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Otolaryngology’s #MeToo: Gender Bias and Sexual Harassment in Medicine

by Karen Appold •

In looking at reasons why sexual harassment continues to be problematic in the workplace, Barbara Fivush, MD, associate dean for women in science and medicine and professor of pediatrics at Johns Hopkins University School of Medicine in Baltimore, and her colleagues reported that medical students, residents, fellows and other post docs, and junior faculty are all in vulnerable positions. (Acad Med. 2018;93:163–165). They are dependent on recommendation letters and evaluations to advance to the next stage of training and to access new opportunities in their careers. Additionally, those in more junior positions often depend on those among the higher ranks to include them in projects, introduce them to colleagues in professional networks, share authorship on relevant scholarship, and provide information on other beneficial, career-advancing opportunities.

Institutions may also not always reprimand offenders, often due to financial concerns. Many accused of harassment are senior faculty who contribute substantially to the bottom lines of their institutions through patient care revenues and/or grant support, the authors wrote.

The American Association of Medical Colleges Graduation Questionnaire reported that 3.8% of 13,897 students said they had experienced unwanted sexual advances; 12.9% had been subjected to offensive sexist remarks or names, and 0.2% experienced requests for sexual favors in exchange for grades or other awards. The questionnaire also reported that 27% of all students who had not reported serious behaviors named fear of reprisal as a reason for staying quiet. “Until victims can be assured that there won’t be any retribution for reporting harassment, I think a lot of cases will go unreported,” Dr. Fivush said.

Stopping Sexual Discrimination

To stop discrimination, Dr. Fivush and her co-authors recommend these first steps, which are based on their research and conversations with thought leaders:

  1. Institutions must develop mechanisms that encourage victims of harassment and discrimination to come forward without fear of retaliation.
  2. Sexual harassment training must be mandatory for everyone at all institutions.
  3. Sexual harassment cannot be tolerated.
  4. The academic medicine community must get to a place where no one engages in sexually charged conversations (“locker room talk”).
  5. Professional societies should break the silence and address harassment during leadership councils and at annual meetings.
  6. Additional research should be done to characterize the nature of sexual harassment behavior, the outcomes of investigations, and the success of interventions with harassers to inform practice moving forward.

Fechte recommends encouraging employers and medical facilities to vocalize their prohibition and intolerance for sex or gender harassment, discrimination, and bias. “It is not enough to have a policy in a handbook and an anonymous complaint hotline,” she said. “Employers should be conducting trainings or holding conferences to discuss what harassment and bias look like, how it should be reported, how it will be investigated, and what consequences harassers will be subject to if they are found to have engaged in the illegal conduct.”