Sexual Harassment during Residency Training: A

Cross-Sectional Analysis
LINDSAY F. ARNOLD, M.D., SHIVA R. ZARGHAM, M.D., CAMILLE E. GORDON, B.S., WILLIAM I. MCKINLEY, B.S.,
ELIZABETH H. BRUENDERMAN, M.D., JESSICA L. WEAVER, M.D., MATTHEW V. BENNS, M.D.,
MICHAEL E. EGGER, M.D., AMIRREZA T. MOTAMENI, M.D.

From the University of Louisville, Louisville, Kentucky

The reality of sexual harassment is unmasking in many fields, and medical trainees constitute a
vulnerable and at-risk group. We report the prevalence of sexual harassment among GI, internal
medicine, and pediatric residents, with a focus on identifying underlying reasons for lack of
victim reporting. A modified previously validated Department of Defense survey on sexual ha-
rassment was e-mailed to 261 GI, 132 pediatric, and 271 internal medicine program directors. Three
hundred eighty-one residents responded to the survey. Female trainees were more likely to be
subject to sexual harassment (83% vs 44%, P <0 .0001). Offensive and/or suggestive jokes and
comments were the most common type of harassment experienced. Most residents were unlikely
to report the offender (87% females, 93% males). Although 77 per cent of residents believed they
would be supported by their program if they reported a sexual harassment event, only 43 per cent
were aware of institutional support in place for victims at their program. Although there is a
persistently high incidence of harassment in training, the avenues in which to report it are largely
unknown and underused. Further research should focus on evidence-based interventions to en-
courage reporting and to design institutional programs for victims of sexual harassment.

T HE REALITY OFsexual harassment is unveiling in

many fields, with more than half of women in the
United States reporting unwanted and inappropriate
sexual advances at some point in their lives.1 Deeply
intertwined within the culture of the medical com-
munity lies its hierarchical infrastructure that leads to
members being ranked by both their disciplines and
levels of authority. Although this leadership ladder has
proven both critical and beneficial to patient care and
resident education, its presence can also lead to an
abuse of power. Resident life is fraught with long work
hours often away from family and is filled with emo-
tional stress, further adding to the vulnerability of this
population and possible exposure to ill-fated situa-
tions.2 Medical trainees are also in vulnerable positions
because they are dependent on superiors for evaluation
and letters of recommendations to further their careers.
A meta-analysis carried out in 2014 showed that most
medical students and residents in multiple countries
experience some type of harassment during training,
and the most common abuse in the United States
training program was sexual harassment.3 A study of
82 internal medicine residents by Komaromy et al.4
showed 73 per cent of female residents at a single in-
stitution reported they had been sexually harassed at
least once during their training compared with 22 per
cent of male residents. Although these data are dis-
turbing and necessitate action, there has been little
evidence that this has improved since it was first re-
ported more than 20 years ago.
Learning the trends of sexual harassment and reasons
behind lack of action by victims in the resident physi-
cian population is essential. This will allow preventative
measures to be put in place and interventions to be fo-
cused appropriately. Although most studies have fo-
cused on the prevalence of sexual harassment, few have
addressed why victims of harassment fail to report such
events. In this study, we attempt to identify underlying
reasons for lack of victim reporting. The objective of
this study was to evaluate healthcare trainees’ opinions
regarding sexual harassment within medical training
with a focus on frequency, type of harassment, and
underlying reason behind victims’ silence among pe-
diatric, internal medicine, and surgical residents pres-
ently enrolled in an Accreditation Council for Graduate
Medical Education–approved residency program.

