Clinical Relevance vs Statistical Significance: The Good, The Bad, and The Future of Sexual Harassment in Orthopaedic Surgery 

 

This guest post comes from Jennifer Beck, MD. 

As a female, mid-career orthopaedic surgeon, I believe I bring a unique perspective to reporting on the changes that I have witnessed over the past 15 years in academic orthopaedic surgery. It is well documented that ours is an overly White, male-dominated field, often associated with the stereotype of “dumb jock” doctors bringing locker-room humor to the operating room. Stereotypes and parodies abound on various social media platforms. Additionally, it is widely known that cultural and demographic change in orthopaedics has occurred at a pace slower than in other fields in medicine.  

I must clarify that the news isn’t all bad. Traiblazing individuals including female orthopaedic department chairs (Drs. Lisa Lattanza, Susan Bukata, Michelle Caird, April Armstrong, Valerae Lewis, Leesa Galatz, and Evalina Burger) and society presidents (Drs. Kristy Weber, Lori Karol, Serena Hu, Mary O’Connor, Heather Vallier, Bess Brackett, Marybeth Ezaki, Jo Hannafin, Judy Baumhauer, Lisa Cannada) and groups like the Ruth Jackson Orthopaedic Society, SpeakUp Ortho, the International Orthopaedic Diversity Alliance, and The FORUM have created pathways for positive change in support of diversity. At a time when health care is being attacked from all sides, we must band together for change and cannot lose momentum they have created. 

When reviewing statistical analysis of my clinical research, the perfectionist in me wants to achieve that elusive “statistical significance” so I can say, “Yes, there was a difference.” However, when finding nonsignificant results, I am often left wondering if they are clinically relevant or useful. At the recent 2021 Annual Meeting of the American Academy of Orthopaedic Surgeons, Dr. Emily Whickers and colleagues presented a poster on sexual harassment in the field of orthopaedics. Based on a survey of members of the Ruth Jackson Orthopaedic Society, her group initiated their study “to better understand harassment in orthopedic medicine in light of ‘the stories that we had all heard,’” Whickers told MedPage Today.  

They did not find a statistically significant decline in harassment during orthopaedic training, with 59% of the current residents reporting harassment vs 72% of the past residents; p = 0.10. How can orthopaedic surgery continue to make progress toward “significance”?   

Encouragingly, the authors did find a trend that current residents felt more comfortable reporting harassment, a step toward defining and acknowledging the problems through a supportive culture. Now is the time to thoughtfully reflect on and openly discuss successful programs that have been instituted and their effect. We can learn from other’s successes, and failures.  

 As we do so, let’s discuss options to the 4 characteristics that contribute to this problem as reported by the National Academies of Sciences, Engineering, and Medicine: 

  1. Male-dominated field 
  • Improve the pipeline of female/nonbinary, LGBTQ, and underrepresented minority members of our field through programs and organizations such as the J. Robert Gladden Society and The Perry Initiative 
  • Create and adequately resource diversity, equity, and inclusion committees and programs 
  • Appropriately promote and actively retain women (who are leaving medicine at record rates due to the COVID-19 pandemic)  
  1. Organizational tolerance 
  • Decrease the prevalence of men who “fail up” in medicine 
  • Create pathways for reporting and evaluating sexual harassment in a safe and nonjudgmental fashion 
  • Create and support resources for victims of sexual harassment 
  • Create and enforce repercussions for offenders through education, behavior modification, and situational modification 
  • Absolve any sense of retaliation through the medical hierarchy 
  1. Hierarchical and dependent relationships during surgical training 
  • Create an educational environment that is supportive and engaging of open conversations on critical issues and topics 
  • Identify and resource faculty mentors who can work with victims and perpetrators of sexual harassment 
  1. Isolationist feelings of female residents 
  • See recommendations from Point 1 
  • Create programs focusing on the needs of female surgical trainees in all subspecialities 
  • Hire, promote, and retain female faculty and mentors 
  • Hire, promote, and retain male faculty and mentors who encourage and engage in open conversations 

It is easy to become discouraged when efforts may not be producing the results as quickly as we want. But as numerous Peloton instructors say, “It’s progress, not perfection” that matters. Sexual harassment is not a one-time, one-solution fix. It’s not a checkbox on a to-do list. It’s the daily grind and grassroots cultural change, the need for program and policy creation and implementation, the constant evaluation of program efficacy, and the continued awareness of the struggle that will lead to the progress we desire for an inclusive and safe field of orthopaedic surgery.  

Jennifer Beck, MD is a pediatric sports medicine surgeon at UCLA and a member of the JBJS Social Media Advisory Board. She thanks Jennifer Weiss, MD and Selina Poon, MD, both pediatric orthopaedic surgeons, for their help with initial editing of this post. 

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