Correspondence
Sexual Harassment in Medical Training
N Engl J Med 1993; 329:661-663August 26, 1993
- Article
To the Editor:
The report by Komaromy et al. (Feb. 4 issue)1 on sexual harassment in medical training has given a high profile to a problem that many have chosen to ignore. We conducted a descriptive, cross-sectional survey of full-time faculty and current house staff at our institution. Stratified, systematic random samples of 70 men and 70 women were drawn from both the house staff (602 men and 242 women) and faculty (703 men and 224 women). The questionnaires addressed a number of sex-related issues, including sexual harassment, and were self-administered and returned anonymously. The response rate among full-time faculty members was 69 percent (77 percent of women and 60 percent of men). The response rate among the house staff was low (33 percent overall; 44 percent of women and 23 percent of men).
Sexual harassment was defined as any sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature that was unwelcome. When faculty members were asked whether they had ever experienced sexual harassment or witnessed harassment of another faculty member, 26 percent of the women and 12 percent of the men responded affirmatively. The event was most often initiated by a fellow faculty member, and no corrective action was taken by the school or university in the majority of cases. More than half the women (63 percent) and 38 percent of the men believed that reporting sexual harassment would have a negative effect on their careers. Almost all the respondents (85 percent of women and 90 percent of men) reported having been given no information at the time of employment regarding the procedure for reporting sexual harassment.
The limited sample of house-staff respondents reported an even higher prevalence of sexual harassment directed at themselves or another house officer (39 percent of women and 25 percent of men). Almost three quarters of the women and half the men reported that the event was initiated by a faculty member or administrator. The majority of the women (71 percent) and 44 percent of the men believed that reporting the harassment would have a negative effect on their careers.
Our survey results and the reports of Komaromy et al.1 and others2-4 indicate that sexual harassment is experienced with regularity by students, house staff, and faculty members in the medical-school environment. Now that the problem has been defined, medical institutions must take an active approach to education and prevention.
4 ReferencesMonica M. Farley, M.D.
Phyllis Kozarsky, M.D.
Emory University School of Medicine, Atlanta, GA 30303for the Committee on the Status of Women in the School of Medicine
1
Komaromy M ,Bindman AB ,Haber RJ ,Sande MA . Sexual harassment in medical training. N Engl J Med 1993;328:322-326
Full Text | Web of Science | Medline2
Richman JA ,Flaherty JA ,Rospenda KM ,Christensen ML . Mental health consequences and correlates of reported medical student abuse. JAMA 1992;267:692-694
CrossRef | Web of Science | Medline3
Baldwin DC Jr ,Daugherty SR ,Eckenfels EJ . Student perceptions of mistreatment and harassment during medical school: a survey of ten United States schools. West J Med 1991;155:140-145
Medline4
Wolf TM ,Randall HM ,von Almen K ,Tynes LL . Perceived mistreatment and attitude change by graduating medical students: a retrospective study. Med Educ 1991;25:182-190
CrossRef | Web of Science | Medline
To the Editor:
Komaromy et al. imply that litigation with regard to allegations of sexual harassment during medical training is likely to result in defensiveness, resentment, retaliation, or a backlash. We disagree. It is because defensiveness, resentment, retaliation, and a backlash are already present that litigation is necessary. Often, litigation is the only way a victim of harassment can gain the power necessary to fight discrimination.
We also believe that it may be dangerous to overemphasize the need for prevention without corrective action when discrimination is found to occur. Currently, the Equal Employment Opportunity Commission (EEOC) has no sanctions for harassers. The EEOC and legal processes are adversarial, and the outcome of these processes, when harassment is found to have occurred, is compensation of the victim1,2. A much better system would include mediation as a first step, to work out misunderstandings and find mutually agreeable solutions. A person found by the EEOC or other legal processes to have engaged in discrimination or harassment would go before a disciplinary board whose job would be to determine appropriate sanctions. Currently, many documented harassers receive promotions and awards and are taken care of by the old-boy network, which rallies to protect them, despite an agency's strong stated commitment to “preventing” harassment.
In the population surveyed by Komaromy et al., it is fortunate that in eight of nine cases, when people filed complaints or spoke to the harassers, the harassment stopped. Our experience is very different. The level of hostility that is often involved and the destructiveness of this hostility to the victim's well-being and career are often not appreciated. Retaliation is more destructive than the original discrimination3. Institutional denial may be profound4. Formal complaint and legal processes continue to be very important in such cases.
4 ReferencesMargaret F. Jensvold, M.D.
Institute for Research on Women's Health, Washington, DC 20009Billie Mackey, M.Ed.
Self Help for Equal Rights, Garrett Park, MD 20896Viola Young-Horvath, Ph.D.
Federation of Organizations for Professional Women, Washington, DC 200091
The federal guideline on sexual harassment. Title VII. Section 703. Washington, D.C.: Equal Employment Opportunity Commission, 1980.
2
United States Congress. Civil Rights Act of 1991. Public Law 102-166. November 21, 1991, Washington, D.C.
3
Jensvold M. Workplace sexual harassment: the uses of and misuse and abuse of psychiatry. Psychiatr Ann (in press).
4
Paul SM . Charges of sexual harassment at NIMH. JAMA 1992;268:603-604
CrossRef | Web of Science | Medline
To the Editor:
No woman who has knowledge of the complaint process for allegations of sexual harassment and the tendency to shift the blame to the victim would voluntarily embark on this course without due cause. A “scrupulously fair and unbiased approach to the investigation of complaints” is certainly desirable, but it may tend to favor the offender, since the victim is unlikely to be able to provide material evidence. The situation is similar to that of children accusing adults of abuse.
