A daylong retreat on changing the medical school’s culture and climate—believed by the organizers to be the first of its kind to take place at a U.S. medical school—was held on May 24 by Yale School of Medicine. The retreat focused on sexual harassment and equity in pay, resources, and promotion and included six working groups presenting lists of actionable items to be implemented within the next six to 12 months. Those items spanned a range of issues, from equity in compensation and resources, to more opportunities for women and minorities in leadership, to transparency in the promotions process. And those in attendance said that they expect to see real change in the short term.
“This is not meant to be a therapeutic exercise,” said Esther Choo, MPH, MD ’02, associate professor of emergency medicine at Oregon Health and Science University, a founder of TIME’S UP Healthcare, and one of the organizers of the event. “We want follow-up.”
Choo worked closely with Darin Latimore, MD, deputy dean for diversity and inclusion and chief diversity officer, in planning the event. “We were enthusiastic about partnering with TIME’S UP Healthcare for this event because we felt this was a critical time to be having this conversation,” said Latimore. Choo and other TIME’S UP Healthcare founding members participated in a panel and facilitated the working groups.
TIME’S UP Healthcare, a network of health care leaders that aims to create safe, fair, and dignified workplaces for women launched on March 1. Yale School of Medicine was the first medical school to become a signatory member. For both the organization and the medical school, the retreat was a pilot initiative as they seek ways to promote equity in health care. TIME’S UP Healthcare is also hoping the retreat will serve as a model for future events at other medical centers as it addresses these issues across the country.
“You just have to read the newspapers every day to see that sexual harassment is rampant across all of society,” said Dean Robert J. Alpern, MD, Ensign Professor of Medicine, in his introductory remarks. “I think we all know we have a problem. What I would love to come out of this is a plan for how we are going to address this as a school.”
The workshop opened with a presentation by Timothy R.B. Johnson, MD, chair of obstetrics and gynecology at the University of Michigan, one of the authors of the National Academies of Science, Engineering, and Medicine report Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. Half of women in academia and up to a quarter of female students report experiencing sexual harassment, the report found. For women of color and members of the LGBTQ community, discrimination can be even more egregious.
Another key finding was that where sexual harassment is tolerated, sexual coercion and gender harassment soon follow. “Institutions need to make system-wide changes to their culture and climate,” Johnson said. “This is a big problem in academic medical centers and it’s up to us to deal with it.”
Indeed, the organizers of the day had no illusions about the enormity of their task. “Harassment is more common in male-dominated fields where power differentials exist,” said panelist Reshma Jagsi, MD, deputy chair of radiation oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan. “We have to change the very structures that are supporting harassment. We have to hire more women, promote more women.”
And, they made clear, jokes about appearance, unwelcome sexual advances, and unequal pay and opportunities can drive women and minorities out of the health care work force. This, in turn, can affect the quality of care. It can also translate into different levels of care, depending on the patient’s gender, race, and sexual orientation. “At the end of the day, this is about patient care,” said panelist Resa E. Lewiss, MD, professor of emergency medicine at Thomas Jefferson University.
In the afternoon, the 85 faculty, students, and staff broke up into working groups to define problems and craft solutions in five areas—harassment policies and procedures; metrics for reporting sexual and gender harassment; raising awareness in the Yale community; representation, leadership, inclusion, and equity; and leadership challenges and accountability.
Areas of focus cited by the groups included improvement in communications, leadership, transparency, awareness, training, and opportunities to discuss the culture and climate.
“There is a disconnect between what we say we want to do and what we do,” said Roberta Hines, MD, chair of anesthesiology. “There is a disconnect between our values and our behavior.”
“We listened to everyone. I heard a lot about what will happen after we leave this day,” Choo said as the session ended. “TIME’S UP Healthcare will be following up in six months to 12 months and asking if there is any value in coming back. It’s a long-term conversation.”
“Over the next few weeks we need to put all this together into a real plan,” Alpern said in his closing remarks. “We are going to have to get going right away and not set it aside. I appreciate your participation and you will be hearing from us.”
“Don’t stop the conversations today. Please, please, remind me if we’re not moving fast enough,” said Latimore. “I want to give you permission to be a thorn in my side and to ask us where we are, what has been done, and what we can do to move it a little bit faster.”