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Is Neurology Having a #MeToo Moment?

Response to NASEM Report on Sexual Harassment in Science and Medicine

Shaw, Gina

doi: 10.1097/01.NT.0000544499.32835.09
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A new report from the National Academies of Sciences, Engineering, and Medicine suggests that sexual harassment greatly impacts women in medicine and science. Women neurology leaders talk about the climate in their own institutions and how they are addressing these issues.

The social media hashtag to promote the release of a report on sexual harassment of women in science in late June was #ScienceToo, not #MeToo. But the message is largely the same. Accounts of sexual harassment and assault, which have rocked nearly every industry from entertainment to broadcast journalism, is prevalent in science and medicine.

Indeed, nearly half of all female medical students said they experienced some form of sexual harassment, and female medical students were more than twice as likely as women who were not science, engineering, and medicine majors to experience such harassment, according to the National Academies of Sciences, Engineering, and Medicine (NASEM) report, Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine, released in late June.

The NASEM report described medical residencies as “breeding grounds for abusive behavior by superiors” in interviews conducted by the nonprofit organization RTI International, which formed part of the report.

“Respondents expressed that this was largely because at this stage of the medical career, expectation of this behavior was widely accepted. The expectations of abusive, grueling conditions in training settings caused several respondents to view sexual harassment as a part of the continuum of what they were expected to endure,” the report noted. One non-tenure-track faculty member, whose specialty was not indicated, commented that residency training exposed most trainees to human rights violations. “So, it's just like tolerable sexual harassment,” she said.

The report dug deep into the available evidence on the issue, noting that some of the most rigorously collected data comes from ARC3, the Administrator Researcher Campus Climate Collaborative, which grew out of a forum on campus sexual harassment at Georgia State University.

ARC3's comprehensive survey instrument on sexual misconduct has been used by at least 150 institutions of higher education to measure their campus climate regarding sexual harassment. The survey broke down sexual harassment into several subtypes, including gender harassment (sexist hostility and crude behavior), unwanted sexual attention, and sexual coercion.

Two of those institutions, the Penn State University and the University of Texas, evaluated all campuses in their systems, and thus had a large sample of data across multiple fields. They found that gender harassment was the most common form of sexual harassment and that women were sexually harassed more often than men.



The overall rates of sexual harassment for students at these two university systems ranged between 20 and 50 percent; medical students and residents reported significantly higher rates of sexist hostility and crude behavior than did science, engineering, and non-STEM majors, although unwanted sexual attention and sexual coercion appeared to occur at about the same rates across majors.

The report did not address neurology specifically, but it noted that research examining different specialties in medicine found that female physicians in specialties that are historically male dominated are more likely to be harassed than those in other specialties, but only when they are in training. “Once they are out of their residency and in practice they experience harassment at the same rates as other specialties,” the report said.

This harassment is unlikely to be reported to anyone in authority, largely because going through this process is perceived to be futile if not counterproductive or detrimental to a woman's career.

A 2015 report by the American Association of University Women found that while almost half of students who experience sexual harassment confide in a friend, only 7 percent report the incident to a college employee. Results from 2016 ARC3 survey at the University of Texas found reporting rates that were even lower: Only 2.2 percent of all students who experienced sexual harassment reported it to the institution, and 3.2 percent disclosed the experience to someone in a position of authority at the institution.

An account from one of the RTI interviews offers insight into why this is so. “My program director pretty much left it up to the site director, who told me that I sounded just like his ex-wife, who we all know he hates, and that maybe if I stopped whining so much I would have more friends. So, they basically blew off the report then. And then he — the one I reported it to — started giving me failing grades.”



The NASEM report suggested that academic institutions create diverse, inclusive, and respectful environments; address gender harassment as the most common form of sexual harassment; improve transparency and accountability; and move beyond legal compliance to address culture and climate.

It is not necessarily that the problem does not exist in neurology, several women neurology leaders told Neurology Today. It's that few women are willing to discuss or report it. [In fact, Neurology Today reached out to a large number of women leaders but only a few were willing to discuss the issue. And the one female neurologist who agreed to talk about her own experience would only agree to speak anonymously.]

Robin L. Brey, MD, FAAN, professor and chair of neurology at The University of Texas Health Science Center in San Antonio (UT Health San Antonio), did want to talk. She said she read the nearly 300-page NASEM report cover to cover. It immediately reminded her of a conversation she had during one of her regular lunches with UT Health San Antonio neurology residents in early 2018. She asked if any of them had experienced harassment in their work based on their gender or race.

“Every single one of my women residents said they had experienced sexual or gender harassment,” she said. “Most of what they described came from patients or patients' families — comments about their appearance, suggestions that they aren't really competent, or being told something like, ‘You can't be the doctor if you're a woman. I want a real doctor.’”

