Sexual Harassment in Medical Training

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Sexual Harassment in Medical Training

• Vijay Rajput MD, FACP
• Program Director, Internal Medicine
• Associate Fellow at Center for bioethics at UPenn
• Associate Professor of Medicine
• Robert Wood Johnson Medical School

2
Sex At Work Right Or Wrong?

• Make your own judgment?

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"David Letterman Broke Two Cardinal Rules
Governing Workplace Romance."
4
Two never get involved with someone if you're
married or in a committed relationship.

• ONE NEVER BECOME INVOLVED WITH SOMEONE IN YOUR
  DIRECT CHAIN OF COMMAND.

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WORK PLACE AFFAIRS

• workplace affairs are very common these days.
• The best advice is not to get involved, but they
  do.
• The best thing to do if you're going to go ahead,
  against all advice, and have a workplace affair,
  your best bet is to keep it very low-key.
• Third cardinal rule Never have sex on company
  property. And that includes supply closets and
  copy rooms and stairwells and parking lots and,
  you know, all these adjacent areas.
• Jennifer Kearns Lawyer on NPR

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Relationship at work !!!!

• The biggest problem in the workplace is when a
  relationship develops between a supervisor and
  his or her subordinate, because there is a
  disparity of power. And so even though the
  relationship may begin consensually, with both
  parties very interested in having a relationship,
  there is always the potential that the
  subordinate may later make a sexual harassment
  claim against the company, claiming that he or
  she was pressured into having that relationship.
• Jennifer Kearns Lawyer on NPR

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What about peer-peer relationship?

• if you've got a reputation for sleeping your way
  to the top, even though that may not be the case,
  it's going to follow you.
• People do gossip. Some people have very long
  memories, and some industries are very
  close-knit. And that reputation could follow you
  if you're a woman. Or if you're a man, you could
  get a reputation as a predator or as someone who
  preys on, you know, other employees.
• Jennifer Kearns and Houston Lawyer and
  infidelity expert on NPR October 8, 2009

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Other issues with peer-peer relationship

• It is not lunch time or water fountain talk
  anymore
• Spend hours on email, face book and twitter
• Decrease productivity

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Jurors award Wal-Mart claimant 50 million

• In 1995 Federal Court jurors awarded Peggy
  Kimzey, who sued Wal-Mart because of sexual
  harassment, 50 million in punitive damages.
• Kimzey resigned from Wal-Mart in 1993, claiming
  an abusive and hostile work environment. Kimzey
  said her two supervisors constantly made
  derogatory remarks and company officials did not
  take action.
• U.S. District Court Judge Scott Wright, however,
  lowered the award to 5 million, claiming the
  jury had awarded Kimzey too much money.
• Kimzey vs. Wal-Mart Stores, Inc., 107 F3rd 568,
  573 (8th Cir 1997)

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Astra to pay 10 million in sex case settlement

• Lars Bildman, former Astra U.S.A. president and
  CEO, was accused of replacing older female
  employees and mothers with younger single women
  who were pressured into having sex with company
  executives.
• In a 1996 Federal lawsuit, six former Astra
  employees argued that executives had created "an
  organized pattern of sexual harassment" to
  "satisfy their personal desires," costing Astra
  nearly 10 million.
• Settlement with EEOC by consent decree, 1998

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Female professor awarded over 1 million

• In 1990, Dr. Jean Jew, a female professor, was
  sexually harassed by colleagues after she
  received tenure at the University of Iowa.
• She filed a lawsuit stating that the University
  was not responding promptly to her complaints.
  The university attempted, unsuccessfully, to
  argue that it was a case of freedom of speech
  rather than sexual harassment.
• Dr. Jew was awarded a total of 1,070,000
  comprising 50,000 in back pay, 125,000 in
  damages, and 895,000 in fees and expenses after
  a lengthy five-year court battle.
• Jew v. University of Iowa U.S. District Court
  1990

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Predisposing factors

• Long training and high stakes
• Many supervisors and peers on each rotation in
  new environment
• Long hours in small group
• Emotionally taxing work
• Breakdown of social barriers
• intimate discussion of body parts

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TWO TYPES OF HARASSMENT

• Quid pro quo Sexual Bribery
• Another one is creating hostile, offensive, work
  environment, sexual advances and offensive
  languages

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Response to harassment

• 2/3 of women do not report the harassment to
  their superior.
• They are not confident, whether they will be
  helped
• Fear of retaliation
• Fear of shame and guilt

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Whose perspective is right one ?

• It is interaction between two people.
• Perception of the person harassed are often
  different from the person accused of being
  harassed.

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• Most of the time it judged by the perspective of
  reasonable women

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Prior Studies

• A large percentage of medical students (36 to 52
  percent) report experiencing some form of sexual
  harassment during medical school.
• Women students being much more frequent than
  those by men.
• Female physicians that included some residents
  reported that 27 percent had been sexually
  harassed in the preceding year.
• None of these studies have examined the frequency
  and type of sexual harassment residents
  experience, the professional status of the
  harassers, the range of negative effects, or the
  likelihood that the harassment will be reported.
• Mental health consequences and correlates of
  reported medical student abuse. JAMA
  1992267692-694. 
• Student perceptions of mistreatment and
  harassment during medical school a survey of ten
  United States schools. West J Med
  1991155140-145.
• Perceived mistreatment and attitude change by
  graduating medical students a retrospective
  study. Med Educ 199125182-190.
• The gender climate of medical school
  perspectives of women and men students. J Am Med
  Wom Assoc 198843109-10, 115.

