Policy Document Sexual

Background

Definition The Australian Bureau of Statistics defines sexual harassment as “experiences or behaviours that an individual is subjected to which made them feel uncomfortable and were offensive due to their sexual nature” (1). It can encompass both physical contact, and verbal harassment, which may be written, and may be received through telecommunications or social media (2). Certain behaviours may constitute harassment even in situations where the individual did not intend for them to be offensive, but were nonetheless perceived as inappropriate by the victim (2). These behaviours can be used to assert power over an individual and degrade and humiliate them (1). Sexual harassment occurs as part of a continuum of and -based which have similar social and cultural underpinnings (3).

Prevalence There is limited research about the prevalence of sexual harassment in Australian medical schools. The majority of studies that have been published in this field are cross-sectional and reported prevalence relies on a subjective interpretation of the term “sexual harassment”, often in the absence of clear definitions. Furthermore, few studies report solely on sexual harassment and many do not provide primary data. (4)

Medical students are at risk of experiencing sexual harassment at all stages of their , including in the pre-clinical academic setting. The Australian Commission (AHRC) have reported that 51% of Australian university students were sexually harassed on at least one occasion in 2016 and have identified that young people, especially young women between the ages of 18 and 24, are at an increased risk of experiencing sexual harassment. Worryingly, 47% of students knew nothing or little about where to seek assistance and support. (5) Postgraduate students were identified as being almost twice as likely as undergraduate students to be sexually harassed by a lecturer or tutor at their university. (6)

As medical students transition to the clinical setting, they are also at risk of experiencing sexual harassment in the . The AHRC reports that 25% of women and 16% of men have experienced sexual harassment in the workplace in the past five years (7). A survey of 293 medical students from an Australian university conducted in 2000 reported that 37.9% had experienced some form of sexual harassment. (8) Female students were twice as likely as their male counterparts to have experienced sexual harassment and fellow students were the most common perpetrators. (8)

Recent media reports suggest that there are many instances of unwitnessed sexual harassment in the Australian medical workplace and that this behaviour is part of a broader cultural issue. (9) The Royal Australasian College of Surgeons (RACS) (9) and the College of Intensive Care Medicine of Australia and New Zealand (CICM) (10) have recently reported the prevalence of sexual harassment amongst their members as 7% and 3% respectively. The RACS Expert Advisory Group on discrimination, and sexual harassment acknowledged the propensity for incidents of sexual harassment to be underreported (9).

Studies from countries such as Canada (11), the Netherlands (12), Japan (13) and the USA (8,14) that sexual harassment is experienced widely by medical students from across the globe. A systematic review (4) about harassment and discrimination in medical training found 35 studies that reported on sexual harassment. 33.1% of trainees and 33.3% of medical students had experienced sexual harassment. The perpetrators of sexual harassment identified by Fnais et al. are overwhelmingly, though not exclusively, male (4). Consultants are the most commonly cited source. While patients also may be perpetrators of sexual harassment, it appears that colleague-related harassment may have a more significant impact on victims, as these colleagues often hold positions of power.

Given the lack of data, it may be appropriate to extrapolate the experience of medical students in the clinical workplace from the experiences of junior doctors. A recent study of PGY1 and PGY2 junior doctors in New South Wales and the Australian Capital Territory reported that 16-19% of junior doctors had been sexually harassed, including 29% of female participants. (15) Participants discussed the workplace normalisation of these behaviours, fear of reprisal and lack of knowledge of confidence in the reporting process. The authors suggest that interventions targeted at the level of junior doctors to improve the culture are unlikely to be helpful due to the systemic nature of the problem.

Further research is required to develop a clearer understanding of the nature and scope of the problem, the adverse effects and the potential targets for change. In particular, further research should examine the specific impact of sexual harassment on medical students in order to inform the development of effective prevention and management strategies.

Contributing factors and risk factors An ecological framework is useful to explore why some people are at a higher risk of sexual harassment than others. Medical students bring their own personal history and behaviours into their day-to-day interactions at university and in the clinical setting. In studies of sexual harassment, several factors are found to increase the vulnerability of an individual, including gender and . (4,16)

Women are more likely to experience sexual harassment than males in the medical workplace (17) and the literature suggests that an entrenched culture of pervades medicine (15). In the systematic review by Fnais et al., 12 studies reported a statistically significant higher prevalence of sexual harassment amongst female trainees. (4) Often these women stay silent for fear of being viewed as overly sensitive or “complainer[s]” (18) and are at risk of experiencing post-traumatic disorder, and depression as a result (19).

