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

Racial and ethnic minorities remain underrepresented in the surgical workforce with well-documented barriers to diversity and inclusion, including financial support, lack of mentorship, and high attrition rates. Recent literature has documented race and sex 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 during surgical oncology fellowship training at our institution.

All graduates in the Department of Surgery at a single institution from 2016 to 2021 were eligible to participate. Graduates were contacted via their last known email address and asked to complete an electronic survey. The survey included de novo multiple choice, Likert scale, and free response questions developed by the authors to identify sociodemographic data and experiences related to unconscious bias.

Overall, 271 graduates were contacted, with a response rate of 26% (n = 72). The majority of responders were male (60%) and self-identified as White (72%). Twenty-five percent reported witnessing someone else being unfairly treated and 10% of responders felt their race affected patient interactions. Free-text responses demonstrated clear examples of macroaggressions and microaggressions related to ethnicity, particularly among international fellows..

In our survey of recent surgical oncology fellows, diversity of graduates was limited and reported experiences of discrimination were more common among international graduates. Assessment of institutional culture and the experience of trainees is a necessary step to ensure adequate support and active strides towards equity and inclusion.