Address correspondence and reprint requests to Amirreza T. Methods

Motameni, M.D., Department of Surgery, University of Louisville,
550 South Jackson Street, Louisville, KY 40202. E-mail: Amirm1231@ This project was approved by the University of
gmail.com. Louisville Institutional Review Board. The survey

65
66 THE AMERICAN SURGEON January 2020 Vol. 86

TABLE 1. Respondent Demographics Results

n % General Demographics
Total respondents 381
Gender identity A total of 381 residents responded to the survey. The
Male 152 40 response rate could not be calculated because we are
Female 227 59.7 unaware of the number of program directors who for-
Other 1 0.3 warded the questionnaire to residents in their program.
Level of training
PGY1 106 28 Demographic data of participants are presented in Table 1.
PGY2 108 28.5
PGY3 105 27.7
PGY4 28 7.4 Harassment by Gender
PGY5 22 5.8 Overall, females were more likely to be the subject
PGY6 4 1.1
PGY7 2 0.5 of harassment than males (82.8% females vs 44.1% of
PGY7+ 4 1.1 males surveyed, P <0 .0001). Offensive and/or sug-
Racial identity 250 65.8 gestive jokes and comments were the most common
White 14 3.7
Black 28 7.4 type of harassment experienced by both genders
Asian 53 14 (70.9% females, 31.6% males). Unwanted attention
American-Indian 3 0.8 was the second most common form of harassment re-
Other 32 8.4 ported by females (47.6%), whereas inappropriate
Specialty
General surgery 136 35.8 flirtation was reported as the second most common
Internal medicine 145 38.2 form of harassment reported by males (12.5%). In the
Pediatrics 99 26 case of female harassment, most transgressors were
Relationship status males (99%) and considered superiors by those sur-
Single 96 25.2
In a relationship 80 21 veyed (60.3%). In cases of male harassment, trans-
Married 196 51.4 gressors were 49.4 per cent men and 42.5 per cent
Divorced 5 1.3 women, but only 30.2 per cent were considered supe-
Widowed 1 0.3 rior to the respondents. Among males, 45.4 per cent
Other 3 0.8
reported experiencing harassment by patients com-
pared with 69.7 per cent of female respondents. The
majority of participants had experienced some sort of
was constructed by modifying the previously vali- harassment during both medical school and residency
dated Department of Defense survey on sexual ha- (55.8% females, 35.6% males). A complete breakdown
rassment.5 A copy of the modified survey and answer of the type of harassment by gender is demonstrated in
choices can be seen in Appendix A. An e-mail con- Table 2 and Table 3.
taining a link to the survey was sent to all GI, pedi-
atric, and internal medicine program directors who Harassment by Specialty
had an e-mail address publicly available on their
There was no significant difference in the number of
department’s website. The survey was written and
residents who reported experiencing any type of sexual
distributed on SurveyMonkey. Program directors
harassment based on resident specialty (69.1% GI,
were notified that all data collected were un-
64.1% internal medicine, and 68.7% pediatrics). Of-
identified to the institution and the resident involved
fensive and/or suggestive jokes and comments were
in to encourage and allow honest responses. A total
the most common type of harassment experienced by
of 261 GI, 132 pediatric, and 271 internal medicine
all specialties (63.2% GI, 49.7% internal medicine,
programs directors were invited to participate in this
and 51.5% pediatrics). Unwanted attention was the
survey. The decision to disseminate this link was left
second most common form of harassment reported by
to the individual program directors. Residents’ gen-
GI and pediatric residents (33.8%, 34.3%). Among
der, level of training, race, medical specialty, and
internal medicine residents, inappropriate flirtation
marital status were collected as demographic data.
(33.1%) was the second most common form of ha-
The final section of the survey focused on resident
rassment reported. A complete breakdown of the type
knowledge and awareness of institutional support
of harassment by specialty is demonstrated in Table 2.
programs for victims of sexual harassment. The
complete survey questions and answer choices are Support Program Awareness
listed in the Results section. A comparison among
subgroups was performed using a chi-squared test Most residents who had experienced harassment
with significance set at P # 0.05. were unlikely to report the offender (87% females,
No. 1 SEXUAL HARASSMENT DURING RESIDENCY TRAINING ? Arnold et al. 67

93.2% males) or confront the offender (80.9% fe-

Total, n (%) Female, n (%) Male, n (%) P Value GS, n (%) IM, n (%) P, n (%) P Value males, 91.1% males). In both genders, the most

