Academic Medicine Needs Zero Tolerance for Sexual Harassment

Tara Haelle

November 21, 2017

Implementing and enforcing zero tolerance for sexual harassment is essential in academic medicine, argues a multidisciplinary group of researchers in an article published online November 7 in Academic Medicine.

"[S]exual assault and sexual harassment of women in medicine continues to occur at all levels in academic medicine," write Carol K. Bates, MD, associate dean for faculty affairs and associate professor of medicine at Harvard Medical School in Boston, Massachusetts, and colleagues.

"[M]any of those accused of harassment are senior faculty who contribute substantially to the bottom lines of their institutions through patient care revenues and through grant support," the authors write, asserting that these employers must take accusations seriously. "Institutions should not sacrifice a safe culture for money."

Scope of the Sexual Harassment

The authors cite several surveys about the high prevalence of sexual harassment in academic medicine. More than half (52%) of the 953 female faculty members surveyed in 1995 for a study reported personally experiencing sexual harassment compared with only 5% of 1010 men in the same survey. Most reported sexist comments or behavior, but just more than a quarter (27%) reported unwelcome sexual advances. A 2014 meta-analysis of 35 studies found that 33.1% of medical students and residents reported experiencing sexual harassment.

Similarly, a 2016 survey of graduating medical students by the Association of American Medical Colleges found that 12.9% reported hearing sexist remarks or names, and 3.8% received unwanted sexual advances. Yet only one in five of these students reported what happened, and just 42.1% reported satisfaction with the results, meaning "less than 10% of harassment events are addressed in a way that is helpful to the victim," the authors point out.

"Our students, trainees, post docs and junior faculty are all in vulnerable positions," the authors write. "They are dependent upon recommendation letters and evaluations to advance to the next stage or new opportunities in their careers, and on more senior faculty to serve as mentors for career development awards and often in writing publications. This power differential leads to a real and justified fear of retaliation that might undermine many years of work and might threaten careers. As a consequence, many women stay silent."

The authors also address concerns that an overzealous system could harm innocent people's reputations if an accusation is untrue.

"There is a very real and difficult problem of false accusations filed against innocent individuals, and thus a critical need for a fair process for all," they write. "We must be careful to address all claims of harassment with seriousness and through due process and to avoid dismissing claims because an occasional false accusation might occur."

Six Steps to Zero Tolerance

The authors recommend six initial steps to guide institutions toward implementing zero tolerance policies. They first advise institutions to "develop mechanisms that encourage victims to come forward without fear of retaliation from their harasser," including informal options and interim measures that do not trigger formal investigations, yet allow institutions to track patterns of behavior.

Sexual harassment researchers have recommended such mechanisms for years as a vital part of successful policies, according to Kathryn Clancy, PhD, an associate professor of anthropology at the University of Illinois Urbana-Champaign, who studies sexual harassment.

"We need more informal mechanisms for reporting so people can actually talk out their experiences to help them to decide whether to come forward, and to help them process it," Dr Clancy told Medscape Medical News. "It's also a low-key way for institutions to keep track of patterns of behavior."

Such mechanisms could include an ombudsperson or office, but people need to know the office exists for it to benefit victims. Any type of victim advocacy contact, group, or office can fill this role as well, Dr Clancy said, but confidentiality and informality are essential components.

"Formal reporting is so traumatizing," Dr Clancy said. "The fear of retaliation is not just a fear. Pretty much everyone who reports has some kind of story of people treating them differently or having negative job consequences or classroom consequences."

Further, "a lot of harassment never meets the legal definition necessary for action even if the behavior unquestionably creates a hostile environment that harms employees' and students' quality of life," Dr Clancy said.

"It's important to notice here that the job of lawyers in the Title IX office is to protect the university," Dr Clancy said. "If they are protecting the liability of the university, it is pretty much in the best interest of the university to have no findings. Their greatest fear is that the perpetrator is going to sue because perpetrators in general have much more power than victims."

The authors next recommend mandatory training at all institutions, including training for bystanders to intervene, report behavior, and help change the culture. The common online training modules are not very effective and can build resentment, Dr Clancy said, but research supports the effectiveness of face-to-face and bystander training.

"Bystander training trains people to intervene, and when you train them to intervene, you also train them to understand what the social norms are," Dr Clancy explained. When all attendees at a training discover that the same behavior makes all of them uncomfortable, for example, they feel more empowered to speak up when they see it occur.

The third step is disciplining and monitoring those who commit sexual harassment, including termination for the most serious offenses.

"While standard human resource practices may prevent full disclosure of reasons for dismissal, we urge those hiring faculty who seem to have been inexplicably dismissed to engage in due diligence to explore the reason for departure and thus avoid hiring faculty who may engage in this serial behavior," the authors write. They suggest the Federation of State Boards consider implementing warning mechanisms.

Specific, Tailored Policies Most Effective

The authors' fourth step is more ambiguous, and therefore concerning, Dr Clancy said. The authors write, "We must get to a place where no one would engage in 'locker room talk' as the concept of any form of sexual harassment would never be accepted in any setting."

But they don't define "locker room talk," which may risk turning workplaces into puritanical spaces that can enable targeting of sexual minorities, Dr Clancy warned.

"The problem with sexual harassment is the harassment, not the sex," Dr Clancy said. "A professional workplace should allow for adult conversation, and if it's not directed, demeaning, or about power, that's not necessarily bad."

Overly restrictive environments may open the door for homophobic individuals to accuse LGBT coworkers of sexual harassment without just cause, for example, Dr Clancy said.

The authors detail policies and codes of conduct adopted in professional organizations such as the Royal Australasian College of Surgeons, the American Astronomical Society, and the American Association for the Advancement of Science that specifically address and prohibit sexual harassment at meetings. Then the authors call for all medical societies to adopt similar policies, including ones that ban retaliation, and conclude with calling for further research into sexual harassment behaviors, outcomes, and interventions in academic medicine.

Although the article focuses on academic medicine, most of these steps, broadly applied, are a place to start for clinics, hospitals, and other institutions, Dr Clancy suggested, but each institution should adapt them to their needs.

"It's important for every workplace to do its own climate survey to find out the locational and contextual interventions that need to happen in that place," Dr Clancy told Medscape Medical News. "I hesitate to say there's one set of guidelines that applies to all workplaces."

Fortunately, more than a quarter century of sexual harassment research exists to guide institutions. Dr Clancy would like to have seen more citations in this paper and pointed to the work of several researchers whose work is helpful, including Jennifer Berdahl, Lilia Cortina, Anna Kirkland, and Vicki J. Magley.

Administrators and departments that care about making workplaces welcoming and free from sexual harassment should reach out to those with training and expertise in the field for guidance, Dr Clancy said.

The article did not use external funds, and the authors have disclosed no relevant financial relationships.

Acad Med. Published online November 7, 2017. Abstract

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