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    Combating Sexual Harassment in Academic Medicine


    One in three female biomedical researchers surveyed said they had experienced sexual harassment according to a study published in the Journal of the American Medical Association (JAMA) in 2016.  Sexist remarks and coercive behavior were the most common incidents reported.

    Shocking? Unwanted verbal or physical behaviors can create a hostile environment in any workplace…including a medical school classroom or research lab.

    The JAMA study was based on a 2014 survey of more than 1,000 female and male biomedical researchers who received career development grants from the National Institutes of Health (NIH) between 2006 and 2009. Beyond the discomfort or feelings of vulnerability expressed through the survey by those who had been harassed, nearly 60 percent said the experience undermined their confidence as professionals. And close to half of those surveyed said the harassment negatively affected their career advancement.

    “Given the more general transformation of our culture, many of us had thought overt harassment was a problem of the past.... But what we found in our research was sobering."

    Reshma Jagsi, MD, DPhil
    University of Michigan Health System

    “Harassment is more common in situations where there are strong power differentials and hierarchies like those in academic medicine,” said the study’s lead author Reshma Jagsi, MD, DPhil, professor and deputy chair, Department of Radiation Oncology, University of Michigan Health System. “Given the more general transformation of our culture, many of us had thought overt harassment was a problem of the past—something that only still happens in rare, egregious incidents. But what we found in our research was sobering,”

    Diana Lautenberger, MAT, director, Women in Medicine and Science at the AAMC, reminds institutions that sexual harassment can be a silent problem. “It’s important for organizations to realize that just because they don’t have complaints about egregious behavior, that doesn’t mean that [people] aren’t having these experiences.”

    See something, say something

    Harassment and gender bias may be partially responsible for the disproportionately low number of women on faculties and in leadership positions at medical schools, Jagsi speculated. Two-thirds of the female researchers surveyed in the JAMA study said they experienced gender bias while trying to advance in their careers.

    Gender discrimination is more common than sexual harassment, said Lautenberger. Calling a female colleague “sweetie” or “honey” in the clinical environment is an example of gender discrimination. So is telling a physician she doesn’t need a higher salary because she has a husband to take care of her. Sexual harassment, on the other hand, involves physical advances, solicitations, or sexual bribery.

    Generally, women in clinical medicine are more likely to be subject to gender discrimination, whereas women in science careers tend to experience more overt forms of sexual harassment along with the gendered comments, said Lautenberger. But these behaviors are linked, she added. “If gender discrimination is allowed, sexual harassment is more likely because there’s a continuum of this kind of behavior. Gender discrimination has to be stopped in its tracks within an organization’s culture [before it escalates to harassment].”

    Jagsi said awareness of the need to transform culture and to take harassment accusations seriously seems to be growing in academic medicine. Spreading awareness has been particularly important “to reassure victims that what they experienced was not their fault and is, sadly, not aberrational or rare,” she added.

    “If gender discrimination is allowed, sexual harassment is more likely because there’s a continuum of this kind of behavior. Gender discrimination has to be stopped in its track within an organization’s culture.”

    Diana Lautenberger, MAT
    Association of American Medical Colleges

    Medical schools, teaching hospitals, and research labs are developing policies and practices to address women’s fear of retribution, to support them in reporting offenses, and to change traditional culture. “We need a goal of zero tolerance of sexual harassment in academic medicine,” said Carol Bates, MD, who chairs the steering committee of the AAMC’s Group on Women in Medicine and Science (GWIMS).

    Bates, who is associate dean for faculty affairs and associate professor of medicine at Harvard Medical School, observed that the biggest hurdle to combating sexual harassment on campus is the fear of retaliation. Many institutions have procedures for anonymous reporting, but victims are often reluctant to report someone who can identify the accuser by using details in the report. Accusing a faculty member or supervisor could also jeopardize a woman’s evaluations, grant applications, or future career.

    “We really need to change the culture so that people report sexual harassment not just when they experience it themselves but also [when they’re] bystanders,” said Bates. “Bystander intervention” is a method used at some campuses to teach people how to respond when they witness sexual harassment. The AAMC’s GWIMS teaches people how to step in and make a comment in a way that is safe and, one hopes, effective.

    Providing support groups and resiliency training for students caught in these situations is important, too, said Abraar M. Karan, MD, an MPH candidate at the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health. “We must focus on protecting students from harm, which is very difficult given the small circle within medicine where your name is sometimes more important than your credentials, unfortunately.”

    Changing the culture

    “We can put faculty through courses on microaggressions and address bad behavior punitively, but this won't change the fundamental reason for this behavior,” said Karan. “From a policy perspective, the most important thing is to acknowledge that much of this [behavior] stems from a culture of training and hierarchy in medicine, which substantiated this behavior in the past.”

    Efforts to combat harassment at medical schools and teaching hospitals are focusing on prevention. Many institutions set expectations about intolerance of sexual harassment and hold occasional lectures about it, but a more aggressive approach is necessary, stressed Robert Alpern, MD, dean of Yale School of Medicine. “You have to punish the offender, but punishment alone doesn’t change the culture.”

    “You have to talk about changing the culture, over and over, and not in large lecture halls but through continuous conversations in small groups,” Alpern continued. “We work with an organizational psychologist who says it will take two years to change the culture, and we’re already seeing [the new culture] growing as we have more conversations about it.”

    “You have to punish the offender, but punishment alone doesn’t change the culture.”

    Robert Alpern, MD
    Yale School of Medicine

    Alpern himself speaks to all 29 departments at Yale School of Medicine each year about the “climate of caring.” “People have to believe that the people at the top really care, so I talk about it and the department chairs talk about it, not HR.”

    At the University of Wisconsin–Madison, the School of Medicine and Public Health employs an ombuds—shared by other professional schools on campus—who is trained to work with students until they are comfortable disclosing details of incidents. “We want to create an environment where it is safe to report, where we respect confidentiality and provide support to students when there’s a power differential between students and faculty members,” said Elizabeth Petty, MD, senior associate dean for academic affairs at the university’s School of Medicine and Public Health.

    Petty said that improving how the univeristy tracks resolutions is the next step at her institution. “How do we track these incidents to complete the loop? One student may think an incident is minor or [may be] reluctant to report it, but [the] perpetrator [in the incident] may have been involved in other incidents. If it’s happening over and over, we need to know there’s a pattern. So we need to encourage reporting along confidential pathways and have multiple ways to report.”

    Hannah Valantine, MD, MRCP, chief officer of scientific workforce diversity at the NIH, said that eliminating sexual harassment is “a multistakeholder issue.” The multipronged approach should include policies and structures for reporting, evaluating, and dealing with offenders and for supporting victims, she said. Valantine also called for “in-depth understanding of the impact of sexual harassment on female scientists’ decision to enter and persist in research careers.”

    In short, said Valantine, all the factors that are keeping academic medicine from completely eliminating sexual harassment in the workplace must be unraveled.