Combating sexual harassment in science and medicine

The number of women entering fields like science, engineering and medicine have been growing in recent decades. However, as women’s representation has grown in these fields, the incidence of bias and sexual harassment has kept pace, according to a recent National Academies of Sciences, Engineering and Medicine (NASEM) report.

As an institution with colleges of dentistry, medicine, nursing, pharmacy and public health, along with a growing partnership with the college of engineering, the Texas A&M University Health Science Center took particular interest in the findings of the report. Three Health Science Center leaders—Carrie L. Byington, MD, senior vice president; Amy Fairchild, PhD, MPH, associate vice president for faculty and academic affairs; and Lavern J. Holyfield, DDS, chair of the Diversity Leadership Committee—highlighted an imperative to address sexual harassment in the Journal of the American Medical Association and synthesized the National Academies’ recommendations.

The report identifies three categories of sexual harassment. First, there is unwanted sexual attention and advances. Second, there is quid-pro-quo behavior, or the coercing of sex in exchange for grades, professional advancement or a favorable review or, conversely, the threat of termination or other consequences if sex is withheld. These types of behaviors are generally already prohibited through laws and policies, but the report underscores that compliance is often not enough.

“Unfortunately, in many cases, an institutional culture of compliance with the law takes precedence over actually protecting women,” said Fairchild, who is also associate dean of academic affairs and professor at the Texas A&M School of Public Health. To address this, the university is taking 11 immediate actions to improve how it deals with Title IX investigations and sanctioning. These changes are the result of internal and external investigations launched earlier this year as a result of concerns about how the university handles reports of sexual misconduct. “The Health Science Center embraces the University initiatives and we recognize that some of our students are the most vulnerable,” Fairchild said. The National Academies report said that medical students are among the most likely to experience harassment.

Even a rigorous approach to preventing the most egregious behaviors can leave women vulnerable. That’s where the third type of sexual harassment comes in, harassment that systematically excludes or devalues women in various subtle ways. This kind of harassment may not be sexually explicit or against any woman as an individual. It falls below the level of explicitly illegal actions, but still has negative consequences for women. Therefore, this harassment can be more difficult to recognize and address. “There are often few institutional structures to deal with these subtler, more pervasive types of harassment,” Fairchild said. “Indeed, some of these are behaviors that many people wouldn’t have identified as even being sexual harassment, they are very common.”

Examples include off color jokes or remarks, failure to recognize the credentials of women physicians and scientists in professional settings, or suggestions that women with children aren’t as devoted to their careers as their peers.

“This is a public health problem right under our noses,” Fairchild said. “There is a vast amount of literature showing women who are subject to sexual harassment have higher stress levels that consequently have a big impact on both mental and physical health. The impact is worse for women of color and sexual minorities.” Sometimes this constant stress can lead to women leaving the scientific and medical professions entirely—and society losing their talents and hard-earned skills. Patients may also suffer, especially women who often feel more comfortable seeing female physicians, who only make up 34 percent of the physician workforce nationwide.

“This is part of a broader discussion about diversity and inclusion,” Fairchild said. “We need a fundamental structural change that involves elimination of harassment, achieving transparency, providing meaningful resources and ensuring accountability.”

Texas A&M Health Science Center defines diversity as the inclusion and support of individuals from all groups and encompasses the varying characteristics of persons within our community.  Each college within the Health Science Center strives to foster a safe, welcoming and nurturing academic environment.  Activities at the Texas A&M College of Dentistry, where Holyfield is the director of diversity and faculty development, are an example of our commitment to these values. The College of Dentistry has implemented many of the NASEM recommendations—and began long before the report was released. The college leadership team has an approved diversity and inclusion plan to shape the culture at the college and is in the process of fully implementing the strategy. One of the cornerstones of that strategy is mandatory diversity and inclusion training for every employee at the college. “So far, we’ve trained 429 faculty, staff and administrators, including all of our full-time employees,” Holyfield said.

The content of the training, which was developed based on the results of a campus climate survey, includes a discussion of why inclusivity and diversity are important and what they mean beyond race, ethnicity and gender. “We try to get them thinking about how their own beliefs and values impact their behavior, what biases and preferences they may have and not realize,” Holyfield said. “We also make it clear that no type of harassment or discrimination will be tolerated at the college and that there are serious consequences for habitually or egregiously belittling others through language or actions.”

However, creating an inclusive, harassment-free workplace may start even earlier, during the hiring process. That’s why the College of Dentistry has developed a tool for each department and administrative office to evaluate the scope of diversity within each unit. “We hope that this evaluation process will result in future searches that consider diversity when ultimately choosing the best candidate,” Holyfield said. “This kind of attention to diversity benefits all populations and helps us meet our core value of excellence.”

Texas A&M University core values are being uniquely emphasized at the College of Medicine as a platform for all faculty, staff and students to promote inclusivity. Amy Waer, MD, vice dean of education and academic programs, is spearheading efforts to create an updated learning environment that focuses on professionalism by celebrating outstanding acts of professionalism and positively addressing acts of unprofessionalism.

By positively engaging all members of the college to recognize and celebrate professionalism and inclusivity, it allows each individual involved with the college to advocate and be leaders in an era dedicated to ending sexual harassment and biases in medicine.

The next step is for the measures at the College of Dentistry and the College of Medicine to spread to the other colleges of the Health Science Center and to the institution as a whole for faculty, staff and students, and in concert with the efforts of the broader Texas A&M University.

“The problem of gender discrimination is one that institutions—including leadership, faculty and staff—have historically enabled through tolerance and perpetuated through the example set for students and trainees,” said Byington, who is also vice chancellor for health services at The Texas A&M University System and dean of the Texas A&M College of Medicine. “If the National Academies’ report is to rise above the din, powerful individuals in academic institutions must understand it as nothing short of a clarion call to action and a national priority in this era of widening health disparities. At the Health Science Center, we are committed to fostering a culture of accountability, inclusion, and transparency. Achieving our goals remains aspirational and our leadership, faculty, staff, and students are engaged in ongoing conversation that will continue as we evaluate the measures put in place.”

“The challenge is not to change belief, which ultimately you have no way of regulating, but to change behavior,” Fairchild added. “You can stop the behavior, and that’s our number one goal.”