Connell, Nathan T.

Abstract Background The National Institutes of Health define African Americans or Blacks, American Indians, Alaska Natives, Hispanics or Latinos, Native Hawaiians, and other Pacific Islanders as being underrepresented in medicine. A number of studies have demonstrated that improving diversity of such underrepresented demographics within the medical profession improves patient outcomes, medical education and reduces health disparities in patients from vulnerable racial or socioeconomic groups. Despite this recognition, significant underrepresentation of various racial, ethnic, and sexual identities still exists within nearly all medical specialties. Aims The purpose of this study was to a gain a greater understanding of the current state of diversity, equity, and inclusion (DEI) efforts among U.S. hematology and medical oncology fellowship training programs. We explored the perspectives of adult and pediatric fellowship program directors regarding current recruitment strategies and suggestions for improvement to help mitigate the effects of implicit and explicit bias. Here, we present an interim analysis of the data using descriptive statistics. Methods: We convened a multi-institutional collaboration of fellowship program directors, teaching faculty, and staff members of the American Society of Hematology to develop a survey examining perceptions of DEI efforts among hematology and medical oncology fellowship program directors. The survey was pilot tested in a small group of program directors representing 6 different academic programs (5 adult, 1 pediatric). The final online survey was distributed via email to 224 fellowship program directors at U.S. adult and pediatric hematology and medical oncology fellowship programs. The survey included 29 questions regarding perspectives on bias within the fellowship selection process, current DEI initiatives, and current faculty and fellow demographics. Survey respondents were asked to rate the importance of numerous factors in determining which applicants to invite utilizing a scale of 0-10, with 0 and 10 representing lowest and highest importance, respectively. To measure program director perceptions of certain applicant groups, survey respondents were asked to rate applicant demographics as being advantaged/disadvantaged based on survey options ranging from 0-5, with 0 and 5 representing very disadvantaged and very advantaged, respectively. Results: At interim analysis, 41 of 224 program directors completed the survey for an interim response rate of 21%, including 25 adult program directors and 16 pediatric program directors, with representation from university and community programs. Of the program directors surveyed, 28 (68%) reported having access to a dedicated diversity committee or DEI policies in place to improve recruitment of underrepresented applicants. In determining which applicants to invite, respondents placed highest value on the applicant's program director letter (mean score ± standard deviation: 7.44±1.93), caliber of the applicant's residency program (7.28±2.06) and letters of recommendations (7.15±2.23). Survey respondents viewed white and male applicants as representing the most advantaged demographic group, while LGBTQI, age>40, and U.S. citizen and non-citizen international medical graduates were the most disadvantaged (Table 1). Suggestions regarding improving DEI in the fellowship selection process included implementing bias training, identifying potentially disadvantaged applicants in ERAS, increasing faculty diversity, and pairing underrepresented applicants with interviewers based on applicant preference. Conclusion: While the majority of hematology and medical oncology fellowship program directors report having DEI programs or policies to improve recruitment of underrepresented applicants, perceptions of advantaged/disadvantaged groups may extend beyond demographics traditionally viewed as being underrepresented in medicine. As our survey is ongoing, we plan to reanalyze our data when the survey has been finalized with a higher response rate utilizing multivariable regression to identify themes that may further improve DEI efforts within the fellowship selection process. Figure 1 Figure 1. Disclosures LaCasce: Bristol-Myers Squibb Company.: Other: Data Safetly and Monitoring. Murphy: North American Thrombosis Foundation: Honoraria. Naik: Rigel: Research Funding. Podoltsev: Pfizer: Honoraria; Blueprint Medicines: Honoraria; Incyte: Honoraria; Novartis: Honoraria; Celgene: Honoraria; PharmaEssentia: Honoraria; Bristol-Myers Squib: Honoraria; CTI BioPharma: Honoraria.

Mentorship Experiences Among Second-Year U.S. Hematology/Oncology Fellows in the 2019 ASH Hematology/Oncology Fellows Survey Introduction: The majority of fellows graduating from U.S. hematology/oncology training programs pursue careers incorporating both fields, albeit with a greater focus on medical oncology than on hematology. Over the past 15 years, the number of physicians in the U.S. identifying as hematologists or seeking certification in hematology has been dwarfed by those identifying as medical oncologists or seeking oncology certification, with only a small percentage of fellows having a primary interest in benign hematology. In response to these concerns, in 2017 the American Society of Hematology (ASH) launched a multiyear study of the U.S. hematology workforce in clinical practice, research, and training in collaboration with the Fitzhugh Mullan Institute for Health Workforce Equity at the George Washington (GW) University. The initial phase of the ASH workforce study was a survey of over 1800 hematology/oncology fellows conducted in 2018, which identified clinical exposure to hematology during training, research experiences, and mentorship to all be positively and strongly associated with career interest in hematology. A follow-up survey of second-year hematology/oncology fellows was competed in 2019, focusing on career interests, mentorship, and job expectations. The present study reports findings of second-year fellows' perceptions regarding mentorship. Methods: The 2019 Hematology/Oncology Fellows Survey was developed by ASH and GW investigators. Survey questions asked about fellows' career and research interests, clinical exposure during training, mentorship, and perceptions of job security and availability after fellowship. Mentorship questions focused on specific mentorship activities (e.g., coauthoring papers, participating in research projects, developing networking, career advice), perceived mentorship needs, and overall satisfaction with mentorship. The survey was pilot-tested in a small group of second-year hematology/oncology fellows. The final survey was sent electronically to second-year fellows in U.S. hematology/oncology fellowship programs (n = 735) in the spring of 2019 using Qualtrics. Descriptive analyses were performed using Stata 15. Results: Among 212 second-year fellows with complete responses (28.8% response rate), 5.2% declared a primary interest in benign hematology, 20.8% malignant hematology, 30.7% solid tumor oncology, and the remainder some combination of hematology and oncology. The vast majority of survey respondents (83.3%) intended to dual board in hematology and oncology. About one-third (31.9%) reported having a new or continuing mentor in benign hematology during their second year of fellowship, compared to 51.2% in malignant hematology and 60.8% in solid tumor oncology. Less than half of all fellows (45.4%) indicated that their training program had a formal mentorship program. When asked to indicate domains where they wanted more support from mentors, second-year fellows prioritized career development strategies (69.9%), job options (43.7%), optimizing fellowship experiences (41.3%), manuscript review prior to submission (19.4%), clinical trial design review (17.5%), and grant review prior to submission (17.5%). The vast majority of fellows expressed a definite (69.7%) or possible (8.7%) interest in interacting with a mentor virtually via Facebook, Skype, email, or other media if in-person mentorship meetings were not an option. Conclusions: Second-year hematology/oncology fellows in the U.S. reported a wide range of mentorship needs and interests. Most second-year fellows believe they could use more advice from mentors about career development strategies. Few fellows have a primary interest in benign hematology, and the percentage of fellows who report having mentors in benign hematology is lower than malignant hematology or solid tumor oncology. The vast majority of fellows are interested in virtual mentorship if local mentorship is not available. Further expansion of existing mentorship systems and the development of new mentorship models including virtual mentorship may improve the mentorship experience for fellows. Disclosures Connell: Michael H. Flanagan Foundation: Membership on an entity's Board of Directors or advisory committees.

Key PointsClinical, research and mentorship experiences in hematology are positively associated with fellows' plans to pursue hematology-only careers.