TO THE EDITOR: We read with great interest the article by Benzil et al.1 (Benzil DL, Muraszko KM, Soni P, et al. Toward an understanding of sexual harassment in neurosurgery. J Neurosurg. Published online November 10, 2020. doi:10.3171/2020.6.JNS201649), in which the authors report that according to the results of the survey they created and administered, most neurosurgeons have experienced harassment during their careers, a finding that highlights the need to assess the depth of this issue.
Harassment strongly affects the lives and work effectiveness of victims and the functioning of the institutions where the harassment occurs.2,3 Sadly, studies have shown a high prevalence of harassment during medical school and residency, where the primary sources of harassment were attending surgeons.4 During their clinical training, medical students are not only exposed to sexual harassment from colleagues but are also vulnerable to other forms of mistreatment, such as gender and racial discrimination for which the principal sources may even be patients and their families.5 There is a multifactorial pattern, whereby a hierarchical structure exists and the student/trainee is under the supervision of a “superior” who feels dominant over the student,6 in a setting where long work hours mean long periods of exposure.6 In addition, social stereotypes create environments conducive to sexual harassment and gender discrimination.5
Hu et al.4 surveyed 7409 residents of all surgical residency programs across the United States to examine the association of harassment and burnout syndrome. These authors found that 31.9% of residents reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment.4 Rates of all mistreatment measures were higher among women and were strongly associated with burnout and suicidal thoughts.3
Because harassment is a problem that is rarely discussed, we should encourage the medical community to foster education among students, trainees, and surgeons about each phase of harassment to be able to identify it and to have clear protocols when harassment occurs.6 New strategies are needed to promote the reporting of incidents of harassment and to assess the treatment of those who are willing to openly talk about it, creating a whole new support network that not only supports victims but also engenders vigilance on the part of work teams.5 We must change misconceptions of what constitutes “being professional” after harassment has occurred.6 We should do our best to create new convivence pathways where the boundaries of intimacy are far away from the professional area. But most of all, to prevent the feeling of supremacy in the perpetrators of harassment, we must alter conditions that foster acceptance of cultural stereotypes and stigmas and create conditions for women’s gender equality.5,6
Disclosures
The authors report no conflict of interest.
References
- 1↑
Benzil DL, Muraszko KM, Soni P, Toward an understanding of sexual harassment in neurosurgery. J Neurosurg. Published online November 10, 2020. doi:10.3171/2020.6.JNS201649
- 2↑
Ceppa DP, Dolejs SC, Boden N, Sexual harassment and cardiothoracic surgery: #UsToo? Ann Thorac Surg. 2020;109(4):1283–1288.
- 3↑
Minkina N. Can #MeToo abolish sexual harassment and discrimination in medicine? Lancet. 2019;394(10196):383–384.
- 4↑
Hu YY, Ellis RJ, Hewitt DB, Discrimination, abuse, harassment, and burnout in surgical residency training. N Engl J Med. 2019;381(18):1741–1752.
- 5↑
Stone L, Phillips C, Douglas KA. Sexual assault and harassment of doctors, by doctors: a qualitative study. Med Educ. 2019;53(8):833–843.
- 6↑
Zeng LN, Zong QQ, Zhang JW, Prevalence of sexual harassment of nurses and nursing students in China: a meta-analysis of observational studies. Int J Biol Sci. 2019;15(4):749–756.
