UPDATE! – MWIA Western Pacific 2021

Slide 1 Audio

Hello everyone! My name is Liz and I am the project manager for a collaborative research anthology on occupational sexual harms in medicine, which is what I will be talking about today. One of our wonderful authors Dr Buowari has kindly offered to attend this conference on our behalf, but if you have any questions for the project lead or for myself, our contact details will be on the last slide along with our website. Before I begin, I would also like to acknowledge that I am presenting on the traditional land of the Kaurna people, and recognise their spiritual relationship with their country, culture, and heritage beliefs. I pay my respects to Elders past and present, and extend that respect to other First Nations people.

Slide 1 Visual

A Title Slide for the presentation, using the background provided by the Medical Women’s International Association (MWIA) Western Pacific Regional Conference 2021. Text in top left reads “Western Pacific Regional Conference 2021 of the Medical Women’s International Association. August 20-21, 2021. Virtual Conference”. Text in the centre reads “Of Doctors By Doctors: An International Perspective. Presenting Author: Dr Dabota Yvonne Buowari. Project Lead: A/Prof Louise Stone. Project Manager, Presentation Delivery: Mx Elizabeth Waldron.

Slide 2 Audio

Of Doctors By Doctors is the working title of our international, interdisciplinary research anthology about occupational sexual harms in medicine. Each chapter is contributed by an author or team of authors from all around the world. The book explores the many factors that influence the experiences of doctors who have been sexually harmed by other doctors. It asks questions about the sociocultural factors that influence survivors’ interpretations and understanding of their experiences, and about the approaches of different disciplines and institutions to understanding, preventing, and intervening in occupational sexual harms.

Slide 2 Visual

Slide title: “about “Of Doctors By Doctors”. In the centre are three bullet points. At the bottom of the slide are four boxes.

First point: “international, interdisciplinary research anthology about experiences of occupational
sexual harms of doctors, by doctors”

Second point: “Focus: contextual factors shaping the ways doctor-survivors experience, interpret,
understand these incidents”

Third point: “We use “occupational sexual harms” to encompass a range of single or
recurring incidents of unwelcome and intrusive conduct by a coworker or colleague,
including but not limited to:”

Box on far left, titled “sexual violence”: ““any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the survivors/victims, in any setting, including but not limited to home and work.”¹“

Box second from left, titled “sexual assault”: “sexual activity with another person who does not consent. It is a violation of bodily integrity and sexual autonomy, and is broader than narrower conceptions of “rape”, especially because (a) it may be committed by other means than force or violence, and (b) it does not necessarily entail penetration”²“

Box second from right, titled “sexual harassment”: ““unwelcome conduct of a sexual nature, in circumstances in which a reasonable person, having regard to all the circumstances, would have anticipated the possibility that the person harassed would be offended, humiliated, or intimidated…conduct of a sexual nature includes making a statement of a sexual nature to a person, or in the presence of a person, whether the statement is made orally or in writing”³“

Box on far right, titled “sexual abuse”: ““actual or threatened physical intrusion of a sexual nature, whether by force or under unequal or coercive conditions””

Slide 3 Audio

The impetus for the book came from a qualitative study published in 2019 by some of our editorial board. Stone, Phillips, and Douglas conducted a narrative study about the impact of occupational sexual harms on doctors. They developed a narrative framework to articulate the ways doctor-survivors interpreted and were affected by these experiences, plotting the trajectory of their experiences through 5 discrete phases.

Prelude is the phase in which people try to make sense of their experiences by understanding the history. 

Assault is the single or recurring incident of sexual harm, centred on the way the survivor interprets the assault, and the questions they still have around it.

Limbo is the period of elective or enforced silence after the event. 

Exposure is the phase in which the survivor’s name becomes known, either in their workplace, in the courts, or in the media. 

Aftermath is the phase in which the long-term impacts of the events begin to emerge, both in terms of their personal and professional life.
While this framework aids in understanding the ways that survivors interpret their experiences, the stories of participants prompted yet more questions.

Slide 3 Visual

Heading: “2019 study by A/Prof Louise Stone, Prof Christine Phillips, Prof Kirsty Douglas:
impact on doctors of sexual harassment and assault by other doctors in the workplace⁴“. In the centre of the slide are 4 dotpoints. At the bottom are 5 arrows each pointing to the arrow on its right. The arrows act as headers for brief quotes that illustrate potential questions a survivor would ask themselves during that particular narrative phase.

First dotpoint is followed by two sub-points. First point reads “participants”. First sub-point reads “doctors who had experienced inappropriate sexual behaviour by another doctor, causing ongoing distress.” Second sub-point reads “gender not specified in recruitment, but all participants women”

Final dotpoint reads “developed narrative framework to analyse interpretations/understanding of lived experiences in 5 phases:”

Arrow on far left reads “prelude”. Text below reads ““why did this happen to me?””

