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Table 1.  Experiences of Sexual Harassment Among Participating Physicians
Experiences of Sexual Harassment Among Participating Physicians
Table 2.  Perpetrator-Related and Structural Factors Correlated With Harassment Experiences
Perpetrator-Related and Structural Factors Correlated With Harassment Experiences
1.
International Labour Organization. Code of Conduct on Sexual Harassment in the Workplace Brochure; 2015. http://www.ilo.org/global/docs/WCMS_371182/lang--en/index.htm. Accessed September 13, 2018.
2.
Bowling  NA, Beehr  TA.  Workplace harassment from the victim’s perspective: a theoretical model and meta-analysis.  J Appl Psychol. 2006;91(5):998-1012. doi:10.1037/0021-9010.91.5.998PubMedGoogle ScholarCrossref
3.
Willness  CR, Steel  P, Lee  K.  A meta-analysis of the antecedents and consequences of workplace sexual harassment.  Personnel Psychol. 2007;60(1):127-162. doi:10.1111/j.1744-6570.2007.00067.xGoogle ScholarCrossref
4.
Mueller  U, Schroettle  M. Lebenssituation, Sicherheit und Gesundheit von Frauen in Deutschland; 2004. https://www.bmfsfj.de/blob/jump/84328/langfassung-studie-frauen-teil-eins-data.pdf. Accessed September 13, 2018.
5.
Krings  F, Schär Moser  M, Mouton  A.  Sexuelle Belästigung am Arbeitsplatz: Wer belästigt wen, wie und warum? Besseres Verständnis heisst wirksamere Prävention. Lausanne, Switzerland: Universite de Lausanne; 2013.
6.
Frank  E, Brogan  D, Schiffman  M.  Prevalence and correlates of harassment among US women physicians.  Arch Intern Med. 1998;158(4):352-358. doi:10.1001/archinte.158.4.352PubMedGoogle ScholarCrossref
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    EXPAND ALL
    CARING RELATIONSHIPs
    Paul Nelson, M.D., M.S. | Family Health Care, P.C. primary physician, retired
    Once again, we learn that the health of our patients is related to their lives lived in the absence of sustained caring relationship when our educational systems portray the same level of Social Capital. For context, I offer an updated definition for both a CARING RELATIONSHIP and SOCIAL CAPITAL.

    A CARING RELATIONSHIP may be defined as
    ...social interaction between two persons,
    ...occurring with an evolving purpose, synergy and permanence,
    ...that both persons perceive as representing a beneficent intent
    ...to enhance each other's autonomy by communicating in harmony
    ...with warmth, non-critical acceptance, honesty and
    empathy.

    SOCIAL CAPITAL may be defined as
    ...a community's norms of Trust, Cooperation and Reciprocity that
    ...its citizens more commonly express to resolve the social dilemmas
    ...they encounter daily with the community's Civil Life
    ...WHEN Caring Relationships progressively characterize
    ...the social networks of the community's citizen,
    ...especially the Caring Relationships promoted by each citizen
    ...within the Micro-Neighborhood Network of their own Family.

    From this vantage point, we have a really long ways to go for solving the disruptive processes originating from within and outside of our healthcare institutions to resolve the cost and quality problems of our nation's healthcare. Look up the definition for an institution formulated by Professor Elinor Ostrom (see below). Her definition's last two words say it all.

    See Ostrom E. UNDERSTANDING INSTITUTIONAL DIVERSITY. Princeton University Press. 2005 - page 3
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Research Letter
    Physician Work Environment and Well-Being
    January 2019

    Prevalence of Sexual Harassment in Academic Medicine

    Author Affiliations
    • 1Equal Opportunity Office, Charité–Universitätsmedizin, Berlin, Germany
    • 2Department of Primary and Transmural Care, Radboudumc, Nijmegen, the Netherlands
    • 3Institute of Legal Medicine, Charité–Universitätsmedizin, Berlin, Germany
    JAMA Intern Med. 2019;179(1):108-111. doi:10.1001/jamainternmed.2018.4859

    Sexual harassment is a form of gender discrimination that affects women and men in all areas of work.1 According to the International Labour Organization (ILO), sexual harassment can occur in 1 or more of 3 forms: verbal, nonverbal, or physical.1 Sexual harassment can lead to physical and psychological symptoms and diseases as well as work-related consequences.2,3 The prevalence of sexual harassment in medicine has been scantily investigated, and reports differ widely in the applied methodology.

    Methods

    All physicians working at a tertiary referral center in Berlin, Germany (n = 1862) were invited to participate in the survey for the current study between May 2015 and July 2015. This investigation was explicitly and solely designed to investigate sexual harassment. Institutional ethical approval (EA1/350/14, December 15, 2014) was obtained from Charité–Universitätsmedizin as well as from the employee representations/staff councils (clinical, academic and general), and all participants provided their written informed consent.

    The survey instrument consisted of 36 items. It was administered online using the survey tool SoSci Survey (SoSci Survey GmbH). We investigated the following: (1) forms of misconduct experienced and whether these were considered harassing or threatening (note that not all misconduct was interpreted as harassment), (2) consequences experienced, (3) perpetrator profiles, (4) structural and organizational information, and (5) training and knowledge about sexual harassment, and (6) assumptions about its causes. Several questions about the type of misconduct or harassment experienced, the perpetrator profiles, and the consequences experienced were adapted from previous studies in German-speaking countries.4,5

    We computed descriptive statistics for sociodemographic and prevalence data. Prevalence and perpetrator profiles were compared bivariately between women and men using the Pearson χ2 test. Multivariate regressions were calculated for structural factors using harassment patterns (any form, physical, nonphysical) as outcomes. We included only those participants who provided information on all investigated variables. All analyses were 2-sided, and P < .05 was considered significant. We performed all analyses using STATA software, version 13 (StataCorp LLC).

