Trainee Development and Wellbeing Service
We all have a responsibility to tackle bias, discrimination and sexual harassment in healthcare. Repeated studies have demonstrated that this occurs in all professional and specialty groups and in every Scottish Health Board area. Up to 60% of our female doctors in training experience sexual harassment during training and many are victims of sexual assault. Although men are less likely to be victims it can still happen to them. People from minority groups are even more likely to be subject to sexual misconduct.
As educators and leaders, we are central to effecting change in two fundamental ways. Firstly, by role modelling appropriate behaviour at all times which includes intervening when we see, or hear about, unacceptable conduct. The second important role is being able to act correctly when someone comes to us to disclose that they have been subject to sexual misconduct. The following information is intended to help us manage these situations as well as possible.
Recognise
Individuals impacted by sexual harassment or assault may experience or express unhappiness or distress about work and may demonstrate aspects of burnout.
Sexual harassment is defined as unwanted behaviour of a sexual nature.
Sexual assault is defined as sexual touching or behaviour without consent. Consent in a hierarchical relationship can be subject to feelings of coercion or fear. Alcohol and recreational drugs can be involved in situations of an abuse of trust.
There is a wide range of inappropriate behaviours which may occur between colleagues. Making sense of upsetting events can be difficult and errors are common due to assumptions about victim blaming, cultural norms, denial, dismissal and reinterpretation. Incorrect initial assumptions can have a devastating effect on individuals, team culture and patient safety.
Listen and validate
Give space and time for individuals impacted to relay their account to you. Avoid active questioning and challenging. Consider how to create a safe space to listen – offer a chaperone or ask the individual if they would like to bring someone with them.
The following responses may be helpful:
“I am glad you have told me this.” People worry about the impact of sharing their story. It is reassuring to say that you are glad the person has felt able to share with you.
“This is not your fault.” Being sexually harassed or assaulted is never the fault of the person to whom it happens. We should be able to expect that those in a position of trust behave in an ethical, professional and trustworthy way. This includes behaviours out with work and at social events.
“I take this seriously.” All examples of poor maintenance of professional boundaries including sexual banter can lead to animosity and mistrust between colleagues and a dysfunctional culture which poses risks to patient safety. All of us have a right to a workplace free of discrimination, bullying and sexual harassment. A culture of civility and respect benefits all staff and enables professionals to work together more effectively improving outcomes for patients. A default position of belief in what is being disclosed is reasonable and false accusations are rare.
“I am here if you want to tell me more but you don’t have to. We could think together about what expert support we can get for you.” Questioning can be intrusive. People who have experienced sexual harassment or assault may not want to repeat their story multiple times. This may not be the right time and you may not be the right person. If the doctor in training wishes to make a formal report consider supportively involving those with responsibility including the employer, regulator and the law.
“It is your choice whether you report this any further. Having said that, I have a responsibility to act if I think that you, or anyone else, is at risk of serious harm or if I think that a colleague may not be fit to practise.” It is crucial that the person who has experienced the sexual misconduct is in control of decisions about information sharing. But you have safeguarding responsibilities towards children and vulnerable adults and duties of public protection. Decision about sharing information without the consent of the discloser can be complex. Any decisions should be made in consultation with appropriate senior colleagues and with consideration of seeking expert advice.
Support and reassure
Acknowledge that sexual misconduct is not rare, is not new, is not harmless and is always unacceptable. It can be helpful to reinforce that the doctor in training is valued, has an entitlement to feel safe in their career and is deserving of the best support we can offer.
Signpost to professional support via the Trainee Development and Wellbeing Service which has an extensive landing page linking to resources and support for doctors in training subject to sexual misconduct.
It may be helpful to look at this resource with the doctor in training to support them to access the most helpful content to them. Reassure that these resources can be accessed independently without any requirement to proceed formally or notify anyone else at work.
In the case of a disclosure of serious sexual assault, consider seeking advice together from the Sexual Assault Response Coordination Service (SARCS) which can be found via the TDWS page or from an online search. This is available 24 hours a day.
