There are high rates of harassment behaviors in obstetrics and gynecology (OB-GYN), according to a recent study published in JAMA Network Open.1
Takeaways
- A systematic review found that 63.6% of OB-GYN professionals reported experiencing sexual harassment, with higher rates among women (70.9%) compared to men (51%).
- Senior OB-GYN attending physicians were the most frequent perpetrators of harassment, involved in 30.1% of reported cases.
- Fear of retaliation contributed to significant underreporting, with only 12.5% of gynecologic oncologists and 8.4% of AAGL members reporting their harassment experiences.
- Medical students in OB-GYN reported high rates of mistreatment, belittlement, and harassment, leading to the lowest professional scores among all clerkship rotations.
- While interventions such as the Gender and Power Abuse Committee reduced general mistreatment, they did not significantly decrease the prevalence of sexual harassment, indicating a need for more effective solutions.
In 2021, a systematic review reported an association between bullying and adverse outcomes for well-being and psychological distress within academic medicine. Additionally, academic bullying was linked to loss of career opportunities among 44% of women.
There are 3 major forms of sexual harassment: sexual coercion, unwanted sexual attention, and gender harassment. A 2018 study reported high rates of sexual harassment, with sexual hostility reported in over 45% of women in medicine and experiencing crude behaviors in 18%.
Findings linked sexual harassment to impeded professional and educational attainment among women. However, harassment has continued to be reported through traditional media outlets and digital and social media.
These issues are at risk of compounding with poor worker mental health observed during the COVID-19 pandemic. According to the Centers for Disease Control and Prevention, an increase of 1.2 days of poor mental health within a prior 30-day period was reported among health care workers from 2018 to 2022.2
To evaluate the prevalence of harassment in OB-GYN and determine interventions to reduce this prevalence, investigators conducted a systematic review.1 The study was conducted by gynecologists, urogynecologists, gynecologic oncologists, and a systematic review methodologist.
Articles were found through searches of the PubMed, Embase, and ClinicTrials.gov databases from inception to June 13, 2023. Harassment among and by health care workers was assessed, with harassment by patients or family members excluded.
There were 22 studies included in the final analysis, 10 evaluating the prevalence of harassment and 12 assessing interventions. One survey reported 63.6% of respondents experienced sexual harassment, with rates of 70.9% among female participants and 51% among male participants.
Sexual harassment included unwanted sexual advancements, sexist remarks, and exchanging sexual favors for an academic position. Additionally, among members of the AAGL, 27.6% reported harassment, with 90.4% of perpetrators being physicians.
A survey of OB-GYN trainees found 69.1% of respondents had experienced sexual harassment. Senior OB-GYN attending physicians were the most prevalent perpetrators, linked to 30.1% of cases. In comparison, 13.1% were residents or fellows, 8.2% patients, and 7.7% operating room staff.
Having reported their sexual harassment was found among 12.5% of gynecologic oncologists and 8.4% of AAGL members. In comparison, 32.6% of OB-GYN trainees reported their harassment, with 71.8% reporting their harassment to another trainee. However, 33.5% to 40.2% of participants did not report their harassment because of fear of retaliation.
When evaluating medical student experiences, 25.1% reported frequent mistreatment, 71.4% belittlement, and 24.2% harassment by OB-GYN residents. Across all clerkship rotations, OB-GYN had the lowest professional scores. Additionally, a small study reported physical abuse experience in 4 of 16 medical students.
Institutional interventions to decrease harassment included the Gender and Power Abuse Committee and the Ending Mistreatment Task Force. These interventions included an ombuds office, a no abuse policy, workshops for medical students and residents, faculty grand rounds sessions, and improved reporting with prompt action.
Student mistreatment reduced from 62.9% to 40.3% over 6 years following intervention implementation. However, sexual harassment remained at 13.4% across all 4 study periods. Video-based discussions were assessed in 4 studies, with results indicating improved recognition of mistreatment and improved confidence in intervening.
Interventions to improve trainee education led to less perceived intimidation and improved satisfaction with reporting systems. However, a statistically significant improvement in perceived abuse was not observed.
These results indicated high rates of sexual harassment in the OB-GYN field, with most interventions not leading to a reduced prevalence. Investigators recommended further research about interventions for improving the practicing climate and professional behavior within OB-GYN and general medicine.
References
- Gupta A, Thompson JC, Ringel NE, et al. Sexual harassment, abuse, and discrimination in obstetrics and gynecology: A systematic review. JAMA Netw Open. 2024;7(5):e2410706. doi:10.1001/jamanetworkopen.2024.10706
- Nigam JA, Barker RM, Cunningham TR, Swanson NG, Chosewood LC. Vital signs: Health worker–perceived working conditions and symptoms of poor mental health — Quality of worklife survey, United States, 2018–2022. MMWR Morb Mortal Wkly Rep. 2023;72:1197–1205. doi:10.15585/mmwr.mm7244e1
