Well before the #MeToo movement began gaining traction, women in medicine have supported one another in solidarity as they dealt with a work culture that all too often turned a blind eye toward sexual harassment and assault. Although national leaders in medicine have been working to mitigate harassment in the workplace for years, the problem lingers.
This is especially true for residents, who may feel ill-positioned to speak out against harassment they experience or witness during training. To reduce sexual harassment in medical environments—and its emotional and career-related consequences—institutions must implement changes rooted in policies, bystander training, and reformed reporting mechanisms.
Sexual harassment can show up in several forms. According to an article published by the American Academy of Medical Colleges, microaggressions and sexual assault are two examples showcasing the scope and severity of harassment behaviors.
In terms of inappropriate sexual attention, victims of harassment may experience unwanted sexual advances from other HCPs or blatant sexual assault.
Katherine Sharkey, MD, PhD, assistant dean for women in medicine and science at the Warren Alpert Medical School of Brown University, distinguishes between different forms of harassment and their varying degrees of harm.
For example, an attending who makes vulgar jokes to medical students requires different action than a principal investigator who provides research funding in exchange for sexual favors.
"Both behaviors should be addressed, but they warrant different consequences,” Sharkey says.
Some HCPs may verbally or nonverbally harass colleagues based on their gender by exhibiting hostility toward them. Objectification and exclusion of HCPs of a particular gender fall under gender-based harassment in healthcare, as well.
Although sexual harassment contributes to elevated stress levels, poor performance, and burnout among any practicing physician, residents occupy a particularly vulnerable position, according to a cross-sectional analysis published by The American Surgeon.
The inherently hierarchical structure of the medical profession that has proven to benefit the education of residents can also provide fertile ground for an abuse of power. Residents rely on their superiors for evaluations and recommendations for career advancement, which can possibly subject them to instances of sexual harassment.
The AAMC’s 2017 Medical School Graduation Questionnaire found that only 21% of students who experienced harassment notified their administration or faculty about it. A considerable 57% of students figured the incident wasn’t “important enough to report.”
An additional 37% thought little would be done to address the issue once they reported it, followed by 28% who felt scared of potential reprisal; 9% of victims didn’t report the incident because they “did not know what to do.”
This dynamic ultimately works to protect perpetrators who hold high-level positions at institutions.
Mitigating sexual harassment in healthcare requires transformative and institutional changes. The American Surgeon details a few protocols that could remedy the issue.
Acknowledgment. Institutions must reckon with the truth of the matter: Sexual harassment is prevalent in medical spaces, and it can lead to major consequences for victims regarding their mental health and career path. Health systems can use anonymous surveys to gauge the severity of the issue within specific institutions.
Implementation of policies. Mandates can be placed on health systems to enact zero-tolerance policies. These policies should clearly explain factors such as confidentiality, the route to reporting, and protections against potential retaliation. Notifying residents of the existence of such policies is crucial.
Bystander training. Individuals who witness harassment may be able to recognize it as inappropriate, but they may not know how to address it. To provide guidance, institutions can implement bystander training modules for faculty and residents. This enables participants to get practice recognizing, intervening, and reporting harassment.
Encouraged reporting. Residents are more likely to come forward about sexual harassment if they know others who’ve done the same. Cultivating a work culture that provides anonymous and confidential methods of reporting—both virtual and face-to-face—may prove effective and curb fears of reprisal.
In addition to this list, institutions may consider making the time and space for a diverse group of individuals who work there to reflect on what kind of work culture could diminish sexual harassment, according to the American Journal of Critical Care.
It’s important not to rely solely on policies and regulations, but also to involve the community in imaginative problem-solving for the issue of sexual harassment in medical spaces.