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AN expert advisory group set up by the Royal Australasian College of Surgeons is due to release the results of its investigation into bullying and discrimination in October, but the college has already made changes to its complaints system to better support victims. (1)
Mr Graeme Campbell, advisory group member and vice-president of the Royal Australasian College of Surgeons (RACS), told MJA InSight that “we used to think that a complaint could be dealt with directly by the employer, but this is too simplistic and people fell between the cracks”.
The expert advisory group was established earlier this year after senior vascular surgeon Dr Gabrielle McMullin told a meeting that complaining about sexual harassment could ruin a trainee's career. (2)
The RACS has now developed a more centralised process for dealing with complaints, which includes a dedicated hotline for complainants to call to speak to a lawyer, who will personally manage their complaint, Mr Campbell said.
He hoped this process would foster a collaborative response to complaints, and encourage more people to put their trust in the system.
Mr Campbell was commenting on an MJA “Perspectives” article by Professor Merrilyn Walton from the University of Sydney, who argued that more enlightened teaching would go a long way to addressing sexual inequality and harassment in medicine. (3)
Professor Walton wrote that while gender-based discrimination and harassment were common challenges faced by women in many workplaces, in medicine there were additional constraints, particularly in surgery.
“Surgery, with its roots in the male apprenticeship model, may underappreciate female learning styles, which can lead supervisors to think female trainees lack commitment or are not cut out for the job, leading to women being belittled, excluded and bypassed on the basis of incorrect assumptions about skills and knowledge.”
It was especially important to nurture female surgeons to become clinical supervisors, and to encourage female surgeons to teach and be involved in mentoring programs, Professor Walton wrote.
She said college policies on harassment and discrimination must be accompanied by strong action by college representatives when instances were brought to their attention.
“That men and women have inherently different characteristics and learning styles is now well established; the next step is to explicitly acknowledge these differences in the design of medical education”, she wrote.
Dr Danika Thiemt, chair of AMA Council of Doctors in Training, told MJA InSight that to date, there was very little verified data regarding the nature of gender-based discrimination in Australian medicine.
“Anecdotally, the numbers are high and from the perspective of doctors–in-training, trainees do feel that gender [contributes to discrimination]”.
Dr Sharon Tivey, president of the Australian Federation of Medical Women, told MJA InSight that discrimination in a learning environment could go “almost unnoticed by the perpetrator and the victim — it is just how things are”.
Professor Nicholas Glasgow, president of Medical Deans Australia and New Zealand, told MJA InSight that while all members of his organisation were united in their wish to eradicate discrimination from medical education, “the difficulty is making this message a reality”.
Professor Glasgow said the best suggestion made by the MJA article was the nurturing of female clinical supervisors.
“Across all industries, it’s important to have [appropriate] representation of women and to have strong women contributing to the shaping of culture.”
He said that as a medical dean, it was very difficult to support students affected by discrimination and bullying in the current system of “natural justice”, where a person who makes an allegation must provide their name, which is then disclosed to the alleged perpetrator.
“This is very scary when there is a power discrepancy [between the victim and the perpetrator].”
Dr Tivey said the medical community must consider better ways of dealing with the authority figures responsible for the discrimination.
She said many women doctors considered this as a major issue, with many examples of perpetrators being promoted and the victim left without a training position or a job.
Dr Thiemt agreed, saying “an external body is needed to report [cases of discrimination and harassment] without the fear of retribution”.
Mr Campbell said the RACS’s new centralised complaints system would be externally monitored, and regular independent reports would be provided to the college on how effectively complaints were being managed.
He said that while serious cases of sexual harassment would be referred to the police, “the majority of other complaints are amenable to non-prejudiced mediation sessions”.
Dr Thiemt said it was significant that the RACS was taking the lead on this issue, considering that surgery is a heavily male-dominated specialty.
However, she said that true change could only happen with the “emphatic involvement of all clinicians across every field”.
(Photo: Photographee.eu / shutterstock)
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Two Way Street – I think most people would agree that the majority of surgeons, or any other doctor, are of good character and opposed to the behaviours that are discussed in the article. The problem is that even one “bad apple” comes into contact with many junior doctors and can reek havoc on junior doctors’ careers. If something is said, the behaviour of the “bad apple” is often overlooked by their peers and hospital due to many reasons including difficulty in recruiting a replacement, fear of litigation for slander, inflamming the behaviours and having them redirected to others. If there was an anonymous end of rotation assessment that was kept by the Colleges and/or for all supervisors as well as junior doctors, then persistent behaviours would be identified. This would not be a guilty until innocent scenario, but would allow hospital superiors or leaders in the Colleges to investigate as to why this pattern of poor assessments is occuring. I have filled out countless assessments of junior doctors. Yet, I have no idea if any are assessing ME and my interactions with the junior doctors, nurses, allied health, AOs, etc. If there is some form of 360 degree assessment, I have never seen the results. Thus – the incorporation of 360 assessments for everyone, consultants included, that are anonymous to the assessed person and are a compilation of the outcomes would help identify these behaviours in the most non-threatening way. It is time that such a system is enacted. Doctors of good character, who are hard working and also good teachers do not need to fear this type of assessment – however, those who do not have these characteristics would be weary of its implementation.
