MeTooSurgery session highlights need for system-wide culture change

At least 50 percent of women medical students have reported an incidence of sexual harassment, according to a report issued last year by the National Academies of Sciences, Engineering, and Medicine, with forms of this disruptive behavior becoming more prevalent in most surgical workplace settings, according to panelists at the Wednesday morning session, MeTooSurgery: Tools for Addressing and Preventing Sexual Harassment in the Surgical Workplace.

“Sexual harassment undermines professional and educational attainment, and mental and physical health,” said Lisa K. Cannada, MD, FAOA, FAAOS, an orthopaedic surgeon and a fellow of the American Academy of Orthopaedic Surgeons. “Organizational climate is the single most important factor allowing this to occur.”

Dr. Cannada—citing a recent national survey of sexual harassment among surgeons—noted that more than half (58 percent) of women surgeons had experienced sexual harassment in the previous year alone. Of the 1,005 surgeons surveyed (men and women), women trainees were more than twice as likely to experience verbal or physical harassment, including unwanted sexual advances (23 percent); 84 percent of these incidents were not reported.

“No one asks to be a victim. The profound effect of [sexual harassment] is incomprehensible. What can we do? We need to establish processes where people can report without fear and ensure that there are actual consequences for those who do this,” Dr. Cannada said.

According to Janet E. Tuttle, MD, MHA, FACS, the Walter Pories, MD, Endowed Chair and professor of surgery, East Carolina University, Greenville, NC, there are four key best practices to promote culture change, particularly regarding gender-based harassment prevention and education: “vision and commitment, having the right people in the right place, determined and insistent pursuit, and developing a movement, not a mandate.”

Culture change management also requires implementing system-wide behavior guidelines and developing action plans, including a review of committee and presenter rosters, she said.

“No more manels,” said Dr. Tuttle, referring to all-male panels. “There is a diverse range of expertise in each field. It doesn’t have to be the same faces each time.

“Have a zero tolerance for buffoonery, and have courage in your leadership,” she added. “Institute consistency in your messaging, and have patience. Culture change comes too fast for some and not fast enough for others.”

“Sexual harassment is systemic and driven by imbalances in power, and the impact is felt beyond the interaction with the victim,” said Thomas K. Varghese, Jr., MD, MS, FACS, a thoracic surgeon from Salt Lake City, UT. Bystander intervention is the most widely used strategy for engaging people in general to prevent sexual and domestic violence, he added.

“Bystander intervention training plays a key role as part of a comprehensive strategy to permanently reduce rates of violence and mobilize and empower all members of a given community,” he said. “Through training, the program engages witnesses to interrupt situations, increases self-efficacy, and provides skill building and specific strategies to increase the likelihood that trained individuals will actually intervene.”

Dr. Varghese outlined the “5 Ds of bystander intervention.” They are: Direct (confront the situation); Distract (take an indirect approach to de-escalate the situation); Delegate (seek help from a third party); Document (record the incident if it is safe to do so); and Delay (check in with the person post-incident).

The difference between being an active bystander and an ally is that an ally “speaks out against sexual harassment and bullying and takes action to prevent it,” said Dr. Varghese, Co-Chair of the ACS Association of Women Surgeons (AWS) #HeforShe Taskforce. The goal of this task force is to “promote male and female surgeon allies in the pursuit of gender equity in surgery.” He noted the #HeforShe Taskforce is in the process of transitioning to an AWS allied committee, although a formal name for the group has yet to be selected.