Addressing Sexual Harassment in Surgical Training.

I n the past several years, workplace sexual harassment has become an increasingly prominent topic both nationally and internationally. Revelations that powerful individuals demonstrated repeated patterns of sexually harassing women in professional settings propelled the #MeToo movement and its demands that women be free to work without being sexually harassed. In medicine, like other fields, increasing attention has been paid to the demand for gender equity in the workplace. Addressing sexual harassment is a key component of gender equity and has recently been highlighted by prominent professional societies. In 2018, The National Academies of Science, Engineering and Medicine published a report Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine which emphasizes high rates of sexual harassment of women in medicine and highlights surgery as a field in which women trainees may be particularly susceptible to sexual harassment. They hypothesized that the hierarchical, male-dominated culture of surgery contributes to a workplace climate in which sexual harassment may be more tolerated than in other fields of medicine. Importantly, the report acknowledges that patients are a frequent and common source of sexual harassment of women physicians and recommend that healthcare institutions formally condemn these behaviors at the time that patients first present to seek care. In this issue of Annals of Surgery, Dr Freedman-Weiss et al present a study of the prevalence of sexual harassment in surgical training and of barriers to reporting sexual harassment incidents. Briefly, the authors recruited trainees from 16 general surgery programs to a survey study regarding sexual harassment in residency training. Overall, approximately 30% of invited trainees chose to participate, with just over half of respondents identifying as men. While the low response rate raises the specter of nonresponse bias, the results are nevertheless stark: over 70% of women respondents experienced some form of sexual harassment, compared with 31% of men. Among the residents who did not personally experience sexual harassment (mostly men), one-third reported witnessing or hearing about a coresident being sexually harassed. Not surprisingly, participants indicated a low rate of reporting of sexual harassment incidents: less than 8% of the affected residents reported any of the sexual harassment that they experienced. The primary barriers to reporting sexual harassment included a belief that the incident was harmless or that filing a report would be a waste of time. These findings resonate with previous work by our group across multiple departments, not just surgery. We found that gender-based discrimination disproportionately affects women residents and also demonstrated that these negative workplace experiences affect the training environment of men, who are frequent observers and witness of gender-based discrimination. Like Dr Freedman-Weiss et al, participants in our multispecialty study indicated high rates of nonreporting of gender-based discrimination including sexual harassment, with <5% of affected residents filing a formal report. Barriers to reporting were similar, with 65% of affected residents indicating a belief that ‘‘nothing would be done’’ as a consequence of filing a formal report. We commend Dr Freedman-Weiss et al for studying this difficult topic which has been studied sparsely in the past and yet occupies an important space in the minds of many in surgery today. From learners having lunch in the cafeteria all the way up to the C-suite where the board of trustees meet, the discussion on how to address sexual harassment and other forms of gender-based discrimination of trainees is beginning to take shape in every hospital in America. In surgery specifically, work has been done to understand and combat gender inequity broadly, ranging from topics including disparities in promotion and advancement, the prevalence of genderbased bias and discrimination, and equal representation at research meetings and in receiving awards. A large recent study of surgical residents has also linked experience of harassment and discrimination to burnout. The American Surgical Association has addressed issues of gender equity and inclusion, highlighting in a recent white paper the duty of academic surgery to catalyze change in an effort to reduce the disproportionate roadblocks women and minorities face in achieving professional success within surgery. Eliminating sexual harassment in the workplace is a key component of this aim, and the authors of the ASA white paper encouraged institutions to include a