Sexual harassment is alarmingly common among budding doctors in Canada, according to new research guided largely by Sudbury academics.
Two faculty members and one student at the Northern Ontario School of Medicine contributed to the study, along with a Queen’s University professor and student, and two University of Alberta med students.
Their paper, titled Sexual Harassment of Canadian Medical Students: A National Survey, paints a distressing picture of sexist remarks, uninvited touching and outright rape, based on reports from students across the country who agreed to complete a questionnaire.
“The responses we got back were stunning,” said Dr. Jacques Abourbih, an associate professor of surgery at NOSM and one of the paper’s co-authors. “I was in charge of collecting data and at some points it became extremely difficult for me to read what was sent to us.”
While a majority of students said they had not experienced harassment, those who had — 188 respondents — reported 807 incidents.
These included being pressured to go on dates, “inadvertent” brushing or touching, requests from patients to have sexual organs examined, groping, inappropriate gifts, harassment through phone calls or social media, stalking, and rape or attempted rape.
Several cases of sexual blackmail and exposure of body parts were also reported, even though respondents were not specifically asked about these types of abuse.
Unwanted advances and assaults are most often carried out by patients or fellow students, the study found, but faculty of medical schools were also implicated in about 20 per cent of the incidents.
Abourbih said he and fellow NOSM professor Marion Maar decided to initiate the study three years ago after hearing disturbing reports from students.
“Medical students will often talk to faculty if they are having problems,” he said. “I wouldn’t say it is a weekly thing, but over my 15 years at the medical school I would have one or two students a year coming to me to confide about something.”
The surgery prof said he also witnessed an example of harassment first-hand when he was consulting with a patient in hospital and a female resident was interviewing someone in the next bed.
“The curtains were drawn but I could hear the patient saying, ‘You know, you’re quite attractive, but those clothes are hiding everything,’ ” he recalled. “My jaw just dropped.”
While the two NOSM profs may have conceived the study, Abourbih said Susan Phillips, a senior researcher and professor in family medicine at Queen’s, was “a major driving force” in seeing the project through to completion.
The paper appeared this month in The Lancet, a prestigious medical journal, after being accepted for publication on Jan. 22.
The survey found the perpetrators of harassment were almost always men and the vast majority of victims — 98 per cent — were women.
The harassment occurred in clinics, medical schools and social settings.
“What emerged was a picture of social, educational and individual conditions under which sexual harassment becomes normalized by faculty, peers and victims,” reads the report.
Another finding was that “students often tried to ignore harassment despite finding it confusing, upsetting and embarrassing.” Just 16 per cent of those surveyed said they had confronted their harasser.
Respondents were assured of anonymity and no school-identifying information was collected.
Ethics boards of all 17 Canadian universities hosting medical schools approved the study, although they chose not to circulate the survey directly to students. Instead, it was made available online through electronic newsletters of the Canadian Federation of Medical Students.
“Participants described experiences of harassment ranging from subtle comments to overt behaviours, aggressive assaults and attempted rape,” the authors state in their report.
The harassment was most often attributed to patients, although peers were blamed in nearly as many instances.
One female victim described “repeated and escalating sexual overtures from a classmate who eventually said he dreamed she was his patient and that he jumped on top of her and stabbed her in the neck to perform a tracheotomy.”
Another described a preceptor who “would inappropriately rub my back, and would stare at my chest instead of my face.”
Harassment by patients (mostly male) of students (almost always female) ranged from unwanted embraces to more invasive touching.
“A patient insisted on hugging me goodbye despite giving a handshake to the two other male students in the room,” wrote one survey respondent.
Another described a patient “grabbing my backside when I was attempting to stitch up his face. I was alone with him on night shift in a separate area in the emergency room.”
Eight instances of stalking were reported — one involving a patient, two involving faculty members and five involving fellow students.
Victims also reported seven cases of rape or attempted rape, with faculty blamed in two of those instances.
“When you read what some of the students said to us, it was shocking,” said Abourbih.
The NOSM teacher noted sexual harassment occurs in other areas of health-care education, pointing to a scandal at the School of Dentistry in Halifax that saw fourth-year male students posting violent sexual comments about female classmates.
Nurses, too, are accustomed to being harassed. “I was talking to an ex-nurse who had applied to medical school and she said yep, that’s par for the course,” said Abourbih.
“It’s not only in the health sciences profession,” he added. “It’s pervasive in many other aspects of our society.”
Those training to become doctors are, however, exposed more to “touching, physical contact, and discussion of sexual function” than is the case in “most academic or work settings,” the report notes.
They are also high strivers who may “fear repercussions and poor assessments” if they come forward with a report of harassment.
“Many participants talked to classmates, friends and family about their experiences,” the research paper states. “However, very few used official reporting channels as they were wary of power differentials, vulnerability, and being labelled as over-reacting or unprofessional.” Many were also afraid of receiving “a poor evaluation.”
The report recommends faculty training to better understand and recognize sexual harassment, to speak up when it happens, and “support the victim.”
As well, there should be better reporting mechanisms to ensure a victim isn’t marginalized or isolated, the authors contend, along with “robust, clear, documented penalties for perpetrators.”