LAUSR

The medical profession is not immune to the phenomenon of sexual violence [1–5]. More than 50% of women faculty and students in medicine have reported being sexually harassed [1, 2]. We in medicine have been aware of gender discrimination and the differential when it comes to salaries, promotions, funding, and publications for some time now [6–9]. The #MeToo movement [10], however, served as a catalyst for the outpouring of call-for-action commentaries [11–14] and the sharing of personal stories about sexual harassment in our workplaces [15–17]. It is clear that we have not done enough to address sexual harassment in our profession. In the February 2019 issue of Academic Psychiatry, four articles examine different aspects of sexual harassment. McAdams [15] shares a personal account of being sexually harassed as a trainee and describes the trauma and growth from the lens of a psychiatrist who now works with patients who are survivors of abuse. Michael et al. [18] highlight both the high prevalence of inappropriate sexual behavior of patients toward trainees and the lack of training on how to handle such behavior. Coverdale et al. [19] discuss that sexual violence against womenwith psychiatric disorders has beenmissing from the conversations related to #MeToo. Finally, Wainberg et al. [20] propose that a takeaway lesson from the #MeToo movement is to teach about sexuality as a mental and physical health issue. These articles shine a light on the fact that we in medicine might have been naïve in thinking that we are less susceptible to the problem, but if one looks at the underlying circumstances that favor sexual harassment, such as gender imbalances, uneven power structures, and promotional tracks, they are clearly present inmedicine [1, 3, 14]. Attending physicians and senior leadership hold tremendous power over trainees and junior faculty. Many of the reports about sexual harassment are from trainees (current or former), although sexual discrimination permeates medicine at all levels [1, 2, 14, 15]. We must recognize that our professional environment is not that different from other professional environments and therefore is subject to similar issues. Corporate America is taking action to reduce sexual harassment in the workplace, and medicine can follow its lead and take similar actions. In 1998, the Supreme Court put forth the Title VII Standards of Employer Liability for Supervisors’ Conduct in Sexual Harassment Hostile Environment Cases [21], clarifying that to avoid liability, organizations must train their employees on their anti-harassment policies. Harassment and discrimination training programs have been rolled out across workplaces to different degrees. It is unclear how effective they are because while it is one thing to educate people about harassment, it is another to facilitate the reporting of harassment in a safe manner and yet another to actually follow through and address the concerns. Unfortunately, some workplace training programs are not only ineffective but may actually be detrimental [1, 11, 14, 22, 23]. The #NowWhat movement [24] is a follow up to #MeToo and aims to bring into the open the discussion about how to address and prevent sexual harassment. Wide-scale, comprehensive reforms to reduce sexual harassment in medicine have been proposed [1, 11, 13]. The medical field is based on measurement and observability. If we bring the same rigor that we apply to medical research to this issue, we can implement programs that are actually effective at combating sexual harassment. We will be successful if we commit to eliminating harassment from our workplaces. It will not happen if, instead, we only commit to meeting legal standards to reduce workplace liability. One prominent aspect of wide-scale organizational changes that has not received as much attention in medicine but has proven to be highly successful elsewhere is bystander intervention [24–29]. Members of academic departments should all be educated about the reporting requirements of their institution and any legal reporting obligations that may be specific to their local or state environment. These requirements can vary by institution, by jurisdiction, and over time. For * Rashi Aggarwal [email protected]