In total, we received 3299 responses to our survey. We firstly excluded 220 participants who had not yet participated in any internship and 64 participants because they had not answered any behaviour-specific question. Hence, 3015 valid responses were analysed (table 1). We obtained a total response rate of 29,6% of which 35% of participants were male and 65% were female.
The potential target population consists of 42.1% men and 57.9% women, whereas the study population consists of 35% men and 65% women. The sex ratio in the study population was not equal to the initial target population according to a chi-square test of goodness-of-fit (p < 0.001).
2. Incidence of sexual violence in medical students and specialty registrars
Within the total study population, 1168 of 3015 participants (38,73%) reported having been victim of at least one type of sexual violence as explored by our survey. This percentage was the highest in GP specialty registrars (53%), followed by specialty registrar (50%) and master students (39%) (table 2). A difference is observed between the relative frequency of incidents reported in male (21%) and female (48%) respondents.
2.1. Hands-off sexual violence
Of the respondents, 32.9% (n = 153 men, n = 831 women) reported at least one experience of comments on physical appearance or disrespectful (derogatory, belittling) jokes. Patients (54.4%), medical staff members (46.6%), (fellow) students (26.7%), supervisors (25.5%) and paramedic personnel (20.1%) were identified as assailants (table 3). The hierarchical position of the specific person exhibiting the behaviour (27.7%) and the inability to flee from the situation (20%) were most 158 frequently reported as circumstances facilitating this behaviour.
Five percent (n = 48 men, n = 95 women) of the respondents reported having received unwanted sexually tinted texts or images. Moreover, being asked to undress (with or without images being taken) or (being witness to) unwarranted undressing was reported by 1.5% (n = 9 men, n = 32 women) of the respondents. Patients were cited as assailant in 55% of these cases. In 28.6% of cases this happened more than once.
2.2 Hands-on sexual violence
Of the respondents, 3.7% (n = 30 men, n = 73 women) had experienced an unwanted attempt to kiss. In 21% of the cases this happened more than once. Moreover, 8.7% (n = 44 men, n = 203 women) were touched or somebody tried to touch them without consent. In 39% of cases this happened more than once and in 4% this happened regularly.
There were ten reports (n = 4 men, n = 5 women, n = 1 unknown) of (an attempt at) unsolicited oral sex (passive or active). The inability to escape from the situation (n = 1), use of alcohol or drugs (n = 2) and physical violence (n = 1) were cited as circumstances facilitating this behaviour.
There were nine reports (n = 3 men, n = 5 women, n = 1 unknown) of (an attempt at) unwanted sexual penetration. The (hierarchical) position of the person exhibiting the behaviour (n = 1), the inability to flee from the situation (n = 3), use of alcohol or drugs (n = 2) and physical violence (n = 1) were cited by these victims. Of the participants, two male respondents reported both unwanted oral sex and penetration.
3. Differences in incidence of sexual violence between men and women
Women reported significantly more (p < 0.001 and OR = 4.36) instances of sexist remarks or jokes compared to men. They also reported significantly more (p < 0.001 and OR = 2.69) unwanted (attempts at) physical contact. For other types of sexual violence, no significant differences between frequencies of incidents reported by men and women were observed.
4. Immediate reaction to sexual violence
In most types of sexual violence, no immediate reaction followed the unwanted behaviour. Except for kissing (53%), the amount of cases in which somebody reacted was inferior to 40%, ranging from around 37% in case of unwanted touching or undressing to barely 22% in the case of unwanted penetration.
In most cases (>80%) this reaction was by the victims themselves. Other persons were more likely to react to inappropriate remarks (45% of reactions, most often by paramedic staff, specialty registrars and supervisor) and unwanted touching (35% of reactions, most often by students, medical staff or paramedic staff). In cases of unwanted oral sex or penetration, there never was a reaction of somebody else than the victim.
The type of reaction, categorised according to the 4 “D’s” of bystander reactions (direct action, distraction, delay and delegation), differed from behaviour to behaviour (figure 1). Direct reaction and distraction were the strategies used most often. Not many incidents were reported to higher instances. There were no statistically significant differences observed in the amount or type of reactions to sexual violence according to the assailant categories.
Figure 1 Type of response to sexual violence in the cases where somebody reacted.
3.3 Disclosure of sexual violence
After having experienced sexual violence, women (57.3%) more often than men (39.7%) disclosed what happened. Most often, victims talked about what happened to a friend or family (92,21%). In 15% of cases they disclosed to a trust person outside of their inner circle. In 12 cases (2,5%) professional help was consulted and in 7 cases (1,5%) the authorities were notified of the event.
4. Indirect exposure to sexual violence
More than one tenth (12.8%, n = 386) of the study population witnessed potential sexual violence towards another medical student or specialty registrar. In 56% of cases this behaviour was by a medical staff member (n=215) and in 22% of cases this behaviour was by a supervisor (n=83). Other reports involved patients (18%), specialty registrar (18%), paramedical staff (12%) and students (10%) as assailant.
After witnessing potential sexual violence, 48.7% asked about the feelings of the person who underwent the situation afterwards, almost one third (33.7%) undertook no action, 27.7% tried to distract the assailant, 5.9% took direct action by intervening or calling out the behaviour and 3.4% notified a superior.
5. Knowledge of support mechanisms and resources in case of sexual violence
Only 40% of respondents claims to know what to do when they experience sexual violence. However, 60% of respondents indicate not to know how to handle these matters. Moreover, 62.8% of respondents do not know how to help somebody who tells them that they have experienced undesirable behaviour, nor know which instances are able to help or give support in this situation (65.1%).