0.014
NS
NS
NS

NS
NS
NS

NS
NS
NS
NS
NS
NS
NS
common reason for lack of reporting and confron-
tation was that residents “did not think it was a big
51 (51.5) deal.” Most residents did not believe entertaining
93 (64.1) 68 (68.7)

34 (34.3)
15 (15.2)

20 (20.2)
30 (30.3)
18 (18.2)
25 (25.3)
3 (3.0)
7 (7.1)

2 (2.0)
1 (1.0)

7 (7.1)
0 (0.0)
sexual advances would work favorably in his or her
career (80% females, 82% males). A complete
breakdown of these responses are demonstrated in
72 (49.7)

43 (29.7)
36 (24.8)
33 (22.8)

23 (15.9)
48 (33.1)
19 (13.1)
Table 3.
8 (5.5)
8 (5.5)
10 (6.9)

0 (0.0)
13 (8.9)
0 (0.0)
Most residents believe their hospital and program
leadership make honest and reasonable efforts to
address sexual harassment. Although 73.1 per cent
86 (63.2)
14 (10.3)
<0.0001 94 (69.1)

46 (33.8)
28 (20.6)

14 (10.3)

26 (19.1)
40 (29.4)
18 (13.2)
of female and 83.1 per cent of male residents be-
2 (1.5)

3 (2.2)

1 (0.7)
15 (11)

19 (14)

lieved they would be supported by their program if

they reported a sexual harassment event, only 38.1
per cent of females and 50.3 per cent of males were
<0.0001

<0.0001
<0.0001
<0.0001

<0.0001
<0.0001
0.0149

0.0002

aware of institutional support in place for victims of

NS
NS
NS

NS

NS

sexual harassment at their program.

48 (31.6)
67 (44.1)

19 (12.5)
9 (5.9)
9 (5.9)
2 (1.3)
14 (9.2)
9 (5.9)
7 (4.6)
0 (0.0)
7 (4.6)
0 (0.0)
10 (6.6)

10 (6.6)

Discussion
The Civil Rights Act of 1964 was a landmark for
civil rights in the United States because it prohibited
discrimination by an employer based on race, color,
161 (70.9)
188 (82.8)

70 (30.8)
108 (47.6)
69 (30.4)

27 (11.9)

99 (43.6)
46 (20.3)

religion, gender, or national origin.6 This was one of

16 (7.0)
21 (9.3)
11 (4.8)

5 (2.2)

1 (0.4)
59 (26)

the first efforts to prevent bias and harassment in the

work place. The term “sexual harassment” was then
first coined by female activists at Cornell University
in 1975 while defending Carmita Wood, who had
210 (55.1)

77 (20.2)
256 (67.2)

123 (32.3)
79 (20.7)

69 (18.1)

56 (14.7)
25 (6.6)
13 (3.4)
30 (7.9)

5 (1.3)
34 (8.9)
1 (0.3)

been denied unemployment benefits from the uni-

118 (31)
TABLE 2. Survey Responses on Harassment by Gender and Medical Specialty

versity when she resigned from her job because of

unwanted touching from a superior. Then in 1991,
there was a shift in public view on the issue of sexual
Being called by derogative language regarding sexual orientation

harassment when Anita Hill gave testimony against

the United States Supreme Court nominee Clarence
Thomas for years of alleged prior sexual harass-
Being shown sexually suggestive or inappropriate images
Number of residents experiencing any of the following

ment. Although he proceeded to become a supreme

court justice, the number of sexual harassment
Having someone flash or expose themselves to you

complaints filed doubled and payouts from court

Inappropriate or unwanted invitations for dates

settlements increased over the subsequent years.7

Offensive and/or suggestive comments/jokes

There is no doubt that sexual harassment exists

Sexual acts in exchange for advancement

in the medical community and has long-term

consequences, including emotional stress, reduced
productivity, and eventual loss of workforce for
examples (percentage of total)

