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Rates of sexual harassment and gender harassment during intern year have decreased, while recognition of these behaviors among interns has increased, according to a cohort study of more than 4,000 trainees.

A survey during the last month of internship showed that sexual harassment incidence decreased from 62.8% in 2017 to 54.6% in 2023 (OR 0.92, 95% CI 0.90-0.94), and gender harassment incidence decreased from 61% to 51.7% (OR 0.91, 95% CI 0.89-0.93), reported Elena Frank, PhD, of the Michigan Neuroscience Institute at the University of Michigan in Ann Arbor, and colleagues.

Meanwhile, recognition of sexual harassment increased from 8.6% to 18.4% (OR 1.12, 95% CI 1.07-1.17), with this change greater among women versus men and surgical versus nonsurgical interns, and gender harassment recognition increased overall, from 8.9% to 18.9% (OR 1.12, 95% CI 1.07-1.17), the authors noted in a research letter in .

"The rates of people recognizing they experienced harassment was much, much lower than the folks who experienced it," Frank told 番茄社区app, adding that either people don't realize it's harassment or that the behavior is so ingrained in the culture "that it doesn't stand out to people as something abnormal or problematic."

Alarmingly, rates of sexual coercion more than doubled for women, from 2.3% to 5.5% over this time period (OR 1.17, 95% CI 1.08-1.28), and from 1.6% to 4% for nonsurgical interns (OR 1.18, 95% CI 1.09-1.27).

The authors noted they were inspired by #MeToo, and the ensuing #MedToo movement.

"Women may have some unique stressors that they experience under an internship, throughout training, and their careers that can be detrimental to their well-being," Frank said.

For instance, recognition of unwanted sexual attention increased particularly for women trainees, from 29.7% to 41.8% (OR 1.09, 95% CI 1.03-1.16), as well as surgical trainees, from 18.8% to 52.5% (OR 1.27, 95% CI 1.12-1.44). Surgical trainees also had a fourfold increase in gender harassment recognition, from 6.8% to 28.8% (OR 1.32, 95% CI 1.19-1.45).

Data came from the larger Intern Health Study, which has been ongoing since 2007 and aims to use internship as a longitudinal model of stress.

"With the large-scale nature of our study, we were in a unique position to be able to assess some of those things," Frank said, noting that having already been asking a cohort of people questions, and thus being able to tack on a survey assessing harassment at the end of intern year, was a methodological strength.

Ultimately, the authors concluded that the "gap between experience and recognition may reflect the extent to which sexual and gender-based discriminatory behavior remains ingrained in the culture of medicine."

Reshma Jagsi, MD, DPhil, of Emory University School of Medicine in Atlanta, told 番茄社区app that this study is important and "both offers encouraging evidence that physicians are becoming more aware of behaviors that constitute sexual harassment but also worrisome evidence that such unacceptable behaviors remain so common" -- problems that require a culture shift.

Frank noted that "medicine should be setting the bar for ... health and well-being." She added that many occupations look up to the field of medicine. "The fact that this is one of the worst for how women are treated is just really, really sickening."

For this study, a total of 4,178 participants answered a follow-up survey during the last month of internship that included the Sexual Experiences Questionnaire-Shortened (SEQ-S), which assesses gender harassment, unwanted sexual attention, and sexual coercion using a five-point Likert scale.

Participants spanned specialties, and median age was 27. Demographically, 51.7% were women, 61.9% were white, 3.6% were Black, 3.3% were Hispanic or Latino, 1.4% were Arab, and 9.4% were multiracial.

The authors noted that the main limitation to their study was potential underreporting. Future research should further explore how specialty-, institution-, and program-specific factors impact sexual harassment and reporting, they added.

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