 I think it has to go to the attendees it went to hosted panel. Yeah, we'll have to type it in again, like maybe at the end. So, all right, well, I'll go ahead and get started. Welcome to the gender equity and ethics McLean 41st lecture series. Welcome to the gender equity and ethics McLean 41st lecture series. Excited to have everyone here we've had a good I think this is our. And if you've been attending you'll know that we're alternating between virtual and in person. And we've had a series of amazing speakers so far really excited to have Dr sales who all introduced in just a second. Next week will be another virtual lecture by Dr Marshall from University of Pennsylvania, and then after the Thanksgiving break will return to have Dr Cortina from University of Michigan so we're really excited about the upcoming talks. I'll go ahead and introduce Dr sales, Dr sales is a national leader in diversity, equity and inclusion, having earned her PhD, studying these topics at Stanford University. Dr sales is also a surgeon and has extensive lived experience as a woman of color working in a male dominated environment. She has completed medical school and residency and general surgery at Stanford prior to completing a fellowship in minimal invasive surgery at Washington University in St. Louis. After staying on faculty at St. Louis, Dr sales moved back to Stanford in 2019 to work with the medical school on issues related to diversity and inclusion. Her research focuses broadly on gender equity implicit bias diversity, inclusion and physician well being. During the pandemic Dr sales so served as a disaster relief physician caring for patients with COVID and the ICU. She was given over 100 national international invited talks related to gender equity and sexual harassment and medicine. Dr sales of the prolific researcher and writer having had her work published in many prominent medical journals like JAMA the Lancet and JAMA surgery. She also writes for a broader audiences through outlets such as USA Today Time magazine and the Washington Post. She is passionate about helping workplaces better support marginalized people. And she serves as a special advisor for DEI programs at the Stanford University Department of Medicine where she's a clinical associate professor. Welcome Dr sales excited to hear your talk today. Thank you so much for this opportunity it's great to be with you all virtually, and you know I personally like I love giving talks in person, but I really love not having to be in person if the place is far away so I really appreciate that you all are flexible with folks and I just wanted to accommodate both. So my talk today is sexual harassment after hashtag me to and you know we just celebrated the five year anniversary of me to and the hashtag going viral. So before I get into the talk. I wanted to have access to chat on this webinar so I wanted to ask whether if people can put in some names of cases like when you see hashtag me to whose name comes to your mind, are there any particular people who have faced either questions or they have been on trial or just at least in the news like what what names come to mind for folks Harvey Weinstein absolutely that's a big one and I would guess he comes to a lot of people's minds. Yeah the chat is private so we'll have to put it in Q&A and we can read it out. Oh shoot it are okay well can we can we make the chat, not private. I think I do have access to that. If not that's okay, I can just throw out some other names, but I was trying to make it interactive for folks. Somebody wrote somebody wrote David have a teeny yes MIT. Yeah, I'm going to talk about him a little bit later. Trump Trump. Yeah. Indeed. Well there's really no shortage of people right you could say Bill Cosby you could say Aziz I'm sorry you could say Louis CK you could say some academic folks like sabotaging I'm going to actually talk about several of them in just a few minutes, but the point was just to remember that there are lots and lots of names that we've heard that there have been allegations of sexual harassment or assault against, but very few of them have faced concrete consequences, like of all those names that we just talked about. Maybe Weinstein is the only one right he's in prison. All the other ones like Trump went on after those allegations to become president. Sabatini for a long time was finding we're going to talk about him a little bit more in a second and he may be facing some accountability currently. But you know there's this idea, at least, you know several years out from the hashtag that it's the pendulum has swung too far, and that it's not safe to be a man I just can't even say that with a straight face like but that it's hard to be a man in this world and apologies to any men who are here but you all have some, some privileges that women and femme appearing folks do not have. So, before I talk any more about this I am going to talk about some specific cases and so just a trigger warning for anyone who doesn't want to hear those kinds of details, you know it's totally fine if you need to step away or whatever but just that is going to be the content of the talk today. I do some consulting work for intuitive surgical and intuitive foundation intuitive as a surgical robotic company. I'm also the co founder of the Center for advancing respect and equity a center that's designed to support people experiencing sexual harassment in medicine, although we haven't published our website just yet, but we're already supporting folks. I'm kind of out of the limelight, but we'll be going live with that this month. And I'm also a cisgender woman, and I am an immigrant I'm from Iran, and many of you may be aware of what's been happening in Iran in the last couple of months which is a woman led revolution against the oppressive regime there so I, I feel I have to acknowledge that. And then I am a heterosexual woman, and I share these things because you know who we are and all these different aspects of our identity impact the ways in which we show up to all the spaces that we're in. And, and it's impossible really to disengage those aspects of our identity from content that we're sharing with folks so I think it's just helpful for people to know that that that's at least some aspects of my identity that relate to what we're talking about. Now, back to sexual harassment there's this idea. Again, like I was saying that there's just instant accountability and basically when claims that are brought against people, especially influential people like Andrew Cuomo that those individuals are immediately canceled and it's unfair right that's the underlying premise that a lot of people have is that it's unfair for there to be accountability. And so people think that what happens is that there's a claim, then there's very quickly an investigation, and then there's very quickly consequences. And that's really not the case so even though you know the media can paint this image and give people this impression, what really ends up happening is far more complicated. Before I go any further, I wanted to just ask based on already what we've talked about like what do people think about where we're at as a society here about sexual harassment and I'm sorry I didn't realize there wouldn't be chat so you can just think about this and kind of maybe write down for yourself like do you think time is up. Like, is it the case. We can have people use the q amp a we've done that in the past so feel free to So that's fine to people want to write into the q amp. Yeah. And then I can publicize that and they can be as anonymous so if you want to say yes or no, you can publicize anonymous. Right and the question isn't, you know, do you think it should be. Do you think time should be up but do you think it really is like, are we living in a society now where people cannot get away with sexual harassment. We had one person say no. Very quiet audience today. Definitely not I like that with conviction, definitely not. Maggie's one of our students are gone so yeah. Well done Maggie. I mean there's no right or wrong answer it's just that, again, there is this idea that we've already kind of handle the problem and their sexual