When the National Academies of Sciences, Engineering and Medicine issued its report on sexual harassment in the field, leaders at Michigan Medicine knew they must take action.

As the #MeToo movement branched into a #MedToo movement, a team of physicians and social scientists at the University of Michigan looked at how they could apply the gold-standard measurement tool for sexual harassment, which medicine has not previously adapted.

They adapted a rigorous, validated measure of harassment and its consequences – already widely used by social scientists – and applied it to a medical setting. And they started by surveying their own Medical School faculty.

"Our view was we could pretend it wasn't happening or we could actually ask about it. Rather than trying to sweep it under the rug, we will lead the way and ask the questions," says Carol R. Bradford, M.D., M.S., executive vice dean for academic affairs at the U-M Medical School and chief academic officer for Michigan Medicine.

The June 2018 National Academies report equates sexual harassment with research misconduct and urges institutions to promote a culture of civility and respect. It also calls for more detailed research to understand the situation in medicine in particular. Limited information has been available specific to the medical community and what surveys have been done relied on short survey instruments known to underestimate sexual harassment.

"Comprehensive, well-validated measures already existed and were used in other contexts, within other types of organizations. We tailored those measures to the unique context of academic medicine," says study co-lead author Emily Vargas, Ph.D., then a doctoral student in psychology at U-M.

The survey tool walks through a series of behaviors that reflect all three types of harassment: gender harassment, unwanted sexual attention and sexual coercion. It leads participants through a series of questions to ascertain the nature of harassment that occurs, the characteristics of those most vulnerable, the extent it happens in various specialties and whether it comes from those within the institution or from patients and their families.

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"We thought it was important to be very detailed and extensive. Without information on the nature, frequency and settings in which sexual harassment occurs, we can't target interventions to eradicate it," says Reshma Jagsi, M.D., D.Phil., Newman Family Professor and deputy chair of radiation oncology and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan.

Jagsi is a national expert on gender equity issues within the medical profession. In 2016, she published a landmark JAMA paper defining the extent to which sexual harassment occurs in the modern academic medical environment. She is also the corresponding author of a new paper in the Journal of Women's Health describing the results of the U-M survey.

SEE ALSO: Improving Equity in Academic Medicine, a Conversation with Christina Chapman, M.D.

First, a warning: "When you use this survey instrument, no organization is going to look good," Jagsi notes.

"U-M as an institution was not having extraordinary problems and was not an outlying institution by any means," she says. "But we happen to have investigators interested in advancing knowledge and progress in this area – and leaders willing to be brave enough to support it. As an institution, we were very aware of the National Academies' recommendations and very eager to continue to be on the leading edge in terms of making progress."

The 20-minute online survey was emailed to all 2,723 Medical School faculty, with endorsement and encouragement from Bradford and Marschall Runge, M.D., Ph.D., executive vice president for medical affairs and dean of the U-M Medical School.

"Sexual harassment is a critical issue in the medical profession that we must address. By engaging our faculty and seeking their input, we can better understand what needs to be done and hold ourselves accountable for improving our climate," says Runge, who is also CEO of Michigan Medicine.

The survey results were not favorable, but reflect what Bradford calls the "messy space" – that point where people are aware of a problem but haven't finished executing strategies to change it.

"We have work to do. Awareness of the issue and understanding the specifics of the issue are the first real steps in moving the needle. It takes courage. Sexual harassment is a real issue that we have to address," Bradford says.

The survey found 82% of women and 65% of men reported at least one incident of sexual harassment from someone within Michigan Medicine within the past year, most commonly gender harassment. In addition, 64% of women and 44% of men reported harassment from patients or patient families.

SEE ALSO: What Happens When the Patient Is the Harasser?

"We knew based on the National Academies report that sexual harassment is a big problem in medicine. Michigan Medicine is no different from any academic medical center in the United States. Our survey results are likely representative of other academic medical centers across the country," says Timothy R.B. Johnson, M.D., Arthur F. Thurnau Professor and professor of obstetrics and gynecology and of women's studies at U-M. Johnson was part of the National Academies report and a study team member on the U-M survey.

"This was an important partnership that brought to bear a tool widely used by social scientists and applied it to the medical workplace," says study team member Lilia Cortina, Ph.D., professor of psychology, women's studies and management, who was also an author on the National Academies report.

"By acknowledging this gap and the inconsistent measurement in previous studies of sexual harassment in medicine, our team is pushing the medical field to more accurately measure this problematic phenomenon and recognize the utility in collaborating with social scientists," adds Sheila Brassel, M.S., co-lead author on the paper and doctoral student of Isis Settles, Ph.D., professor of psychology and Afroamerican and African studies, who was also on the study team.

Since the National Academies' report, U-M leaders at both the Medical School and university level have begun several specific programs to improve the culture. In fall 2018, the university launched a centralized website devoted to sexual misconduct reporting, prevention and education. "We have always had opportunities to report sexual harassment, but now we're raising awareness and making reporting easier," Bradford says.

The university has also contracted with the Center for Research on Learning and Teaching, a U-M group that uses performance modules to facilitate learning and spark dialogue. They have created a daylong workshop designed to support academic leaders in developing the knowledge and skills to cultivate climates that are resistant to sexual harassment.

At the Medical School, leadership has identified and implemented best practices in faculty searches, with an eye toward broadening the talent pool and increasing diversity, including gender diversity. More than 7,000 faculty and staff have participated in unconscious bias training. The school has also begun offering bystander training to help people feel more comfortable speaking up when they witness something uncomfortable.

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Bradford has required all department chairs to put forward plans around civility and wellness. She says this has resulted in a variety of creative and innovative approaches to improve the culture.

Notably, for the first time, the Medical School's annual survey of graduating students showed an improvement in ratings of faculty professionalism.

But it's not only about holding faculty responsible. In order to also hold patients and families accountable for their actions and attitudes, Michigan Medicine incorporated into its Patients' Rights and Responsibilities language about patients respecting Michigan Medicine personnel, another recommendation from the National Academies report.

"We're starting to move the needle," Bradford says. "We all have to hold ourselves accountable."

Jagsi says as she speaks on this issue at institutions across the country, many have expressed interest in implementing the survey among their faculty. The researchers have made the survey instrument available to other academic medical centers who would like to gain a better understanding of their situation.

"Institutions can only address the problem when they understand the issues they face – and every institution is different," Jagsi says. "Work like this informs how we can best transform the culture and advance efforts here at Michigan Medicine. We hope that it will also help other academic medical centers to develop a positive path forward."

Paper cited: "#MedToo: A Large-Scale Examination of the Incidence and Impact of Sexual Harassment of Physicians and Other Faculty at an Academic Medical Center," Journal of Women's Health. DOI: 10.1089/jwh.2019.7766

This study was funded by the U-M Center for Bioethics & Social Sciences in Medicine, the Department of Obstetrics and Gynecology and the ADVANCE Program.