An AAOS Opinion on Ethics and Professionalism is an official AAOS statement dealing with an ethical issue, which offers aspirational advice on how an orthopaedic surgeon can best deal with a particular situation or circumstance. Developed through a consensus process by the AAOS Committee on Ethics and Outside Interests, an Opinion on Ethics and Professionalism is not a product of a systematic review. An AAOS Opinion on Ethics and Professionalism is adopted by a two-thirds vote of the AAOS Board of Directors present and voting. The following Opinion on Ethics and Professionalism was last updated in July.

AAOS promotes an environment of respect, professionalism, fairness, integrity, empathy, and inclusiveness. These values are reflected in the AAOS Principles of Medical Ethics and Professionalism in Orthopaedic Surgery and Code of Medical Ethics and Professionalism.

Sexual harassment in any capacity by an orthopaedic surgeon is unethical, unacceptable, and frequently illegal. Sexually harassing behavior can occur in a variety of settings, including the workplace, an academic setting, a meeting, or a social event related to work. It may involve a colleague, supervisor, trainee, or others in the allied healthcare space. Harassment may also involve a patient. The conduct may be directed toward a person of the same or different sex. Examples of unethical conduct include but are not limited to:

• jokes, slurs, or degrading comments of a sexual nature
• offensive sexual flirtations
• sexual advances or propositions
• graphic verbal commentaries about an individual or his or her appearance
• sexual innuendo or suggestive comments
• sexually oriented “teasing” or “joking”
• unwanted physical touching of another person’s body
• display in the workplace of sexually suggestive objects, pictures, or other visual materials
• obscene or harassing use of telecommunications or other technology

No one should be subject to sexual harassment. In orthopaedic surgery, females comprise only 4 percent of AAOS fellows and 13 percent of residents, further elevating the need for sensitivity to sex- and gender-related issues.

Orthopaedic surgeons share in the responsibility of helping to create an environment that is safe, productive, and free from harassment. Orthopaedic surgeons should ensure that appropriate anti-harassment policies have been adopted and enforced in the workplace, that appropriate training is provided, that the policies adopted provide a reporting mechanism for victims and prohibit retaliation, and that sexual harassment training is required for all employees.

Recommendation

AAOS urges that orthopaedic surgeons must be aware of and sensitive to issues of sexual harassment.
It is essential that orthopaedic surgeons conduct themselves professionally and prevent any activities that may jeopardize patient care through sexually harassing behavior. The orthopaedic surgeon should conduct him/herself in a manner that promotes a healthy workplace environment.

Orthopaedic surgeons should ensure that policies prohibiting sexual harassment are adopted, fully implemented, and uniformly enforced to ensure that all members of the healthcare team may perform their professional duties without fear of sexual harassment. They should strive to stop sexually harassing behavior by others in the work environment, whether they are witness to, or the recipient of, such activity.

©February 1993 American Academy of Orthopaedic Surgeons®. Revised February 1997, May 2002, September 2005, December 2012, July 2018.

References:

• Code of Medical Ethics of the American Medical Association: Opinion 9.1.3, Opinion 9.3.2, and Opinion 9.4.2. Chicago: American Medical Association; 2017.
• Van Heest AE, Agel J: The uneven distribution of women in orthopaedic surgery resident training programs in the United States. J Bone Joint Surg Am 2012;94:e9.
• Walsh MN, Gates CC: Zero tolerance for sexual harassment in cardiology. J Am Coll Cardiol 2018;71:1176-7.
• Jagsi R: Sexual harassment in medicine—#MeToo. N Engl J Med 2018;378:209-11.
• Association of American Medical Colleges: Medical School Graduation Questionnaire: 2017 All Schools Summary Report. Available at: https://www.aamc.org/data/gq. Accessed January 11, 2018.
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• Feldblum CR, Lipnic VA: EEOC Select Task Force on the Study of Harassment in the Workplace: Report of the Co-Chairs of the EEOC. Federal Laws Prohibiting Job Discrimination: Questions and Answers. Available at: https://www.eeoc.gov/eeoc/task_force/harassment/upload/report.pdf. Accessed January 11, 2018.
• Jablow M: Zero Tolerance: Combating Sexual Harassment in Academic Medicine. Available at: https://news.aamc.org/diversity/article/combating-sexual-harassment-academic-medicine/. Accessed January 16, 2018.
• Royal Australasian College of Surgeons: About Respect: Addressing Bullying and Harassment. Available at: https://www.surgeons.org/about-respect. Accessed May 15, 2018.