‘Shocking’ Sexual Misconduct in Surgery Survey Prompts New Calls for Change

Sexual misconduct across the surgical profession is “experienced widely” in the United Kingdom, according to an explosive study published last week in the British Journal of Surgery (BJS).

Of the more than 1,400 individuals who responded to the survey, nearly 90% of women and more than 80% of men reported they had personally witnessed sexual harassment in some form, and almost 36% of women and 17% of men had witnessed sexual assault. Worse, two-thirds of women had been the specific target of sexual harassment and nearly 29% had been victims of assault, including rape; those figures for men were far lower, but not zero.

“The results of this study on sexual misconduct over the past 5 years among the UK surgical workforce indicate that both sexual harassment and sexual assault may be commonplace in the UK surgical environment, and that rape happens,” write Christopher Begeny, PhD (University of Exeter, England), and colleagues. “These are illegal and criminal acts.”

Just a fraction of the survey respondents identified as cardiothoracic surgeons (1.9%)—more than half identified trauma/orthopedic or general surgery as their subspecialty. For that reason, Begeny told TCTMD, “we can't provide much in the way of specific—evidence-based, meaningful—insight on this or related specialties.”

Moreover, for research ethics purposes, disaggregation of the data, particularly by subspeciality, isn’t possible. “That said,” he continued in an email, “we do think it's important to dig into some more specialty-specific questions, but this will require greater investment from relevant organizations and regulators to support collection of even larger samples of workforce members. Going forward, we hope the National Health Service, the General Medical Council, and other regulators choose to step up and support this call.”

Also speaking with TCTMD, Malin Sund, MD, PhD (Umeå University, Sweden), a BJS editor who co-authored an accompanying editorial, said it was “quite difficult” to estimate how these results would apply to cardiovascular surgeons or indeed, other areas of medicine. “But I would assume that the more male-dominated the field is, likely the bigger the problem,” she said.

Pamela Douglas, MD (Duke University, Durham, NC), a past president of the American College of Cardiology (ACC) and lead author of the ACC’s 2022 Health Policy Statement on Building Respect, Civility, and Inclusion in the Cardiovascular Workplace, agreed. The ACC has not collected sexual misconduct data to the extent done by the Begeny and colleagues, she said, so it’s not possible to know “whether it’s just as bad, or a little less frequent, but I would be very surprised if there wasn’t some of this happening.”

Surveys in cardiology, she noted, have documented harassment rates among female cardiologists ranging between 65% and 75% since the mid-1990s, with men, too, reporting rates of 20% to 25%.

Survey Results

Members of the surgical workforce, from early trainees up to senior consultants, were invited to respond to the survey and answered two sets of questions regarding sexual harassment and assault, the first as witnesses and the second as targets. Women made up more than half of the respondents—738 to 696—and also reported the larger proportion of more-serious acts.

For example, while a majority of both men and women said they’d heard sexual jokes (89% and 81%, respectively), three times as many women as men said they were aware of a colleague being repeatedly pressured to date and five times as many women had witnessed someone being threatened for refusing a sexual favor.

Disparities were even greater by sex when it came to questions about being sexually targeted. Here, more than ten times as many women said they’d endured forced contact in return for career opportunities (10.9% versus 0.7%), roughly the same scale of difference for those who had experienced unwanted touching of genitals or breasts (5.4% vs 0.6%). In the most horrifying finding of the survey, 0.8% of women and 0.1% of men surveyed said they’d been raped at work, or in a work-related context such as a conference or after-work event.

These are illegal and criminal acts. Christopher Begeny

In a weighted analysis that adjusted the survey responses to estimate responses within the broader NHS surgical workforce, all of the numbers ticked higher for both men and women, both witnessed and targeted, and for all three categories of harassment, assault, and rape. Due to the small number of respondents who identified as nonbinary, the analysis was confined to a comparison of men and women, in part to protect anonymity.

Discussing the journal’s decision to publish the survey, Sund pointed to the quality of the study methodology, but also the galvanizing results. “We all felt it was important to put this out there,” Sund said. “It was such an important issue and many of us were quite shocked by the results.”

Sund speculated, however, that the results may not apply equally to countries that have adopted less hierarchical structures for training and delivery of care.

“The UK system is perhaps more hierarchical than the Nordic countries or the Scandinavian countries where I work, where I would say that we probably have an issue as well, but it's not of this magnitude.”