physicians.3 Among female physician faculty pre-

Inappropriate body language

viously surveyed, a little over half reported being

Unwanted physical touch

sexually harassed, with 48 per cent of this harass-

Inappropriate flirtations
Pressure for sexual acts
Inappropriate starting

ment being classified as sexist remarks or behavior.8

Unwanted attention

In a 2014 meta-analysis, there was a mean preva-

Verbal advances

lence of 33.1 per cent of students and residents

reporting sexual harassment.9 Episodes of harass-
ment have been reported through every step of
training, and studies have shown women choosing
GI are most likely to experience gender discrimi-
nation and sexual harassment even during residency
TABLE 3. Further Survey Responses 68
All Internal
Respondents, Male, Female, GI, Medicine, Pediatrics,
n (%) n (%) n (%) P Value n (%) n (%) n (%) P Value
Have you witnessed one of your colleagues
experiencing sexual harassment?
Yes 142 (37.6) 45 (30) 97 (42.9) 0.0114 60 (44.4) 49 (34.3) 33 (33.3) NS
No 236 (62.4) 105 (70) 129 (57.1) 75 (55.6) 94 (65.7) 66 (66.7)
At what point in your training did you experience
sexual harassment?
Medical school 48 (17.5) 13 (15.5) 35 (18.4) 0.0007 7 (7.4) 19 (18.3) 22 (29.3) 0.0024
Residency training 90 (32.7) 41 (48.8) 49 (25.8) 38 (40) 36 (34.6) 16 (21.3)
Both 137 (49.8) 30 (35.7) 106 (55.8) 50 (52.6) 49 (47.1) 37 (49.3)
Was the transgression committed by a superior?
Yes 146 (50.2) 29 (30.2) 117 (60.3) <0.0001 59 (55.7) 40 (37.4) 46 (59.7) 0.0039
No 145 (49.8) 67 (69.8) 77 (40.9) 47 (44.3) 67 (62.6) 31 (40.3)
Was the transgression committed by a patient?
Yes 181 (61.8) 44 (45.4) 136 (69.7) <0.0001 64 (60.4) 77 (71.3) 39 (50) 0.0123
No 112 (38.2) 53 (54.6) 59 (30.3) 42 (39.6) 31 (28.7) 39 (50)
What was the gender of the offender?
Male 234 (83.6) 43 (49.4) 190 (99) <0.0001 81 (84.4) 88 (82.2) 64 (84.2) NS
Female 37 (13.2) 37 (42.5) 0 (0) 12 (12.5) 14 (13.1) 11 (14.5)
Other 9 (3.2) 7 (8.0) 2 (1.0) 3 (3.1) 5 (4.7) 1 (1.3)
Have you ever confronted the individual(s)?
Yes 45 (15.8) 8 (8.9) 37 (19.1) 0.0288 20 (19.8) 17 (15.9) 8 (10.5) NS
No 240 (84.2) 82 (91.1) 157 (80.9) 81 (80.2) 90 (84.1) 68 (89.5)
If you answered “No” to the above question, why?
THE AMERICAN SURGEON

I was fearful of academic retaliation 41 (‘5.8) 13 (15.7) 28 (16) 16 (17.8) 15 (14.9) 10 (14.7)
I did not think it was a big deal 93 (35.8) 38 (45.8) 54 (30.9) 29 (32.2) 35 (34.7) 28 (41.2)
There is no system in place to report such behavior 10 (3.8) 0 (0) 10 (5.7) 4 (4.4) 6 (5.9) 0 (0.0)
I did not feel I would have been protected by my program 19 (7.3) 3 (3.6) 16 (9.1) 7 (7.8) 3 (3.0) 9 (13.2)
I consider that normal behavior to my peers 19 (7.3) 4 (4.8) 15 (8.6) 7 (7.8) 6 (5.9) 6 (8.8)
Other 78 (30) 25 (30.1) 52 (29.7) 27 (30) 36 (35.6) 15 (22)
Have you ever reported the individual(s)?
Yes 31 (11) 6 (6.8) 25 (13) NS 11 (11.1) 11 (10.4) 9 (12) NS
No 250 (89) 82 (93.2) 167 (87) 88 (88.9) 95 (89.6) 66 (88)
January 2020

If you answered “No” to the previous question, why?