harassment is no more. And I'm going to argue to you for anybody out there who thinks that yeah with the pendulum has gone too far that that's not the case. I have a few other comments. No people still protect harassers. Better than before but not gone. And then another one that's come through chat to the host. I fear that with power and money. Anyone can now get away with certain acts. And then from Dr. Burnett our section chief of general medicine it is known to be unacceptable now, but it's subjective and often slides by so definitely a lot of people thinking about where we are in transition. Lots of lots of great points and you know this, the one that said that we're, I forget the wording but it was like, basically. Let me see if I can find it, it might be under the answered. Better than before but not gone. Yes, people so it wasn't that one anyway whatever. The power and money was in the chat to the host so yeah okay power and money with power and money. Anyone can get away with certain acts. Yes, and I think that that's always been the case so I think that was the comment that was like now with power and money and again I apologize if it wasn't that one because I can't see them all right now, but this has always been the case and sexual harassment is not about sex, it's about power. So that's why when I talk about this I show this pyramid and show power differential being at the bottom the foundation of the pyramid for sexual harassment, because while there can be sexual harassment going in the other direction. It's much less common. It is far more common for people with higher positions or positions and higher power to be harassing those who have lower power lower status. So once you have a power differential in a situation that allows for things such as gender based harassment. Sexual harassment is verbal and nonverbal behaviors that indicate second class status of people of a particular gender. And that is one aspect of sexual harassment and we're going to talk about some specific behaviors in on the next slide. Sexual attention or unwanted sexual attention can be things like asking people repeatedly for a date or touching people inappropriately. That's kind of the next most aggressive type of sexual harassment and then finally what is at the top here is sexual coercion or what people call quid pro quo so it's basically making particular opportunities contingent on sexual favors like you can be in this research study you can lead this committee you can have this job, if you perform the sexual acts for me. And so I've also put them in this way in the pyramid because they're in increasing degrees of severity as you go up and also fortunately decreasing in frequency as we go up. And so the National Academy of Science Engineering and Medicine and other widely accepted definitions, all three of these forms gender based harassment sexual unwanted sexual attention and sexual coercion are all part of sexual harassment. And I point this out because often when we think about sexual harassment, even like the examples that we just talked about, you really have focused on unwanted sexual attention and sexual coercion, which are the top two parts of this pyramid, but gender based harassment is actually even more pervasive. And so the National Academy's gave this a really nice portrayal so visual to help people understand this exact fact that many of the things that are under the water with this iceberg model so things that we may not actually be noticing are those gender based harassment behaviors like relentless women's pressure for sex relentless pressure for dates sexual insult offensive remarks about bodies, sabotaging women's equipment, saying things like, you can't do this job with small kids at home, etc. So those are a really big part of what is sexual harassment yes it's sexual assault rape unwanted groping threatening professional consequences all the stuff that's above the water, but it's also all the stuff that's below the water. So I put a red box around all of the things that I personally have experienced in my career. And, you know it's not to say I don't do this to say wow I've had such a bad experience and I'm so different from everyone else but it's actually to say that. I think my experiences are pretty representative of women in medicine. You may look at this and say, especially for folks who aren't women. They might be surprised to see that someone has experienced all this and I'm not like very old. I mean I'm middle aged, but I have a lot of career in front of me hopefully and I've already experienced all of these things. So, what does this look like in academia, how does sexual harassment play out in academia, you know a lot of the examples that we talked about already were in entertainment, which is obviously pretty different. So what happens in academia well actually wanted to share this example which probably you all are pretty aware of because this professor and anthropologist actually was at University of Chicago, originally. And he, this is John Comeroff so he was at University of Chicago to my understanding of what's available publicly was asked to leave miss many years ago, because of issues related to improper treatment of other individuals and in particular sexual harassment. And what happened after he left was Harvard hired him because why not. And so he went on to allegedly behave inappropriately with students and trainees at Harvard. And this went on for many, many years and really only came to light earlier this year when students at Harvard filed a lawsuit against Harvard for their mismanagement of the situation. Because there had been internal investigations that did not end up supporting the students who had reported him. And of course there were significant consequences for these students because they had to change their fields, because it's such a small field of study to avoid interacting with them they had to change their entire field of study. And when this came out, again earlier this year, a number of faculty at Harvard actually signed on to a letter in support of Professor Comeroff and some of these folks are listed here like Jill LePore, but also Paul Farmer who many of you may know. And all these people, you know it's kind of surprising that they just signed on to this letter saying we support this man. It's you'd have to have to think like they didn't read what the students were saying or they I mean they definitely didn't talk to any of the students because when you read the lawsuit. I don't see how a rational reasonable person would sign on in support of this professor. And this is from the lawsuit itself where the folks at Harvard in basically doubted the process the internal review process of Harvard so much that they specifically encourage students to go to the press. And this is something that had been successful for this other professor they sat here, Professor Jorge Dominguez that there was no accountability for in that case until the students went to the press. And even the department chair in this case encouraged three plaintiffs to to go to the crimson and then and the Chronicle of higher education. So that's a broken system. If you're the authorities within the institution are saying yeah, don't worry about our reporting system it's not going to work for you so just go public with your story. There's worrisome for the institution but also this is a huge ask of these students to go public to bring a lawsuit. There's no much risk for them professionally personally these lawsuits they do not go like from this week to next week or this month to next month they're done these things drag on for years. So it's really embarrassing for an institution that I think probably a lot of us have some respect for to say yeah we're not going to actually handle this we're going to ask you three young people with your entire lives in front of you to alter your life and focus on this in order to right or wrong that we are just going to let pass. And they're not right for question. And then once that one question of do you need to provide evidence when reporting sexual harassment. Do you need to provide evidence and bring sexual harassment so usually what happens at most institutions