Sexual Harassment of Canadian Medical Students: A National Survey

Abstract

Background Despite explicit policies and reporting mechanisms in academia designed to prevent harassment and ensure respectful environments, sexual harassment persists. We report on a national survey of Canadian medical students' experiences of sexual harassment perpetrated by faculty, patients and peers, their responses to harassment, and their suggestions for improving the learning environment. Methods With ethics approval from all 17 Canadian universities with medical schools, an invitation to participate in an anonymous, electronic survey was included in three Canadian Federation of Medical Students' newsletters (2016). Narrative information about sexual harassment during medical training, perpetrators, ways of coping, sources of support, formal and informal reporting/discussion, and suggestions for change was sought. Three authors then conducted a qualitative analysis and identified emergent themes. Findings When asked to estimate the number of occurrences of SH experienced during medical school, 188 students reported 807 incidents perpetrated by peers, patients, and, to a lesser extent, faculty. Perpetrators were almost always men and 98% of victims were women. What emerged was a picture of social, educational, and individual conditions under which sexual harassment becomes normalised by faculty, peers and victims. Students often tried to ignore harassment despite finding it confusing, upsetting, and embarrassing. They offered strategies for schools to raise awareness, support students, and prevent or mitigate harms going forward. Interpretation Sexual harassment is a part of the Canadian medical education environment where most who reported harassment are subject to the dual vulnerabilities of being learners and women. Although survey respondents recognised the systemic nature of the problem, as individuals they often described shame and self-blame when victimised, came up with solutions that implied they were the problem, and often reported thinking silence was less risky than confrontation or official reporting. Many participants believed in the transformative power of education – of themselves and faculty – as a means of improving the medical environment whilst we await social change.

Prevalence of intimidation, harassment, and discrimination in resident physicians: a systematic review and meta-analysis

“…Although the general findings of our study are consistent with IHD literature, 14,18,[22][23][24] IHD prevalence appears to be higher among residents than staff physicians. However, among staff physicians, IHD prevalence is highly variable.…”

“…13 As trainees are learners who are dependent on their supervisors and senior residents for promotion through the medical education system, this creates a power gradient, which sets the stage for IHD. 14 In medicine, IHD behaviours are often rationalized as 'rites of passage' or 'beneficial to training' 15 -not unlike the role of distorted cognition in initiating and maintaining cycles of sexual abuse and assault. 16 Similarly, a number of cultural factors within medicine that discourage reporting of IHD and encourage victimization have contributed to the e99 phenomenon of "whistleblowing" within medicine.…”

“…16 Similarly, a number of cultural factors within medicine that discourage reporting of IHD and encourage victimization have contributed to the e99 phenomenon of "whistleblowing" within medicine. 14,[17][18][19][20][21] In response to mounting criticism, 14,18,[22][23][24] multiple professional organizations, including the Royal College of Physicians and Surgeons of Canada, the Canadian Medical Association, Resident Doctors of Canada, the American Medical Association, and the World Medical Association, have published position papers denouncing IHD in medicine. 13,[25][26][27][28][29] Several Canadian medical schools, including Queen's University, Memorial University of Newfoundland, and the University of Manitoba, have developed IHD policy statements and imposed IHD reporting protocols.…”

“…34,35 While these estimates may also reflect decreased barriers to reporting, particularly as many surveys are kept anonymous, the effectiveness of anti-IHD infrastructure is unclear. 14,18,[22][23][24] Previous reviews have described IHD across different Canadian medical education settings. In 2014, Karim and Ducherer reported that between 45% and 93% of residents reported at least one instance of IHD during residency.…”

Acknowledging complexity in evaluation of gender equality interventions

“…Such considerations of complexity emerge from a number of studies published in the recent collection on gender equity in EClinicalMedicine. For example, a national survey of Canadian medical students’ experiences of sexual harassment demonstrates that when official policies regarding sexual harassment in medical education fail to disrupt societal gender norms, such policies are not only ineffective, but can also inadvertently cause harm to victims [8] . Several association studies also highlight the complex causality and non-linear impact of gender equality interventions.…”