How prevalent is sexual harassment in neurosurgery?

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Responses from 622 neurosurgeons to an online survey show that the majority have either witnessed or experienced sexual harassment.

When the Me Too movement gained worldwide visibility in 2017, the prevalence of sexual harassment across industries and socioeconomic environments became very clear.

The movement often highlights harassment in the workplace where there are power imbalances. In 2018, the Pew Research Center published a survey that found that 59% of women and 27% of men experienced sexual harassment in or out of the workplace.

More than half the women (55%) reported that the sexual harassment had occurred in the workplace.

Understanding how often such harassment happens is crucial for creating a safe workplace. To this purpose, Dr. Deborah L. Benzil, a neurosurgeon with Cleveland Clinic in Cleveland, OH, conducted a survey on the prevalence of sexual harassment in the neurosurgery field on behalf of the One Neurosurgery Summit, which brings together seven neurosurgery associations, boards, and academies.

The findings of the survey appear in the Journal of Neurosurgery. The survey found that a high percentage of females and males working in neurosurgery reportedly experienced some form of sexual harassment at work.

According to the journal, the goals of the survey were to:

  1. Assess perceived attitudes toward systemic issues that might be permissive of sexual harassment.
  2. Measure the reported prevalence and severity of sexual harassment.
  3. Determine the populations at highest risk and those most likely to perpetrate sexual harassment.

Dr. Benzil included a variety of questions in the survey, including asking about the gender of respondents, details about the environment where the harassment occurred, and the culture of neurosurgery. The survey also asked where the harassment took place, such as at a hospital or private practice.

The study addresses how many people experienced sexual harassment in the workplace and how many also witnessed it.

Dr. Benzil used SurveyMonkey to send the survey to all members of the Society of Neurological Surgeons and Congress of Neurological Surgeons.

Dr. Benzil sent out 5,166 surveys and received a response from 12% (622) of people, 20% of whom identified as women.

According to the study paper, this is more than we might expect given that women in the U.S. make up just 8% of practicing neurosurgeons and 19% of residents in the specialty.

According to the findings, “This study demonstrates that neurosurgeons report significant sexual harassment across all ages and practice settings.”

Sixty-two percent of all respondents (85% of females and 56% of males) have witnessed some form of bullying or sexual harassment in neurosurgery. Additionally, 88% of females and 44% of males reported having experienced such harassment.

The survey asked the respondents to describe their worst experience of sexual harassment.

One such example records the following experience: “One of my professors becomes flirtatious. I indicate that I am not interested. He begins to grab me and tear my blouse… [I] calmed him down.. he said, ‘Remember we are a small group and your reputation can easily be lost. There are ways we can fail you, and no one will ever know’.”

Dr. Benzil writes that “Given societal patterns and the high proportion of male neurosurgeons, it is not surprising that men were overwhelmingly identified as the offenders in allegations of sexual harassment.”

“Responses confirm that factors associated with the risk of sexual harassment — male dominance, a hierarchical environment, and a permissive environment — remain prevalent within the neurosurgical community,” she concludes in the paper.

The study took the ages of the survey takers who witnessed harassment into consideration. It is useful to look at how responses vary by age to see if people across the board notice sexual harassment or if one group sees it happen more so than others. The survey included sections for respondents of the following ages: 40 and under, 41–50, 51–60 years, and over 60.

Sixty-seven percent of females and males in the “under 40” age bracket reported witnessing harassment. This is higher than any other age bracket.

The survey revealed that 63% of respondents aged 41–50, 60% of people aged 51–60, and 56% of those over 60 witnessed harassment.

Sexual harassment situations often come at the hand of someone in a position of authority over the person they harasss. The survey suggests that this applied to the field of neurosurgery as well.

Survey takers identified colleagues in positions of authority as perpetrators in the majority of harassment incidents across all age groups.

For example, in the 41-50 age bracket, 94% of respondents said a superior was responsible for the harassing behavior.

Only 31% of respondents said they reported the harassment. The majority of neurosurgeons feared retaliation if they made a report.

The survey results should help neurosurgery departments determine what steps to take in the future to create a safe workplace.

In the study, Dr. Benzil notes that:

“For more than a decade, organized neurosurgery has been committed to attracting and retaining more women to reach the best and brightest for our specialty. The persistent and pervasive presence of sexual harassment, and the environment that permits it, will continue to undermine these crucial endeavors.”

Dr. Douglas Kondziolka and Dr. Linda Liau, both senior neurosurgeons, commented on behalf of the One Neurosurgery Summit and the Neurosurgery Professionalism Taskforce on the findings in an editorial.

The editorial notes that the response rate of 12% was normal for practice surveys. Its authors also corroborate the ongoing nature of the problem by highlighting sexual harassment claims that people reported in anonymous feedback from oral board examinations in neurosurgery.

They emphasize that there should be zero tolerance for sexual harassment in the workplace.

Despite the high reported rate of harassment events, the survey brought some good news too, the senior neurosurgeons note.

“Most of those surveyed felt that people they worked with were respectful and civil,” they write.

They also comment that the percentage of female neurosurgeons is higher now than ever: “When we started training, only about 5% of neurosurgery residents were women. Now in 2020, females comprise 19% of neurosurgery residents.”

Still, they caution that despite these improvements, the field of neurosurgery should make space for more workplace diversity and rethink its approach to hierarchical authority.

“[O]ur own hierarchy should have levels where open discussion can occur, and fear of reprisal is mitigated,” they write.

“Hierarchy has been the standard in education and practice for centuries, but it need not be static. Neurosurgery has relied on hierarchy because so much is at stake. But neurosurgery as a job is hard enough without creating an unpleasant or threatening work experience. The risk, as the authors discuss, is burnout,” they emphasize.

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