NYMC Faculty Publications

Sexual Harassment, Abuse, and Discrimination in Obstetrics and Gynecology: A Systematic Review

Ankita Gupta, Division of Urogynecology, University of Louisville Health, Louisville, Kentucky.Follow
Jennifer C. Thompson, Division of Urogynecology, Department of Obstetrics and Gynecology, Northwest Kaiser Permanente, Portland, Oregon.
Nancy E. Ringel, Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut.
Shunaha Kim-Fine, Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.Follow
Lindsay A. Ferguson, Division of Gynecologic Oncology, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, Ohio.
Stephanie V. Blank, Division of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Cheryl B. Iglesia, Division of Urogynecology, MedStar Health, Washington, District of Columbia.
Ethan M. Balk, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island.
Angeles Alvarez Secord, Division of Gynecologic Oncology, Duke University Medical Center, Duke Cancer Institute, Durham, North Carolina.
Jeffrey F. Hines, University of Connecticut Health Center, Farmington, Connecticut.
Jubilee Brown, Atrium Health Levine Cancer, Charlotte, North Carolina.
Cara L. Grimes, Department of Obstetrics and Gynecology, New York Medical College and Westchester Medical Center, Valhalla, New York.Follow

Author Type(s)

Faculty

DOI

10.1001/jamanetworkopen.2024.10706

Journal Title

JAMA Network Open

First Page

e2410706

Document Type

Article

Publication Date

5-1-2024

Department

Obstetrics and Gynecology

Abstract

IMPORTANCE: Unlike other surgical specialties, obstetrics and gynecology (OB-GYN) has been predominantly female for the last decade. The association of this with gender bias and sexual harassment is not known. OBJECTIVE: To systematically review the prevalence of sexual harassment, bullying, abuse, and discrimination among OB-GYN clinicians and trainees and interventions aimed at reducing harassment in OB-GYN and other surgical specialties. EVIDENCE REVIEW: A systematic search of PubMed, Embase, and ClinicalTrials.gov was conducted to identify studies published from inception through June 13, 2023.: For the prevalence of harassment, OB-GYN clinicians and trainees on OB-GYN rotations in all subspecialties in the US or Canada were included. Personal experiences of harassment (sexual harassment, bullying, abuse, and discrimination) by other health care personnel, event reporting, burnout and exit from medicine, fear of retaliation, and related outcomes were included. Interventions across all surgical specialties in any country to decrease incidence of harassment were also evaluated. Abstracts and potentially relevant full-text articles were double screened.: Eligible studies were extracted into standard forms. Risk of bias and certainty of evidence of included research were assessed. A meta-analysis was not performed owing to heterogeneity of outcomes. FINDINGS: A total of 10 eligible studies among 5852 participants addressed prevalence and 12 eligible studies among 2906 participants addressed interventions. The prevalence of sexual harassment (range, 250 of 907 physicians [27.6%] to 181 of 255 female gynecologic oncologists [70.9%]), workplace discrimination (range, 142 of 249 gynecologic oncologists [57.0%] to 354 of 527 gynecologic oncologists [67.2%] among women; 138 of 358 gynecologic oncologists among males [38.5%]), and bullying (131 of 248 female gynecologic oncologists [52.8%]) was frequent among OB-GYN respondents. OB-GYN trainees commonly experienced sexual harassment (253 of 366 respondents [69.1%]), which included gender harassment, unwanted sexual attention, and sexual coercion. The proportion of OB-GYN clinicians who reported their sexual harassment to anyone ranged from 21 of 250 AAGL (formerly, the American Association of Gynecologic Laparoscopists) members (8.4%) to 32 of 256 gynecologic oncologists (12.5%) compared with 32.6% of OB-GYN trainees. Mistreatment during their OB-GYN rotation was indicated by 168 of 668 medical students surveyed (25.1%). Perpetrators of harassment included physicians (30.1%), other trainees (13.1%), and operating room staff (7.7%). Various interventions were used and studied, which were associated with improved recognition of bias and reporting (eg, implementation of a video- and discussion-based mistreatment program during a surgery clerkship was associated with a decrease in medical student mistreatment reports from 14 reports in previous year to 9 reports in the first year and 4 in the second year after implementation). However, no significant decrease in the frequency of sexual harassment was found with any intervention. CONCLUSIONS AND RELEVANCE: This study found high rates of harassment behaviors within OB-GYN. Interventions to limit these behaviors were not adequately studied, were limited mostly to medical students, and typically did not specifically address sexual or other forms of harassment.

Link to Full Text

Share

COinS