Regarding an Offensive Figure in the Article Entitled "National Survey of Burnout and Distress Among Cardiothoracic Surgery Trainees".

To the Editor:

We authors of The Annals of Thoracic Surgery article entitled “National Survey of Burnout and Distress Among Cardiothoracic Surgery Trainees” are writing this letter to address a grievous error. In the accompanying visual abstract to this article, the cartoon figure intended to depict a cardiothoracic trainee suffering burnout and distress can be interpreted as a depiction of Sambo, a racist trope that has caused untold suffering to generations of Black/African American individuals and has reinforced anti-Black attitudes among bigots. We made a mistake when we did not see how this figure would allude to this hateful character, and we thank those who have been gracious with their feedback about this connection that we missed and should not have.

If we could go back in time and select a different icon for this visual abstract we would—not because it saves us from the lens of public scrutiny, but because hurtful actions, even when completely unrecognized and unintended, remain hurtful. We should have seen the connection that would have been made. We did not, and we apologize with profound remorse. We want to be clear that we are not apologizing that it could be interpreted as offensive; we are apologizing that it is offensive and for our lack of awareness.

How could we have done better? If a Black/African American author had been among us, our error likely would have been avoided. Each of us self-identifies as progressive and committed to equality, yet we were not socially conscious enough to be alarmed by the insensitive nature of the figure. Clearly, increasing diversity within our ranks leads to cognitive additive value that is crucial to preventing this type of mistake.

But that cannot be the only solution. It is not enough to let those marginalized and oppressed be the sole activists responsible for changing all of us. We who are not Black/African American need to step up. The fact that we have not personally shouldered the emotional toll of generations of mistreatment in this country as has the Black/African American community does not absolve us of our responsibility to know it deeply. Rather our entire community individually and collectively needs to add energy to the effort of becoming antiracist. This involves growing in our awareness of the historical and current discrimination that Black/African American people face and learning how to be a part of the solution. Unfortunately in this example of obtuseness we have perpetuated the problem, and for that we are profoundly sorry.