is there are different ways to report. I don't know how much detail people want to get into on this point but. The basic pathway usually is somebody raises a concern for example, you know a student says hey I work with Professor so and so and he said these inappropriate things to me. And that goes to eventually at an educational institution gets routed to the title line office, if a formal complaint is desired. In the title line office at most places will do some kind of investigation, they will talk to individuals involved, and you know try to gather data as best they can to determine what harm was caused, and by whom. I would say one major issue is that the majority of instances of sexual harassment are not reported, because the reporting process actually inflicts often more harm on people than the original act. So, that's one of the challenges so is there evidence that needs to be brought. Yeah eventually there is through this investigation evidence but. And, and I would say for, I don't know exactly who's asking is what position they're in but for anyone who's experiencing any sort of mistreatment in the workplace I always recommend documenting from the very beginning like the first time somebody says something inappropriate to you jot it down on PC paper paper send it to an email to yourself put it in your notes on your phone. In some way keep record because you never know what's going to become a pattern later, and that type of documentation notes to yourself does count as evidence. And was there you said there was another question. What the most most conversation go till the end I think I'll let you, I don't want to enter too much. Okay, no that's fine. I'm fine either way it doesn't matter to me. All right so what I was going to say next is so we just talked about an anthropologist who's in academics obviously and we're all in academics, but what's happening in medical sciences and so this is where I was going to talk to me to the person who brought it up earlier, or brought him up earlier. So, the story in broad strokes is that this person is a scientist who is thought to be a genius. I don't like the use of that word it allows people to excuse all sorts of people all sorts of behavior that isn't appropriate. But, you know, had done some some important work related to the mentor pathway, when he was a graduate student and you know was a very well funded researcher. And basically, he was at the Whitehead Institute and working through hard here's medical Institute and had an appointment MIT, when an internal investigation at the Whitehead Institute found that his lab created an environment that was toxic, and that he had been involved with a junior faculty member, and that in that relationship or the interactions were inappropriate. Essentially, there's a lot more to but that's kind of the basic just. And what happened after this internal investigation was that he was removed from the Whitehead Institute, and removed from hard use medical Institute, but he maintained an appointment MIT for quite a while. Actually, after all of that. And people may recall that earlier this year he was being considered for a new faculty appointment at NYU. And what what people may have seen that was in the news was students at NYU and postdocs and other researchers being very vocally against this appointment and to the point that they were in like literally in the streets with signs of protesting. And the medical school initially insisted that it was very important to consider his candidacy, and the dean of the medical school put out a statement talking about how cancel culture is worrisome and they need to be able to look at both sides. So basically they double down initially and it wasn't until after several weeks of folks within NYU and the press, talking about this that they. Well then they did it in my opinion pretty cowardly thing which is that they said that Sabatini withdrew his name from consideration so NYU never even said. You're right, we're not going to consider this person because we want to create a safe environment for our trainees never said that they just said well, he has withdrawn his name. So anyway, I guess good news is he didn't end up getting that appointment but I mean that was an opportunity for NYU in the School of Medicine specifically to have really been vocal and clear about their support of their trainees and how important it is to create a safe environment for everyone and they just didn't do it. And this is another example of Francisco Ayala was at University of California and Irvine and had complaints brought against him, at least as early as 2015 didn't end up leaving Irvine until 2018 at which point he resigned. He remained a member of the National Academy of Sciences until 2021. And as I said at the beginning people have this impression that people bring a concern. There's a quick investigation then there's accountability and it all happens too quickly and it's not fair to those who are being accused. And all these are examples of different ways in which it takes quite a long time, and often there isn't enough, any justice or in this case for Francisco Ayala some of the folks who had been involved and bringing concerns about him said, basically this is too little too late that, okay he resigned at the end of his career. And then after he resigned several years later, the National Academy of Sciences ejected him like, is that really anything is that even accountability. Who knows. And then there was this very public case that came out of it and this is specifically in medicine now so moving a little bit outside of the research world directly into clinical medicine and this is a professor who was at the Mayo Clinic in Rochester, who again allegedly had been having many inappropriate relationships, well I don't know many but several inappropriate relationships over a long period of time with women he mentored and he eventually after a lot of advocacy from individuals within Mayo Clinic Rochester was asked to leave Mayo Clinic Rochester but then was given a chair appointment in the Department of Medicine at Mayo Clinic in Scottsdale. Just really kind of mind blowing if you think about it that's within the Mayo system it's not even like he went somewhere else there's no way they could have known and they just hired him like no within their own system he was basically getting a promotion. And he had no problem getting license in Arizona there's no checks on sexual harassment when licensing individuals in medicine in most states. And, and it wasn't until folks at Mayo Clinic Rochester found out that he had been given this appointment that they were able to complain and then eventually he didn't end up taking that job. Because, because of this advocacy on the on the part of the folks at Mayo Clinic in Rochester, and even despite that initially he continued to hold really powerful position at the NCI where he was leading a clinical trials group which was then affecting these four other individuals including the folks who had brought these concerns about him at Mayo Clinic Rochester. And you see this statement at the bottom here from one of the individuals at Mayo Clinic. So she was to embarrass ashamed and frightened to come forward to her employer because she feared more consequences that would further limit her career possibilities because this person, Dr. was an influential person. And that's far more common a story than there being, you know, immediate accountability or even any real accountability. So I wanted to share a couple of examples from the Cuomo lawsuit, because I think they really are reflective of a lot of what happens in medicine actually. If you read it. Well let me read these bits to you and think about what you've seen an experience and whether it resonates for you but it really resonated for me so for example this woman who worked in his office said, if you got yelled at in front of everyone it wasn't special. It was controlled by his temper and he was surrounded by people who enabled his behavior. And as a result when he said inappropriate things, she says I was uncomfortable, but I also was acutely aware that I did not want him to get mad. So, I'm a surgeon surgical