Recent high-profile cases of sexual harassment illustrate that such experiences still occur in academic medicine.1 Less is known about how many women have directly experienced such behavior. Most studies have focused on trainees, single specialties, and non-US settings or lack currency.2 In a 1995 cross-sectional survey,3 52% of US academic medical faculty women reported harassment in their careers compared with 5% of men. These women had begun their careers when women constituted a minority of the medical school class; less is known about the prevalence of such experiences among more recent faculty cohorts.
After approval from the University of Michigan institutional review board and waiver of written informed consent, in 2014 we conducted a postal survey of individuals who had received new K08 and K23 career development awards (hereafter referred to as K-awards) from the National Institutes of Health from 2006-2009. Items on gender bias (both perceived in the environment and personally experienced), gender advantage, and sexual harassment were included in a larger questionnaire evaluating career and personal experiences. Additionally, those who had experienced sexual harassment in their professional careers were asked to report perceived effects on confidence and career advancement and specify the severity of the experience using 5 levels4: 1, generalized sexist remarks and behavior; 2, inappropriate sexual advances; 3, subtle bribery to engage in sexual behavior; 4, threats to engage in sexual behavior; and 5, coercive advances. The proportion of respondents experiencing more severe forms of harassment (levels 2-5) was quantified and the perceived effects and severity described. These items are commonly administered in national studies of sexual harassment and are comparable with those in the 1995 survey (Supplement).
SAS (SAS Institute), version 9.4, was used to describe and compare responses by gender using multiple variable logistic models adjusting for self-reported race (categorized by the investigators as non-Hispanic white vs other), specialty (grouped as medical; surgical; women, children, and families; hospital-based; basic sciences5), and years in faculty position. Two-sided P values less than .05 were considered statistically significant.
Of all 1719 new recipients of K-awards in 2006-2009, 1066 recipients (62%) responded to the survey. Response rate was not significantly different by gender (61% among men vs 64% among women, P = .13) but differed by K-award type (59% among K08 recipients vs 66% among K23 recipients, P = .002) and year (58% for 2006, 62% for 2007, 60% for 2008, and 68% for 2009, P = .01). Mean respondent age was 43 years (SD, 4.3); 46% were women; 71% were white.
Women were more likely than men to report perceptions (70% [95% CI, 65%-74%] vs 22% [95% CI, 19%-25%]; difference, 48% [95% CI, 43%-53%], P < .001) and experience (66% [95% CI, 62%-70%] vs 10% [95% CI, 8%-13%]; difference, 57% [95% CI, 52%-62%], P < .001) of gender bias in their careers (Table 1). Women were more likely to report having personally experienced sexual harassment (30% [95% CI, 26%-35%] vs 4% [95% CI, 3%-6%]; difference, 26% [95% CI, 22%-31%], P < .001). Among women reporting harassment (n = 150), 40% (95% CI, 32%-48%) described more severe forms (Table 2), 59% (95% CI, 50%-67%) perceived a negative effect on confidence in themselves as professionals, and 47% (95% CI, 39%-56%) reported that these experiences negatively affected their career advancement.
In this sample of clinician-researchers, 30% of women reported having experienced sexual harassment compared with 4% of men. Although a lower proportion reported these experiences than in a 1995 sample, the difference appears large given that the women began their careers after the proportion of female medical students exceeded 40%.
Limitations include nonresponse bias, which could inflate estimates of prevalence if those who experienced harassment were more motivated to respond; to minimize this risk, we placed these questions at the end of a 12-page instrument that otherwise focused on general career experiences. Our estimates were based on self-report, not documented cases.
Recognizing sexual harassment is important because perceptions that such experiences are rare may, ironically, increase stigmatization and discourage reporting. Efforts to mitigate the effect of unconscious bias in the workplace and eliminate more overtly inappropriate behaviors are needed.
Corresponding Author: Reshma Jagsi, MD, DPhil, Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr, UHB2C490/SPC 5010, Ann Arbor, MI 48109 (firstname.lastname@example.org).
Author Contributions: Dr Jagsi and Mr Griffith had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Jagsi, Ubel, Stewart.
Acquisition, analysis, or interpretation of data: Jagsi, Griffith, Jones, Perumalswami, Stewart.
Drafting of the manuscript: Jagsi, Griffith.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Griffith.
Obtained funding: Jagsi.
Administrative, technical, or material support: Jagsi, Jones, Perumalswami, Stewart.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
Funding/Support: This work was funded by grant 5 R01 HL101997-04 from the National Institutes of Health to (Dr Jagsi) and by the Robert Wood Johnson Foundation Clinical Scholars Program (Dr Perumalswami) and the US Department of Veterans Affairs (Dr Perumalswami).
Role of the Funder/Sponsor The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Disclaimer: Any opinions expressed herein do not necessarily reflect the opinions of the National Institutes of Health, the Robert Wood Johnson Foundation, or the Department of Veterans Affairs.
Additional Information: Study data were managed using REDCap electronic data capture tools hosted at the University of Michigan, supported by the Clinical and Translational Science Award (UL1TR000433) from the National Center for Advancing Translational Sciences of the National Institutes of Health.
et al. Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad Med
. 2014;89(5):817-827.PubMedGoogle ScholarCrossref
et al. Faculty perceptions of gender discrimination and sexual harassment in academic medicine. Ann Intern Med
. 2000;132(11):889-896.PubMedGoogle ScholarCrossref
F. Sexual Harassment: A Report on the Sexual Harassment of Students. Washington, DC: National Advisory Council on Women's Educational Programs; 1980.
PA. Sex differences in attainment of independent funding by career development awardees. Ann Intern Med
. 2009;151(11):804-811.PubMedGoogle ScholarCrossref