Second arrow from left reads “assault.” Text below reads: ““what do I think/feel about what happened to me? How do I interpret/understand the incident/s?””

Middle arrow reads “limbo”. Text below reads: “Should I tell anyone? What does it mean for me to be silent, and what happens when I am silent?””

Second arrow from right reads “Exposure”. Text below reads: ““what is it like for me at and outside of work, now that people link my name to this case? How do I negotiate these events in relation to my career?””

Arrow on far right reads “Aftermath.” Text below reads: “how have these experiences affected my personal and professional life, years later? How have they affected my personal and professional sense of self?”

Slide 4 Audio

What factors actually influence survivors’ interpretations and understandings of their experiences? What factors influence the paths they take, or even consider, during these journeys? What factors contribute to these incidents happening at all? Each of these questions is crucial to informing intervention strategies, which must target different factors depending on whether they’re attempting to minimise the risk of incidence, improve reporting rates, or mitigate harm and impact on survivors’ futures where incidents do occur.
So Louise decided to expand this pilot study to explore the how of sexual harms, engaging  with expertise from different cultural contexts as well as different disciplines. By taking an exploratory approach to mapping out the landscape of this under-researched field, we aim to explicate these contextual factors so that policymakers, educators, medical regulators, and clinicians and colleagues can make better decisions about prevention, intervention, and management of occupational sexual harms. The other main aim of this book was to ensure, as we build this community of practice, that a diversity of perspectives was woven into its core. 

Slide 4 Visual

Two boxes are side by side at the top of the slide, with purple arrows associating dotpoints in the left box with dotpoints in the right box.

The box on the left is titled “questions arising from participants’ stories:”. The first dotpoint in this box reads “What factors influence survivors’ interpretations/ understandings of their experiences?”. The second dotpoint in this box reads “What factors influence survivors’ behaviour (especially during Limbo,
Exposure, Aftermath)?” The third dotpoint reads “What factors contribute to incidents happening at all?”

The box on the right is titled “can inform intervention strategies depending on aim:” The first dotpoint in the left box is linked by a purple arrow to a dotpoint in the right box that reads “Mitigating betrayal trauma and harm (especially from report handling) after
sexual harms” The second dotpoint in the left box is linked by a purple arrow to a dotpoint in the right box that reads “improving likelihood that incidents will be reported.” The third dotpoint in the left box is linked by a purple arrow to a dotpoint that reads “minimising risk of incidents occurring.”

The bottom half of the slide is a heading, “Aims”, followed by 5 dotpoints.

The first dotpoint has one sub-dotpoint and 2 sub-subdotpoints. It reads “to explore and articulate contextual factors that influence the ways doctors experience and interpret sexual harms by other doctors”. The sub-dotpoint reads “taking into account:”. The first sub-subdotpoint reads “Differences that arise in different cultural contexts.” The second sub-subdotpoint reads “Approaches of different disciplines to conceiving/solving the issue”

The final dotpoint reads “To protect the balance of diverse voices in the community of practice we build around occupational sexual harms in medicine”

Slide 5 audio

So the book as a whole has been designed with 4 main areas of inquiry in mind.

Section 1 provides a little background context for the ways that gender and medicine and marginalisation operate and interact in general, engaging expertise from disciplines such as history and gender studies.

Section 2 asks experts from a variety of disciplines to explore the ways different actors conceive their role in addressing occupational sexual harms in medicine, and how these different approaches impact survivors’ attempts to navigate pathways for reporting and justice.

Section 3 presents qualitative case study analyses based on the pilot study, conducted in different countries around the world.

Section 4 reflects on theoretical and historical approaches to advocacy, including the opportunities and conundra faced by leaders, grassroots activists, and medical students trying to build and sustain momentum towards change.

As the book enters its next stage of chapter reviews this month, we expect to see thematic similarities and differences emerge between disciplines and cultural contexts in the ways that people conceptualise, and aim to address, the issue. Still, there are 3 main take-aways that are already beginning to emerge.

Slide 5 visuals

The top of the slide has 4 purple boxes (describing the “sections” of the book) that each contain a number of green boxes (describing the chapter titles within that section).

The purple box on the far left reads “section 1: Context.” There are 4 boxes within, which read (from top to bottom) “introduction”, “the history of women in medicine”, “intersectionality”, and “gender in medicine and the role of men”.

The second purple box from the left reads “Section 2: Interdisciplinary lenses.” There are 6 green boxes within, which read (from top to bottom): “law”, “Medical education”, “organisational behaviour”, “regulatory bodies”, “therapy”, and “integrating interdisciplinary lenses”.

The second purple box from the right reads “section 3: International perspectives”. The single green box within reads “Qualitative case studies
conducted around the world, based on the pilot study ⁴(full chapter list below)”.”