training is, you know, not the best of medical training I would say, in terms of the culture, and this exact set of statements could easily have been made about a number of different faculty in surgery at the different places that I worked at, where you just, you know, tried to stay quiet, tried to stay out of the way. And then they would yell, and nobody cared, like, there was no accountability. And on the bottom right, they say, for whatever reason, in his office the rules were different, it was, you should view it as a compliment if he finds you aesthetically pleasing enough, and if he finds you interesting enough to ask questions like that. And even though it was strange, uncomfortable and technically not permissible in a typical workplace environment, I was in this mindset that it was the Twilight Zone and the typical rules did not apply. And again, and we think about all the different things that we put up with that we tolerate within medicine. And I think it's so much that way, like, I'm sure we all have folks in our lives who are outside of medicine and we share stories with them and they're like, how is this, how is this allowed in your workplace like it's so inappropriate but we make excuses and people are given a pass because they bring in a lot of RV use or because they're a genius or whatever else. And what really this case highlighted as well is how people and this was mentioned in one of the comments how people enable this behavior. People were very aware of how damaging Cuomo's behavior was, but instead of doing anything directly about that they adopted these strategies like implementing a practice whereby individual staff members who are women were not going to be left alone with the people and we do this as well right we tell we have our own little whisper networks in a way where we warn people like oh hey this person can sometimes be handsy or this person says inappropriate things don't take it personally or, you know, that's definitely been my experience that there's a lot of that going on in medicine. And ultimately, this in this lawsuit they concluded that this behavior by the government was part of a pattern that extended to his interactions with women outside of state and was enabled and facilitated by culture within the executive chamber and the culture was secrecy, loyalty to the governor and fear, as well as normalization of inappropriate comments and interactions with the governor. Again, all of this I have seen within medicine as well. So that brings me to this which is coming out of the National Academy's report. We kind of defined four main characteristics of workplace environments that basically predispose to or enable sexual harassment to occur. And I mean even just at a first glance you can see these are things we have in medicine so a male dominated environment, one in which there is a hierarchy, a very steep hierarchy and some specialties where there is tolerance for sexual harassment where we act like it's not even happening where we normalize it where we develop strategies to work around these individuals who are causing harm rather than having any accountability for them. And one in which people can be isolated whether they're one on one with an attending in an exam room, examining a patient or they're in the, you know, office the work room and it's just two people at a certain point in time. They're in a lab and it's just the research one research, the student trainee and their and their faculty supervisor or mentor. There are many situations in which people are isolated especially I would say traveling to conferences that's another risky endeavor that we all have to undertake. So these are kind of the four major characteristics that predispose to sexual harassment and of these. We have Dr over and and I and some of our colleagues are trying to address the tolerance bit and I'm going to talk about that in a little bit. But that's the piece that we're targeting. Some of these other things are like, you know, we're not going to change the hierarchy and medicine overnight. And we're not going to change the representation and medicine overnight either although we are doing much better in terms of having women in medicine now than we did 50 years ago. But so tolerance is something we're going to try to see if we can impact and again I'm going to talk about how a little bit later. But because all of those things still exist in medicine. You know I wrote this article, two years ago now. It's still true. Sexual harassment is really the norm in healthcare, whether it's patients harassing physicians or physicians harassing each other of supervisors harassing trainees, nurses. Or harassment of nurses nurses harassing others all of these things are pretty rampant, or at least they have been in my experience and I've worked at seven or eight hospitals in my career and it's everywhere. And this is why several of us including Dr or I wrote this piece around the actual growthy case which was saying we've got to stop passing the buck, we've got to stop passing the harassers passing the trash whatever you want to call it. We have to keep thinking that we're creating accountability by telling a person they can't be at our institution anymore, but then helping them to get a position somewhere else, which is very common. How do you think Comer off went from University of Chicago to Harvard. People at University of Chicago warn the Harvard off right, they most likely said things like well you know it just didn't work out for him here, but he's a really great guy so you should, you should consider him for this position, or even maybe more strongly worded than that it's hard to know. But what's really disturbing to me about this particular phenomenon the way that men and I should note by the way the women are capable of harassing people as well and. And obviously there's more than just male and female genders and actually those who are sexual and gender minorities are more likely to experience sexual harassment. The vast majority of cases that we know of anyway are men harassing women. But so anyway when when organizations do eventually say, you know this person can't be in our organization anymore. There seems to be a concerted effort to help them land on their feet and on the other side of it, the people who they've harassed whose careers have been damaged, they're often ousted completely from the field, because they can't get letters of compensation, they can't get support and they don't want to interact with this person ever again. So that's the other side of the coin that I feel like we're not talking about as much as we should be. So I want to just briefly talk about what that experience is like for the person who's been sexually harassed. So the first thing of course is that the harassment happens. And for that there's often confusion like, well what they really mean. There's like this second guessing that you do have like, well maybe am I overreacting like this person has done XYZ nice things for me like maybe they didn't mean it etc. In that process of like not really knowing whether to believe what you personally experienced and not knowing who you can talk to about it leads to a lot of mental and emotional distress. So the first question of reporting which we talked about people have to consider that and it's not an easy choice because if you don't report, then that behavior can continue on. But if you do report, then you risk all of the really challenging things that happen after reporting, which is this investigation that happens often by the way the reporting system is so flawed, just in general, across our institutions. One of the things that happens is that once people report they really have no control over anything that happens they have no control over who the title nine office talks to for example or what they share exactly about the story or what the consequences are if any for the person who created the harm. There's not really like a restorative justice model yet for this process. And so often people who report don't even know eventually what the consequences of any there were for the person who they reported. So it can be a really difficult thing to go through. And then of