Background to discrimination, harassment and reporting in medical students
Discrimination and harassment based on gender, sexuality and ethnicity remains an issue in medical training despite improvements, although the issue is often undiscussed, possibly due to its sensitive nature and a perception that evidence of discrimination puts those institutions involved in a bad light. On the contrary, we believe that exploring the issue and finding solutions is a crucial, positive step, and should be seen as best practice. As such, our study aims to raise deeper understanding of the issue, its prevalence and consequences within the wider medical student community and to identify practical solutions to prevent its occurrence and detrimental consequences to all involved. In addition we have several additional objectives which complement our aims, including to understand how students perceive discriminatory and harassing behaviour, and whether and how students report it, and its impact on their lives.
Discrimination has been defined in terms of behaviour towards a person in a given social group that is different due to a perception of the group rather than an individual’s characteristics, often with a negative consequence. In contrast, harassment has been defined as behaviour that is deemed unreasonable from the perspective of the victim, which may incorporate physical harassment including sexual bribery or non-physical harassment such as offensive comments or unwelcome propositions. These issues are inextricably linked, and form part of a spectrum of stressful behaviours that medical trainees are unfortunately exposed to. Such issues may be associated with a range of consequences for the individuals involved, the educational institution and, ultimately, patients, including problem drinking, an intimidating learning environment, poor communication and teamwork . These may be precipitated by local factors such as a strict hierarchy, and an emotionally charged working environment, and societal factors such as male domination and the performance of gender. Estimates of prevalence vary widely, highlighting the limitations of measuring rates, but a recent study in the United States suggests around 10% students may have experienced abuse of a sexual, ethnic or physical nature, with others suggesting higher numbers . Anecdotal experience from the authors’ involvement in student committees and with personal contacts suggests the issue still remains prevalent and underreported. Whilst studies of physical and gender-based discrimination and harassment exist in the medical literature, there is little research into sexuality or ethnicity, and research of these phenomena particularly lacks in the UK. As such, we believe this study will contribute to the medical literature by assessing these different forms of discrimination, as well as probing into its precipitating factors and consequences.
For more reading on this topic, please visit one of the following:
Carr, Phyllis L., Arlene S. Ash, Robert H. Friedman, Laura Szalacha, Rosalind C. Barnett, Anita Palepu, and Mark M. Moskowitz. “Faculty Perceptions of Gender Discrimination and Sexual Harassment in Academic Medicine.” Annals of Internal Medicine 132, no. 11 (2000): 889–896.
Elnicki, D. Michael, et al. "Medical students' perspectives on and responses to abuse during the internal medicine clerkship." Teaching and learning in medicine 14.2 (2002): 92-97.
Anonymous. “I Was Sexually Harassed as a Junior by Senior Doctors: It Still Goes On, and It Needs to Stop.” BMJ : British Medical Journal 347 (October 21, 2013). doi:10.1136/bmj.f6302.
Witte, Florence M., Terry D. Stratton, and Lois Margaret Nora. “Stories from the Field: Students' Descriptions of Gender Discrimination and Sexual Harassment During Medical School:” Academic Medicine 81, no. 7 (July 2006): 648–654. doi:10.1097/01.ACM.0000232421.04170.d2.
Discrimination has been defined in terms of behaviour towards a person in a given social group that is different due to a perception of the group rather than an individual’s characteristics, often with a negative consequence. In contrast, harassment has been defined as behaviour that is deemed unreasonable from the perspective of the victim, which may incorporate physical harassment including sexual bribery or non-physical harassment such as offensive comments or unwelcome propositions. These issues are inextricably linked, and form part of a spectrum of stressful behaviours that medical trainees are unfortunately exposed to. Such issues may be associated with a range of consequences for the individuals involved, the educational institution and, ultimately, patients, including problem drinking, an intimidating learning environment, poor communication and teamwork . These may be precipitated by local factors such as a strict hierarchy, and an emotionally charged working environment, and societal factors such as male domination and the performance of gender. Estimates of prevalence vary widely, highlighting the limitations of measuring rates, but a recent study in the United States suggests around 10% students may have experienced abuse of a sexual, ethnic or physical nature, with others suggesting higher numbers . Anecdotal experience from the authors’ involvement in student committees and with personal contacts suggests the issue still remains prevalent and underreported. Whilst studies of physical and gender-based discrimination and harassment exist in the medical literature, there is little research into sexuality or ethnicity, and research of these phenomena particularly lacks in the UK. As such, we believe this study will contribute to the medical literature by assessing these different forms of discrimination, as well as probing into its precipitating factors and consequences.
For more reading on this topic, please visit one of the following:
Carr, Phyllis L., Arlene S. Ash, Robert H. Friedman, Laura Szalacha, Rosalind C. Barnett, Anita Palepu, and Mark M. Moskowitz. “Faculty Perceptions of Gender Discrimination and Sexual Harassment in Academic Medicine.” Annals of Internal Medicine 132, no. 11 (2000): 889–896.
Elnicki, D. Michael, et al. "Medical students' perspectives on and responses to abuse during the internal medicine clerkship." Teaching and learning in medicine 14.2 (2002): 92-97.
Anonymous. “I Was Sexually Harassed as a Junior by Senior Doctors: It Still Goes On, and It Needs to Stop.” BMJ : British Medical Journal 347 (October 21, 2013). doi:10.1136/bmj.f6302.
Witte, Florence M., Terry D. Stratton, and Lois Margaret Nora. “Stories from the Field: Students' Descriptions of Gender Discrimination and Sexual Harassment During Medical School:” Academic Medicine 81, no. 7 (July 2006): 648–654. doi:10.1097/01.ACM.0000232421.04170.d2.