Medical students stand up to sexual harassment
Sexual harassment in the medical profession is common, under-reported, and inconsistently dealt with by medical schools
When Louise agreed to a night out with her general practitioner supervisor, she could not have foreseen how it would end up. Being molested in the back of a London taxi by a married father of two was not something medical school had prepared her for.
Louise recalls having to “literally fight him off” to stop him forcing his way into her home. She managed to do so, and mustered the courage to report the incident to her medical school. Three years on, Louise spoke to Student BMJ under a pseudonym to help shed light on the topic.
The BMA Medical Students Committee is urging the profession to take sexual harassment more seriously. A motion passed at its annual conference in April 2016 called on medical schools to raise awareness of sexual harassment within the NHS and provide formal training for students on how to deal with it. With research suggesting one in three medical trainees experiences harassment, why isn’t such training already standard?
Emma Gill, a third year medical student at the University of Edinburgh, proposed the motion. “As future medical professionals we need to address this issue and lead the way in confronting it,” she told the conference.
Sexual harassment describes behaviour ranging from inappropriate comments, jokes, or wolf whistles through to sexual gestures, “sexting,” or unwanted touching.
The Citizens Advice service defines it as any “unwanted behaviour that you find offensive or which makes you feel intimidated or humiliated, and the behaviour is of a sexual nature.”
Any medical student can experience it, regardless of their sex or sexuality, and it can come from superiors, fellow students, or patients.
One student, writing anonymously in The BMJ, recalled consultants commenting on the size of her breasts, “humiliating” female students by getting them to perform unnecessary intimate examinations on male patients, and offering career progression in exchange for sex.
Students interviewed by Student BMJ shared stories of inappropriate physical contact and overtly sexualised comments: a surgeon “creepily” telling a student she was beautiful, female patients leering at young male students, or older patients grabbing at a student’s intimate parts.
Preparing students for these sorts of incidents, and teaching them how to handle them appropriately, is a priority for Gill. She wants medical schools to provide guidance and training, including how to de-escalate situations without damaging the student-patient relationship.
She remembers her embarrassment when, performing a lower limb examination with five of her peers watching, she was invited by the patient to sit on his lap and examine his “middle leg,” adding “nobody knew how to handle the situation.”
She believes such training should be based around interactive workshops rather than lectures and could fall under the remit of communication skills or teaching professionalism.
Common and under-reported
Sexual harassment is experienced by 33% of trainees, according to the most comprehensive estimate to date: a 2014 meta-analysis of 35 studies including 27 919 participants. Rates of harassment remained stable over the 24 year period in which these studies took place.
A study in JAMA of 1066 US clinician-researchers found that 30% of women and 4% of men had personally experienced sexual harassment: 59% of these women said the experience negatively affected their confidence as a professional and 47% said it hindered their career advancement.
Another US study named obstetrics and gynaecology, general surgery, and emergency medicine as the placements in which students were most likely to experience sexual harassment and gender discrimination. Such incidents had a substantial impact on women’s subsequent choices of specialty.
With only a minority of events reported, academic staff are likely to be unaware of just how widespread sexual harassment is in medical training, according to Jonathan Broad, an academic foundation year 2 doctor at the University of Bristol, who is researching the subject.
Preliminary results from his study of 230 students at one UK medical school found around 40% had experienced or witnessed inappropriate touching, gestures, or advances from healthcare professionals. Just 19% of those who witnessed discrimination, harassment, or abuse reported it to someone. Most told a friend, and some reported it to a medical team member. No one reported it to the medical faculty.
“Harassment has many consequences for students’ wellbeing, health, mental health, and problem behaviours such as alcohol consumption,” says Broad. “It has an impact on exams, career choices, and workforce planning. But it’s changeable and preventable with the right programmes in place.”
In Australia, change was foisted on surgeons after allegations in 2015 of endemic sexism, harassment, and bullying in their ranks.