course there's Darvo deny attack reverse victim and offender, which is very commonly used strategy, which by the way sabbatini has tried to use against the junior faculty person who he was involved with saying that basically she she's wrong this isn't what she's saying isn't true and she's the problem because XYZ, because this is very common that the person who has been accused of causing harm says no no it's not me actually it's the other person who's the problem. And this is why people talk about the need to be a perfect victim and how if the person who is reporting has any flaws whatsoever like they drink alcohol sometimes or they were in an abusive relationship at some point in their past or whatever that that ends up being used against them to say that they're not credible, or that they deserved whatever was happening. And so it's really messed up and adds obviously to the harm that these folks are experiencing. And then of course if they're, if they want to have any legal representation if they're going to pursue any kind of suit then there's huge amounts of fees that come into play. And many people need therapy to deal with all of the harm. And it can all lead, as I mentioned earlier to career loss because it's very hard to move forward in any profession, if the people who you've worked with the people who've trained you will not support you and if you have been sexually harassed by someone if you did the brave thing and reported it they're obviously not going to support you in your next step. The relationship strain within all our personal relationships also happens because as we're going through something that's so difficult and stressful. It's really hard to be to show up in our best possible way as our best self for the other people in our lives. And then there's a question of whether you settle, which is a big question that we're not going to really address today but settlements often require a non disclosure agreement. So sometimes there can be, you know, some terms that they will agree with that may even include some financial compensation in exchange for not saying anything. And that also puts people on a really tough bind because again, they many people come forward because they don't want the harm to continue to other people. And so if there's an NDA and everything's kept under wraps, then that goal does not happen. It's not achieved. So this is from the National Academy's report again, showing all the things that we just talked about that when people experience sexual harassment there is decreased job satisfaction there's organizational withdrawal. People are more likely to leave the institution to leave their profession there's harms or decreases in productivity and worsening performance. And I would say more importantly, really significant mental and physical health outcomes for these individuals. And because of all of this that the NASA report concluded that the cumulative effect of sexual harassment is a significant and costly loss of talent in academic science engineering and medicine. So you can think about all the ideas that never were explored because of people who left the all the solutions, all the, the treatments for diseases that were never discovered, because the people who would have cared to work on those issues. They had to take a career pivot because they met a roadblock that was sexual harassment and their institution wasn't willing to handle it. So they instead pivoted another direction and we as a society lose in that circumstance. And I just want to add very quickly because I know you're going to be talking about this a little bit next week as well that sexual harassment. Like this is an extension, this maternal discrimination is an extension of sexual harassment and is another barrier to women's careers in science engineering and medicine. And it's it's motherhood in particular that people have a problem with it's not parenthood, it's motherhood. This study of physician mothers experiences of workplace discrimination that came out a couple of years ago, showing that there are several different assumptions that women who are mothers and medicine faced like these ideas that mothers cannot be successful doctors that doctors cannot be good mothers that women physicians should delay childbearing that childbearing necessarily ruins women physicians careers and by the way of course nobody thinks any of those things about men who are having children. They also talked about a significant lack of support during pregnancy and the and the postpartum period including needing to forgo leave being subjected to rules and expectations that were not applied to male colleagues. And then being passed over for leadership positions in favor of people who are less qualified. So they found insidious persistent sometimes blame discrimination experienced by physicians based on their status as mothers. And we had a study that we did a few years back, looking at specifically surgery residents and what their experience was with thinking about taking leave and building their families during their training. And what we found was that this will not be surprising to most of you that residents felt that a leave would put an unreasonable strain on other residents in their training program. And, and this was true for maternity and for paternity so regardless of which parent was taking the leave. And when we asked them what were the biggest obstacles for those who did take parental leave what were the biggest obstacles that you faced and taking parental leave. And for those who hadn't taken leave, we said what would what would be the biggest obstacles obstacles for you to take parental leave and for both of these groups, a perceived or actual lack of support from faculty and peers was one of the major factors. So, as women are building their careers we're facing sexual sexual harassment in gender based harassment in a number of different ways, and we're receiving all these messages about how we can't or shouldn't build our families during our training. And even after training there's a lot of negative connotations to building a family if you're a woman. And those things are not, it's not considered to be negative if you're a man, and actually data on CVs or sorry hiring studies show that men who are parents get a boost in how hireable they are and women who are parents are thought to be less worthy candidates. So I'm going to wrap up here in just a minute so that we can have a little more time for questions. But despite all of this, the sexual harassment, the paternal discrimination, the delaying of our childbearing, the delaying of our families, women physicians are still able to provide better care on a whole than our men physicians. And there's a number of studies that have been looking at this this was a commentary that I wrote earlier this year about a study that came out in JAMA surgery looking at surgical outcomes showing that regardless of the patient's gender they had better outcomes they were less likely to die if their surgeon was a woman, rather than if the surgeon was a man. It just makes me think like, how well would our patients be doing and how well would be be doing. If we didn't have to overcome all these obstacles right there would be an even bigger gap in our performance. And despite all that we're still not getting paid we're not being promoted at the same rates we're not getting nominated for leadership roles and we're not getting appointed to these leadership roles at the same rate as our men. So it's pretty much completely unjust. And so I want to take us back to 2018. So, hashtag me to went viral and follow 2017 January of 2018 was the Golden Globes and the rollout of times up, which is a topic for another day but many of us remember Oprah's speech which was impassioned. And this quote has still stuck with me where she said, for too long women have not been heard or believed if they dare to speak the truth to the power of those men. But their time is up she said, and I for one was very hopeful that that statement was true. And unfortunately I don't think it is yet. But hopefully we'll get there I think that all the things that I've marked in red here are places where we can intervene