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    Addressing sexual harassment in academic medicine

    A new report highlights the extent of sexual harassment among faculty, as well as promising practices that might prevent and address it.

    Doctor wearing protective face mask standing with head in hands at clinic

    In 2018, the medical and scientific communities were jolted by revelations of widespread sexual harassment of women, as detailed in a groundbreaking National Academies of Science, Engineering, and Medicine (NASEM) report, Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine.

    In the five years since, not much has changed.

    That is the finding of a new AAMC report released July 26: Understanding and Addressing Sexual Harassment in Academic Medicine. Using data from the AAMC StandPoint™ Faculty Engagement Survey gathered between 2019 and 2021, the report found that 34% of women faculty and 22% of faculty overall have experienced sexual harassment.

    The highest rates of harassment among women faculty were in departments of anesthesiology and emergency medicine, each at 52.6%. The lowest rates were in urology and radiology, at 20.7% and 21.6%, respectively. Pharmacology faculty reported the largest gender differences in harassment experiences: 7.6% of men and 47.7% of women.

    Even among those departments with the highest proportions of women faculty according to the AAMC Faculty Roster — OB-GYN and pediatrics — rates of harassment reported by women were similar to the overall average of 34%.

    Faculty experiences of sexual harassment

    Sexual harassment can be divided into three categories — gender harassment, unwanted sexual attention, and sexual coercion. This report focuses on instances of gender harassment, defined as “verbal and nonverbal behaviors that convey hostility, objectification, exclusion, or second-class status about members of one gender.”

    Specifically, survey participants were asked about five behaviors and how often they experienced them.

    1. Tell sexist stories or jokes that were offensive to you (19.7% of women, 9.6% of men)
    2. Make offensive remarks about your appearance, body, or sexual activities (7.4% of women, 3.0% of men)
    3. Refer to people of your gender in offensive, insulting, or vulgar terms (12.0% of women, 3.6% of men)
    4. Put you down or acted in a condescending way toward you because of your gender (24.0% of women, 2.8% of men)
    5. Send offensive messages based on your gender or show you obscene images (1.4% of women, 0.8% of men)

    Certainly, the fallout of any form of harassment is substantial.

    Faculty who experienced harassment were, in general, less knowledgeable about how to report it, felt less safe reporting it, and were less confident their institution would resolve their complaints than those who were not harassed, according to the survey.

    Even more concerning, faculty who experienced harassment were less engaged, less satisfied with their medical school as a place to work, and less likely to stay at their institution than their peers who did not report experiencing harassment.

    While it is a fact that women are overwhelmingly the targets of sexual, including gender, harassment, men also experience harassment. Therefore, approaching harassment in a binary way — men as perpetrators, women as victims — ignores the many types and identities of people who face harassment as well as how other behaviors, such as bullying, contribute to an overall culture of harassment.

    Institutional strategies

    Multiple efforts are underway across academic medicine to address and prevent sexual harassment. Several institutions, identified through the NASEM Action Collaborative of institutions actively engaged in this area, were interviewed for the AAMC report to identify innovative practices.

    For instance, The Ohio State University College of Medicine has instituted a faculty pre-hire screening for misconduct, which requires all potential candidates to sign an authorization form that permits the college to contact current and past employers about any investigations into misconduct. Similarly, the University of Wisconsin School of Medicine and Public Health uses a Stop Passing the Harasser background check to address the practice of faculty and staff leaving an institution after being found responsible for harassment or while under investigation for harassment.

    At the Mayo Clinic College of Medicine and Science, any report of sexual harassment is assigned to one of the college’s 100 in-house trained professional investigators. Once an investigation is complete, the investigator meets jointly with the Personnel Committee and department leadership to decide next steps, according to the Mayo Clinic Fair and Just Culture Framework, which outlines potential consequences ranging from a conversation to termination. This process has served as a model for several other medical schools.

    Multiple schools, including the University of Michigan Medical School, University of New Mexico School of Medicine, Wake Forest University School of Medicine, and University of Virginia School of Medicine, offer robust resources for reporting harassment. Several schools, including Mayo and University of New Mexico, also inform their communities about the types of harassment reported and the actions taken to address it. That helps create a culture of anti-harassment and raises awareness about the institution’s commitment to addressing harassment.

    Finally, many schools offer trainings beyond what’s required by state and federal mandates. For instance, Columbia University Vagelos College of Physicians and Surgeons provides training that includes content on protected classes, affirmative action law, relationship policies, and the types of behaviors that should (or don’t have to) be reported.

    Preventing harassment

    These institutional efforts to identify harassers and address harassment behaviors are critical. So too are innovative approaches to creating safe and inclusive environments.

    Preventing sexual harassment starts with addressing the less overt but still harmful behaviors, such as patronizing language and comments about appearance, which in turn sets the foundation and tone for creating a safe and inclusive environment. When institutions focus on these less overt behaviors and comments and address them head on and early, they can create cultures of accountability that build trust, engagement, and, ultimately, greater support for all in academic medicine.

    Diana Lautenberger is AAMC Director of Gender Equity Initiatives. Valerie Dandar is AAMC Director of Medical School Operations. They are co-authors of the report, along with You Zhou, a doctoral student at the University of Minnesota.