This year, the Australasian College of Dermatologists (ACD) began a process to analyse the prevalence of bullying, discrimination, harassment and sexual harassment amongst the profession.
Whilst these behaviours had not previously been identified as a key area of concern for the ACD, anecdotal evidence, plus the experiences of other medical Colleges, raised the matter and indicated that the exploration of these issues were required.
In September 2015, a Taskforce, comprising the CEO, Fellows and a Trainee of the ACD, was convened by Associate Professor Chris Baker, President of the ACD, in order to examine these issues.
Earlier this year, the ACD engaged a third party provider (the same company that has been appointed by the College of Surgeons and several other medical Colleges), to conduct a survey to ascertain the prevalence of bullying, discrimination, harassment and sexual harassment amongst and affecting dermatologists and the profession.
Electronic surveys were sent to 652 active Fellows, trainees and IMG candidates via email. Of the 251 (38%) who opened the survey, 216 respondents (33%) took part in completing the survey. Of the total 216 responses received, 76 respondents (35.2%) stated that they had been subjected to bullying, discrimination, harassment or sexual harassment, as defined in the survey tool itself (please see the definitions below). The responses showed that these unwanted behaviours are prevalent within the profession and, in some cases, some individuals reported experiencing more than one of these.
The findings indicate that bullying represents the principal issue, however, discrimination, harassment or sexual harassment cannot be ignored as these behaviours also clearly occur, or have occurred previously (please see the definitions below). The frequency of occurrence suggests that these incidents are less likely to be isolated, one-off events, signifying that these patterns of behaviour do exist and are ongoing.
After references to generally ‘being bullied’, humiliation was the second most frequently observed theme of the bullying. The scope of discriminatory behaviour identified was ‘cultural or racial discrimination’, followed by ‘pregnancy or maternity biases’. The scope of harassment and sexual harassment behaviours was both ‘aggression and physical abuse’, and ‘sexual innuendo and propositioning’ of equal reported prevalence.
The Taskforce found that, depending on which behaviour was identified, 40-60% of these incidences occurred more than five years ago, however 25-40% occurred in the last two years. This indicates that, whilst these incidences may have occurred to our Fellows who are now more than 10 years out of the training program, there has also been an unwelcome persistence of these behaviours into the present day, albeit at lower levels, affecting mostly trainees and more recent Fellows.
When asked whether they took action or not, many identified the barriers to taking action. These included concerns: for the effect on their future career options; that they may become subject to victimisation; or that they may suffer reputational loss.
Overwhelmingly, females reported the highest incidences of experiencing one or more of the four types of behaviour (70.8%). Most events also occurred as a trainee, with 85% reporting that they experienced one of these behaviours during this time.
In relation to the role of the person who displayed the behaviour against an individual, males were identified as the predominant gender, displaying this behaviour (93.3% in discrimination, 80% in bullying, 95% in sexual harassment and 72.7% in harassment).
Department Heads and Clinical Supervisors were the main roles of people reported as perpetrating the behaviours, specifically, bullying, discrimination and harassment, however hospital staff, practice administration staff, nursing staff and others (clinicians and in some cases, patients) were also involved as perpetrators, inflicting behaviours including sexual harassment, demonstrating that challenges exist within the healthcare system and the wider society.
The findings reflect themes, which are similar to those reported by other professions and in other countries. Some results indicate that specific focus is required within dermatology as a profession. Whilst numbers are small and lower by comparison with other Colleges, they are unacceptable at the levels reported, indeed at any level, and cannot and will not be tolerated. A previous attitude of tolerance of these behaviours needs to change. There have been societal shifts in expectations leading to changes of standards and changes to legislation reflecting this. The ACD will provide learning resources so that it is very clear on what the full scope of inappropriate behaviours are, and how to correct them. It is of paramount importance to the ACD that the prevalence of these behaviours diminish and become non-existent. This is a whole-of-profession cultural issue to discuss and become familiar with.
The ACD recognises that training in a workplace, where there are abundant pressures to clear waiting lists and see large patient loads, present major challenges for trainees, supervisors and department heads alike. The ACD will embark on communication skills and supervision skills training. There are simple techniques and, for more sensitive conversations, well-practiced methods that can take time to learn. The ACD supports the various State health systems as employers of our trainees and many of our Fellows, and is committed to use its sphere of influence to make a difference.
The ACD will continue to provide support to those experiencing any of the unwanted behaviours and work to improve its complaints handling processes. It is of the utmost importance that any issues regarding bullying, discrimination, harassment and sexual harassment do not remain hidden and are resolved. The ACD views discrimination, bullying, harassment and sexual harassment in the workplace and in the ACD as completely unacceptable.
A/Prof Chris Baker, President
Mr Tim Wills, CEO
16 December 2016