Is it Time for #MeToo in Medicine?

Originally published in the Medical Post, Tuesday February 27, 2018

Over the last year, the #MeToo movement has gained considerable momentum in bringing to light the prevalence of sexual harassment and abuse across all sectors of society. Women have long complained about harassment in the workplace, but until actress Rose McGowan pointed her finger at Harvey Weinstein, women’s complaints have been disregarded, minimized and discounted as lies. McGowan’s accusations burst open the dam, with accusations coming from some of Hollywood’s most successful actresses. It brought about a revival of #MeToo, a social media movement started in 2006 by by Tarana Burke, to bring attention to the extent of sexual harassment and abuse. It has since circled the globe, with women around the world raising their hands to say: #MeToo.

Medicine has not been immune from accusations of gender discrimination, sexual harassment and abuse, particularly in medical education, where individual power and authority can prey on vulnerable learners.

The hidden curriculum refers to the behaviours and values of educators, tutors and clinical staff that are transferred through observation and experience to learners. In an ideal world, the hidden curriculum reinforces the official curriculum and creates learner harmony. Unfortunately, it also reinforces and perpetuates the negative behaviours and values that impact adversely on learner attitude and behaviour and, ultimately, patient care.

The hidden curriculum in medical education has long been recognized as a dark force to be countered with enhanced professional competencies and an emphasis on communication skills. There is an idea that it can be “trained out” of the corridors, classrooms, operating and meeting rooms, by establishing policies, raising awareness and offering workshops on reflective practice, diversity, communications skills etc. How successful these strategies are remains to be seen; behaviour change can take generations.

For women in medicine, the impact of the hidden curriculum has had a profound effect. For decades, women medical students, residents and junior physicians have had to negotiate unwelcome, and in some cases, outright hostile, learning spaces. The hierarchical structure and competitive nature of medicine makes it difficult to counter the negative influences of the hidden curriculum. Add to the sexism that is found in traditionally male occupations the god-like status conferred on some medical school faculty and it makes reporting transgressions particularly difficult. Women of colour, lesbians and trans women are especially vulnerable to harassment and abuse in medicine, just as they are in society.

Physicians are taught to be tough and take it. Nowhere is this more evident when we consider women physicians managing harassment and abuse.

The FMWC supports all women who have come forward in calling attention to learner harassment and abuse, and we recognize the many challenges they face in naming their abusers. We salute these women for their courage.

We acknowledge that sexual violence is a problem in medical education, but we must ensure that due process includes justice for all parties involved. While we applaud institutions and schools that implement fair and transparent policies and procedures to address complaints, we must be mindful that processes should not re-victimize victims, but should provide protection to them while they navigate the reporting process. The expectation must be of an unbiased investigation done with discretion and fairness. And most importantly, women must have faith in the process.

Medical schools have been developing internal processes to address learner complaints, but there is no doubt that more work needs to be done. These are ongoing issues that have historically been hidden and kept secret. Bringing them to light is important work and difficult to do.

The Federation of Medical Women of Canada is committed to keeping the conversation going and advocating for Canadian women physicians in the area of sexual harassment and violence. #WeToo add our voices to the growing number of people and organizations speaking out. #TimesUp on sexual harassment and abuse.

Dr. Beverly Johnson
National President
Federation of Medical Women of Canada

References:

Plenty of "Me Too" Stories Exist in Medicine, Yale Medical School https://medicine.yale.edu/ysm/news/article.aspx?id=16224