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We thank Dr. Satenstein for their interest in this important topic and completely agree that it is critical to have an appropriate investigation process that is transparent and objective when any harassment allegations are made. We also agree that there are different types of harassment and that their prevalence varies across studies, thereby highlighting the importance of conducting a systematic review on the topic.[1] Even if the lower limit of the confidence interval from this review is considered, we think that most people would agree that this prevalence is too high.
Since the systematic review was published in Academic Medicine[1], many studies have been published, with estimates of how common harassment is and we have provided references to but a few of these.[2-6] We agree that it is difficult to obtain accurate estimates of harassment because of the lack of sufficient safeguarding to protect those who do report concerns, thereby leading to significant under-reporting. We would also point to the 2018 report released by the National Academies of Sciences, Engineering and Medicine [7]. This latter report highlighted that harassment is reported to be a larger problem in medicine than in other disciplines including engineering.
Everyone brings conscious and unconscious bias into discussions; this is the reality of being a human being. We are encouraged by work from Carnes and colleagues illustrating how these might be addressed and hope that other researchers test strategies in such a rigorous fashion.[8]
We hope that we can move beyond discussing how common harassment is and move towards addressing how it can be mitigated. For patients to have optimal care, we need a safe, secure environment for all.
1. Fnais N, Soobiah C, Chen MH, Lillie E, Perrier L, Tashkhandi M, Straus SE, Mamdani M, Al-Omran M, Tricco AC. Harassment and discrimination in medical training: a systematic review and meta-analysis.<https://www.ncbi.nlm.nih.gov/pubmed/24667512> Acad Med. 2014 May;89(5):817-27.
2. Llewellyn A, Karageorge A, Nash L, Li W, Neuen D. Bullying and sexual harassment of junior doctors in New South Wales, Australia: rate and reporting outcomes. Aust Health Rev.<https://www.ncbi.nlm.nih.gov/pubmed/29448972> 2018 Feb 16. doi: 10.1071/AH17224
3. Crebbin W, Cambell G, et al. Prevalence of bullying, discrimination and sexual harassment in surgery in Australasia. ANZ J Surg 2015; 12:905-9.
4. Venkatesh B, Corke C, Raper R et al. Prevalence of bullying, discrimination and sexual harassment among trainees and Fellows of the College of Intensive Care Medicine of Australia and New Zealand. Crit Care Resusc 2016;18:230-4.
5. Siller H, Tauber G, Komlenac N, Hochleitner M. Gender differences and similarities in medical students' experiences of mistreatment by various groups of perpetrators. BMC Med Ed 2017;17:134. Doi:10.1186/s12909-017-097404.
6. Jagsi R, Griffith KA, Jones R e tal. Sexual Harassment and Discrimination Experiences of Academic Medical Faculty. JAMA 2016;315:2120-1.
7. National Academies of Sciences, Engineering and Medicine, 2018. Sexual harassment of women: climate, culture and consequences in academic sciences, engineering and medicine. Washington, DC: the National Academies Press. https://doi.org/10.17226/24994.
8. Carnes M, Devine PG, Baier Manwell L et al. The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomised controlled trial. Acad Med 2015;0:221-30.