LGBTIQ students represent a marginalized group in medical school and LGBTIQ physicians have reported verbal harassment, derogatory statements, inferior treatment, and refusal of privileges based on their sexual orientation (16). LGBTIQ students not only feared disclosing the harassment they may have experienced, but also reported feeling uncomfortable regarding their sexual orientation (16).

Additionally, non-white racial groups are at greater risk of sexual harassment in predominantly Caucasian countries. (20) Discrimination towards Indigenous medical students is prevalent, showing in various forms such as “blatant racism”, negative expectations from non-Indigenous peers and faculty members, as well as derogatory comments. (21) Such forms of harassment have prevented these Indigenous medical students from seeking out support or even reporting harassment (21).

Understanding these broader patterns of discrimination, power and privilege provide a context for the occurrence of sexual harassment at university and in the clinical environment. The competitive medical environment contains established hierarchies, power imbalances and gender stereotypes that have enabled the institutionalisation of bullying and harassment (22). Medical students readily accept this culture in order to begin their professional . (23)

It is important to acknowledge the powerful influence of on learning outcomes for medical students under the existing system of “patronage”; (23) Medical students, whose professional advancement may be threatened by reporting unwanted sexual advances, especially by consultants (22,24), often let unprofessional actions go unreported in order to retain access to educational and professional opportunities (15).

This notion is further supported by evidence from an Australian study (25) which highlighted that of inappropriate actions are identified, vilified, and often denied further professional advancement. Furthermore, logistical barriers, such as receiving limited support from the Director of Medical Services and other senior staff made reporting difficult (26). Thus, the framework that underpins medical culture enables sexual harassment to occur at a wide scale, and are unfortunately underreported.

Consequences Victims of sexual harassment report losing autonomy and control, along with feeling guilty, humiliated and alienated (27). This has broader implications on an individual’s psychological state of mind resulting in reported higher rates of depression, anxiety and alcohol (28,29). This highlights that for many individuals, the impact of the harassment lasted longer than the incident itself and that it shaped their future behaviours. (30)

Following an incident of sexual harassment, most students said they avoided the perpetrator or department where the incident occurred, and one-sixth considered leaving medical school altogether (30). By feeling the need to avoid certain locations, students potentially miss out on educational opportunities, including clinical experiences, which can significantly impact their learning (8). To minimise the impact of sexual harassment, students reported that they would like training in how to respond to unwanted sexual behaviours and maintaining professional boundaries, along with clearer guidelines and information on who and where to report issues should they arise (8). Students who experienced gender and sexual based discrimination and harassment during their training noted that these experiences influenced not only their choice of specialty, but also the hospitals and environments in which they chose to work (29). In particular, whilst men are less likely to experience sexual harassment, their experiences weighed even more heavily on their future choices (29).

Current policies and procedures

Cultural Reform As sexual harassment is fostered by a culture that accepts negative and disrespectful attitudes, instituting cultural change to eliminate these attitudes has become the cornerstone of sexual harassment policies. To communicate this, all universities with medical schools have instituted advisory bodies on and sexual harassment, 16% of which are led by the Vice Chancellor or CEO of that university (6). All but one have standalone policies addressing sexual assault and sexual harassment. However only three universities have policies solely addressing sexual harassment (6), as recommended by Universities Australia (31) and the AHRC (5). Barring one, all medical schools offer seminars for student leaders and staff, and have web pages offering educational resources and access to services (6), such as appropriate contact information, campus security services, and in some cases, incidence data (32). Of all Australian universities (including those without medical schools), of those that offer online training, 10% consider this mandatory (6).

An organisation is perceived as more tolerant of sexual harassment where are male-dominant (33), where there exists gender stereotypes, where traditional masculine traits are valued (5,33,34), or where women are underrepresented in leadership roles. Despite this, objectives remain largely absent from university and hospital policies regarding harassment.

