Do neurosurgeons face sexual harassment in their profession?

Charlottesville, VA (November 10, 2020). It's 2020, and as much as we wish it weren't so, sexual harassment is still with us. One need only look at social media or a steady stream of court cases: most recently, the #MeToo movement has cast a light on sexual harassment.

Sexual harassment isn't defined by social status, wealth, or educational experience. It affects both women and men. Sexual harassment can be found in the workplace, at social activities, and even in the home. It is also found in the medical specialties.

Do neurosurgeons face sexual harassment in their profession? Yes. We've known this for some time from anecdotal evidence. What we did not know, until now, is the depth and breadth of sexual harassment in this field.

At the behest of the One Neurosurgery Summit, which represents the major neurosurgical organizations in North America, a survey on this matter was developed and disseminated to members of the neurosurgical community. The results of this survey have been published in a new article in the Journal of Neurosurgery: "Toward an understanding of sexual harassment in neurosurgery" by Deborah L. Benzil, MD, and colleagues. "While the results of this study are distressing, having the information will allow us to start some important conversations and continue forward progress!" the lead author has remarked.

Broadly speaking, the survey was designed to elicit the following information: 1) respondents' perceived attitudes about systemic issues in neurosurgery that permit sexual harassment; 2) the prevalence and severity of sexual harassment in the field; and 3) populations at highest risk of experiencing sexual harassment and those most likely to perpetuate it.

The survey was performed using the SurveyMonkey platform, and all responses were collected confidentially and anonymously. To capture respondents from all levels of neurosurgery, emailed invitations were sent to active and resident members of the Society of Neurological Surgeons and the Congress of Neurological Surgeons (CNS), as well as to transitional, emeritus, and inactive members of the CNS. The emails were sent to 5166 persons; 622 (12%) completed the entire survey.

Twenty percent of the survey respondents were female, and this represents a greater percentage than that of women actively engaged in neurosurgery: 19% of residents and 8% of practicing neurosurgeons are female. Looking back over their neurosurgical careers, 62% of respondents reported that they had witnessed sexual harassment and 55% reported that the harassment had been directed against them.

Sexual harassment was demonstrated across several behaviors: "the telling of explicit or offensive jokes (49%) ... unwelcome flirtations (22%), inappropriate physical contact (16%), discussion about sex/personal life (18%), and inappropriate comments about the body (15%). Although rare, rape was reported by 2 individuals (< 1%)."

Of persons who had been subjected to sexual harassment, 78% experienced it during training, 49% during post-residency employment, and 17% while attending national professional or educational meetings. Disappointingly, 37% reported that they had experienced sexual harassment more than 10 times. One would like to believe that over the years such occurrences have become less frequent. Unfortunately, the authors tell us, "there was a fairly even distribution between less than 1 year and more than 10 years ago."

Fewer than one-third of respondents reported that they had addressed incidents of sexual harassment when they occurred, and 85% reported barriers to reporting incidents, such as fear of retaliation or retribution, negative impact on future careers, loss of reputation, and associated stress.

Given the predominance of men in the neurosurgical community, it is not surprising that men were identified far more often as perpetrators of the harassment (72%). Female neurosurgeons were more likely to report having witnessed or experienced harassment, but it does affect both women and men. People in positions of power (such as chairs, faculty members, or supervisors) (86%) were most often identified as the persons responsible for the harassment.

"Male dominance, a strong hierarchical structure, and a permissive environment" are associated with the risk of sexual harassment in institutions. Based on the responses to the survey, all three can be found in neurosurgery, despite the fact that the profession has made great strides in the last decade to attract and retain more women. One effect of sexual harassment is that it can deter talented people from following their professional goals. The authors worry that such an atmosphere can lead to female neurosurgeons experiencing burnout and having less involvement in the profession. As Dr. Benzil has commented, "We want the best and brightest to enter and succeed in neurosurgery. The data about sexual harassment suggests we still have work to do."

To counteract the negative behaviors revealed by the survey, the authors suggest a change in the culture of the neurosurgical profession, "starting with an improved awareness of unconscious bias in medical school and reaching every level of organized neurosurgery and leadership." Some practical steps are proposed, such as a profession-wide zero tolerance statement with regard to sexual harassment, fair and transparent mechanisms of reporting its occurrences, establishment of best practices for social events, and greater diversity in speakers, honored guests, and scientific panels.

This paper offers detailed tables showing responses to the survey questions broken down by age or gender, and abundant demographic information on the respondents. Supplemental online materials include the questionnaire itself as well as written responses by respondents on incidents of sexual harassment that they have faced. These personal accounts are well worth reading.

When asked about the article, Dr. Benzil responded, "Unfortunately, many of us knew how serious this problem was within neurosurgery, but we needed to make all aware of the depth and breadth of it. With this data in hand, we can build on the positive steps neurosurgery has made, face the problem and find effective solutions."

The article is accompanied by an editorial by Drs. Doug Kondziolka and Linda Liau, who discuss some findings of the survey and steps to address and overcome sexual harassment in the neurosurgical community.

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Article: Benzil DL, Muraszko KM, Soni P, Air EL, Orrico KO, Rutka JT: Toward an understanding of sexual harassment in neurosurgery. Journal of Neurosurgery, published ahead of print November 10, 2020. DOI: 10.3171/2020.6.JNS201649

Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Editorial: Kondziolka D, Liau LM: Editorial: Sexual harassment in neurosurgery: #UsToo. Journal of Neurosurgery, published ahead of print November 10, 2020. DOI:

10.3171/2020.8.JNS202583.

Disclosures: The authors report no conflict of interest.

For additional information, please contact Ms. Jo Ann M. Eliason, Communications Manager, Journal of Neurosurgery Publishing Group, One Morton Drive, Suite 200, Charlottesville, VA 22903. Email: jaeliason@thejns.org; Phone: 434-982-1209.

For 76 years, the Journal of Neurosurgery has been recognized by neurosurgeons and other medical specialists the world over for its authoritative clinical articles, cutting-edge laboratory research papers, renowned case reports, expert technical notes, and more. Each article is rigorously peer reviewed. The Journal of Neurosurgery is published monthly by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons. Other peer-reviewed journals published by the JNS Publishing Group include the Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, Neurosurgical Focus, and Neurosurgical Focus: Video. All five journals can be accessed at http://www.thejns.org.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 10,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada, or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, and peripheral nerves. For more information, visit http://www.AANS.org.