to make the experience of what happens after the harassment better for those who are experiencing it. And I think that as a single one of these things you can probably even say the mental and emotional distress relationship strain but all along here are ways that we could do better for example institutions cover legal fees for people people who are bringing concerns because why because they're actually helping the institution. And this is actually an act of courage to bring forward a concern. We could change reporting to be a much more supportive process for those who are who are willing to take it on. There's many many things we could do there. Recognizing Darvah when it happens and stopping this idea or interrupting this idea that people need to be the perfect victim in order to be able to bring a concern or to have their concerns listen to. So anyway all of these points are points of potential intervention I'm going to skip over that and then say that back to what I said earlier that what we're trying to do is to look at the tolerance piece. And how do we prevent the harassment from happening in the first place right because like I said we could intervene at all those points on that last slide. But what if we could just prevent the harassment from happening in the first place. And so, Dr Aurora and Dr file in at Yale and several of our colleagues and I have submitted this grant which we recently got funded from the NIH to do a five year study looking at T 32 postdoctoral training programs to implement an intervention on sexual harassment. And it's going to include civility training micro aggressions upstanding implicit bias and specifically sexual harassment. So trying to address multiple different related issues that would lead to, or allow sexual harassment to occur. And then we're going to measure outcomes at the level of the, the mentors and the PI so the intervention really is focused on the people who are doing training in those programs but the PIs and the mentors. And it's going to look at, you know, their experience of those PIs and mentors but also to look at the climate and culture of their training programs and see, you know, if we're able to impact the experience of those trainees if there's differences in their level of productivity and, in particular, their persistence in biomedical research careers. Again going back to that point I made earlier about how people who face sexual harassment often will just leave the field or change their career path so we're trying to change that and retain folks who have already shown a commitment to biomedical research and try to prevent the harms that might cause them to leave. So this is the last quote I have here which is from that piece that I wrote in 2019 vulnerable sick people deserve to be cared for by experts who can work at the top of their game unfettered by workplace harassment and discrimination. And while that's what they deserve. It's not yet what we have. And, you know, I think that everyone here hopefully can commit to trying to create that space and to try to mitigate harm and try to support the people who are having these negative experiences and valuing them when they, when they dare to speak up when they have the courage to speak up because it's a very, very hard thing to do. Thank you for the slides and you can connect with me in any number of ways. I'm probably the worst on email out of all those things but anyway, I'll stop there. Thank you doctor sales so I'll just going to read a couple of comments from the chat that came up and if anyone else wants to put another question in. Rachel Herman wrote, What is your perspective on why institutions are so hesitant to publicly address sexual harassment and those involved. Do you feel that this is still a major cultural change that has yet to happen. Yeah, I think that it's complicated. So, you know, I don't think that institutions are trying or want to do the wrong thing like I don't think that people are malicious. But I think it's very challenging the title nine law and all the details of it, make it very hard for institutions to behave in a different way and even though title nine was initially, you know, it was supposed to help. And it does in many ways, aside from this specific topic, it does help. But the things around, you know, basically protecting the identity of the person who's been accused and employment issues of like not being able to share consequences with people because of privacy concerns. And the idea of mandatory reporting which I didn't mention earlier but you know many institutions folks like us are mandatory reporters and that means that if somebody like a trainee were to come to me and tell me about an instance of sexual harassment, I'm not regardless of what that trainee wants I have to report it, which again takes power away from that trainee, and that was instituted of course to be like we want to not have sexual harassment so everyone who hears about it should report, but that the unintended consequence is that we're then disempowering the people who we really should be supporting the most. So I think a lot of it is is to do with just the legalities and the way that the good intentions have been operationalized. So I think in pretty much all our institutions I think that's a major issue, but I also think that there is a reticence to have true accountability like I think that people want to believe the best and other people and in particular people they've been doing it for a long time. And so they don't want to believe that this person who was nice to them right how often do we hear well he's never done anything like that to me or I've never experienced that with this person, as though the fact that you never experienced it means it never happens. Right, and this is just a human thing like we all do this where we think that the people interacting with us interact the same way with everybody else as they do with us and that's just not true right. So I think it's, you know, some legal factors and it's just some natural human factors, and we need to kind of address both. Also I'll just say it's very hard to hold people accountable for these things so I'm not trying to make excuses for leaders but I do understand that it's challenging, because they'll have their own version of the story and then, you know, in many of them there's not video, you know, like, so that's where you get into this idea that it's he said he said she said but I just wanted to state clearly that reporting is very very hard. So to me, anyone who brings a claim and is willing to go through this process. That gives them immense credibility for me because you would be really irrational to go through all that for something that didn't happen to you because the harms are just too much. Thank you for that I've seen that too. Um, Denver net had her hand up in the middle of the talk I don't know if she still has a question but I gave her some space to talk as she still has a comment. No I didn't have a question I did put some stuff in the chat earlier but I'm sorry I didn't have a question right now. Okay, great. I think I have the question and we have another question I'll read off in the chat after that. Great. Thank you so much Dr Salas I wanted to reflect a little bit with you about where our institution is. You know I think not everyone here might know that we are one of the founding members of the National Academy's collaborative to end sexual harassment and higher education with along with Stanford and other institutions, and. And so we have a team of people working on this from the campus side from the, you know, higher ed, especially from the college. And certainly, you know it's something that we need to think about in healthcare as well. So we have a requirement now in the state of Illinois for one hour of sexual harassment training for all licensed providers. You know that that we routinely meet through this campus education, you know that that we are doing I just got my email for doing next years. And so I know that you know you're thinking about this as an expert with the stop grant, etc. But you know, as as an, you know, the question for educators is, does this work like does a one hour training