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A call for open discourse

Authors: Hester Lacey; Specialised Foundation Year Two Doctor, Royal Sussex County Hospital; Brighton; United Kingdom

While the themes in the Begeny, et al. (2023) paper published in BJS last week were a stark representation of the issues relating to sexual harassment in the surgical workplace, they will unlikely be shocking to many trainees who have first-hand experience of such issues and continue to work in uncomfortable and problematic environments1. The effects of these issues on engagement with, and continuation of surgical training are hard to appreciate, given only a recent understanding of the extent of the issue in the surgical community.

With the “Me Too” movement and ongoing discourse relating to sexual harassment and abuse in both personal and professional lives, increasingly victims are encouraged and facilitated to speak out and highlight their experiences. The launch of the NHS sexual safety charter at the beginning of September highlighted how workplaces are engaging with this issue, with the overarching aim of ‘eradicating sexual harassment in the workplace’2. Issues identified within this charter include supporting victims of sexual misconduct and educating workers to support their colleagues and patients relating to these issues. What remains to be seen is how instances of harassment and abuse can be prevented at source, individuals supported to challenge abuse as it occurs, and the number of perpetrators reduced.

A constructive approach to target these issues practically should focus on education and understanding. Cultural differences between generations, while not excusing abusive and insulting behaviour, may result in skewed perceptions of how actions and comments are perceived and understood, and appropriateness to make in relation to female colleagues. Power and gender dynamics continue to shift massively in surgical practice – along with this, we need to ensure that intergenerational expectations of how these dynamics now should manifest in workplace interactions are aligned. We must ensure that with continued efforts to support victims of sexual harassment and abuse to speak out, we do not create a blame culture or a ‘them and us’ perception between generational cohorts that must work alongside each other for many years to come. Reframing the intergenerational perception of the narrative relating to workplace harassment can be done with proactive education and discussion, to ensure that parties work together to solve these issues and are not antagonised. A formal educational approach is required to achieve this, as intuitive learning in relation to these issues has been insufficient to ensure that all parties understand the need to adopt positive behavioural workplace practices.

At the core of addressing the issues highlighted by the Begeny, et al. (2023) paper, is open, honest discourse between all the parties, and a reframing of the issues to one that we target as a whole community, working together to improve the landscape of the surgical workplace for all those who interact with it.


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