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Sexual and Gender Harassment: Why You Should Care!

By Rita Agarwal, MD, FAAP, FASA

Highlights from a conversation with Diana Lautenberger for CSA’s Podcast, Vital Times.

We have a problem in anesthesiology: we have the highest incidence of burnout, intention to leave and sexual harassment. Of any specialty.

In July 2022 an article titled “Understanding and Addressing Sexual Harassment in Academic Medicine”1 was published by the Association for Academic Medical Colleges (AAMC), which is a non-profit organization of all 155 accredited medical schools in the US and 16 in Canada. It represents over 400 teaching hospitals and 70 medical societies. The authors identified anesthesiology as the profession reporting the highest rates of sexual harassment among all specialties for men and women (men anesthesiologists 21.3%, women anesthesiologists 52.6%). Overall, across all departments and specialties, 34 % of women and 22% of men reported experiencing some form of sexual of gender harassment, even in fields where the majority are women (e.g., pediatrics, ob-gyn). I recently had the pleasure of talking to Diana Lautenberger, who is the author of the AAMC article, for Vital Times: The Podcast on the research and implications of this study. Diana is the Director of Gender Equity Initiatives for the AAMC and an unabashed feminist. When asked about why this matters, she says, “We cannot deliver the best education, medical care and scientific advancements while harmful, often illegal behaviors are tolerated.”

This is particularly important, when considering 2 other very recent articles looking at burnout and intention to leave (ITL), which found that:

  1. Almost 70% of ASA members who completed a national survey were at risk for burnout and approximately 19% met criteria for burnout syndrome2.
  2. Compared to other physicians, anesthesiologists had the highest incidence of intending to leave their current institution in the next year3.

While gender or sexual harassment are clearly not the only contributors to these issues, they are often part of a larger culture that is hostile or at the very least not supportive to many. In fact, the biggest factor associated with an ITL was an unsupportive workplace, followed by staff shortages. The incidence of burnout was higher in women, and women reported higher levels of dissatisfaction with their professional development.

Ms. Lautenberger and her colleagues analyzed data that was part of a larger and recurring survey by the AAMC on faculty engagement. The data is based on the answers to a subset of validated questions on gender and sexual harassment and interviews with institutional leaders. The authors sought to explore the prevalence of sexual or gender harassment, the perception of faculty that their institution could appropriately address issues of harassment, and what leading institutions are doing to address and prevent harassment.

Some Definitions:

Gender Harassment: verbal and nonverbal behaviors that convey hostility, objectification, exclusion or 2nd class status about members of one gender

Unwanted sexual attention: unwanted verbal or physical sexual advances, which can include assault.

Sexual coercion: when favorable professional or educational treatment is conditioned on sexual activity.

The survey was distributed to 22 medical schools, with a 56% response rate and over 13,000 respondents. The questions asked were based on previously validated questions used in sexual/gender harassment research. Ms. Lautenberger and her coauthors were  surprised by the incidence reported of gender/sexual harassment and skeptical regarding the accuracy of the number, with a suspicion that this type of harassment is often so accepted in hierarchical organizations that the true number is probably higher. A 2021 study by Methangkool, et al, analyzed 153 women cardiac anesthesiologists4.  Many women reported experiencing derogatory comments (55.6%), intimidation (57.8%), microaggression (69.6%), sexual harassment (25.2%), verbal harassment (45.2%), and unwanted physical or sexual advances (24.4%).  The behaviors were most often from a surgical attending (64.4%), anesthesiology attending (35.6%), or patient (44.4%).

One of the more important aspects to the study was recognizing that faculty who reported harassment had lower morale, engagement, satisfaction and desire to remain at the institution. The most common types of harassment were gender put-downs, and while this occurred in both males and females (there were not enough results from non-binary people or other genders to analyze), it was more common in women, across all specialties and surprisingly even more common in women with leadership and administrative roles.

There is good news, however. As a result of the recognition that harassment is harmful, destructive and expensive, many organization are looking towards innovative solutions to prevent harassment of any sort. The authors summarize these approaches with the following 10 recommendations:

  1. Begin with zero tolerance. Start at recruitment by making clear the commitment to a harassment-free environment, ask candidates to disclose previous or ongoing investigations, and work with HR.
  2. Take a coordinated multidisciplinary approach with Faculty Affairs and HR.
  3. Hold Chairs accountable.
  4. Leverage the parent university, which may have more resources, training and tools.
  5. Hire trained investigators – Ms. Lautenberger emphasized the importance of this step. It is too easy to overlook problematic behavior when someone is a friend or respected colleague; remaining objective can be difficult, and trained investigators know what to look for. 
  6. Centralize and expand reporting — this is to ensure absolute anonymity and centralizationa of reporting systems.   The most common reasons people give for not reporting, is fear of retribution, retaliation, and lack of anonymity.
  7. Address less overt, yet still harmful behavior problems early and often. Develop support for perpetrators, who may be unaware of how harmful or hurtful their behaviors may be. Train supervisors and develop clear guidelines for consequences if the behavior continues.
  8. Use proportionate sanctions — create a scale for different levels of offenses, and ensure that faculty, staff and trainees are aware that there will be consequences for unacceptable behavior.
  9. Communicate transparently about harassment incidents.
  10. Train beyond compliance.

I hope you will listen to the entire podcast for more!  

References:

  1. Lautenberger DM, Dandar VM, Zhou Y. Understanding and Addressing Sexual Harassment in Academic Medicine. Washington, CD. AAMC: July 2022
  2. Afonso AM, Cadwell JB, Staffa SJ, Sinskey JL, Vinson AE.U.S. Attending Anesthesiologist Burnout in the Postpandemic Era. Anesthesiology. 2024 Jan 1;140(1):38-51. doi: 10.1097/ALN.0000000000004784.PMID: 37930155
  3. Ligibel JA, Goularte N, Berliner JI, et al. Well-Being Parameters and Intention to Leave Current Institution Among Academic Physicians. JAMA Netw Open. 2023;6(12):e2347894. doi:10.1001/jamanetworkopen.2023.47894
  4. Emily Methangkool, Jessica Brodt, Lavinia Kolarczyk, Natalia S Ivascu, Megan H Hicks, Elizabeth Herrera, Daryl Oakes Perceptions of Gender Disparities Among Women in Cardiothoracic Anesthesiology Journal of cardiothoracic and vascular anesthesia 36/71859-1866 7/21
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