The purple box on the far right reads “section 4: the way forward”. The 3 green boxes within read (from top to bottom): “cultural change and accountability in leadership”, “everyday advocacy: from theory to praxis”, and “medical students”.

The bottom of the slide has green boxes detailing the chapters and authors of Section 3, the full list of which can be found here. These are superimposed on a world map. Countries which are being written about in the book have been highlighted in teal; all other countries are grey.

Slide 6 Audio

Firstly, that occupational sexual harms in medicine occur all around the world. Despite the dearth of literature, there remains an untapped wealth of lived experiences. While retrieving and analysing data from lived experiences of such a sensitive subject poses ethical and methodological challenges, they can still provide a fruitful basis for exploring the how and why of sexual harms in many different contexts. Future research should focus on exploring and understanding the contextual factors at play, and considering their cultural specificity.

Slide 6 Visuals

This slide is titled “Take-away 1: occupational sexual harms of doctors by doctors is pervasive.”

Below are three dotpoints. The first reads “Despite dearth of prevalence data, we know this happens
around the world.” The second reads “Retrieving and analysing data from doctors’ lived experiences of
sexual harm by other doctors poses ethical, methodological challenges.” The third reads “But still important to continue qualitative, exploratory work as we
continue mapping the field”

At the bottom right there is a purple box, with a green arrow attached and pointing right. The purple box reads “future research directions”. The green arrow reads “Select and explore specific contextual factors in more detail, considering cultural specificity”

Slide 7 Audio

Secondly, this issue is deeply shaped by social dimensions, involving a complex interplay of factors both internal and external to the medical workplace that cannot be addressed through generalised simplistic measures. Resolutions will require nuance and flexibility. Future research should consider translatability when using pre-established interventions as case studies, taking care to recognise the degree of cultural specificity of these contextual factors.

Slide 7 Visuals

Slide 7 is titled “Take-away 2: occupational sexual harms have social dimensions.”

Below are 3 dotpoints. The first reads “They involve a complex interplay of factors both internal and external to medical cultures/workplaces.” The second reads “Simplistic measures, and measures non-specific to medicine, are likely to neglect key aspects of the dynamics at play.” The third reads “Resolutions, interventions, will require nuance, flexibility”

At the bottom right there is a purple box, with a green arrow attached and pointing right. The purple box reads “future research directions”. The green arrow reads “Explore global case studies of workplace interventions, analyse potential for translatability while accounting for cultural specificity of factors involved”

Slide 8 Audio

Thirdly, a multi-disciplinary, multi-layered approach will be required to generate the policy and cultural changes necessary to reduce incidence, improve reporting, and decrease trauma related to reporting, and a wealth of further research will be needed to form the basis of these responses. We will need the courage of survivors and future researchers, and the encouragement of their colleagues and peers, in order to make meaningful changes to sexual harms of doctors, by doctors.

Slide 8 Visuals

This slide is titled “Take-away 3: occupational sexual harms require multi-disciplinary, multi-layered, evidence-based approach.” Below are 4 main dotpoints

The first dotpoint reads: “Policy change and cultural change both necessary to:” This is followed by 2 sub-dotpoints, which read “reduce incidence” and “increase reporting”

The second dotpoint reads “We need survivors to be courageous about contributing their experiences to informed research.” The third reads “We need researchers to be courageous about engaging in more
controversial/less prestigious types and topics of research.”

The fourth dotpoint reads “we need colleagues and peers”, and is followed by 2 sub-dotpoints, which read “to support survivors who do contribute their experiences” and “to support researchers who are attempting to address the dearth of research.”

Slide 9 Audio

We are currently in the final stage of recruitment, looking for contributors to write a chapter in section 3 from any countries in the region of the Americas, other than the USA or Mexico.

If you are interested in writing any of these, please reach out to us! We don’t have any requirements for minimum qualifications or publication history, and we are happy for you to write in whatever language you are most comfortable.

If you want to be part of this growing community of practice, but don’t fit into any of our chapter categories, reach out anyway! We are currently working on expanding this project beyond the book, to facilitate a continued dialogue and to encourage future research.

If you’re interested in learning more, you can visit our website, or you can email our project lead Louise at the address on the slide. Thank you once more to Dr Buowari for kindly facilitating this process on our behalf, and thank you for your interest in this project.

Slide 9 Visuals

This slide is split into two columns. The left column is titled “currently recruiting contributors.” Below is a map of the WHO region of The Americas, with all countries greyed out except the USA and Mexico, which are coloured in teal. The map is accompanied on the left by text reading “For a section 3 case study from any country in the WHO region of the Americas (except USA or Mexico).”

The right column is titled “contact us.” The text below reads “More details available on
our website: ofdoctorsbydoctors.com. Full bibliography and notes. To contact Project Lead: A/Prof Louise Stone Louise.stone@anu.edu.au“