How much bullying is there NOW in surgery, and is the #OperateWithRespect project working?
In much anticipated news, the results of the @RACSurgeons 2021 Building Respect prevalence survey are out, as part of the very comprehensive Phase 2 evaluation.
A thread-
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The whole report is BIG- 185 pages. I'll bet this is the most substantial report into disrespectful behaviours by any specialty medical college anywhere worldwide. It indicates how seriously RACS takes the issue and makes me proud to be a Fellow. Link-
2/- surgeons.org/-/media/Projec…
The prevalence survey results span pages 100-147 with the survey instrument spanning pages 148-185. This is all in the public domain and any College wishing to conduct similar research is welcome to access and build on it. Disrespect isn't just a surgical problem!
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So, how much bullying, discrimination, and sexual harassment *is* there now in surgery after 6 years of #OperateWithRespect?
Well- more and less. A non- significant 2% increase in raw prevalence *but* measured over a shorter timeframe (12 months) *but* also...
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...an increase in awareness and knowledge of DBSH, which may mean behaviours normalised in 2015 are now seen for what they are. I know this myself- in the 2021 survey I ticked 'yes' for harassment based on sexist jokes, but I didn't in 2015...😬 #TheStandardYouWalkPast
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So who is displaying the unacceptable behaviour?
Similar to 2015- males and surgical consultants. But it is improving, with some early evidence that DBSH from other groups are forming a greater proportion of aggressors. We *are* slowly getting our house in order.
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In very heartening news for me and everyone else who has taken flak for speaking up immediately, delivering innumerable 'cup of coffee' conversations, and carefully considering when and how to escalate- the proportion of repeat episodes is significantly decreased. #SpeakUp!💪
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In more evidence that speaking up works, a far greater proportion in 2021 than 2015 found that disrespectful behaviours stopped after addressing it directly with the person.
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We're not there yet though. 18% puff people who witnessed DBSH took no action and the factors that influenced their response, while showing a positive effect from the intensive education efforts around #OperateWithRespect, also show the negative effects of surgical culture.😔
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So, where to from here?
There were many excellent suggestions from respondents👇.
And I've only given my take up to page 126. The qualitative data that follows is harrowing and uplifting in equal measure- another thread anon. In the meantime- #OperateWithRespect!💪
10/fin
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It’s fascinating to see ‘[insert man] was the first to speak up about sexual harassment’ when it was simply that many women had spoken up… AND BEEN IGNORED.
Even the men being named as women’s great grand champions are dismayed to see this gendered silencing. 1/
There have been MANY papers about sexual harassment in medicine and surgery. A cook’s tour-
Miriam Komaromy described sexual harassment in medical training in 1993. In one of the largest journals in the world. And it has been cited more than 300 times. 2/ pubmed.ncbi.nlm.nih.gov/8419819/
Phyllis Carr et al. described it in 24 medical schools and 3332 faculty members in 2000.
Dr Claire Stewart presents the results of the @ANZCA Gender Equity survey and they are devastating- almost half of women have experienced bullying and over a third have had difficulty obtaining a position, compared to just 3% of men. 1/5
The nature of the disrespect experienced by women anaesthetists is insidious, not overt- this makes it particularly challenging to address. This is amplified by a lack of awareness/allyship by men.☹️ 2/5
Nearly half of women anaesthetists experienced #discrimination relating to pregnancy 🤨🤰3/5
.@drpwh62 and I supervised soon-to-be Drs Angela Chen and Neha Ravi in a #LGBTQI+ literature review. Very impressed to see students present 'off podium' with minimal notes at the @BondUniversity MD conference! #MedEd 1/5
The review looked at the gap between medical students and consultancy/attending practice. This is the career stage with the least research, and yet makes the biggest difference to eventual specialist workforce #LGBTQI representation. 2/5
There were just 19 studies, and the results were as awful as expected. Bullying, discrimination, poor mental health, burnout, and lots of emotional labour. There were risks in both disclosing and not disclosing personal #LGBTQI identity. 3/5
I've been asked what I mean by responsibility = privilege.
If you are poor you can't afford masks or sanitizer.
If you live in crowded housing you can't isolate.
If you don't speak English there is almost no messaging for you. 1/4
If you have insecure work you can't take the time to queue for hours to get tested.
If you are First Nations you might only recently have had access to your First Jab.
If you're a rest home resident your 'personal responsibility' lies entirely in the hands of others.
2/4
If you don't have a car there are limited testing locations on public routes.
If you care for kids it's really hard arranging care or wrangling them while waiting for jabs/testing.
If you have a vax contraindication you take a risk even just going out to get tested.
3/4
Do you need a TL break? Here's some wonderful work from @RACSurgeons- the latest Surgical News, with an Indigenous theme 🖤💛❤️and cover art from Sumaya Issa. Too many highlights to cover them all, but here's some highlights. Full link at surgeons.org/-/media/Projec… 1/6
Profiles of two rising stars, Dr Rachel Farrelly who will be the first woman Aboriginal orthopaedic surgeon, and Dr Andrew Martin, who joins @KelvinKongENT as an Indigenous ORL and is just starting his Head and Neck fellowship. 2/6
Wise words from @KelvinKongENT, Dr John Mutu-Grigg, and Dr Alan Woodward about the #COVID19 pandemic response and Indigenous people. For example, initial vaccination prioritisation for age 65+ meant fewer Indigenous people vaccinated, due to the pre-existing mortality gap. 3/6
6 weeks since my appendix tried to kill me, including an inter-hospital transfer on inotropes, I have learned some hard truths about serious illness that will inform my practice going forward.
A thread.
1/13
The tweets I posted at the time? I have no memory of writing them. Ditto this text exchange with hubby👇.
I apparently signed a consent form for the operation. No memory of that either. In future I'm not going to equate 'apparently oriented' with competence.
2/13
Being a suspected #COVID19 case (at that point I was septic with no clear cause) was incredibly hard on family. Hubby was not allowed to accompany me in the ambulance or visit. He was told to stay home and wait with the kids in case they all had to quarantine.
3/13