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Sexual Harassment in Medical Training

• Background Sexual harassment has become a
  national concern and one that is increasingly
  recognized in the field of medicine. Although
  there are reports of the sexual harassment of
  medical trainees, there is little information on
  the prevalence of this problem and whether it is
  adequately addressed by training institutions.
• Methods Surveys with descriptions and examples of
  sexual harassment were mailed to 133 internal
  medicine residents in a university training
  program. The residents were asked to report
  anonymously whether they had encountered sexual
  harassment during medical school or residency,
  the frequency and type of harassment, its effect
  on them, whether they chose to report it to a
  person in authority, and the factors that
  influenced this decision.
• Results Surveys were returned by 82 residents
  (response rate, 62 percent) -- 33 women and 49
  men. Twenty-four women (73 percent) and 11 men
  (22 percent) reported that they had been sexually
  harassed at least once during their training. The
  women were more likely than the men to have been
  physically harassed, and the women's harassers
  were of higher professional status. Among those
  harassed, 19 of the women (79 percent) and 5 of
  the men (45 percent) thought that the experience
  created a hostile environment or interfered with
  their performance at work, but only 2 women and
  no men reported their experiences to an
  authority. The women cited a lack of confidence
  that they would be helped as the main reason for
  not reporting the experience, whereas men most
  commonly said that they had dealt with the
  problem without the need for outside assistance.
• Conclusions Many medical trainees encounter what
  they believe to be sexual harassment during
  medical school or residency, and this often
  creates a hostile learning and work environment.
  Training institutions need to address the adverse
  effects this may have on medical education and
  patient care.
• Miriam Komaromy, Andrew B. Bindman, Richard J.
  Haber, and Merle A. Sande   NEJM 1993328322-326

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Behavior Often Associated with Sexual Harassment
Komaromy M et al. N Engl J Med 1993328322-326
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Reports of Sexual Harassment Made in a Survey of
Medical Residents
Komaromy M et al. N Engl J Med 1993328322-326
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Characteristics of Those Engaging in Sexual
Harassment, as Reported by Those Who Completed
the Survey
Komaromy M et al. N Engl J Med 1993328322-326
22
Behavior Associated with Sexual Harassment, as
Reported by the Study Respondents
Komaromy M et al. N Engl J Med 1993328322-326
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• Sexual harassment may be defined as sexual
  advances, requests for sexual favors, and other
  verbal or physical conduct of a sexual nature
  when
• submission to such conduct is made either
  explicitly or implicitly a term or condition of
  an individual's employment or academic success,
• submission to or rejection of such conduct by an
  individual is used as a basis for employment or
  academic decisions affecting such an individual,
  or
• such conduct has the purpose or effect of
  unreasonably interfering with an individual's
  work or academic performance or creating an
  intimidating, hostile, or offensive work or
  academic environment.

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Sexual harassment and exploitation

• Abuse the rights and the trust of those who are
  subjected to such conduct
• May influence the academic and professional
  advancement of medical trainees in a manner that
  is unrelated to their scholastic or clinical
  performance
• May harm professional, working relationships
• Likely to jeopardize patient care.

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Consensual sexual relationship

• Consensual sexual relationships between a medical
  trainee and a supervisor, when the supervisor has
  professional responsibility for the trainee, are
  objectionable because of the potential for
  exploitation and the potential impact on patient
  care.
• Consensual sexual relationships between a medical
  trainee and a supervisor when no professional
  relationship exists may also be a cause for
  concern.
• CEJA Report B A-89 Sexual Harassment and
  Exploitation Between Medical Supervisors and
  Trainees

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NJ on sexual harassment

• The New Jersey Supreme Court held in 2002 that
  absent managerial and supervisory training on
  harassment, there were questions of fact as to
  whether the policy was effective and whether the
  policy could shield the organization from
  vicarious liability for supervisor misconduct.
• See Gaines v. Bellino, 801 A.2d 322 (N.J. 2002).
  In its decision the court also noted the
  importance of making such training available to
  all employees.
• This ruling in essence made supervisory and
  managerial training mandatory for employers
  covered by the New Jersey Law Against
  Discrimination. It also made all-employee
  training essential.

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NJ laws on gender discrimiation

• Categories Protected by state FEP Statutes
• Training Education Requirement New Jersey Race,
  creed, color, national origin, nationality,
  ancestry, age (18-70), sex (including pregnancy,
  childbirth, and related medical conditions),
  civil union status, marital status, domestic
  partnership status, affection or sexual
  orientation, gender identity or expression,
  atypical hereditary, cellular or blood trait,
  genetic information or the refusal to submit to a
  genetic test or make available the genetic test
  of an employer, liability for service in the
  Armed Forces of the United States, mental and
  physical disability or handicap (including AIDS
  and HIV-related illnesses)
• N.J. Stat. 105-1 et seq., 346B-1, et seq.

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SOME COMMON EXAMPLES

• Verbal conduct such as epithets, derogatory
  comments, slurs, or unwanted sexual advances,
  invitations, or comments.
• Visual conduct such as derogatory posters,
  photography, cartoons, drawings, or gestures.
• Physical conduct such as unwanted touching,
  blocking normal movement, or interfering with
  work directed at you because of your sex or any
  other protected basis.
• Threats and demands to submit to sexual requests
  in order to keep your job or avoid some other
  loss, and offers of job benefits in return for
  sexual favors.
• Retaliation for opposing, reporting or
  threatening to report harassment, or for
  participating in an investigation, proceeding or
  hearing conducted by an investigating agency.
• http//elt-inc.com/our-solutions/harassment/resour
  ces/sample-harassment-policy

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Professionalism
Professionalism
ACCOUNTABILITY
ALTRUISM
EXCELLENCE
HUMANISM
ETHICAL AND LEGAL REASONING
COMMUNICATION SKILLS
CLINICAL COMPETENCE
David Stern 2005