Julian – I do not see how the above comments seek to justify poor behaviour ! They are a very real flip side to the article. Unfortunately there have been and will be cases of unacceptable behaviour and I strongly support attempts at justice. However, I think the big majority of surgeons are of good character, dedicated and hard working. A complaint system that lacks transparency which can put someone in a “guilty until proven innocent situation” due to secrecy is sinister, vulnerable to manipulation and wrong. Can we really risk reputations and the well being of good Fellows ? In the time it takes for RACS to investigate and get to the truth of an allegation a lot of stress can occur and reputations dented. RACS must take care of its rank and file too.
The comments to this article are quite concerning.
Half of them are irrelevant, and the remainder seek to somehow excuse poor behaviour by doctors.
The problem is exactly as the review and article suggests, and the starts from the second rung on the hierarchy in medicine – the struggling, overworked new registrar, and continues to and includes AHPRA and the Medical Boards, none of whom are competent or reasonable.
It’s difficult balancing a doctor’s authority and responsibility with humility, and for some reason senior doctors often fail.
Let’s not let other imperfections in the workplace detract from the need to work on this issue. Of course there are other issues – but do those other issues mean we should not work to minimise gender-based discrimination? Nobody is saying that only female specialty trainees need justice and fairness. We should work towards fairness and justice for all concerned – the supervised AND the superviors (remembering, of course, that supervisors do have the greater power). It is, however, a legitimate strategy to work on individual risk groups separately, but in parallel.
Any commenters here who feel that their cause has been neglected can also work towards a solution – write something, make a presentation, set up your own study or survey, then propose solutions.
In terms of a just and safe process for supervision of the struggling trainee goes, the more evidence, the better. The most vulnerable supervisor-supervisee pairs are those where there is a single supervisor, little documentation, and failure to address difficult issues untilt the final assessment. If the trainee appeals – as is their right – a strong case can be defended (multiple supervisors, good documentation, evidence of attempts to address deficits constuctively).
Medical training and management is suffering from the same type of risk-aversion and micro-management that is afflicting clinical practice. Common sense, wisdom and humanity are often left behind.
While I accept that gender based discrimination occurs in every workplace ( and this includes anti-male bias in areas such as primary school teaching, social work and nursing) it is very easy to play this card when a trainee is criticised or fails an attachment. Some years ago my colleagues and I were accused of racism and sexism after failing an overseas trained female doctor working as an intern, who simply was not competent. This assessment was made extremely carefully and reluctantly, after several non-fruitful counselling sessions with the intern. We were later called before the Medical Director of the hospital to answer these unfounded accusations. We had followed the correct protocols and the complaints were discounted. Over forty years in the system I have seen bullying and harrassment but it has been minimal overall, and in one case a female doctor sexually harrassed a number of male colleagues. I am not minimising the problem, just putting the other side of the argument.
We all know of people who have fallen through the cracks. The problem is that for many to seek redress is too difficult, depressing and dangerous to careers. Hospital administrators are usually disinterested if not actively hostile to the suggestion that they harbor sociopathic cuckoos and will do anything but help the hapless victim of such pathological personalities.
It is not just juniors who are victimized. All it takes is one malignant administrator, medical or nonmedical and a well established and productive career can be all but over.
I know of a number of very capable senior specialists, all very impressive individuals, who suffered just such a fate. In all cases the colleges were either very unhelpful if not actually an active part of the problem. Neither is it just colleges. It is often so called intelligent and, one assumes, caring colleagues who wittingly or witlessly provide ‘evidence’ and ‘findings’ that are used by such hospital administrators, The Medical Board and even VCAT, to support their duplicity. All in the name of “standards” of course, on the word of specially selected witnesses. Lives, personal, professional, family and extended, have been irreparably damaged in the process of these various malignant events
Do we need more commissions to obtain redress for these unfortunate people? When ?
Complaints (harrassment) are not only made against the young. I have been subject to criticism by a Junior Regstrar because of my age and ?confusion and ended up retiring prematurely from Queensland Health as an Emeritus Consultant, and I am a Child Psychiatrist not a Surgeon. The Medical Board exercises poor support and in fact does not follow the principal of examination clinically by one’s peers .
What protection do trainee supervisors have from a vindictive accusation of harrasment or bullying that may arise from failing a trainee ? It is important that supervisors have the support to fail unsatisfactory trainees without fear of having to defend such allegations brought about by the bruised ego or lack of insight by the poor trainee. During the time it may take RACS to investigate and clear a supervisor, damage to reputation may occur. It would be of most concern if supervisors felt it safer to just pass a poor trainee rather than risk having to defend vindictive allegations. This form of retaliation by a failing trainee DOES occur. Alternatively, the failing trainee attacks the supervisor whilst socialising with other registrars without making a formal complaint. How can RACS support a supervisor in this situation ? I have witnessed this situation which can be very distressing, especially when there is no support from RACS. I am also concerned, under the proposed system, that a supervisor can find him/herself in a “guilty until proven innocent” situation, as can happen in PC practices at Universities in which both the allegations and identity of the accusor are kept confidential from the accused, leaving the accused in a very stressed state. It is important that any new system remember its Fellows.