Original Article|Articles in Press

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

Published:March 06, 2023DOI:


      • A survey to improve diversity in Adult Cardiothoracic Anesthesiology
      • Complexity of cases/competency in TEE is a major motivator in pursuing fellowship
      • 56% of female fellows felt their experience was negatively impacted by their gender
      • Female fellows felt more often less courtesy and less respect compared to males



      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 perception of unconscious biases during their application process and training.


      A survey was created by the authors and distributed electronically by the Society of Cardiovascular Anesthesiologists to the ACTA Fellows, April to June 2022.


      Multi-center survey.


      2021-2022 ACTA fellows.




      68 fellows were included in the analytical sample; 37.3% were female, 58.2% were male. Half of the sample was White (47%), 26% Asian, 8% Hispanic or Latinx, 5% Black, and 2% Pacific Islander or Native Hawaiian. Most fellows indicated complexity of cases/competency in TEE was “very important” in their motivating factor (74.0%). When examining gender differences, female fellows reported (p value<0.05) their experience was negatively impacted by gender and were more often treated with less respect and less courtesy. There were no statistically significant differences on whether perceived discrimination differed by race/ethnicity.


      This study identified several motivators to pursue ACTA and the perceptions of unconscious biases during fellowship. Female fellows felt unconscious bias and a negative impact against them, due to gender. Due to the small number of URM, the results should be interpreted with caution. 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.


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