Improvisation to combat sexual harassment on the wards.

Abstract

In the spring of 2021, medical students at the University of Geneva, Switzerland, conducted a survey amongst their peers concerning sexual harassment during the clinical clerkships. The survey collected multiple testimonies of sexual harassment that occurred during their clinical rotations. These results inspired an awareness campaign against sexual harassment. Knowing that the impact of sexual harassment includes physical and psychological repercussions, burnout, career change and avoidance of learning opportunities, the medical school created a sexual harassment awareness course for medical students before beginning their clinical rotations. Due to the sensitive nature of the subject matter, we decided to use actual testimonies of the campaign as part of the teaching strategy. We sought to create an active learning exercise that would stimulate students to reflect deeply on prevention and response strategies with the purpose of removing students from the role of victim or passive witness. In collaboration with an improvisational theatre troupe, Impro-Impact, we created the course using the extended parallel process model (EPPM) as our conceptual framework.1 This model purports that if one believes that a threat is harmful and that they are at risk, while at the same time they believe in the effectiveness of solutions and have the confidence to practice them, they are more likely to take protective action to avoid or reduce the threat. The course was constructed in five parts: (1) a brief theoretical introduction, (2) a performance depicting the day in the life of a female medical student who experiences sexual harassment on the first day of her surgery clerkship, (3) students formed small groups to debrief the scenarios and to brainstorm potential responses as a victim and as a bystander, (4) the scenes were replayed by the actors using the suggestions of the students, and (5) the course concluded with a presentation of available resources. Feedback from the medical students showed that our initial objective of increasing awareness was attained, but in addition, we learned that this course was able to empower students to speak up about their own experiences, to question the status quo and to give students enough agency to react in these uncomfortable situations. In the first clinical rotation following the course, students in the surgery rotation were able to come forward about incidents of sexual harassment, allowing the medical school to intervene on their behalf. Students were also vocal about the necessity to train faculty in order to bring about a culture change. Two multiple-choice questions asking students to decide upon next steps in a sexual harassment vignette were included in the final exam. Surprisingly, responses to the questions showed that students did not identify medical school faculty as an important resource. Future work will need to focus on ways to increase student confidence in the medical school's response to sexual harassment. The course will occur annually and there are now plans to create similar courses for medical school faculty and other faculties associated with the university. Pauline Hämmerli, Lygia Pavitt and Nadia M. Bajwa designed, constructed, implemented and evaluated the project. Nadia M. Bajwa wrote the draft manuscript. Pauline Hämmerli and Lygia Pavitt revised the manuscript.