An update on the progress of work to tackle sexual misconduct in the surgical workforce

31st March 2024

Sophie Donaghue, BOTA Women in Surgery Rep

Background

Sexual misconduct is unwanted behaviour of a sexual nature and describes sexual harassment, sexual assault, and rape 5. These acts are illegal or criminal. Publication of impactful personal stories, followed by an outpouring of concerning anecdotes on social media, led to the establishment of the WPSMS 1-3, 5. This is composed of committed NHS surgeons, clinicians and researchers who are working to raise awareness of sexual misconduct in Surgery, to bring about cultural and organisational change 5.

The WPSMS conducted an anonymous survey in 2022 on the experience in the last 5 years of sexual misconduct in colleagues in the surgical workforce 4. This survey obtained 1434 responses (51.5% women). Of respondents, two thirds of women (63.3%) had been the target of sexual harassment from colleagues and almost a quarter of men (23.7%). Nearly one third of women (29.9%) had been sexually assaulted by a colleague and an overwhelming majority of respondents to the survey had witnessed sexual misconduct by colleagues (89.5% of women and 81% of men). 10.9% of women had experienced forced physical contact linked to career opportunities. There were cases of rape and only 16% of individuals affected by sexual misconduct made a formal report. There was a significant lack of faith reported in accountable organisations’ (including the BMA, GMC and HEE) adequacy of dealing with sexual misconduct with female respondent’s confidence as low as 15% and as high as only 31%. These figures speak for themselves and show just how high the prevalence of sexual misconduct in the surgical workforce is, with women disproportionately affected than men, and a feeling that accountable organisations are not dealing adequately with this issue 4.

It is vitally important that these issues are addressed urgently with clear reporting mechanisms, training programs and support for those involved. Research suggests that doctors who perform acts of sexual misconduct towards colleagues also demonstrate this towards patients, and that dysfunctional teams have poorer patient outcomes 6, 7. Despite more women than men entering medical school since 1996, the proportion of female surgical consultants remains disappointingly low at 15% 8, 9. This male predominance in surgery is listed by women as a deterrent to entering surgical training, and toxic misogyny has been cited as a reason for women leaving surgical training. Individuals affected by sexual violence can experience irreparable psychological damage, which impacts them personally, their work, and the care they provide for their patients. Our surgical profession cannot afford to let this culture continue, to lose our valuable female staff, and to put our patients at risk. Cultural change and prevention, a zero-tolerance approach with consequences for perpetrators, and appropriate investigation of sexual misconduct in healthcare are ways that can help eradicate sexual misconduct in surgery 10.

Progress so far

WPSMS presented their quantitate data in May 2023 to key stake holders, professional bodies, and policy makers, including the GMC and NHS England, which has led to productive round table discussions on the challenges and solutions of this issue. The outcomes of these discussions have been published with clear national recommendations on how policies should be reviewed, and what training, support, and guidance should be available 10. One of the recommendations was that trusts and regulatory organisations sign NHS England’s sexual safety in healthcare organisational charter. To assess the impact of the charter and inform future interventions, the NHS Staff Survey now includes the following question:

“In the last 12 months, how many times have you been the target of unwanted behaviour of a sexual nature in the workplace? This may include offensive or inappropriate sexualised conversation (including jokes), touching or assault.”

NHS England has asked Integrated Care Boards (ICBs) to review Sexual Safety Policies and expressed the need for “a systematic zero-tolerance approach to tackle this issue which encompasses prevention, support and decisive action against perpetrators”. They have also asked ICBs and Trusts to appoint a Lead for Domestic Abuse and Sexual Violence by July 2023 to enhance support for both patients and staff.

The GMC have published an updated version of ‘Good Medical Practice – Professional Standards’ to include the statements on sexual misconduct and raising concerns under the section “Contributing to a positive working and training environment”. This guidance came into effect on 30th January 2024 11. Updated guidance includes the following:

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The GMC also included new questions in their 2023 National Training Survey asking trainees if they had experienced “unwelcome sexual comments or advances causing you embarrassment, distress or offense”, which will further aid in ongoing monitoring of this issue. The results of this latest training survey have now been published and can be found in the ‘further reading’ section of this page. The Joint Committee on Surgical Training Survey, will now also include questions around sexual safety so the health service can monitor progress.

Next steps

WPSMS continue to work closely with stakeholders who have the power to change working conditions and have pledged their commitment to ensuring progress in this area. Other organisations such as Surviving in Scrubs are also contributing to ongoing awareness and promoting change. You can follow both these organisations for updates on their twitter pages, linked in the resources section. WPSMS are due to publish further research and Surviving Scrubs have recently published their own report analysing 150 survivor stories submitted to their website identifying challenges and recommendations for healthcare organisations. Such work will add to the existing evidence base in this area and contribute to ongoing progress and monitoring of interventions.

By continuing to engage in the national conversation on this issue, policies and cultures should change, and as a profession we should move towards a zero-tolerance stance on sexual misconduct where perpetrators are held to account, reports are investigated appropriately, and those involved feel able and supported to speak up. We must all work together at both an organisational and individual level to ensure the healthcare system is a safe and supportive environment to work, to educate and to treat our patients.

Reporting

Whilst BOTA as an organisation is not able to receive reports of this behaviour, the resources below and our ‘Sexual Misconduct’ area of our website list the appropriate pathways of escalation and reporting.

Acknowledgements

BOTA would like to acknowledge the hard work of the members of WPSMS, Surviving in Scrubs, and the brave victims who have shared their stories. We would also like to acknowledge the stakeholders who have taken onboard the data and personal stories and have begun to make steps to make the healthcare workspace a safer place to be for staff and patients.

References

1.RE: Sexual assault in surgery: a personal perspective. Bull R Coll Surg Engl. 2022(104):58–9.

2.Fleming S, Fisher R. Sexual assault in surgery: a painful truth. The Bulletin of the Royal College of Surgeons of England. 2021;103(6):282-5.

3.Jackson P. Sexual assault in surgery: a personal perspective-A letter to the authors. The Bulletin of the Royal College of Surgeons of England. 2022;104(1):7-8.

4.Begeny CT, Arshad H, Cuming T, Dhariwal DK, Fisher RA, Franklin MD, et al. Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. British journal of surgery. 2023;110(11):1518-26.

5.WPSMS. The Working Party on Sexual Misconduct in Surgery (WPSMS) 2022 [Available from: http://wpsms.org.uk/.

6.Mazzocco K, Petitti DB, Fong KT, Bonacum D, Brookey J, Graham S, et al. Surgical team behaviors and patient outcomes. The American Journal of Surgery. 2009;197(5):678-85.

7.Searle R. Sexual misconduct in health and social care: understanding types of abuse and perpetrators’ moral mindsets. 2019.

8.HCHS Doctors in Surgical Group Specialties, by Specialty, Grade and Gender, in England 2022 [Available from: https://digital.nhs.uk/supplementary-information/2022/hchs-doctors-in-selected-surgical-specialties-by-gender-and-grade-jun-22

9.T M. Number of women entering medical school rises after decade of decline. bmj. 2018:167.

10.WPSMS. BREAKING THE SILENCE: Addressing Sexual Misconduct in Healthcare. An Independant Report on Sexual Misconduct By Colleagues in the Surgical Workforce. 2023.

11.Council GM. Good Medical Practice. Contributing to a positive working and training environment 2024.