Matters of the Heart: Examining Motivating Factors and Unconscious Bias in the Adult Cardiothoracic Anesthesiology Fellowship

Objectives: The purpose of this study was to identify barriers to improving diversity within adult cardiothoracic anesthesiology (ACTA) and to provide possible strategies that could be implemented by evaluating the demographics of current ACTA fellows, examining motivating factors to pursue the sub-specialty, and assessing perceptions of unconscious biases during their application process and training. Design: A survey was created by the authors and distributed electronically by the Society of Cardiovascular Anesthesiologists to the ACTA Fellows from April to June 2022. Setting: A multicenter survey. Participants: Recent 2021 to 2022 ACTA fellows. Interventions: None. Measurements and Main Results: A total of 68 fellows were included in the analytical sample; 37.3% were women, and 58.2% were men. Half of the participants in the sample were White race (47%), 26% were Asian, 8% Hispanic or Latinx, 5% Black, and 2% were Pacific Islander or Native Hawaiian. Most fellows indicated that the complexity of cases and/or competency in transesophageal echocardiography was “very important” in their motivating factor (74.0%). When examining sex differences, female fellows reported (p value <0.05) that their experience was impacted negatively by sex and was more often treated with less respect and courtesy. There were no statistically significant differences in perceived discrimination by race and/or ethnicity. Conclusions: This study identified several motivators to pursue ACTA and the perceptions of unconscious biases during the fellowship. Female fellows felt unconscious bias and a negative impact against them due to sex. Due to the small number of undergraduate enrollments, the results should be interpreted cautiously. Additionally, this provides support to complete further studies. Implicit bias training is one strategy that can be implemented to decrease unconscious bias experienced by ACTA fellows.