More than two-thirds of U.S. female orthopedic medical trainees said they experienced sexual harassment on the job, and current residents are experiencing the same level of abuse as veteran physicians did years ago, a researcher reported.

In a 2019 online survey to 682 members of the Ruth Jackson Orthopaedic Society — a support and networking group for women orthopedic surgeons — the response rate was 37% (n=250), including 51 current residents (20%) and 199 surgeons (80%) currently in fellowship or practicing, explained Emily Whicker, MD, of the University of Pittsburgh Medical Center.

And 68% (n=171) of the women reported experiencing sexual harassment during their training as orthopedic specialists, Whicker and colleagues reported in a poster at the American Academy of Orthopaedic Surgeons annual meeting.

“Sexual harassment of female orthopedic trainees is a pervasive problem. The stories are universally terrible,” said Whicker. “Harassment occurs in all programs across the country, not just in those who have an enduring ‘old boys club’ label.”

Whicker’s group launched their study to better understand harassment in orthopedic medicine in light of “the stories that we had all heard,” she told MedPage Today. “I had heard some really terrible stories from some of my female attendings about their experiences while they were in training. There really wasn’t much in the literature. While we all knew sexual harassment was a problem via word of mouth, there had not yet been any studies that specifically looked into it.” They adapted the survey used in the study from Speak Up, an organization that advocates to prevent sexual harassment.

They found no statistically significant difference in the levels of abuse encountered by current residents (59% reported experiencing abuse) and former residents (72% reported experiencing abuse, P=0.10), and no difference in sexual harassment rates by region of the U.S.

Harassers were most commonly male attendings and male residents, according to the survey results.

“Residency training is a particularly vulnerable time in a doctor’s career,” Whicker noted. “There is a hierarchical structure that is necessary for patient care, but it can also create power dynamics that could make trainees more vulnerable to harassment.”

Comments from survey participants included:

• “Had co-workers grab and/or slap my buttocks more than once. Was asked as an intern about how many men I’ve had sex with, what kind of birth control I use, how heavy my menstrual flow is…Was told I’m not allowed to get pregnant during residency. Have had co-workers and clinic staff discuss and vote on my best physical attributes.” — A current resident
• “Many comments about how I shouldn’t get pregnant in residency, and people were going to put birth control in my food.” — Physician who was a resident 0-5 years ago
• “My buttock was grabbed by a patient as I held counterforce during a reduction maneuver.” — Physician who was a resident 0-5 years ago
• “While fixing a lateral epicondyle fracture, a male attending normally says ‘Get on your knees to better see the fracture.’ After he said that to me, he followed up with ‘I know that you’re used to that position.'” — Physician who was a resident 6-10 years ago
• “An attending talked to me about his sexual escapades during surgery. These were relations with someone other than his wife. An attending made comments about an asleep patient’s breasts.” — Physician who was a resident 11-15 years ago
• “An unscrubbed attending grabbed my butt while I was nailing a femur fracture.” – Physician who was a resident 30-plus years ago

Harassment isn’t limited to the speciality of orthopedics. A 2020 survey of 381 residents in the gastrointestinal, pediatrics, and internal medicine fields revealed that 83% of women reported sexual harassment during training versus 44% of men.

A 2018 report about sexual harassment in medicine by the National Academies of Sciences, Engineering, and Medicine noted that “four characteristics strongly contribute to why the healthcare environment can be a perfect set up for the sexual harassment of female residents: it is typically male-dominated, there is organizational tolerance for these behaviors, and importantly the hierarchical and dependent relationships between faculty and female residents and the often isolating of environment of the hospital can only promote these problematic behaviors,” noted Lynn E. Fiellin, MD, of Yale New Haven Hospital in Connecticut.

In addition, 77% of residents in the 2018 study said they thought they would be supported by their program if they reported a sexual harassment event, but only 43% said they were aware of institutional support in place for victims at their program.

Fiellin, who has studied sexual harassment in medicine, told MedPage Today that it’s not entirely clear how to fix the problem. “What is still a mystery, in some ways, is how best to deal with this serious ongoing issue in such a way that new systems and infrastructure are created that then, in turn, shift the culture in the right direction. These system changes need to be efficient, effective, and sustainable,” she stated.

“We need to put efforts towards intentionally promoting women to leadership positions and creating systems by which there is accurate and transparent communication about problematic individuals so they are not put in positions where they can cause these types of harm to any trainees,” said Fiellin, who was not involved in the current study.

“While the data does suggest that things have not changed much, I think that with the increased awareness, they are starting to improve,” Whicker noted. “We did notice a trend that current residents are more likely to report that sexual harassment they experience to their programs. This may suggest that these female residents feel more supported by their residency programs due to the recent increase in awareness of sexual harassment.”