Dr. Kamaromy and her colleagues also do not address the question of how to deal with confirmed sexual harassment. Clearly, telling the offender to stop is desirable. But what if the offense is severe, and the damage to the victim is done? . . .
Deirdre H. Donaldson, M.D., Ph.D.
University of Colorado Health Sciences Center, Denver, CO 80262To the Editor:
I have been struck by the variability in both the intensity and type of sexual harassment that occurs in different medical specialties. Dr. Conley (Feb. 4 issue)1 states that she was harassed while practicing neurosurgery, an extremely male-dominated subspecialty. Neither she nor Komaromy et al.2 address the issue of the prevalence of sexual harassment in male-dominated surgical specialties as opposed to less traditionally male-dominated specialties. Komaromy et al. suggest that sexual harassment has a major impact on the general training experience of women in medicine. I believe it may also play a part in female medical students' choice of specialty. Sexual harassment may thereby effectively serve to preserve the male domination of certain specialties.
2 ReferencesSarah Schlesinger Frankel, M.D.
Buffalo General Hospital, Buffalo, NY 142031
Conley FK . Toward a more perfect world -- eliminating sexual discrimination in academic medicine. N Engl J Med 1993;328:351-352
Full Text | Web of Science | Medline2
Komaromy M ,Bindman AB ,Haber RJ ,Sande MA . Sexual harassment in medical training. N Engl J Med 1993;328:322-326
Full Text | Web of Science | Medline
To the Editor:
Sexual exploitation may occur in academic medicine for the purpose of career advancement. Consider a situation in which a female surgical resident is retained and promoted in a pyramidal system toward chief resident over a male resident and there is a consensual sexual liaison between the female resident and a male surgeon on the faculty. The relationship ends after the woman completes her residency. When sexual rather than professional qualifications become criteria for promotion, both patients and physicians may be harmed. An effective complaint-resolution process should be available both to residents who may be victims of sexual harassment and to those whose careers may be jeopardized by the sexual agendas of others in the academic community.
Steve Laverson, M.D.
Nassau County Medical Center, East Meadow, NY 11554Author/Editor Response
The authors reply:
To the Editor: We are pleased that Drs. Farley and Kozarsky are pursuing some of the issues yet to be explored regarding sexual harassment and discrimination. We also appreciate Dr. Frankel's suggestion that the prevalence of sexual harassment may be very different in male-dominated specialties.
Dr. Jensvold and colleagues express concern that we have overemphasized the prevention of sexual harassment. As we stated, a formal complaint-resolution process must be available and should include both compensation for the victim and sanctions against the harasser in cases in which sexual harassment is found to have occurred. We believe, however, that individuals and institutions would be better served by stopping sexual harassment from occurring, rather than by simply providing redress for the minority of cases that are actually reported. Prevention also does not expose people to retaliation or create an adversarial environment in the institution.
Dr. Donaldson reminds us that there are other problems with a formal complaint-resolution process. We agree that proving charges of sexual harassment may be very difficult, but feel strongly that any complaint-resolution process must attempt to be unbiased. Even though it is unlikely that many people would choose to undergo the unpleasantness of bringing false charges, that does not mean that alleged harassers can automatically be assumed to be guilty. This is another argument for emphasizing prevention as the most fruitful approach to sexual harassment.
Finally, Dr. Laverson reminds us that although the most frequent victims of sexual harassment are women, men may also be harmed by the “sexual agendas of others in the academic community.”
We are glad that our article has stimulated discussion. We hope that the academic medical community will take responsibility for addressing the problem of sexual harassment in our profession.
Miriam Komaromy, M.D.
Andrew B. Bindman, M.D.
Richard J. Haber, M.D.
Merle A. Sande, M.D.
University of California, San Francisco, San Francisco, CA 94143Author/Editor Response
Although I have not done an extensive review of the literature, I am unaware of any studies that have explored the degree and type of sexual harassment as a function of a particular medical or surgical specialty. Anecdotal evidence suggests that there is considerable variation among disciplines in the amount and content of harassment female medical students and physicians experience. Surgical specialties win uncontested first place for spawning the most egregious and prevalent forms. Dr. Frankel's premise that female medical students avoid certain career choices after experiencing harassment is undoubtedly correct. I know numerous would-be and former female surgeons. We must remember that harassment based on sex is a power play, and one manifestation of power is the ability to exclude those who are powerless. So long as leaders in medicine do not consider sexual harassment a serious problem, men will remain in total control over the specialties that have excluded women.
Dr. Laverson raises a different, but equally serious point about the umbrella effect of sexual exploitation when used by either sex for career advancement. As academic institutions struggle to formulate sexual-harassment policies, the issue of and inherent dangers in consensual romantic or sexual activity between faculty, staff, students, and attending physicians should be addressed. At present Stanford University does not plan to adopt a formal policy prohibiting these relationships. Wording contained in a draft statement recently endorsed in principle by the academic senate states:
When possible, the person with the power and control in such a relationship should be removed from any direct supervisory role over the other person. In situations such as that described by Dr. Laverson, the person in the position of power must not have a voice in decisions that affect the career of either the subordinate involved or any others whose work places them within the immediate sphere of influence of the involved pair.
1 ReferencesFrances K. Conley, M.D.
Stanford University School of Medicine, Stanford, CA 94305- Citing Articles (2)
