A validated sexual harassment questionnaire in the medical working environment is not available in German speaking countries. We translated an international questionnaire from the Medical Women´s Medical Association (MWIA) into German.12 The MWIA drafted the questionnaire for their own global survey in 2017. The original English version of the survey can be found in the supplementary material. The MWIA study and questionnaire used was approved by the Monash University Human Research Ethics Committee, Melbourne, Australia (Project ID 10064) and was designed by an international team of experts in medical education led by Prof. Jan Coles. The German version of the questionnaire was anonymous and did not collect any identifying or potentially identifying personal data. For this reason, Human Research Ethics Committee approval was not required after discussion with the local ethics panel.
The German questionnaire was distributed via a mailing list of all our medical students as a link. We started, after asking for gender affiliation, with definitions and legal aspects concerning sexual harassment and bullying as well as equality under public law in Germany. The definition of sexual harassment was in accordance with the WHO definition outlined in the section headed “background” 13-16. We also applied definitions from the German Penal code. The Penal Code in Germany starts with an anti-discrimination statement17:
“1. Prohibition of Discrimination Under Civil Law
- Any discrimination on the grounds of race or ethnic origin, sex, religion, disability, age or sexual orientation shall be illegal when founding, executing or terminating civil-law obligations,16 and further refers to employer and employee duties and rights.
- Penal Law: Enforcement
(1) Where a breach of the prohibition of discrimination occurs, the disadvantaged person may, regardless of further claims being asserted, demand that the discriminatory conduct be stopped. Where other discrimination is to be feared, he or she may sue for an injunction.
(2) Where a violation of the prohibition of discrimination occurs, the person responsible for committing the discrimination shall be obligated to compensate for any damage arising therefrom. This shall not apply where the person committing the discrimination is not responsible for the breach of duty. The person suffering discrimination may demand appropriate compensation in money for the damage, however not for economic loss.
(3) Claims in tort shall remain unaffected.
(4) The person responsible for committing the discrimination shall not be permitted to refer to an agreement which derogates from the prohibition of discrimination.
(5) Any claims arising from Subsections (1) and (2) must be asserted within a period of two months. After the expiry of the time limit the claim may only be asserted when the disadvantaged person was prevented from meeting the deadline through no fault of their own.”
A total of 2162 medical students, 1427 females, at the Westfalian University of Münster were asked to participate deliberately and anonymously in the online survey between 10 October and 30 November 2018.
The survey was divided into two sections: one contained ten statements on general and individual experiences and different forms of sexual harassment, including verbal and sexual contact, and forced physical sexual contact. The second section detailed the frequencies of specific sexual harassment experiences and perpetrator groups. Each part finished with a free text option on personal narratives, consequences and ideas for intervention. Inclusion criterion was completed data set. Incompletely answered surveys were excluded. Demographic data solely concerned gender affiliation. Agreement or disagreement with ten different statements followed in Part 1 of the questionnaire. Answers could be given with a five step Likert scale.
Part 1: Statements to (dis-)agree with included: ‘Did you observe sexual harassment against males/females within your medical educational field?’ Response options ranged from: I agree completely; I agree partially; I do not know; I disagree partially; and I disagree completely.
Statements in Part 2 contained: ‘Have you ever felt that your job or your future job was dependent on you performing an unwanted sexual behaviour?’ They could choose between ‘never’ to ‘once’, ‘two to five times’ and ‘more than five times’.
In Part 2, questions concerning people who were responsible for sexual harassing actions including ‘manager or supervisors?’, ‘colleagues?’, ‘patients?’ or ‘other group of people’ were asked.
A contingency plan was put in place to help survey respondents deal with the potential for emotional and/or psychological distress resulting from completing the survey and reliving potentially traumatic experiences. The Medical Faculty in Münster has a helpdesk for students and the leading psychologist, Mrs Janina Sensmeier, is a co-author of this manuscript. In addition, a special support consultation was available in case of need as part of the study.
Continuous data are presented as the mean ± standard deviation (range) and categorical data are presented as the frequency (percentage). Continuous data were analysed using the Mann–Whitney U test. Paired continuous data were compared using the Wilcoxon signed rank test. Proportions were compared using the Chi-square or Fisher-exact test, as appropriate and as necessary. Examples of qualitative data are presented but the formal analysis of the free text is yet to be completed. Data of partial and complete agreement were collapsed, as were partial and complete disagreements.