work. Do we need to do more, you know what is it that we can do as a campus and as a community to be confident that we can actually, you know improve our culture and tackle the iceberg if you will. Yeah, no I think that's a great question and I actually was talking about our grant and a little bit about sexual harassment to a non medical audience last week and one of the people said, well how did you decide that you wanted to target. Preventing harassment because culture change is really hard, like why did you decide to try to do that. And I said, true. But really, I think I think it's worth, as I think you do too worth trying because if we can prevent the harm in the first place we don't have all that spin out of all the things that come after, but does a one hour training work. I mean the data that I'm aware of anyway suggests that no one hour training is ineffective. There is a lot more data on so called diversity trainings and there is specifically on sexual harassment trainings at least that I'm aware of and those data suggests that we need at least four hours of training to have an impact. But in general I think the idea is to have more distributed learning so not a one once a year one hour thing that you maybe even just turn on and walk away and then come back later, or just click through and then answer the questions where like clearly we all know that we're not getting anything out of that process. So distributed learning that is more than an hour a week certainly that seems to be necessary for something to be effective but I think, as we've talked about before like, it's not clear what's going to be effective like we're going to try civility training, training, etc, because these are things that make sense to try. But that doesn't mean they're going to be effective. No thank you and certainly an area that we look forward to hearing more about so. In the summer is Robert gave three comments which are interesting when you're referring to the male tradition is moved from me to the mayor Arizona he is just commenting it's like moving a priest from church to church. And then also just supported your stop the, you know, prevention that you're the grant that you got with Dr Rora. I'll read out the next question. In the JAMA article about female surgeons having less desk than male surgeons with that broken down by surgical specialties. So they actually have 25 different cases that they looked at across different specialties so I do know that they, they included procedures from many different surgical subspecialties. I don't recall if they were able to look within each specialty because of the data becomes fragmented. Either, I have to go back and look at so I don't know exactly the right answer but either there was no difference or they weren't able to look at it. That's as much as I remember that one sorry. All right, another one for Elizabeth posture you mentioned earlier how a lot of women experiencing texture harassment and the workplace can compartmentalize those experiences and consider themselves in the Twilight zone, where somehow obviously wrong action they're acceptable. I think that this can make it more difficult in the future to move forward with reporting when you believe that you were actively accepting that behavior at the time. Any thoughts how people can reframe their experiences with this in mind. Yeah, I mean I don't think that we should judge ourselves for our past choices because we're constantly learning and evolving and so how we look at a situation today should be different from how we looked at it a year ago or five years ago if we're not growing as people. So I think that's just normal to, especially when you're like relatively junior early on in your career and you're not sure what is supposed to be happening around you. Certainly the most conservative safest thing for you to do to protect your career is to say nothing right so that there are reasons that we behave in the ways that we do like I think there's a lot of pathologizing that occurs, especially related to women's behaviors and then people want to like fix us, but there's a reason that we behave the ways that we do for example people say like, oh you shouldn't apologize in your emails, or you shouldn't use exclamation marks or exclamation points, because like you don't need to do that that's just over whatever emoting. But the thing is the reason people, especially women do those things is that if we don't over apologize and if we don't have those exclamation marks people just think that we're going to be harsh. So it's very easy to say oh like you shouldn't have done that, or you shouldn't do that, but at the same time that's ignoring the very reasons for which we do those things so I guess what I'm saying is, give yourself some grace that whatever you accept and I'm not I don't actually agree that you accepted but whatever you chose not to report at the time doesn't it's not a moral failing to not have reported it, it's part of your own growth to understand what is acceptable what is not acceptable. And, and to know where you want to take the stand, which there is no right answer we all have to make those decisions for ourselves so I just don't think there's. I don't think it's that helpful to you know go oh I wish I had done XYZ yeah like there's many things that many of us wish we had done differently but we can't go back in time so the question is how does that inform the choices you make moving forward. Yeah, great. Thank you for that. I think that be that is in a room of ethics fellows here in the ethics library and one of the ethics fellows, I have a question be that I don't know if you want to do it say a verbally or just want me to read it out. Yeah, I can read it out for you so it is in the chat. And Carly asked, do we have data on the effects to the careers of the reporters. Um, like, first, I don't know that I have thinking about that for a second. I don't think that I've seen numbers on that. I think what we know is, you know from the experiences of folks who've shared so for example the students in that lawsuit against Comer off they talk about how you know they left anthropology, completely. In order to avoid this person or I forget exactly what his like sub specialized area in anthropology was but if they didn't leave anthropology they definitely stopped studying that specific thing. In order to avoid him so we know that that it happens. And I think it probably happens to every single person who reports to some degree, but I don't, I'm not aware of any specific data on that. I can add that we will have an expert in sort of the discussions around what the network of silence and why people are silenced coming so Dr. Lillia Cortina is coming from Michigan and and so that would be a great question to carry over as well. Um, because I do think there's a lot of debate as, as our government mentioned about mandatory reporting and so put into place as a good thing but I know that Department of Education was taking a lot of comments about whether or not this, this stifles reporting and so, so I think these are good questions for the policies. So there's a couple questions I can answer easily one is is the recording available and yes the recordings are always available on the McLean YouTube channel, which you can go to by just typing in between YouTube. And then there is CME if we put the CME in the chat you can get CME. And I'll just say one more thing is that Dr. Lillia Cortina is coming in person. So she'll be here the week after Thanksgiving and will be in P117 live and also on zoom for those who want to join that way. So I will I'm just going to, you know, continue to read these questions to Dr. Sales so the notion that the notion of believing the best in people doesn't apply to everyone equally I feel like more grace is afforded afforded to white men. Yep, accurate. Okay, and then are there any papers on which medical specialties are the most male dominated. Oh yeah you can look AMC has data that they publish every year on the breakdown by gender and even different ranks and gender and race for all the different specialties. Yeah, exactly. And then maybe I can send that link so I think I have that data to