I was fearful of academic retaliation 31 (11.8) 12 (14.3) 19 (10.8) 11 (12.1) 13 (12.9) 7 (10.1)
I did not think it was a big deal 106 (40.5) 41 (48.8) 64 (36.4) 33 (36.3) 43 (42.6) 29 (42)
There is no system in place to report such behavior 15 (5.7) 1 (1.2) 14 (8.0) 5 (5.5) 7 (6.9) 3 (4.3)
I did not feel I would have been protected by my program 26 (9.9) 3 (3.6) 23 (13.1) 12 (13.2) 3 (3.0) 11 (15.9)
I consider that normal behavior to my peers 12 (4.6) 3 (3.6) 9 (5.1) 5 (5.5) 2 (2.0) 5 (7.2)
Other 72 (27.5) 24 (28.6) 47 (26.7) 25 (27.5) 33 (32.7) 14 (20.3)
Do you feel that entertaining sexual advances would
work favorably in your career?
Yes 26 (7.5) 7 (5.5) 19 (8.7) NS 12 (9.8) 6 (4.6) 7 (7.4) NS
No 280 (80.5) 106 (82.8) 173 (79.4) 99 (80.5) 103 (79.2) 78 (83)
Unsure 42 (12.1) 15 (11.7) 26 (11.9) 12 (9.8) 21 (16.2) 9 (9.6)

(continued)
Vol. 86
 No. 1

TABLE 3. Continued
All Internal
Respondents, Male, Female, GI, Medicine, Pediatrics,
n (%) n (%) n (%) P Value n (%) n (%) n (%) P Value
If several other victims came forward would that increase
your likelihood of reporting an incident?
Yes 156 (46.8) 36 (28.8) 120 (58.3) <0.0001 43 (36.4) 65 (51.2) 48 (61.5) 0.0087
No 85 (25.5) 50 (40) 34 (16.5) 43 (36.4) 24 (18.9) 18 (23.1)
Unsure 92 (27.6) 39 (31.2) 52 (25.2) 32 (27.1) 38 (29.9) 21 (26.9)
Do you believe your program leadership makes honest
and reasonable efforts to address and stop harassment?
Yes 255 (70.1) 107 (75.4) 146 (66.4) NS 86 (67.2) 103 (74.1) 65 (67.7) NS
No 35 (9.6) 8 (5.6) 27 (12.3) 18 (14.1) 10 (7.2) 7 (7.3)
Unsure 74 (20.3) 27 (19) 47 (21.4) 24 (18.8) 26 (18.7) 24 (25)
Do you believe your hospital leadership makes honest
and reasonable efforts to address and stop harassment?
Yes 215 (79.1) 97 (68.3) 116 (52.3) NS 86 (66.2) 74 (53.6) 54 (55.7) NS
No 34 (9.3) 9 (6.3) 25 (11.3) 14 (10.8) 14 (10.1) 6 (6.2)
Unsure 117 (32) 36 (25.4) 81 (36.5) 30 (23.1) 50 (36.2) 37 (38.1)
Do you feel you would be supported by your program if
you reported a sexual harassment event?
Yes 283 (77.1) 118 (83.1) 163 (73.1) NS 91 (70) 112 (81.2) 80 (81.6) NS
No 24 (6.5) 5 (3.5) 19 (8.5) 11 (8.5) 8 (5.8) 5 (5.1)
SEXUAL HARASSMENT DURING RESIDENCY TRAINING

Unsure 60 (16.3) 19 (13.4) 41 (18.4) 28 (21.5) 18 (18.8) 13 (13.3)

Are you aware of institutional support in place for
?

victims of sexual harassment at your program?