Though the Australian Sexual Discrimination Commission exists to promotes and to eliminate sexual harassment from Australian workplaces, it has not yet undertaken a specific review of medical work places. (35)

Application of Policy

As medical students must share their time between their university and practicum locations (hospitals, community practices, clinics or agencies) they are frequently exposed to individuals not affiliated with their original institution. Hospitals and universities need policies that accommodate employees, students, visitors, clients and contractors. Some policies, such as that of the University of Sydney, explicitly address this issue: “If a student makes a complaint of sexual assault or sexual harassment by a visitor or other person over whom the University has no jurisdiction, the University may seek assistance from another organisation or to refer the complaint to an external agency for resolution,” such as the NSW Anti-Discrimination Board or the Australian Human Rights Commission. (36)

Accessibility

The Tertiary Quality and Standards Agency (TEQSA) reports that despite 91% of Australian universities providing web pages with information on access to services, “47 per cent of students knew nothing or little about where to seek support/assistance, and 60 percent knew nothing or little about where to make a complaint”. (6) Measures should be taken so that these resources are visible and well promoted. As recommended by Universities Australia policies should also differentiate between sexual assault and sexual harassment. (6)

A feature of medical school is that it involves a large practicum component that necessitates students to spend significant periods in settings other than their university. When instances of sexual harassment occur in these settings, there can be confusion or limitations in reporting sexual harassment, and this may represent a large barrier to reporting (9,37). Where there exists confusion regarding the purview under which policies students may fall, it is difficult for these policies to be enforced. Dual reporting structures for each institution’s sexual harassment policies creates increased burden on the victim which may entail confusion regarding to whom they are able to report to, or require them to give duplicate reports which represents a vexatious barrier to the individual. Without resolution, universities and hosting practicum organisations do not uphold their duty of care to students.

University and organisational services also require expert input from specialist disability services to ensure accessibility for victims with a disability. Information about accessing help should be readily available in multiple languages, with translator services provided for in-person or telephone appointments. Many universities (6) and organisations (38) offer training to staff involved with handling complaints of sexual harassment. This should include a survivor- centered approach, which provides strategies to staff receiving complaints to treat victims with dignity and respect, to reduce victim-blaming and promote agency. (39) Anonymity There are many reasons a victim may desire anonymity when reporting sexual harassment, such as fear of repercussions to their reputation, reprisal or not being believed (26,40,41). Absence of the ability to report anonymously may discourage victims from reporting their experience. Organisations should offer avenues through which sexual harassment may be reported anonymously. Accountability Accountability plays an important role in preventing sexual harassment, as the incidence is lower in leadership environments that are intolerant of sexual

harassment. (42,43) Most organisations include provisions to stop the offending behaviour and require appropriate disciplinary action. (9,38,44,45) Protecting victims Medical students are protective of their reputation as they know that they are dependent on personal recommendations for competitive roles. (46) Though organisations stipulate that should not be perpetrated against complainants, medical students are wary of retributory measures that occur in the context of medical hierarchy. Covert retaliation is an action performed by a perpetrator of sexual harassment, and may manifest as offering influential and detrimental comments about their accuser in a confidential setting such as a trainee or fellowship board, or grant review. (46) This may also include breach of confidentiality during and after investigations of sexual harassment. (9,26) Patient-perpetrated sexual harassment is a complex issue as access to healthcare is a basic human right for all patients. There is very little guidance on how to protect medical students from patient-initiated sexual harassment; however, it should not be accepted as an intrinsic hazard of the medical student role. (47)

Model for Improvement

In 2018, the then Minister for Education and Training, Simon Birmingham, requested that all Australian universities inform the TEQSA (6) of their response to the specific issues surrounding sexual assault and harassment raised in the 2017 ‘Change the Course’ report. (6) The Change the Course Report (2017) recommends that an effective university initiative to respond to sexual assault and harassment is led by Vice-Chancellors, engages all levels of the university (including students), is transparent, and is based on evidence and expertise. The Commission further recommends that each university develop an advisory group to guide and evaluate the implementation of such initiatives, which includes representatives of the university’s senior leadership and academic staff, the student body, affiliated residential colleges, student wellbeing services and frontline sexual assault services.