Consider how to facilitate training and personal development for the doctor in training. This is helpful in restoring the ability to function and thrive at work.
Ask the doctor in training if they currently feel safe in their place of work and ensure steps are taken to address relevant factors if not.
Act
Keeping a record: Record any concerns shared with you. Record your actions including signposting to support and any advice given. Document any decisions taken between you and the doctor in training. Document any discussions you have with other colleagues. This helps to prevent problems where “everyone knows and nobody tells”.
Disclosure only without formal reporting: The person may gain benefit from having been able to tell you and having been listened to. They may feel unable to share their story with anyone else. They may be unwilling to put themselves at perceived risk if they are identified. Their confidentiality should be respected with all necessary action taken to protect their identity. This could mean that no further action can be taken at this stage. Leave your door open for further discussion. For some people the journey of disclosure is slow and long and they may only feel confident to report formally to you or to someone else later, sometimes after several years. This is recognised in the GMC framework. You may however have a professional responsibility to report (see below)
Reporting: Remain aware that you have a professional responsibility to report if you think that the target or anyone else is at risk of serious harm or if you think that a colleague may not be fit to practise.
Support for people receiving reports
Receiving a report of sexual harassment, assault or misconduct is likely to be a stressful event. You can seek support from the your trade union/Employer/Deanery, colleges and medical indemnity provider. If you feel unable to treat the report impartially, perhaps because you know, or work closely with the person accused you should pass the concern on to an appropriate person or team after explaining why to the discloser. Keep a written record of your actions and the information you have passed on.
Sexual misconduct towards colleagues can impact patient safety in several ways. It may result in burnout with direct implications for the doctor’s ability to deliver care. A team may be dysfunctional where there are toxic behaviours and passive bystanding is common. Patients have poorer outcomes when looked after by dysfunctional teams. If you feel obligated to escalate a disclosure due to safety concerns you should tell the discloser that you are taking this step and explain why.
All of us as educators must ensure that we seek training to manage these situations as well as we can. Please ensure that you have undertaken the following as part of your learning and share effective learning with each other:
Active Bystander and unconscious bias (or equivalent)
Managing sexual harassment as line managers
Guidance for managing doctors in training or trainers accused of sexual misconduct
It is recognised that this will be a very traumatic event for those accused. Doctors in training must disclose any accusations made against them to their TPD/FPD and be encouraged to meet and discuss the situation. Doctors in training should be encouraged to access TDWS which will offer non-judgmental support during the process.
While it is appropriate to presume innocence until proven otherwise it is also reasonable to discuss strategies to support all parties which might include altering placements or work patterns or agreeing time off to avoid interaction between parties. A judgement should be made about the doctor in training's ability to continue to work safely due the stress of the situation. Any decision to suspend a doctor in training can only be made by their employing Board and is not a decision for NES. If a doctor in training is suspended the ES and/or TPD should ensure the doctor is referred to TDWS and has an ongoing link person with NES. This can be their TDWS case handler, ES or TPD as long as none of them are involved in the formal conduct process.
The meeting between TPD and an accused doctor in training can be treated in confidence unless something is disclosed which suggests a risk to the safety of colleagues or patients or the ability of any party to work safely. This should be explained at the start of a meeting.
If a trainer (CS, ES, TPD, APGD) is accused of sexual misconduct they must disclose this to their line manager. In the case of ES,CS this is their Clinical Director/AMD. For TPDs and APGDs this will be to their NES line manager. A meeting should be held with the NES line manager to discuss support and mitigations to ensure that they and their doctors in training are safe. This may include the need to alter doctor in training allocations or temporarily step down from training duties to avoid any risk of conflict of interest.
Further resources
Working Party on Sexual Misconduct in surgery https://www.wpsms.org.uk/
https://www.wpsms.org.uk/Identifying and tackling sexual misconduct - ethical topic - GMC
New GMC resources to support victims of sexual misconduct by doctors - GMC
allegations-of-sexual-misconduct-support-for-employers-and-responsible-officers_pdf-108558475.pdf
This page was last updated on: 27.11.2024 at 13.20
