Entrenched sexism in surgery

There is an expectation among some senior surgeons that junior trainees should endure the same training circumstances as those in place when they trained. Trainee surgeons do not complain for fear of being seen as weak or unsuitable for surgery. They fear being black-balled.

Those who have the courage to complain risk career suicide. Sometimes a surgical career is over before it starts.

The expert committee also identified "bystander silence" as a serious problem. Within a culture of fear and reprisal, colleagues who witness bullying, discrimination and sexual harassment are rarely prepared to complain. They see no point in making a complaint.

Complaint processes protect the status quo. The person responsible for dealing with complaints is often a close colleague of the person who is being complained about. Not surprisingly, complaints often hit a brick wall.

The college has responded to the current toxic professional culture within surgery with a 21-page action plan. The document "Building Respect, Improving Patient Safety: RACS Action Plan on Discrimination, Bullying and Sexual harassment in the Practice of Surgery" claims to show "RACS' commitment to dealing with unacceptable behaviours; strengthening surgical education and training; and reshaping the culture of surgery on foundations of collaboration and respect".

The action plan is difficult to read, let alone understand. It is replete with weasel words. Phrases create an impression that a meaningful statement has been made, when only a vague or ambiguous claim has been communicated.

According to the current President of the Royal Australasian College of Surgeons: "We must make it safe for victims and bystanders to speak up. There must be clear consequences for those whose behaviour is unacceptable." Unlike the action plan, his statement is clear.

The Royal Australasian College of Surgeons plans to provide education in countering discrimination, bullying and sexual harassment. Once again, the onus is on the victim to take action. However, with better complaints mechanisms, perhaps the victims will now get justice.

The college also plans to change the way surgeons are trained. Current surgical training arrangements provide disincentives for doctors seeking work-life balance to join the surgical profession. The current arrangements favour those without family commitments or with partners who have less demanding careers.

They aim to embrace diversity and foster gender equity. However, simply bringing females into the surgical boys club will not change this culture. Changing the toxic culture among surgeons requires structural change.