    Results

    A total of 790 physicians participated in the study (42% overall response rate), but 47 did not provide detailed information; 2 did not provide information on sex; and 4 (1%) self-reported as transgender, intersex, or nonbinary. The low number of individuals self-reporting other than distinct male or female gender prevented statistical testing of this category, but it should be noted that all 4 of these participants (100%) reported experiencing some form of harassment. Of the 737 participants included in the full analysis, 60% were women (n = 448), and 39% were men (n = 289).

    All of the absolute numbers for the following reports can be found in Table 1. Among all male and female participants, 70% reported some form of misconduct while performing their work. The most common form self-reported as harassment was verbal harassment (including degrading speech [62%] and sexualized speech [25%]). Nonphysical misconduct was perceived as harassing by 76% of the individuals, more frequently by women than by men (83% vs 61%; P < .001). Physical misconduct was perceived as harassing by 89% of those reporting such misconduct and as threatening by 28%, with no significant sex differences (Table 1).

    Women reported the perpetrators of harassment to be almost exclusively male, both for nonphysical harassment (85% of perpetrators against women compared with 38% of perpetrators against men; P < .001) (Table 2) and for physical harassment (95% of perpetrators against women compared with 13% of those against men; P < .001) (Table 2). Colleagues were reported as the main perpetrators at similar rates by men and women, while women reported superiors to be the perpetrators more frequently (37% vs 18%; P < .001) (Table 2).

    Strong departmental or divisional hierarchy appeared as the only structural factor significantly associated with harassment in both male and female victims (all supporting data reported in Table 2).

    Discussion

    Sexual harassment frequently affects female and male physicians during their careers. In the present study, both groups reported verbal harassment as the most frequent form of misconduct. While perpetrator patterns differed between male and female victims, strong institutional hierarchies were associated with sexual harassment in both sexes, highlighting the importance of organizational culture.6 These results support the need for cultural change in the form of structural and widespread action to truly reduce the high incidence of sexual harassment in academic medicine.

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    Article Information

    Accepted for Publication: August 4, 2018.

    Corresponding Author: Sabine Oertelt-Prigione, MD, PhD, MSc, Chair of Gender in Primary and Transmural Care, Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Geert Grooteplein 21 (route 117), 6500HB Nijmegen, The Netherlands (sabine.oertelt-prigione@radboudumc.nl).

    Published Online: October 3, 2018. doi:10.1001/jamainternmed.2018.4859

    Author Contributions: Dr Oertelt-Prigione had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Study concept and design: Jenner, Kurmeyer, Oertelt-Prigione.

    Acquisition, analysis, or interpretation of data: Jenner, Djermester, Prügl, Oertelt-Prigione.

    Drafting of the manuscript: Oertelt-Prigione.

    Critical revision of the manuscript for important intellectual content: Jenner, Djermester, Prügl, Kurmeyer.

    Statistical analysis: Oertelt-Prigione.

    Obtained funding: Kurmeyer, Oertelt-Prigione.

    Administrative, technical, or material support: Djermester, Prügl, Kurmeyer.

    Study supervision: Jenner, Oertelt-Prigione.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This work has been supported by the Charité Foundation, Berlin, Germany; the Equal Opportunity Program of the City of Berlin, Berlin, Germany; and the Hans Böckler Stiftung, Duesseldorf, Germany.

    Role of the Funder/Sponsor: The funding organizations had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Meeting Presentation: This article was presented at the North American Menopause Society Annual Meeting; October 3-6, 2018; San Diego, California.

    Additional Contributions: We thank all the participants, who have generously provided us with their time and have shared their sometimes difficult experiences.

    References
    1.
    International Labour Organization. Code of Conduct on Sexual Harassment in the Workplace Brochure; 2015. http://www.ilo.org/global/docs/WCMS_371182/lang--en/index.htm. Accessed September 13, 2018.
    2.
    Bowling  NA, Beehr  TA.  Workplace harassment from the victim’s perspective: a theoretical model and meta-analysis.  J Appl Psychol. 2006;91(5):998-1012. doi:10.1037/0021-9010.91.5.998PubMedGoogle ScholarCrossref
    3.
    Willness  CR, Steel  P, Lee  K.  A meta-analysis of the antecedents and consequences of workplace sexual harassment.  Personnel Psychol. 2007;60(1):127-162. doi:10.1111/j.1744-6570.2007.00067.xGoogle ScholarCrossref
    4.
    Mueller  U, Schroettle  M. Lebenssituation, Sicherheit und Gesundheit von Frauen in Deutschland; 2004. https://www.bmfsfj.de/blob/jump/84328/langfassung-studie-frauen-teil-eins-data.pdf. Accessed September 13, 2018.
    5.
    Krings  F, Schär Moser  M, Mouton  A.  Sexuelle Belästigung am Arbeitsplatz: Wer belästigt wen, wie und warum? Besseres Verständnis heisst wirksamere Prävention. Lausanne, Switzerland: Universite de Lausanne; 2013.
    6.
    Frank  E, Brogan  D, Schiffman  M.  Prevalence and correlates of harassment among US women physicians.  Arch Intern Med. 1998;158(4):352-358. doi:10.1001/archinte.158.4.352PubMedGoogle ScholarCrossref
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