#WeToo

Hi everyone:

We should have known #MeToo would eventually come to academic medicine. We’re no different than Hollywood, journalism, politics, or any domain where men abuse power. All institutions are vulnerable, including our own. So #WeToo.

Gender discrimination in medicine ranges from frank harassment to unconscious bias. At least 30% of women physicians experience sexual harassment at work, usually from superiors, but also from colleagues and patients. The numbers are undoubtedly worse when you consider under-reporting. What’s clear, particularly as more stories emerge, is that the problem is more widespread than many of us, particularly men, would have imagined.

While blatant harassment often hides within private encounters, more routine discrimination occurs in the open and is visible to all who look. A recent emergency medicine study showed that female residents get systematically worse evaluations than male peers. Internal medicine studies, including two from Yale, are mixed on this topic, but bias plays out before us every day. Make note, for example, how often men speak up at teaching conferences while women stay silent. Or watch how often patients listen to male physicians, however junior, and ignore the women in charge.

Let’s use this #WeToo moment to assert our residency’s values and expectations. Because we honor and respect one another, we will not tolerate abuse of any kind. Because we want all trainees to thrive, we will work to eliminate discrimination wherever we find it. And because we all have blind spots, we will identify bias when our colleagues fail to see it.

Let’s reaffirm our commitment to making our residency safe and just. Let’s start by recognizing our vulnerability. For those of us who have eluded gender bias and harassment ourselves, let’s acknowledge that many of our sisters have not been so lucky. Next, let’s speak up when we witness bad behavior. If we want to make things better, we have to act. If you can’t speak up, for whatever reason, please share your concerns with your chiefs, residency leadership, the GME Office, or the university. Confidentiality will be respected. Finally, let’s teach each other about gender bias and use the light of education to mitigate our blind spots. I’ve listed some suggested readings below. Feel free to add you own.

#WeToo compels us to make our residency a haven for everyone. No one is safe until we are all safe, and no one can thrive until we all thrive. This is our moment, and our opportunity.

In solidarity,

Mark

Suggested Reading:

1. Jagsi R. Sexual Harassment in Medicine — #MeToo. NEJM 2017; Online First http://www.nejm.org/doi/pdf/10.1056/NEJMp1715962
2. Gunter J. I was groped by the editor of an OB/GYN medical journal. I’m not the only one. https://drjengunter.wordpress.com/2017/12/14/i-was-groped-by-the-editor-of-an-ob-gyn-medical-journal-im-not-the-only-one/amp/?__twitter_impression=true. Accessed December 17, 2017.
3. Jagsi R, Griffith KA, Jones R, Perumalswami CR, et al. Sexual Harassment and Discrimination Experiences of Academic Medical Faculty. JAMA 2016; 315:2120-1
4. Fnais N, Soobiah C, Chen MH, et al.Harassment and discrimination in medical training: a systematic review and meta-analysis. Acad Med. 2014;89(5): 817-827.
5. Rand VE, Hudes ES, Browner WS, et al. Effect of Evaluator and Resident Gender on the American Board of Internal Medicine Evaluation Scores. JGIM 1998; 13:670-4
6. Brienza RS, Huot S, Holmboe ES. Influence of Gender on the Evaluation of Internal Medicine Residents. J Women’s Health 2004; 13:77-83
7. Holmboe ES, Huot SJ, Brienza RS, Hawkins RE. The Association of Faculty and Residents’ Gender on Faculty Evaluations of Internal Medicine Residents in 16 Residencies. Acad Med 2009; 84:381-4
8. Dayal A, O’Connor DM, Qadri U, BA; Arora VM, Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training. JAMA IM 2017; 177:651-7
9. Tapper AP. I’m 10. And I Want Girls to Raise Their Hands. NY Times 10/31/2017. https://www.nytimes.com/2017/10/31/opinion/im-10-and-i-want-girls-to-raise-their-hands.html.