On Thursday, 番茄社区 hosted a Twitter chat in which physicians, nurses, medical students, researchers and anthropologists from around the country shared their experiences and perspectives regarding sexual and gender harassment in medicine.
This was an opportunity to explore clinicians and trainees' fears around reporting sexual harassment, concerns around career advancement -- i.e., "The Pence Effect" -- and strategies for preventing sexual harassment.
Participants in the chat included members and leaders from TIMES UP Healthcare, the American Medical Association (AMA), the American Medical Women's Association (AMWA), the American Nurses Association (ANA), and the Association of American Medical Colleges (AAMC), as well as researchers, clinicians and students from the University of North Carolina, the University of Illinois, and Harvard University.
Participants first explored the pervasiveness of sexual harassment and explained why certain environments invite sexual harassment.
Studies of sexual harassment report that 20%-60% of women in medicine are affected by the behavior, with medical students experiencing harassment at a rate of about 50%, participants noted.
"When there is a threat of sexual harassment due to inequalities, discriminatory practices, and significant power imbalances in #nursing, #nurses are susceptible also to sexual harassment and unable to protect their own interests, dignity, integrity, or rights," Cheryl Peterson, the ANA's vice president of Nursing Programs tweeted.
When there is a threat of sexual harassment due to inequalities, discriminatory practices, and significant power imbalances in , are susceptible also to sexual harassment and unable to protect their own interests, dignity, integrity, or rights
— ANA Ethics (@ANAEthics)
On reporting and retaliation...
One of the core challenges faced by targets of sexual harassment is fear of retaliation.
Barbara McAneny, MD, AMA president, cited a 2016 JAMA study which found nearly 60% of targets of harassment said they "experienced a negative impact on their self-confidence as professionals, while 47% reported a negative impact on career advancement."
(See 番茄社区's video interview with Reshma Jagsi, MD, DPhil, author of the report.)
This is why people don’t report.
— Arghavan Salles, MD, PhD (@arghavan_salles)
Participants in the Twitter chat also shared their own experiences reporting harassment or trying to support targets of harassment.
Ana Safavi, MD, an internal medicine resident at Northern Ontario School of Medicine in Sudbury, Ontario, Canada, said she was suspended for reporting sexual harassment and know aims to hold her institution accountable.
"I reported, and I regret it," Safavi tweeted, asserting that one reason medical students don't report is because they see the repercussions for people who do.
Safavi said she has filed a lawsuit, but victory will be bittersweet.
Learners don't report because they see what happens to learners who do. Some trainees at my school have told me that seeing the way that has retaliated against me and others has scared them off from reporting anything.
I reported, and I regret it.
— Ana Safavi, MD (@ana_safavi)
"Even if I win in court (and I expect that I will), my career in medicine is already over," she tweeted.
Yep. Even if I win in court (and I expect that I will), my career in medicine is already over.
— Ana Safavi, MD (@ana_safavi)
Roberta Gebhard, DO, AMWA president, shared how helping a target of sexual harassment to find a new position elsewhere came at the cost of her own job.
I supported one of my residents who had been sexually harassed by the assistant program director, since nothing was being done. I helped her get another position elsewhere, and my contract was not renewed because of it.
— Roberta Gebhard DO (@gebhard_roberta)
For targets of harassment, trying to change institutions can be difficult, said Miriam Knoll, MD, a radiation oncologist in New Jersey. The Accreditation Council for Graduate Medical Education (ACGME) "makes it almost a crime to switch programs," she tweeted. Barriers to switching represent a major obstacle to reporting, Knoll pointed out.
"If you can't switch, why bother complainig? [sic]" she tweeted.
i'm more shocked you were successful helping your trainee switch programs!
— Dr. Miriam Knoll (@MKnoll_MD)
The makes it almost a crime to switch programs.
THIS IS ALSO A MAJOR PART OF THE PROBLEM. If you can't switch, why bother complainig?
Towards Solutions
Gebhard noted that AMWA's Gender Equity Task Force, which she founded, plans to study the issue of trainees switching institutions due to harassment, or leaving medicine altogether, through an AMA grant focused on the ".
The AMWA Gender Equity Task Force is doing a study on this, funded by the Giambalvo Grant from the AMA-WPC called Fixing the Leaky Pipeline
— Roberta Gebhard DO (@gebhard_roberta)
McAneny tweeted about the AMA's own efforts in addressing harassment, citing recent steps intended to "better maintain safe and welcoming environments for all, particularly at conferences and AMA-sanctioned events."
A2: has taken a number of steps to strengthen policies and procedures in recent years to better maintain safe and welcoming environments for all, particularly at conferences and AMA-sanctioned events.
— Barbara McAneny (@BarbaraMcAneny)
At the AMA's 2018 interim meeting, leaders faced criticism that they had not responded appropriately to at least one claim of harassment said to have taken place at a previous AMA conference. The group's House of Delegates passed an emergency resolution calling for an independent investigation into the AMA's approach to assessing and adjudicating claims of harassment and calling for the organization to establish new processes if consultants deem it necessary.
In a last month, McAneny and AMA Chair Jack Resneck Jr., MD, reported findings from the inquiry by outside consultants.
The AMA's existing policy "includes many of the critical elements of an effective anti-harassment policy," their report found, but they also identified areas for improvement, including "simpler ways to report alleged violations, processes to more promptly investigate and resolve claims, changes to ensure investigation independence and avoid conflicts of interests, and greater flexibility in procedures and processes."
"The AMA Board strongly supports implementing these recommendations () to raise the AMA Code of Conduct, including our anti-harassment enforcement procedures, to the highest standards," Resneck and McAneny wrote, adding that the report will be discussed at the AMA's June meeting.
That same month, the AAMC will host a leadership forum to address issues of gender and sexual harassment, according to the group's chief healthcare officer, Janis Orlowski, MD.
is hosting a leadership forum in June 2019 focused on gender and sexual harassment, which will bring together leaders from across the academic medicine community to discuss strategies and approaches to address this critical issue.
— Janis Orlowski, MD (@JanisOrlowskiMD)
The AAMC also co-founded the Societies Consortium on Sexual Harassment in STEMM in February 2019 to address problems of sexual harassment, she tweeted.
A3: To address this issue in science and medicine, co-founded the Societies Consortium on Sexual Harassment in STEMM in Feb 2019 w/ , & several other orgs
— Janis Orlowski, MD (@JanisOrlowskiMD)
The association has also begun exploring new models and procedures to rethink its selection process for various honors and awards to address nominees who are also "alleged perpetrators" of harassment.
A More Radical Stance
As for more out-of-the-box ideas, Jane van Dis, MD, a founder of #TimesUpHC and medical director for the Maven Clinic in New York City, previously argued that CEOs and deans of medical schools should be held responsible for sexual harassment.
"Why not tie executive and dean compensation to metrics on this?" she suggested in a conversation with 番茄社区 in March.
Safavi had her own suggestions as well. She recommended a "new rule" in which medical school leadership must be elected by residents and can also be removed by them; and hospital department heads can be voted out by nursing staff.
New rule: med school post grad deans and program directors are elected by residents, and can be removed from their post by residents via vote of no confidence.
Similarly, hospital department heads can be voted out of their post by the nursing staff.
— Ana Safavi, MD (@ana_safavi)