Yes 158 (42.9) 72 (50.3) 85 (38.1) 0.0165 65 (49.6) 50 (36.2) 43 (43.9) NS
No 130 (35.3) 38 (26.6) 91 (40.8) 38 (29) 54 (39.1) 37 (37.8)
Unsure 80 (21.7) 33 (23.1) 47 (21.1) 28 (21.4) 34 (24.6) 18 (18.4)
Arnold et al.
69
70 THE AMERICAN SURGEON
selection.10 Furthermore, an annual survey by the
Association of American Medical Colleges of medical
students found 12.9 per cent of students had experi-
enced offensive sexist remarks or names and 3.8 per
cent reported experiencing unwanted sexual advances.11
Twenty-seven per cent of these same students did not
report the sexual harassment to their institution because
of fear of reprisal.12 These data emphasize the impor-
tance of this topic and its pervasive nature across all
stages of training.
In this study of GI, internal medicine, and pediatric
residents, 67.2 per cent of respondents reported ex-
posure to some type of sexual harassment during their
medical training. What make these findings more
concerning are that the percentages seen in this study
are similar to those of a survey published more than
20 years ago.4 As expected, there were significantly
more women who cited sexual harassment as com-
pared with men, and the harassers were almost ex-
clusively men. Of note, almost half of harassment to
men was carried out by a male harasser. Similar to the
previously mentioned study, women were more likely
to be harassed by someone of a higher professional
status when compared with men.4 Also of note, 18 per
cent of respondents stated they were subject to ha-
rassment exclusively in medical schools and 62 per
cent of respondents stated they had been harassed by a
patient. Addressing harassment by patients toward
trainees is an important but difficult area to attempt
to make interventions for improvements. This is be-
yond the scope of this study but warrants further
investigation.
Previously, it has been reported that surgery is often
identified as the least hospitable field of practice for
women in terms of harassment.12 Another study
showed that 60 per cent of females entering GI felt they
experienced gender discrimination or sexual harass-
ment in their residency selection.12 However, in this
study, there was no significant difference in sexual
harassment noted among the surveyed specialties of
GI, internal medicine, or pediatrics. We believe this
highlights the generational and cultural change in
fields with historically high rates of harassment.
Sexual harassment remains largely underreported in
the medical field. Despite recent efforts to increase
reporting by victims of sexual harassment, in the 2016
American Medical College Graduate Questionnaire,
only 20 per cent of those harassed reported their ex-
periences and only 42.1 per cent were “satisfied” or
“very satisfied” with the outcome.13 In our survey, 89
per cent of those surveyed had not reported their ha-
rasser and 84.2 per cent had not confronted their
harasser. The most cited reason for not reporting an
instance of sexual harassment was because of the
trainee “not thinking it was a big deal.” This is a
January 2020 Vol. 86
difference from previous studies that noted a lack of
confidence that one would be helped as the main reason
for not reporting.4 Of note, “other” was the next most
likely reason for not reporting or confronting one’s
harasser. This shows one area of further investigation to
further identify reasons for not reporting harassment.
Within our own program, we have developed orga-
nizational policies and annual training for residents
and faculty on sexual harassment and reporting prac-
tices. In response to the findings in the current study
and others, we suggest the following actions to de-
partments and institutions to acknowledge and remedy
this problem within the medical community:
1) Acknowledge the scope of the problem: Multiple
studies, including ours, show sexual harassment
is still prevalent in the medical training com-
munity and has significant long-term impacts on
career, lifestyle, and trainees’ mental health. It is
critical to recognize the enormity of this problem
in the medical community, but of equal impor-
tance is to recognize the culture within one’s own
institution. We believe more institutions should
conduct anonymous workplace climate surveys
to identify and understand the scope of the
problem within one’s own institution.
2) Develop organizational policies: Regulations
that mandate zero-tolerance policies should be
developed within one’s institution and broader
throughout the medical community. These poli-
cies should call for confidentiality, outline clear
ways to report acts of harassment, and explain
clear protections against retaliation. In this study,
we found that only 42.9 per cent of residents
were aware of any institutional support in place
for victims of sexual harassment at their pro-
gram. Not only it is important to enforce such
