Statement on Harassment, Bullying, and Discrimination

The American College of Surgeons (ACS) Women in Surgery Committee, in collaboration with the Committee on Diversity, developed the following updated Statement on Harassment, Bullying, and Discrimination. The ACS Board of Regents approved the statement at its June 7−8, 2019, meeting in Chicago, IL.


The professional practice of medicine requires an environment in which patients, staff, colleagues, physicians, trainees, and all other individuals are treated with respect, civility, and tolerance. All members of the surgical team have a shared responsibility to create a culture that values all individuals equally.

Harassment, bullying, and discrimination are three distinct interpersonal behaviors that can negatively affect professional relationships, physical health, mental health, and job satisfaction. These behaviors create a hostile work environment that can compromise patient safety and jeopardize patient outcomes, in addition to damaging the well-being of staff.

Harassment includes, but is not limited to, offensive remarks and actions based on or about gender, race, religion, sexual orientation, age, culture, or ethnicity. Similar to bullying behaviors, harassment can lead to a hostile and intimidating work environment.

Bullying can be defined as the use of negative and aggressive interpersonal behaviors to intimidate and dominate others. Bullying behaviors often are persistent and repeated. Examples include humiliation, insults, threats, coercion, isolation, and overwork—sometimes involving repetitive or meaningless tasks. Bullying often arises in contexts in which there is an imbalance of power. This disruptive behavior, therefore, can be common in the surgical environment.

Discrimination entails negatively charged, differential treatment based on one’s personal characteristics or attributes, including, but not limited to, gender, race, religion, sexual orientation, culture, ethnicity, disability, or age. The effects may be more subtle than those associated with bullying and harassment and can manifest as punitive actions or impediments in employment, practice, and/or career advancement. Actual or perceived discrimination may cause a decline in work morale and job satisfaction, ultimately affecting patient care. Implicit bias may contribute to discrimination unless institutions commit to adequate training and cultural change.

The ACS values respect, fairness, and professionalism in all interactions with patients, staff, colleagues, and trainees. The following guidelines provide a framework for surgical departments and practices to create a work environment free of bullying, harassment, and discrimination:

  • It is essential to build a culture of respect and collaboration in all aspects of surgical practice.
  • Health care professionals should have zero tolerance for discrimination, harassment, or bullying based on personal attributes, including, but not limited to, age, sexual preference, gender, race, culture, ethnicity, disease, disability, or religion.
  • Administrators should develop and implement transparent policies to address bullying, discrimination, and harassment.
  • Staff, physicians, and trainees must have access to nonpunitive reporting structures, counseling services, and remediation programs.
  • Surgical training should include a curriculum to address implicit bias, bullying, harassment, and discrimination.

Bibliography

American Surgical Association. Ensuring Equity, Diversity, and Inclusion in Academic Surgery. Available at: http://americansurgical.org/equity/. Accessed June 11, 2019.

Association of American Medical Colleges. Medical school graduation questionnaire—all schools report. Available at: www.aamc.org/download/481784/data/2017gqallschoolssummaryreport.pdf. Accessed June 11, 2019.

Coombs AA, King RK. Workplace discrimination: Experiences of practicing physicians. J Natl Med Assoc. 2005;97(4):467-477.

Dzau VJ, Johnson PA. Ending sexual harassment in academic medicine. NEJM. 379(17):1589-1591.

Halim UA, Riding DM. Systematic review of the prevalence, impact, and mitigating strategies for bullying, undermining behavior and harassment in the surgical workplace. Br J Surg. 2018;105(11):1390-1397 [Epub ahead of print].

Ling M, Young CJ, Shepherd HL, Mak C, Saw RP. Workplace bullying in surgery. World J Surg. 2016;40(11):2560-2566.

Rayner C, Hoel H. A summary review of literature relating to workplace bullying. J Community Appl Soc Psychol. 1997;7(3):181-191.

Royal Australasian College of Surgeons. About respect: Addressing bullying and harassment. Available at: www.surgeons.org/about-respect/. Accessed June 11, 2019.

Royal College of Surgeons of Edinburgh. Are you being bullied? Available at: www.rcsed.ac.uk/professional-support-development-resources/anti-bullying-and-undermining-campaign/are-you-being-bullied. Accessed June 11, 2019.

The Joint Commission. Quick Safety, Issue 24: Bullying has no place in healthcare. June 20, 2016. Available at: www.jointcommission.org/issues/article.aspx?Article=rFhOFvmOhideyaeaXWHwdF7iIsdGP%2bTcEobEhA7d2RU%3d. Accessed June 11, 2019.

U.S. Equal Employment Opportunity Commission. Sexual harassment. Available at: www.eeoc.gov/laws/types/sexual_harassment.cfm. Accessed June 11, 2019.

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