Sydney vascular surgeon Gabrielle McMullin, director of the South Sydney Vascular Centre at Miranda, triggered a public outcry by telling the Australian Broadcasting Corporation that such treatment of female surgeons was so common and poorly dealt with that, “What I tell my trainees is that, if you are approached for sex, probably the safest thing to do in terms of your career is to comply with the request. The worst thing you could possibly do is to complain to the supervising body, because then . . . you can be sure that you will never be appointed to a major public hospital.”
Under pressure from the Australian Medical Association and others, the Royal Australasian College of Surgeons surveyed its members and found 49% had been bullied, discriminated against, or harassed. The college eventually apologised to all its members, set up an advisory group, and now has an action plan under way.
To report or not to report
Students who experience or witness sexual harassment face several immediate questions. First, how to react in the moment? Should you speak up? If so, now or later? And to whom? To the perpetrator, or to someone more senior? In front of others or as a quiet aside?
Secondly, comes the question of whether or not to report the incident formally. Students often fear that doing so will have negative consequences: stress, unwanted attention, retaliation or hostility from the perpetrator, and even humiliation and ostracisation from peers, according to a study exploring students’ attitudes on the matter.
Some students don’t want to get the alleged perpetrator into trouble, while others describe uncertainty about where to draw the line between “playful talk” and sexual harassment. Some even blame themselves for encouraging the behaviour.
For Louise, her taxi incident was complicated further by the involvement of alcohol. Yes, the GP’s behaviour was wrong, given his position of power over a student, but he had been a good mentor and always behaved appropriately while sober, she says. In the end, she spoke informally to her university’s dean of students. Not wanting the GP to “get into real trouble” or to create extra hassle for herself, Louise declined formal university involvement but agreed that she would speak directly to him to tell him his behaviour had been unacceptable.
Louise firmly supports Gill’s motion, saying she would welcome more education for medical students on dealing with sexual harassment.
“At the time I had no idea who best to report it to, or any awareness that it happened to others, or that I could say it wasn’t acceptable without it being a massive deal,” she says.
Lots to do
Student harassment became a topic of national debate in 2015, culminating in the launch of a Universities UK taskforce to examine the issue.
Many have already toughened their stances on sexual harassment, launching campaigns such as “Not On” at the University of Birmingham and “It Stops Here” at King’s College London.
Student unions such as at Cambridge University have declared “zero tolerance,” while Oxford provides specially trained harassment counsellors.
Some of this work is filtering down to the medical schools: the University of Leicester Medical School, for example, has launched a bullying and harassment policy, piloted sexual consent workshops for first year medical students, and is including building resilience and coping strategies in an upcoming revamp of the curriculum, according to Judith West, the school’s head of support.
However, Student BMJ could not identify any institutions that provide specific training on handling inappropriate sexual behaviour in clinical settings, such as the BMA Medical Students Committee is calling for.
West says such training is feasible, but would need a good level of engagement from students. “Anything that the BMA does will need to align with policies and procedures that already exist in NHS trusts and deaneries,” she adds.
The Medical Schools Council also welcomed the BMA motion. “It is essential that medical students are supported in extending what they learn from university anti-sexual harassment initiatives into the NHS context,” a spokesperson said.
Broad says the literature showed that there are lots of things medical schools could do to tackle sexual harassment, mainly by strengthening monitoring and response systems, and educating students on what constitutes overt and covert harassment.
The Medical University of South Carolina, for example, established a dedicated office in 1997 to tackle gender equity and sexual harassment and says the programme has been “highly successful” at providing expert support and handling complaints.
Within the UK healthcare system there is also plenty of expertise for the BMA and medical schools to draw on. One medical student at the University of Edinburgh reports experiencing regular inappropriate behaviour and comments while working with wheelchair bound patients at a private respite centre.
However, staff were so well versed in handling it that observing and learning from them became a strongly positive experience, which has boosted her confidence to tackle the issue as a future doctor, she adds.
“In my experience, it’s about communicating within the team . . . being aware of the language you’re using, and just being very firm but polite with patients. If you politely say to somebody that you’re not comfortable with something or you don’t feel it’s appropriate, they do tend to apologise and back off,” she says.David Brill, third year graduate entry medical student
St George’s, University of London, UK
Competing interests: None declared
Provenance and peer review: Commissioned; not externally peer reviewed.
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