PARTNER PUBLICATIONS

The greatest predictor of sexual harassment in the workplace is the organizational climate, which refers to the tolerance for sexual harassment and is measured on three elements: a lack of sanctions against offenders; a perceived risk to those who report sexually harassing behavior; and the perception that one’s report of sexually harassing behavior will not be taken seriously.

Female residents in surgery and emergency medicine are more likely to be harassed than those in other specialties because of the high value placed on a hierarchical and authoritative workplace.

These environments historically are male dominated, tolerate sexually harassing behavior, and create a hierarchy in which men hold most of the positions of power and authority.  Moreover, dependent relationships often exist between these gatekeepers and those subordinate to them, with gatekeepers directly influencing the career advancement of those subordinates.

Higher-education environments are perceived as permissive environments in part because when targets report sexual harassment, they are retaliated against or there are few consequences for the perpetrator.

Women are less likely to be directly harassed in environments that do not tolerate harassing behaviors or have a strong, clear, transparent consequence for these behaviors.

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Professional societies are in a unique position to be ethical and lead by example: to use their influence to address gender discrimination in the medical communities they represent.

While every professional surgical society has statements and policies that address issues pertaining to gender equity, [the results of our review conclude that] current publicly available statements are inadequate.  Very few of these statements are specific to gender or pertain to the breadth of gender equity issues that include implicit bias, gender discrimination and sexual harassment.  Moreover, the inexact wording allows for liberal interpretation, creating loopholes for enforceability of professional misconduct.

Statements and policies should be a means to the end of establishing equitable standards of behavior rather than merely seeking to influence attitudes and beliefs.

[They should] reflect the leadership’s awareness of these problems and the steps taken for correction.  [They should] provide a framework that guides the specialty with expectations of performance and behavior that upholds a set of core values.

Moreover, these statements and policies should have actionable consequences for deviations in professionalism and metrics to capture meaningful improvements in gender equity.

Surgical culture will require a major overhaul such that diversity, inclusion and respect are categorical imperatives.

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All professional societies must commit to examining their own culture and addressing systemic disparities including, but not limited to, leadership at the highest levels.

A key element of this culture shift involves addressing the spectrum of micro- and macro-aggressions and inequities that women in medicine face on a daily basis.

One important consequence of the #MeToo movement is increased attention, not only on the perpetrators, but on two other groups: leaders who have failed to effectively address problems within their purview and bystanders who have witnessed such behavior and opted not to intervene–especially those in a position of power who risk little harm to their own reputations and have at the minimum a moral and ethical obligation to protect those who are vulnerable.

Educational efforts should focus on when and how to speak up and report problems, in order to break the pervasive culture of silent complicity in the face of workplace harassment.

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Research over the last decade has revealed aspects of gender disparity and detailed probable underlying causes.

Gender bias, microaggressions, discrimination, and an environment tolerant of sexual harassment cumulatively contribute to creating a challenging workplace for women [physicians].

Among early-career surgical faculty, 50% of women experienced sexual discrimination ... [and] 38% reported gender as a barrier to career development.

Creating an environment in which women can optimally contribute, thrive, and succeed will benefit organizations, the community, future generations of surgeons, and, most importantly, positively affect the care of patients.

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In the context of the hierarchical male-dominated field of surgery, the voices of women surgeons have not historically been empowered nor embraced.

The stories contained in this ... symposium ... are an elegant sampling of the volumes of stories brave women in surgery have to tell.

There is hope for the future of gender equity, diversity, and inclusion in the surgical workforce but only if its leaders adopt a zero tolerance policy against the range of gender-disparities identified and prioritize a culture of safety, dignity and equity.

It’s time to change the narrative of who surgeons are by amplifying the collective voices of women in surgery.

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One day, I was called to an urgent meeting in the hospital executive suite that I assumed would be to discuss [the inappropriate] pelvic examination incident [I reported].  Instead, the meeting opened with a question, “do you think you have problems getting along with other people?”

I sensed retribution for having complained…  I had raised [previous questions] about other patient safety issues (e.g., lost specimens, complications and deviations from standard operating procedures).

I described what I perceived as hazing from nursing and staff inconsistencies in the operating room, and the trouble I was having finding advocacy for the infrastructure that I needed in order to care for my patients.

I presented objective data [for my performance]: improved patient satisfaction; decreased length of stay; increased surgical volume; elimination of surgical site infections; a burgeoning research program.

[I] pleaded for empathy for my patients who were amongst the most vulnerable in the hospital.  I repeated the words “patient safety,” hoping they would be buzzwords and instigate action in this office.

When I was done and it was my turn to listen, however, I was told how, in this Institution, people exchange pleasantries. I was encouraged to smile more.

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I know that future times will be more perilous for all of humanity, with challenges no-one can currently foresee.  It will take all of our energy as a species to survive and create a world that works for us all.  I know that this cannot be done if we do not include the feminine half.  I believe that many of the direct failures of our life we see today stem from our shortsightedness regarding allowing women full involvement.

Humor, luck, and psychological defenses only go so far. I would be brought down to earth in ways as mundane as attending my first surgical conference and being excluded from the perks of dinners and cruises on the bay because I did not look like a surgeon…

I was being passed over for promotions, awards, and assignments in favor of men who were not as qualified.

If [my story] can help one person realize they are not alone in their experience, if it can convince one person of power to extend mercy to one below, if it makes one recognize a part of themselves in another, then my goal will be attained.  I and others like me are ready with hearts open and helping hands out. We are not hothouse flowers. To be a woman is a rich and dangerous job.

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My memory is long regarding the inequities that I confronted during my training and my career.

I never ‘showed up to work’ without my ‘armor.’  That armor took many forms including minimizing my femininity, consciously focusing on my body language, my verbal presentations, and my hand gestures all in an attempt to be seen as a surgeon and not a ‘woman surgeon.’  This distinction is crucial to understand as, with the passage of time, I have finally become proud of being a woman and a surgeon.

Over the course of my career I experienced gradual acceptance that, as a woman and a surgeon, I bring a different perspective to the care of my patients and their families, a different view for my students and residents, and a different face for the community that I serve.

We owe it to the next generation of surgeons, of patients, of families, and to the daughters and sons of surgeons to change the narrative… to change the definitions of power and strength.

My journey has shown me that strength should be defined by unyielding empathy and compassion, by a genuine drive to empower others, and by an unwavering commitment to speak up when the right thing is not being done.

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These narratives document the experiences of women surgeons and the resilience they demonstrate in overcoming the gender-related obstacles they face.

‘Having voice,’ having one’s reality witnessed by others, can open way for dissolution of pain, enhancement of understanding, and integration of meaning.

When you hear one story it can be dismissed as it being the woman’s problem. Two stories gets you wondering if women are just difficult. Three, four, five stories and you realize that there is a surgical culture that is deeply dysfunctional.

These narratives contain overlapping examples of sexism, harassment, gaslighting, isolation and hostile work environments. Although the details are different, together they paint a painful picture of what many women surgeons experience.

[W]e need to “Stop Fixing Women” and address the systemic issues and inequities that result in women surgeons continuing to have these experiences.

[T]he contributions that women can bring—empathy, collaboration, compassion, kindness, wisdom, empowerment, and zero tolerance for abusive behavior, to name a few—will enrich the culture of surgery and improve patient care.

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