Harassment and intimidation in residency education are less likely to be swept under the carpet today, but experts who discussed the issue at a recent conference on residency education have concluded that much remains to be done before the problems are solved.
Dr. Donna Stewart of the University of Toronto told the Fifth Annual Conference on Residency Education that incidents of harassment still "nearly always go unreported because of the fear of negative consequences." This happens even though there are already numerous position papers and guidelines, and despite the fact that some faculties have policies and others include it in collective agreements. Noting that 75% of women and 20% of men report some type of harassment, she called for a national program that ensures fairness and confidentiality.
Dr. Peggy Ross, associate dean of equity at the University of British Columbia, regularly visits residency programs to explain behaviour that isn't tolerated. "Many people who harass don't know they are intimidating," she said. She thinks the worst offenders are relatively young physicians "who were harassed or intimidated during their residency and can hardly wait to dish it out. It's unprofessional, but that's the reality."
Stewart, who has a long-standing interest in the issue (CMAJ 1996;154:643-9; 1996;154:1021-5), says there are 2 main groups of perpetrators: young supervisors who don't see any difference between themselves and trainees, and mid- to late-life physicians who may be depressed or abusing substances.
Cathy Lace, legal adviser to the Professional Association or Internes and Residents of Ontario, said harassment and intimidation are not only ethical and accreditation issues, but also raise legal issues. Every province and territory has a human rights statute prohibiting discrimination in employment. Since universities and hospitals are legally bound to have a policy that is enforced vigorously, Lace said the legal liability is a serious issue. "Everybody has an obligation to act against harassment. Otherwise, the institution is vulnerable."