TEQSA undertook a review of 42 Australian universities and 126 TAFEs to evaluate their adoption of these recommendations, using self-reported data and information available on their websites. Despite the Higher Education Standards (HES) Framework 2015 identifying providers as responsible for ensuring the wellbeing and safety of students within the learning environment, TEQSA described their capacity “...to address the many drivers in [...] wider society that may contribute to the issues experienced in a higher education setting” as “limited”. (6) Such a revelation is troubling and underscores the critical role that individual universities must play in mitigating sexual harassment and its undesirable sequelae, and providing reporting mechanisms that can drive cultural change.

As at February 2019, toolkits designed to equip Victorian workers to have safe conversations about sexual harassment at work are being evaluated by the Victorian and Human Rights Commission. (5) Should these pilot programs prove successful, universities may be expected to implement such conversation topic scheduler kits and various online tools, providing both survivors and bystanders with the opportunity to speak up. The implementation of scheduler kits and online tools would be consistent with the commitment made by the RACS to “accept new standards” in the domain of sexual harassment in surgery (5,9) and combat the challenges identified by various representative bodies, including TEQSA. (6)

Given the ongoing intensification of public focus and discourse on sexual harassment, which particularly emphasises cultural change, (5,9,48) it is only appropriate that Australian medical schools incorporate contemporary methods to prevent and appropriately respond to the sexual harassment of their students. It will, as declared by the Royal Australasian College of Surgeons’ Expert Advisory Group, “...take courage, resources and a commitment to change. It will take enforcing the and imposing sanctions as needed… It will take witnesses ending their silence and speaking out.”

In parallel with the Expert Advisory Group to RACS, AMSA strongly believes that change in sexual harassment must take place in the following three areas: culture and leadership, education and complaints management. (9) AMSA emphasises that is in these areas that medical schools must be prepared to tackle sexual harassment in their own universities, clinical schools and all sites unto which the clinical practicum extends. Transparent, trans-hierarchical and technologically current systems will be necessary to support a new epoch in sexual harassment prevention and management, in what are undeniably exigent circumstances. (5,9)

Position Statement

AMSA believes that sexual harassment disproportionately affects medical students due to their intersecting vulnerabilities both as students in tertiary settings, and as juniors within medical workplaces. Sexual harassment has significant acute and long term consequences including mental and physical health issues and both direct and indirect negative career implications. AMSA believes that these barriers to reporting also obfuscate its prevalence within our medical community and perpetuate a culture in which this behaviour is tolerated. The appropriate management of sexual harassment needs to be substantiated in clear, accessible policies; and its reduction and elimination necessitates cultural change and clear accountability procedures for offenders. AMSA acknowledges that sexual harassment occurs on a spectrum of sexual and gender-based violence that includes, but is not limited to, sexual assault and ; however, this specific issue is more thoroughly addressed within AMSA’s Campus Health and Intimate Partner Violence and Assault policies.

Policy

AMSA calls upon:

1. AMSA Board and Executive to: a. Minimise risk within AMSA events by focusing on sexual harassment mitigation and developing thorough, well-publicised policies and procedures to deal with such incidents; b. Provide and publicise guidelines regarding how and where to report bullying and harassment for AMSA events; c. Educate all medical students on what sexual harassment is, how to notice it, how to prevent it, and their rights to pursue action; d. Encourage students to understand their rights and responsibilities in their education, as it pertains to sexual harassment; e. Accept that, upon taking on their leadership position within the company, they are highly influential in driving a positive working culture within AMSA, and that this includes model behaviour with regards to sexual harassment; f. Recognise, generate and regularly review strategies to act upon instances of harassment as a matter of priority; g. Support and advocate for those medical students affected by sexual harassment; h. Support medical student societies to facilitate change through every means available including: i. Collaborative advocacy effort to their medical school; ii. Facilitation and education of medical students about the issues surrounding sexual harassment; iii. By assisting in generating reporting structures. 2. Federal Government to: a. Strengthen the mandate of the Australian Discrimination Commissioner to investigate sexual harassment associated with health professionals and medical students within hospitals and universities;

