Sexual Harassment in Academic Medicine

Francis S. Nuthalapaty, MDAs we engage in a national conversation about sexual harassment in the workplace that spans from Silicon Valley to Capitol Hill, there has been a deafening silence among those of us who share the privilege of providing health care to women and also training students, residents, and fellows. One of the most concerning issues with current reports in the media is that, in most cases, people in leadership positions knew about the sexual harassment but either failed to address it or addressed it in a way that had no real consequence. It was not until the concerns entered the public space that the leaders and companies took substantive action. Is it possible that the same is true in the hallowed halls of our obstetrics and gynecology departments? The truth is, sexual harassment is common in medical education environments. Since 1978, the Association of American Medical Colleges has reported results from the Graduation Questionnaire, a survey of fourth-year allopathic medical students. In 2017, approximately 618 students (4.3%) reported being subjected to unwanted sexual advances and 2,128 (14.8%) students reported being subjected to offensive sexist remarks or names.1 It is more difficult to describe what is happening in graduate medical education owing to a lack of standardized reporting. A small study from McMaster University in Ontario, Canada, demonstrated that, on average, 40% of the resident participants, especially women, reported experiencing offensive body language, receiving sexist teaching material, and receiving unwanted compliments on their dress.2 I've now spent 25 years in academic medicine, spanning medical school, residency, fellowship, and faculty life, and in each phase and place I've been a witness to sexual harassment. I saw it and heard about it, but didn't speak up about it. I wish I was the only one, but I suspect my experience is not unique. As the people who not only care for women but also train those who do, we need to have a zero-tolerance policy for sexual harassment, regardless of the name or academic status of the perpetrators. The following examples in our obstetrics and gynecology world illustrate the issue. EXAMPLE 1 An obstetrics and gynecology clerkship director received a phone call from a medical school leader. The clerkship director was informed that a male, fourth-year medical student wrote a detailed account about an encounter that had occurred months ago on the obstetrics and gynecology clerkship. In the report, the student noted that he was asked to enter into a storage room by a male surgical technician. Once the door closed, the student wrote that the surgical technician said, “Okay, drop your pants so I can give you a whipping.” The student told the technician that he was not going to do that and left the room. When asked about the reported incident, the student agreed to identify the perpetrator. A human resources investigation was conducted, and the technician was fired. The student graduated shortly thereafter. After his residency, the student came back to work at the same hospital. The clerkship director asked him about the incident and why he didn't report the occurrence when it first happened. He said that he felt ashamed and embarrassed that he had been singled out. He didn't want the event to be what people remembered about him as a medical student. He waited until his fourth year of medical school to write about the account because he knew that he would be leaving for residency and it would be behind him. EXAMPLE 2 A junior obstetrics and gynecology resident observed that a senior faculty member made daily comments about a senior female resident. When she wasn't present and there were only male residents around him, he would say things such as, “Boy, which one of you wouldn't like to do her?” When she was in his presence, he would call her “baby doll” and say things to those around her such as, “boy this girl is a real looker, isn't she?” or “she was in my office for hours last night,” or “she really likes spending time under my desk.” The junior resident felt terrible for her. Every time it happened, the senior resident would just laugh and sometimes purr like a kitten, which seemed to elicit approval from the faculty member. The junior resident asked the senior resident if the comments bothered her. She just winked, and said it was all part of the game. After residency, the senior resident stayed on as faculty for a year or two until her husband finished his residency, and then they left. As far as the junior resident knew, no one ever addressed the issue. EXAMPLE 3 A junior obstetrics and gynecology faculty member was approached by a female senior resident about a concern she had about a male faculty member. She reported that he constantly made comments about the physical appearance of the female residents. He would also make sexual jokes about patients while they were under anesthesia in the operating room. She said all of the residents knew about it and would joke about the faculty member being a pervert. The resident was now only a few months from finishing her residency and finally felt like she was in a place where it would be safe to report her concerns and wanted to know what she should do. Following advice from the faculty member, the resident reported her concerns to the residency program director, who then reported the same to the departmental chair. The chair eventually got back to the resident and told her that the issue was addressed in the context of a human resources review. The resident said that, although the faculty member had since changed his behavior, she was disappointed that there were no apparent consequences for him. He was allowed to stay in his leadership position, one in which he had oversight of the department’s educational mission. My guess is that these cases sound familiar. The first response from each person with whom I shared them is usually, “I knew a situation just like that.” Despite a lack of data, our personal experiences affirm that sexual harassment occurs even in our obstetrics and gynecology departments. During what many are calling a watershed moment in our country's history, I want to encourage all those working in obstetrics and gynecology departments to join together in not only breaking the silence on workplace sexual harassment, but actually doing something about it once and for all. As obstetrics and gynecology faculty, we need to be exemplary in the way we handle sexual harassment concerns. I am asking our community to join together in doing the following: We need to formally acknowledge the national dialogue about sexual harassment with our residents, fellows, and co-faculty and explicitly state that our cultural expectation is a zero-tolerance policy for sexual harassment, regardless of the name or academic status of the perpetrator(s). If there have been any past concerns about sexual harassment in our obstetrics and gynecology departments, we need to revisit them and make sure the right decisions were made. We should ask, “Is our decision the same decision that would have been made if it was examined in the public domain?” We need to implement safe and reliable processes for our learners to report sexual harassment concerns and establish unbiased processes for evaluating those concerns. Concurrently, these processes need to protect the victim from discrimination or retribution. To the extent possible, the people involved in this process need to be able to act independently and objectively in evaluation of the allegations. We need to establish explicit enforcement policies about the consequences for any faculty member who faces sexual harassment concerns in our obstetrics and gynecology departments. Specifically, those policies should include a suspension from any leadership role (eg, educational program director, division director, vice-chair, chair) until the concerns are adequately resolved. Organizations engaged in medical education curriculum development and policy (eg, the Association of Professors of Gynecology and Obstetrics and the Council on Resident Education in Obstetrics and Gynecology) should embrace the opportunity to create and disseminate these types of policy recommendations. Our current national dialogue on workplace sexual harassment was sparked by courageous people who found their voice and came forward to share their experiences. It is time for all of us who share the privilege of training tomorrow's women's health care providers to draw from their courage and end sexual harassment in our learning environments.

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