the devil and see and then a substantial meaningful train sponsored by with or sponsored by the local leaders which could be the department The decision head is more useful than a brief online requirement set from a kind of anonymous office. This approach was chosen recently in one of our units and is being as being a more promising approach for meaningful change I think that like live or discussion is the purpose to watch this, you know, kind of online module that's required for you I think is the point. Well it's that but it's also that we value our leaders. And so if the leader is showing up and saying this is something that matters. If this is something that's really important than that impacts how everyone else takes in that information. So I do agree like in general live things are more engaging right for all of us. But, but it's also the impact of the leader endorsing this as being an important thing and and taking a stand that that enables other people to also view it the same way and also makes people feel like oh well if this person cares then, if I do bring up a right that it may be handled more appropriately than I would otherwise have assumed. Yeah, I have a question myself and that is I've heard this argument. A lot is that the culture has changed so what was acceptable previously is now not acceptable and, and that is a little bit of an excuse, you know, so that I didn't I didn't see I didn't understand that the culture was changing so I've been doing this for a long time and now it's unacceptable and how am I to know that you know what I mean so do you have any discussion around that. Yeah, I mean I know that people do say things like that or they'll say like oh well he's older, he didn't mean anything by patting you on the head or whatever. I, I, I mean, I, yes, we have to like have some grace for the people around us if if an intention does matter to some degree, I think, even though some people think intention doesn't matter at all I do think it matters some, but impact matters more than intention, and it really kind of doesn't matter what your attention was if the person who you're interacting with felt harmed. And that's the part that we need to focus on and figure out how to stop that harm. And again it doesn't matter like maybe you didn't mean anything by it, but in reality it doesn't matter what you meant what matters is how it was received. And I know that that's a hard concept for a lot of people because they feel like, well if I didn't mean it, I shouldn't be held accountable or something like that, but that's just not how the world works like what we say and do impacts the people around us. Which is reality, and we may not always be able to predict what those impacts are. And I think that that's okay, but when people tell us what the impact is then we have to believe them. And it has to be from a place of, rather than be defensive. We have organizations and institutions and departments where everyone is doing that and, you know, giving each other feedback on frequently and in low stakes manner, then we can start to change the culture. Thank you. I have a question I don't know if you want to type it in or if you want me to promote you so if you just mess it up I'll figure out how to do what you would like and then I'll just read Pringle Miller had a comment the physician just equity nonprofit organization has found that of the peers they've supported 22% have changed specialties due to discrimination. Dr Pringle Miller is going to be another speaker, I think later down the road I don't have exact date on there but it's somewhere in the winter or spring. And so I don't know if you're familiar with her work but I think she was just commenting and giving some feedback on what you what you talked about. No, it's great. Thank you. Yeah. Yeah, Dr. Humphrey is also speaking later say a lot of our future speakers coming to hear you, which is wonderful. I'm going to allow you to talk about if I let you do that and you can see if you want to unmute yourself and ask a question. By the way, Dr Humphrey was just here last week. At Stanford for a talk that's great. Also, it should doesn't escape me that the Association of American Medical Colleges is meeting in Nashville this week weekend for the first time in person, and a lot of the talks focus on diversity equity inclusion as well as learning environment so certainly this is top of mind for quite a number of our medical schools and academic medical centers. You know, if I may, I wanted to say I enjoyed very much your talk and particularly, I was impressed that you connected it with power. And, and I just wonder, in part, if this is not evolution or issue that not only in relation to the sexual issue is related to the power as a whole in a society that in which we haven't learned to respect individual right. If you look at the animals, you could see, as soon as another male and female come the male jumps on the female without any permission, or if it comes to the areas of the thing they they try to hit that animal and get it out of there. And a part of the becoming human is that we put break on our desire in order to be civilized and a part of it is to learn individual human right that we would learn it at a school, not only in relation to the sexual, but even in relation to what you were talking in relation to the medicine. Thank you, Dr. Heckman, I'll give her an opportunity just to respond to your reflections. Yeah, I mean, I, I, I think I follow what you're saying and I think that the issue of power for me also. One part of the issue about power is that often people do not recognize their own power. So, you know, a faculty member at a school of medicine might be interacting with a resident, and that faculty member may not really see him or herself as different from the resident, because maybe they're very humble that they, and, and they think that they're just showing up in that space just like everyone else. But there is inherent power right in their role. And so when that person speaks to residents or medical students. There's not really a free exchange of ideas because they're in a position right where they're supervising where they're evaluating and so on and if, and I think part of where people get in trouble is not recognizing the power that they have, because sometimes if you said to a troop here like they may not be offended or take harm or think that it was a microgression or whatever. But when you're someone in a position of power saying that to someone who you're supervising or mentoring or evaluating, then it can be very different. The impact can be very different. And so we have to be aware when we show up in spaces of how much power we have or don't have and what's the status associated with different aspects of our identity that we don't control. And so people is getting to the comment earlier about how, yeah, white men have higher status in our society. So yes, they're given more grace they're given more opportunities, their words are carry more weight, etc. And so they need to be aware of that too when they show up in spaces. So there's power in our, you know, whether we have an accent or don't have an accent, the color of our skin how light or dark, regardless of what our race or ethnicity is. Our formal power comes from our different titles and positions that we may hold but also informal power from our gender or sexual orientation and so on. So anyway, there's all of that is kind of goes together like you can't really disentangle. But I think that one of the biggest challenges is people who don't recognize where they're coming in, like in terms of that power and status and acting like, or thinking that they, they don't. We're not understanding how much extra weight their words have because of that power and status. Right. Yeah, one of the anonymous attendees said to that point men have been socialized to think that this behavior is okay. Maybe necessary, make me necessary to move up like having that power is necessary so. Thank you so much for a wonderful talk, I think we'll end the recording there and then Dr sales does have 10 to 15 minutes ish epic sellers want to raise their hand we can promote you to a panelist you can.