Eliminating gender harassment in academic medicine will require a multipronged approach that includes a firm commitment by leaders to end gender inequities, effective institutional policies that support reporting and thorough investigations, and training staff, leaders, and learners to prevent harassment and intervene when appropriate.
That was the primary message of the 2019 AAMC Leadership Forum, held June 18 and 19, which drew more than 100 of academic medicine’s top leaders to the AAMC headquarters in Washington, D.C. During two days of spirited and sometimes emotional discussion, speakers and participants outlined the challenges for women experiencing and reporting harassment, the institutional barriers in investigating and disciplining faculty accused of harassment, and the tremendously difficult task of changing the culture and climate in academic medicine that has allowed harassment to flourish for so long.
“What I pledge to you today is that we will move the needle. … A conversation is not enough. It’s time for action. It’s time for change.”
Joseph Kerschner, MD
AAMC Board of Directors
“We’ve known about the problem for a long time, but we haven’t moved the needle,” Joseph Kerschner, MD, chair-elect of the AAMC Board of Directors, told the attendees. “What I pledge to you today is that we will move the needle. … A conversation is not enough. It’s time for action. It’s time for change.”
The statistics are real and disturbing: Academia has the second-highest rate of sexual harassment behind the military, according to the 2018 National Academies of Sciences, Engineering, and Medicine (NASEM) report Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Over 58% of women faculty and staff in sciences, engineering, and medicine (SEM) and 20%-50% of women students report having encountered or experienced sexual harassing behavior. Women medical students are 220% more likely than students from non-SEM fields to experience sexual harassment. More than 30% of postdoctoral students in academic medicine had personally experienced harassment, with women of color experiencing even higher rates.
The majority of harassment doesn’t rise to the level of criminal behavior, said plenary speaker Reshma Jagsi, MD, DPhil, deputy chair of the department of radiation oncology and director of the Center for Bioethics and Social Sciences at the University of Michigan Medical School. But the microaggressions that occur daily at most academic institutions nonetheless have “terrible consequences for women in academic medicine,” said Jagsi. Crude comments, sexist insults, obscene gestures, put-downs, and implications that women don’t belong in a certain specialty or institution can lead to lost productivity, physical and emotional distress, depression, and even women deciding to leave an institution or the profession. And they create the kind of environment that allows more extreme types of harassment — from unwanted sexual advances to sexual assault — to flourish.
Speakers noted that efforts to change the environment ultimately must include programs to prevent harassment as well as strong and transparent interventions to address it when it happens.
Prevention and intervention: Allies and bystanders
Leon McDougle, MD, MPH, chief diversity officer at The Ohio State University Wexner Medical Center, still remembers the talented female educator he once knew. She had been encouraged to teach more so two men in her department could focus on research — and then was denied a promotion because she failed to produce enough research.
To end such behaviors and the attitudes that fuel them, people in positions of power must step up and speak out, said McDougle.
“There’s a degree of courage needed to do this work…. You have to have the courage to ask questions and be willing to be challenged and to shift.”
The Ohio State University
One program at Ohio State is working to help men do just that. The Advocates and Allies for Equity initiative is designed to help transform the institution’s climate by enhancing men’s engagement in gender equity work. Advocates recruit and train other male faculty and staff, and they work together to increase and share their knowledge on such topics as unconscious bias.
“There’s a degree of courage needed to do this work,” acknowledged Jennifer Beard, director of The Women’s Place at Ohio State, who runs the program there. “You have to have the courage to ask questions and be willing to be challenged and to shift.”
What’s more, those who want to promote equity and stem harassment must adopt a stance of humility, noted John Cullen, PhD, director of diversity and inclusion for the Clinical and Translational Science Institute at the University of Rochester Medical Center. “Remind yourself that this is not about you and that your discomfort in speaking up is not greater than the experience of being harassed or discriminated against,” he said.
Cullen also advised acknowledging one’s own implicit biases, recognizing the role of intersectionality, and studying the deep history of the struggle for equity. “It’s important to remember to be humble, listen, and learn,” he said.
McDougle echoed the importance of mitigating implicit biases. At Wexner Medical Center, he noted, 200 staff members have participated in a training on the issue, and all incoming leaders are required to complete the training as part of their onboarding process.
Another type of training spotlighted at the meeting was the effective approach of bystander prevention and intervention. In a two-hour interactive session, leaders at the University of New Hampshire’s Prevention Innovations Research Center and founders of Soteria Solutions, which works to build safe and respectful environments, shared practical skills for intervening.
“Direct intervention options include asking the harasser to stop the behavior and talking with the harasser’s supervisor,” explained Jane Stapleton, MA, Soteria Solutions president and co-founder. “Indirect options include creating a distraction like intervening by saying, ‘We’re late for class.’”
Stapleton noted that the organization’s research indicates the success of trainings in increasing bystanders’ confidence and willingness to intervene.
“We used to say to women, ‘Here’s what you can do to prevent being harassed,’ and we’d say to men, ‘This is bad behavior, don’t do it.’ That definitely isn’t working. Focusing on bystanders instead is about engaging the entire community so everyone has a role to play,” she said. “It works because it really seeks to engage everyone as a part of the solution.”
When leaders at the Perelman School of Medicine at the University of Pennsylvania send a job offer letter, they embed 10 statements about professionalism and equity, and applicants who accept the offer make a commitment to uphold those principles. “When a line is crossed, we can go back to the letter and say you agreed to this,” noted J. Larry Jameson, MD, PhD, dean of the medical school. “I want to move from our being reactive to proactive.”
Such institutional steps are essential to overcoming the many barriers to ending gender harassment. For example, someone just beginning their career may fear speaking up against a staff member who holds a position of prestige and power. In fact, fear of retaliation is the most common reason women don’t report harassment. Add institutional concerns about privacy and confidentiality and possible nondisclosure agreements, and the landscape grows even more complex.
The key, says Gina Maisto Smith, chair of the Institutional Response Group at the law firm of Cozen O’Connor, is for institutions to fully understand the laws around Title IX, including reporting requirements and the obligation to maintain an environment free from discrimination and harassment. Having clear policies and procedures to address patterns of misconduct and conducting regular culture and climate assessments is also essential for leaders to have a complete picture of what’s happening at their institutions.
“It ultimately comes down to institutional integrity versus institutional reputation. If we confuse the two, we are lost.”
Karen Antman, MD
Boston University School of Medicine
Leaders need to “be the eyes and ears of the institution,” noted Vicki J. Magley, PhD, University of Connecticut psychology professor and NASEM report co-author. “Having a common language when we talk about sexual harassment is very important, especially when talking about gender harassment.” She pointed to the telling statistic that only 20% of women recognize examples of gender harassment as harassment.
“You can’t address sexual harassment in isolation,” said Karen Antman, MD, provost and dean at the Boston University School of Medicine. She noted that Boston University has taken various steps to mitigate harassment, including a two-hour mandatory workshop on harassment and intermittent reports that outline the medical school's response to complaints.
"It ultimately comes down to institutional integrity versus institutional reputation," she added. "If we confuse the two, we are lost.”