b. Mandate university and hospital administrations to adopt and promote clear sexual harassment reporting and documentation policies, with victim protection and offender repercussions at the core; c. Fund and conduct research into sexual harassment in medical education and in healthcare settings and/or conduct a Royal Commission into Sexual Harassment in the Medical Workforce; d. Promote cultural change on a national level through the promotion of gender equality. 3. State and Territory Governments to: a. Lead the response in identifying institutionalised sexual harassment and dismantling the risk factors inherent to the medical workplace; b. Host education sessions for Hospital Administrators to understand their role in the reporting of sexual harassment in the medical workplace; c. Mandate that all clinical employees of the health system, especially any person in a medical student supervisory position undertake education regarding the prevention of sexual harassment; d. Undertake of the reporting structures to: i. Provide an evidence base for their efficacy; ii. Understand hospital or health specific barriers that exist to reporting iii. Identify hospitals that have increased incidence of sexual harassment to provide targeted training and assistance to improve the culture thereof. e. Create and adopt universal reporting, documentation, and follow-up guidelines for public hospitals and universities regarding sexual harassment; f. Fund counselling and support services for victims of sexual harassment; g. Adopt legislative change ensuring the criminality of sexual harassment, thereby redirecting the onus of accountability to the perpetrator. 4. Teaching Hospitals & Healthcare Clinics to: a. Provide accessible, effective and, where appropriate, anonymous reporting systems for student and staff complaints; b. Ensure that all students and staff members can report on instances of sexual harassment without encountering the threat of reprisal, particularly on a student’s clinical education and academic performance; c. Include all on-campus personnel and those at networked sites, including medical students and volunteers, in their sexual harassment policies; d. Audit the prevalence and incidence of sexual harassment in the workplace, and to include medical students in this analysis and use this research to regularly update policies and guidelines; e. Establish and promote clear “” guidelines in relation to sexual harassment that protect students, staff, visitors and patients; f. Liaise with universities to establish continuous duty of care for students on clinical placements. 5. Specialty Training Colleges to: a. Implement Sexual Harassment policies that appropriately respond to reports of sexual harassment without impacting upon the progression of trainees. b. Regularly audit the prevalence and incidence of sexual harassment within the college; c. Provide training to their members on: i. Behaviours that constitute sexual harassment, and recognition of such. ii. How to counter sexual harassment; iii. How to appropriately intervene when witnessing a situation of sexual harassment; iv. Effective use of reporting mechanisms. d. Institute strategies which promote gender equality, including flexible training places;

e. Evaluate and acknowledge the impact ingrained sexual harassment has on medical student perception and choice of specialty training; f. Furthermore, acknowledge the importance of an equitable workplace, free from sexual harassment, for best medical practice and patient outcomes. 6. Health professionals to: a. Recognise their responsibility to report sexual harassment if witnessed and support those affected (including medical students); b. Educate themselves and their colleagues regarding the behaviours that encompass sexual harassment, sexual harassment policies and procedures in place at their workplace and actions available including bystander action and reporting; c. Consider the risk factors for sexual harassment present in their workspace and act on their findings, to foster an environment in which staff members and students feel safe; d. Advocate for change to those reporting structures if they feel they are inadequate; e. Assist in addressing the institutionalised aspects of health system to foster a culture in which sexual harassment is not commonplace, and in which barriers to reporting are eliminated. 7. Universities and Medical Faculties to: a. Provide compulsory sexual harassment education and training within the curriculum, including inclusion in and dissemination of student rights and responsibilities; b. Promote and, where applicable, develop effective reporting structures, ensuring analysis of the efficacy and relevance of those structures is undertaken; c. Liaise with hospitals and other clinical placement providers to ensure continuous duty of care for students and facilitate, where required, the removal of a student from a placement in which they feel unsafe or harassed; d. Ensure university staff who handle matters pertaining to sexual harassment are: i. Sufficiently independent of academic processes, but adequately informed on the nuances of the medical environment and the challenges this creates. ii. Easily identifiable and accessible for students; iii. Trained to provide support or to appropriately refer students to support services as required; e. Develop medical student specific sexual harassment policies and procedures that: i. Clarify whether people who are employees of teaching hospitals are included under the university’s purview; ii. Include disciplinary action that is appropriate, quantifiable and specific to medical students that perpetrate sexual harassment; iii. Address recommendations in the Change the Course report; f. Address the institutionalised aspects of medical school structure and culture that foster an environment in which sexual harassment is commonplace, and in which barriers to reporting are perpetuated. g. Promote support services to students who both experience sexual harassment and who access reporting, whilst attempting to: i. Decrease the stigma associated with accessing sexual harassment structures; ii. Increase the accessibility of services for all students. h. Conduct research into sexual harassment of university students and, more specifically, medical students, and use the evidence obtained to provide targeted strategies and solutions 8. Students, and Medical Student Societies to:

a. Advocate for Faculties to be active in amending their sexual harassment policies to address the specific circumstances of medical students in both protections and consequences; b. Work with Faculties to identify and publish sexual harassment reporting pathways, both for those who have been harassed and for bystanders or knowledgeable parties; c. Work with Faculties to recognise barriers to accessing sexual harassment reporting pathways at their University and implement strategies specific to those identified; d. To decrease the stigma associated with accessing sexual harassment structures through recognition, education and provision of adequate support to students who access reporting; e. Support their peers in educational settings to prevent occurrences of sexual harassment, and advocate for students if they are a witness to or subject to sexual harassment; f. Acknowledge that sexual harassment occurs between medical students and to implement strategies to reduce the incidence of incidents in the realm over which they have control e.g. events run by societies. 9. Regional Training Providers: a. To recognise that medical students and doctors are at an increased risk of sexual harassment when working in a rural or remote clinical setting; b. To support and provide compulsory sexual harassment training to medical students and health professionals working or learning within the jurisdiction of the training provider; c. To promote or institute sexual harassment reporting structures that exist within rural hospitals, and within the regional training providers themselves. 10. The Australian Medical Association to: a. Lead the 's efforts to eliminate sexual harassment in the medical workplace, particularly through hospitals and colleges b. Advocate for the development of safe environments within the medical workforce where persons can lodge their complaints without fear of recrimination; c. Support and advocate for those doctors and medical students affected by sexual harassment; d. Develop campaigns aimed at promoting knowledge and understanding of sexual harassment among medical staff and students 11. The Australian Health Practitioner Regulation Agency (including the Medical Board of Australia) to: a. Support training colleges and universities in developing, maintaining, and promoting sexual harassment reporting structures; b. Effectively evaluate sexual harassment behaviours in those registered with AHPRA, particularly those with a history of perpetrating sexual harassment in their workplaces; c. Ensure consequences for practitioners that perpetrate sexual harassment in the medical workplace. 12. Australian Medical Council a. To include sexual harassment training amongst its accreditation standards for medical schools & doctor-in-training frameworks.

References

1. Australian Bureau of Statistics. Personal Safety [Internet]. Canberra: Australian Bureau of Statistics; 2016. ABS Cat. no.: 4906.0.

2. Royal Australasian College of Surgeons. Discrimination, Bullying and Sexual Harassment [Internet]. Melbourne; 2017. Policy ref. no.: REL-GOV-028.

3. Australian Institute of Health and Welfare. Family, domestic and sexual violence in Australia [Internet]. Canberra: Australian Institute of Health and Welfare; 2018. AIHW Cat. no.: FDV 2.

4. Fnais N, Soobiah C, Chen M, Lillie E, Perrier L, Tashkhandi M et al. Harassment and Discrimination in Medical Training: A Systematic Review and Meta-Analysis. Acad Med [Internet]. 2014;89(5):817–27.

5. Australian Human Rights Commission. Change the Course: National Report on Sexual Assault and Sexual Harassment at Australian Universities [Internet]. Sydney: Australian Human Rights Commission; 2017.

6. Tertiary Education Quality and Standards Agency. Report to the Minister for Education: High education sector response to the issue of sexual assault and sexual harassment [Internet]. Canberra: Australian Government Tertiary Education Quality and Standards Agency; 2019.

7. Australian Human Rights Commission. Working without Fear: Results of the Sexual Harassment National Telephone Survey [Internet]. Sydney: Australian Human Rights Commission; 2012.

8. White GE. Sexual harassment during medical training: The perceptions of medical students at a university medical school in Australia. Med Educ [Internet]. 2000;34(12):980–6.