What Sund highlighted as “extremely distressing” in the study was the extent to which respondents felt that they could not speak out about what they were witnessing or experiencing.

Just 20% of female trainees and surgeons surveyed (as compared with 59% of male) said they trusted the British Medical Association to deal adequately with sexual misconduct complaints, a number that dipped to the 15% range for the General Medical Council and the NHS Trusts. Just under one-third of women said they thought the Royal Colleges would adequately handle misconduct, as compared with 60% of men. Perhaps not surprisingly, women who had witnessed or experienced sexual misconduct had the least faith in professional organizations for appropriately handling complaints.

Group Action

Following the publication of the survey, Latifa Patel, MBChB, equality lead for the British Medical Association, released a statement that said the “scale and severity of sexual assault against female surgeons over the past 5 years, revealed by this survey, is atrocious. It is appalling that women in surgery are being subjected to sexual assault and sexual misconduct from their colleagues, at work and often whilst they are trying to care for patients. The impact this will have on their well-being for years to come as well as their careers is profound.”

Patel’s statement does not directly address the lack of trust in the BMA, however, saying only that the BMA has “long called for more to be done to require employers to bring in policies that eliminate any form of sexual harassment in the workplace. This survey shows the need more than ever for action to be taken urgently and we will continue to highlight the prevalence of these behaviors being experienced by doctors and the fears around reporting that prevent people from speaking up.”

According to the BBC, members of the UK Parliament’s Health and Social Care Committee announced they will be “looking into” the “shocking” revelations made in the BJS report, and that it will be considered in future NHS leadership decisions.

As for what individual societies and professional groups could do differently: that’s complicated.

Just prior to the release of this survey, the UK’s General Medical Council issued an update to its professional standards guidance that, for the first time, set out the Council’s position on sexual harassment. That followed a joint investigation by the British Medical Journal and the Guardian newspaper which found that 35,000 sexual safety complaints were made to 212 NHS Trusts in England, but fewer than one in 10 trusts had dedicated policies for dealing with sexual assault and harassment.

Douglas, who for decades has advocated for women in cardiology, notes that the ACC, too, in January 2020, updated its code of ethics to include more-robust language expressly prohibiting discrimination and harassment towards other professionals (as well as patients). That said, Douglas continued, the ACC does not have a dedicated ombudsperson, or any ability to do an impartial review of a specific complaint, leaving that up to institutions where the complaints are made.

Where the ACC has made strides, she believes, is in education and exposure of the issues, and in requiring any participants to adhere to the College’s code of ethics when participating in ACC-sanctioned activities or meetings.    
James Ford, responding to TCTMD on behalf of the European Association for Cardio-Thoracic Surgery (EACTS), called the actions described in the study “appalling [with] no place in surgical training or the practice of cardiothoracic surgery.”

Asked what EACTS is doing to change the culture, Ford noted that EACTS has been “increasing representation of women in our membership, at our meetings, and within leadership,” adding that EACTS will be inaugurating its first female president, Franca Melfi, MD, PhD (University of Pisa, Italy), at the association’s annual meeting in October. “We know there is more to do to ensure more women play a leading role within the Association and across the specialty,” he said. Several initiatives, he noted, are underway to address this, including the Women in Cardiothoracic Surgery Committee, which champions the role of women within EACTS and focuses on supporting more women in leadership roles, and a recent webinar series detailing the challenges women surgeons face—a topic also being showcased in a dedicated session at the upcoming EACTS congress.

The American Association for Thoracic Surgery (AATS), declined to provide “an official statement” in response to the BJS paper, but stressed that the society’s surgeon leaders and members “all abide” by its Code of Ethics, and Diversity, Inclusion and Equity position, and that they require all surgeons and associates to adhere to these when they are named members of the Association.

Some Encouraging Signs?

For Sund, the fact that so many men agreed to respond to the survey is a hopeful sign, since it indicates that men are aware there is a problem and were willing to take the step of speaking out. She hopes that publishing these data will not only spur organizations to take a zero-tolerance stance on harassment and assault, but also make it easier for witnesses to come forward to support colleagues in less powerful positions to blow the whistle on perpetrators.

Douglas, too, sees hope in the fact that 48.5% of respondents were male.

“I think the response rate of the men in this survey is a positive,” she said. “I think that shows that they don't think this is a bunch of whiny women, complaining about things, or that this is something that doesn't happen, or it doesn't involve them, or it's not relevant for them. I think they're beginning to see that this is relevant for them and for their institutions. I think that is a big step forward.”