step to ensure adequate support for diverse trainees and active strides towards equity and inclusion. We strongly encourage other institutions to examine their culture closely from the perspective of trainees as a part of their ongoing DEI initiatives.