9. Knowles R, Szoke H, Campbell G, Ferguson C, Flynn J, Lay K et al. Expert Advisory Group on discrimination, bullying and sexual harassment: Report to the Royal Australasian College of Surgeons [Internet]. Melbourne; 2015.

10. Venkatesh B, Corke C, Raper R, Pinder M, Stephens D, Joynt G 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 [Internet]. Crit Care Resusc [Internet]. 2016;18(4):230–4.

11. Moscarello R, Margittai K, Rossi M. Differences in abuse reported by female and male Canadian medical students. Can Med Assoc J [Internet]. 1994;150(3):357–63.

12. Rademakers JJ, van den Muijsenbergh ME, Slappendel G, Lagro-Janssen AL, Borleffs JC. Sexual harassment during clinical clerkships in Dutch medical schools. Med Educ [Internet]. 2008 May;42(5):452–8.

13. Nagata-Kobayashi S, Maeno T, Yoshizu M, Shimbo T. Universal problems during residency: abuse and harassment. Med Educ [Internet]. 2009 Jul;43(7):628–36.

14. Mangus RS, Hawkins CE, Miller MJ. Prevalence of harassment and discrimination among 1996 medical school graduates: a survey of eight US schools. JAMA [Internet]. 1998 Sep 2; 280(9):851–3.

15. Coopes A. Operate with respect: how Australia is confronting sexual harassment of trainees. BMJ [Internet]. 2016 Sep 1; 354:354:i4210.

16. Lapinski J, Sexton P. Still in the closet: the invisible minority in medical education. BMC Med Educ [Internet]. 2014 Dec 15; 14(1):171.

17. Sexual Harassment in the Medical Workplace [Internet]. Canberra: Australian Medical Association; 2015.

18. Tang AL, Seiden AM. Sexism and Sexual Harassment: Considering the Impact on Medical Students, Residents, and Junior Faculty. Laryngoscope [Internet]. 2018 Sep; 128(9):1985–6.

19. O’Neil A, Sojo V, Fileborn B, Scovelle AJ, Milner A. The #MeToo movement: an opportunity in public health?. Lancet [Internet]. 2018 Jun 30; 391(10140):2587– 9.

20. Frank E, Brogan D, Schiffman M. Prevalence and correlates of harassment among US women physicians. Arch Intern Med [Internet]. 1998 Feb 23;158(4):352–8.

21. Garvey G, Rolfe IE, Pearson S-A, Treloar C. Indigenous Australian medical students’ perceptions of their medical school training. Med Educ [Internet]. 2009 Nov; 43(11):1047–55.

22. Stone LE, Douglas K, Mitchell I, Raphael B. of doctors by doctors: professionalism, complexity and the potential for healing. Med J Aust [Internet]. 2015 Aug 17; 203(4):170–1.

23. Mathews B, Bismark MM. Sexual harassment in the medical profession: legal and ethical responsibilities. Med J Aust [Internet]. 2015 Aug 17; 203(4):189–92.

24. Walton MM. Sexual equality, discrimination and harassment in medicine: it’s time to act. Med J Aust [Internet]. 2015 Aug 17; 203(4):167–9.

25. Faunce T, Bolsin S, Chan W-P. Supporting whistleblowers in academic medicine: training and respecting the courage of professional conscience. J Med Ethics [Internet]. 2004; 30:40–3.

26. 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 Heal Rev [Internet]. 2018 Feb 16. doi: 10.1071/AH17224.

27. Recupero PR, Heru AM, Price M, Alves J. Sexual harassment in medical education: liability and protection. Acad Med [Internet]. 2004 Sep;79(9):817–24.

28. Richman JA, Flaherty JA, Rospenda KM, Christensen ML. Mental Health Consequences and Correlates of Reported Medical Student Abuse. JAMA [Internet]. 1992;267(5):692–4.

29. Stratton TD, McLaughlin MA, Witte FM, Fosson SE, Nora LM. Does students’ exposure to gender discrimination and sexual harassment in medical school affect specialty choice and residency program selection? Acad Med [Internet]. 2005 Apr;80(4):400-8.