But when she saw that nearly half of all female medical students at UT Health San Antonio had reported experiencing some form of sexual harassment, Dr. Brey was shocked. “I honestly have to say that I didn't have any idea that things were that bad,” she told Neurology Today. “At that lunch, we hadn't really talked about what may be coming from peers or faculty, and I hadn't had any reports brought to me by residents about sexual harassment. But as the National Academies publication points out, the vast majority of this goes unreported.”

Dr. Brey said that the university's Title IX director has convened a diverse group of 22 members (from more than 200 volunteers) for a Campus Climate Task Force on Sexual Harassment, requested by UT Health San Antonio's President William Henrich, MD, in the wake of the new data.

“At this point, no one from neurology is specifically on the task force, but I have let them know that I'm very interested in being involved in any activities or projects they undertake,” Dr. Brey said. “The biggest take-home message for me was how important the culture of an institution is. The term they used is a culture of civility, and I just love that. If you can create a civil culture, a whole lot of things that make people uncomfortable in a work environment — gender, race, ethnicity, socioeconomic status — will be made better.”



Ann Tilton, MD, FAAN, clinical professor of neurology and pediatrics and chief of the section of child neurology at LSU Health New Orleans School of Medicine, praised the NASEM report as “organized quite well to address a number of the things that many of us have been perceiving, with the science to back it up.” But, she said, she believes that the culture of a children's hospital may be less likely to foster sexual harassment than in other institutions.

Kathleen Shannon, MD, FAAN, FANA, professor and chair of neurology at the University of Wisconsin-Madison, agreed with the NASEM report's conclusion that complaint-driven systems are likely to miss many cases of sexual harassment.

“We need to move to a less complaint-driven system,” she said. “Many people feel nothing will be done or that they will experience retaliation. We've heard things from bystanders who've witnessed behaviors and come forward, but when you go to the person, they don't want to go on record.”

Dr. Shannon noted that responses to University of Wisconsin's departing medical student survey sometimes include complaints about sexual harassment and grades affected by gender. “But at that point, of course, we can't go back and identify the harassed individuals or their harassers,” she said. “We need an institution-wide effort to get this kind of information in real time.”

[Indeed, in one of his last emails to Neurology Today in response to a story about challenges for women researchers in academic neurology, “The Leakiest Pipeline: All Too Few Women Get to Run Their Own Neuroscience Labs,” neuroscientist Ben Barres, MD, PhD, who died in December, wrote: “Another barrier that women in training continue to confront is sexual harassment. This is very widespread but there are not a lot of data. But nearly every women trainee I meet tells me that they cannot go to a research conference...without being hit on (sometimes many times in one meeting) by senior males (for example, faculty attending the meeting).

“One famous male neuroscientist about my age (I am 62) brags about having bedded 200 trainees at these meetings in his career,” Dr. Barres wrote. “I have been pestering these meeting halls over the past few years to put in place sexual harassment policies, and Gordon and Keystone have done so.”]

The NASEM report noted that some research has suggested that sexual harassment and gender discrimination may be more common in academic medical centers than in community hospitals and the outpatient office setting. But one neurologist in private practice in Texas, who asked that her name not be used, shared her own experience of sexual harassment with Neurology Today.

“When I first started practice about a decade ago, I joined a group with two male neurologists who had been in practice for some time,” she said. “The older of the two was an inappropriate person in general, and didn't have good boundaries. He pushed everything as far as he could with off-color jokes and comments. Over time he got more outrageous and started watching porn in his office, on his desktop computer that was facing the hall. After this went on for a few days, I told my other partner about it, and he said nothing could be done. I reached out to the administrator and she promised to talk to him and get it under control, but again, nothing was done. Finally, I wrote him a letter and left it on his desk, and two days later he rearranged his office so we couldn't see the monitor anymore.”

The doctor finally left the practice a year or so later for unrelated reasons, and the female neurologist in his practice told Neurology Today that she always felt like it was “not that bad of a story. It's something a lot of women have dealt with. But nothing is worth being degraded in this way. If more people can find the confidence to speak up and say that this behavior isn't tolerable, and it isn't just ‘boys being boys,’ things might change.”



Dr. Brey said she had planned on introducing the issue with her new incoming neurology interns in July. “One very important message from this report is that we have to ask,” she said. “If I hadn't asked my residents that question at lunch, they never would have told me about what they were experiencing with patients. We need to ask these questions in an environment where they feel safe to answer honestly and freely, and we need to make sure they believe that we will listen to them, and take them seriously. We have terrific guidelines, but guidelines are not enough unless our students and residents know we're willing to enforce them. Our job is to convey to them that we will.”

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•. National Academies of Science, Engineering, and Medicine. Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine June 2018.
    •. Avitzur O The Leakiest pipeline: All too few women get to run their own neuroscience labs Neurol Today 2017. 17(3): 1,18–20.
      © 2018 American Academy of Neurology