What medicine can learn from astronomy in the #MeToo Era

Recently a group of astronomers have made inroads into a terrestrial problem—with some down-to-earth applicability to the medical community.

Fed up with sexual harassment, a select group of astronomers formed the Astronomy Allies Program. As a first step, the program is run by selected senior female astronomer volunteers who act to form a “safe zone” at astronomer scientists’ meetings. “Need a walk home or to your hotel? A friendly ear? An intervener? Information to report harassment? We are here to help!” says their poster. The Astronomy Allies make themselves available: their aim is to provide judgement free help when someone believes it is needed. 

Astronomers are not unique in their concerns about sexual harassment or other gender-based inequities in their ranks. Similar issues in medical practice and in medical training have been brought into the open by a recent article in the New England Journal of Medicine: “Men’s fear of mentoring in the #MeToo Era—What’s at stake for academic medicine.” 

The stakes are high because academic physicians have a professional obligation to mentor the next generation of doctors. In the context of the so called #MeToo Era some teaching physicians and scientists expressed the fear of possible baseless allegations of sexual misconduct that would end their careers. Such a fear may lead physicians and scientists to avoid mentoring female colleagues or students. Lack of mentorship would deprive women the opportunities needed to advance their medical career. 

The fact is that at all levels of training and practice women still continue to experience gender discrimination and sexual harassment. 

When I was going through my medical education in the early 1950s there were only four women in my class of 60. I was ignorant then of what now I would consider unacceptable gender-related blocks to their career development. I remember that there were questions about letting one of the students return in our third year because of her pregnancy. I also recall hearing about hazing of a lone female resident in a urology program. In general, however, because of the very few women in my class there was no sense of competition between male and female students for desirable internship or residency positions. Also, in my time, most clinical procedures were simpler to learn. Residency training environment now resembles the proverbial hot kitchen. There is competition among the trainees to acquire more and more complex skills – and jealousies may develop. The pressure is also on the teachers to supervise the trainees and ultimately take responsibility for safeguarding the patients. In this hot kitchen environment tempers may flair, unwise, un-funny, or thoughtless and demeaning comments may be uttered or preference may be given to one student over another for unexplained reasons. It is not surprising that in such tense clinical/educational environment signs of intended or unintended career obstruction are identified. The blame then may be focused on an “old boys’ network,” institutional paralysis to adjust to modern life style, on individual prejudices of some physicians or authority (which actually could be directed against female or male students or persons of different race) or on a host of other issues. 

Things are not simple: these are real issues and fear is in the air.

The wide-ranging analysis of the situation and the resulting recommendations by the authors of the “Men’s fear of mentoring” article include creating “safe places” where men and women can talk directly about concerns regarding mentoring; being transparent about compensation arrangements, supporting universal access to family and medical leave policies, offering flexible promotion and advancement criteria that reflect unique contributions of female physicians. Professional guidance is recommended to address implicit biases toward women or explicit sexual misbehaviors. 

These are rather general recommendations. Trust the astronomers to be ahead in trying to change the world with small but smart steps. The time has come: surely we in medicine must not be left behind.   
—George Szasz, CM, MD

Further reading

Biringer A, Carroll JC. What does the feminization of family medicine mean? CMAJ. 2012;184(15):1752. https://doi.org/10.1503/cmaj.120771 

Jagsi R. Sexual harassment in medicine—#MeToo. N Engl J Med. 2018;378:209-211. https://doi.org/10.1056/NEJMp1715962

Schmeltz J. Fed up with sexual harassment II: The Astronomy Allies Program. Women in Astronomy. 10 September 2014. http://womeninastronomy.blogspot.com/2014/09/fed-up-with-sexual-harassment-ii_10.html

Soklaridis S, Zahn C, Kuper A, et al. Men’s fear of mentoring  in the #MeToo era—What’s at stake for academic medicine? N Engl J Med. 3 October 2018. https://doi.org/10.1056/NEJMms1805743

This posting has not been peer reviewed by the BCMJ Editorial Board.

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