30. Wilkinson AP, Gill DJ, Fitzjohn J, Palmer CL, Mulder RT. The impact on students of adverse experiences during medical school. Med Teach [Internet]. 2006;28(2):129–35.

31. Universities Australia. Guidelines for university responses to sexual assault and sexual harassment [Internet]. Canberra: Universities Australia; 2018.

32. Universities Australia [Internet]. Respect. Now. Always. 2018 Aug 1. Available from: https://www.universitiesaustralia.edu.au/uni-participation- quality/students/Student-safety/Respect--Now--Always-#.XGkc7pMzafQ

33. Kabat-Farr D, Cortina LM. Sex-based harassment in : new insights into gender and context. Law Hum Behav [Internet]. 2014 Feb; 38(1):58–72.

34. Heilman ME, Okimoto TG. Why are women penalized for success at male tasks?: The implied communality deficit. J Appl Psychol [Internet]. 2007 Jan; 92(1):81–92.

35. Australian Human Rights Commission. Sex Discrimination [Internet]. Australian Human Rights Commission. 2019 [cited 2019 Mar 17]. Available from: https://www.humanrights.gov.au/our-work/sex-discrimination

36. The University of Sydney. Student Sexual Assault and Sexual Harassment Policy 2018 [Internet]. Sydney: The University of Sydney; 2018 Aug 1.

37. Horne M. Medical students call for clearer pathways for reporting sexual assault [Internet]. Australian Medical Association. 2017 Oct 10.

38. The University of Melbourne. Appropriate Workplace Behaviour Policy [Internet]. Melbourne: The University of Melbourne; 2018 Oct 19. Policy ref. No.: MPF1328.

39. DeBari J. From inevitable to preventable a survivor-centered approach to sexual violence. Physicians for Human Rights [Internet]. 2015 Oct 7.

40. Sable MR, Danis F, Mauzy DL, Gallagher SK. Barriers to Reporting Sexual Assault for Women and Men: Perspectives of College Students. J Am Coll Heal [Internet]. 2006 Nov; 55(3):157–62.

41. Baker LL, Campbell M, Straatman A-L. Overcoming Barriers and Enhancing Supportive Responses: The Research on Sexual [Internet]. Western University Centre for Research and Education on Violence against Women and Children. Ontario; 2012.

42. Berdahl JL. Harassment based on sex: Protecting social status in the context of gender hierarchy. Acad Manag Rev [Internet]. 2007; 32(2):641–58.

43. Tenbrunsel AE, Rees MR, Diekmann KA. Sexual Harassment in Academia: Ethical Climates and Bounded Ethicality. Annu Rev Psychol [Internet]. 2019 Jan 4; 70(1):245–70.

44. Western Sydney University. Sexual Harassment Prevention Policy [Internet]. Sydney: Western Sydney University; 2015 Sep 9.

45. University of Wollongong. Sexual Harassment Prevention Policy [Internet]. Wollongong: University of Wollongong; 2017 July 25.

46. Binder R, Garcia P, Johnson B, Fuentes-Afflick E. Sexual Harassment in Medical Schools: The Challenge of Covert Retaliation. Acad Med [Internet]. 2018 Dec; 93(12):1770–3.

47. Viglianti E, Oliver A, Meeks L. Sexual harassment and abuse: when the patient is the perpetrator. Lancet [Internet]. 2018 Aug; 392(10145):368-370.

48. Raise it! Conversations about sexual harassment and workplace equality [Internet]. Victorian Equal Opportunity & Human Rights Commission . 2019 [cited 2019 Feb 12]. Available from: https://www.humanrightscommission.vic.gov.au/home/our-projects-a- initiatives/raise- it?fbclid=IwAR1k2uyEr8IF4g7obSdNCV2lJiPYrOokSbDxDvLlQNMSUORzR4i_ EA856S8

Policy Details

Name: Sexual Harassment (2019)

Category: Category: C - Supporting Students

History: Reviewed and Adopted, Council 1, 2019 Katie Blunt (Co-lead Author), Lauren Taylor (Co-lead Author), Anita Stubbs, Louise Rait, Courtney Tiller, Kaitlyn Trompert-Thompson, Neha Vatnani, Daniel Zou (Policy Officer) Adopted, Council 2, 2015