policies but also it is critical to inform trainees on
the existence of such programs. We must develop
and enact evidence-based antiharassment cur-
riculum for all levels of training and staff mem-
bers. These should address ways to change
behavior in addition to stating the relevant poli-
cies and procedures. Multiple organizations have
made innovative curriculum and protocols to
combat harassment in their fields. The Royal
Australian College of Surgeons has developed an
“Operating with Respect” curriculum to help
fight discrimination and sexual harassment in
surgery.14 The United States Army has also de-
veloped the SHARP Amazing Race to test team
members on their knowledge about sexual as-
sault and prevention.15 Such curricula are critical
and for understanding and implementing these
policies.
No. 1 SEXUAL HARASSMENT DURING RESIDENCY TRAINING
3) Bystander training: In one study where in-
dividuals were observed witnessing harassment
in operating room simulations, the participant
demonstrated several behaviors showing that he
or she recognized behavior as inappropriate but
was unable or unsure of how to resolve the
conflict.16 To this end, bystander training is an-
other effective avenue in preparing colleagues to
recognize, intervene, and report harassment. In
this study, we noted 42.9 per cent of female and
30 per cent of male residents had witnessed
others being harassed. Cornell University re-
cently won the 2018 Best Practices: Health
Promotion and Education Award from the
American College Health Association for its
“Intervene,” a 20-minute video and 60-minute in-
person workshop, to model effective student
bystander interventions.17 Also, the American
Astronomical Society has developed a program
called “Astronomy Allies,” which serves as a
buddy system to walk people home from astronomy-
related parties and conference events in response
to staggering statistics on sexual harassment in
the field.18 These programs and others serve as a
template to develop similar initiatives in medical
training.
4) Encourage reporting: In this study, 46.8 per cent
of those surveyed stated they would feel more
comfortable reporting sexual harassment if
others came forward as well. These data support
creating an environment that encourages report-
ing sexual harassment. Anonymous, confidential
avenues of reporting must be available to trainees
including both direct face-to-face and electronic
routes to minimize fear of personal reattribution
and academic detriment. In contrast to all other
subgroups, the “male” and “GI resident” sub-
groups are the groups where the majority stated
they were not more likely to report sexual ha-
rassment if others also came forward first. We
presume this likely shows the historical stigmata
of sexual harassment and the need for further
education and training in environments with
historically high levels of harassment.
Our study has several important limitations that
should be considered. This study is limited by re-
sponder bias to the distributed survey; one can argue
residents who have experienced harassment are more
likely to respond. There is also possible selection bias
in that the survey was only sent to the program
directors of GI, pediatric, and internal medicine pro-
grams with e-mail addresses available on the de-
partment websites. There also is variability and some
confusion on the definition of sexual harassment. We
? Arnold et al. 71
attempted to address this by providing specific exam-
ples rather than “yes or no” questions; however, this
still does not address issues such as a study showing
women typically define a broader range of social-
sexual behaviors as harassing than do men.19 Fur-
thermore and most importantly, we were not able to
calculate a response rate because we were unaware of
the number of program directors who forwarded the
survey to their residents. Although this survey only
looks at a small percentage of current medical trainees’
experiences with harassment, it shows the need for
continued large-scale investigation into the reality of
sexual harassment among current trainees and ways to
effectively intervene.
This cross-sectional analysis demonstrates that sexual
harassment continues to be a problem in medical
training. Although there is a persistently high incidence
of harassment during training, the avenues in which to
report it are unknown and underutilized. As the medical
community recognizes its deficiencies, there needs to be
increased awareness in recognizing and reporting sex-
ual harassment in medical training. We believe there
must be an emphasis on continued research and
evidence-based interventions to encourage reporting
and to design institutional programs and policies for
victims of sexual harassment during medical training.
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