Education on Sexual Misconduct: Why the Lesson Begins Before an NHS role

14 September 2023

Our newest University of Cambridge ThinkLab Research Associate Dr Sarah Steele has been working on research with both NHS and clinical school training. This work has been featured across the Royal Society of Medicine’s publications in 2022 and 2023:

In this post, ThinkLab’s Tyler Shores asks Sarah to reflect on the recent revelation across the UK press.

Tyler: Sarah, you’ve been working in ThinkLab and across the wider University on sexual misconduct, did this week’s revelations come as a surprise to you?


Sarah Steele Cambridge Sarah: Recent revelations about sexual misconduct in the surgical field are jarring, but for many like me, they are unsurprising and are reminiscent of behaviours witnessed or experienced. Earlier in 2023, a report in the BMJ revealed that issues of power dynamics and misconduct, suggesting they often stem from a lack of policies and training. If such behaviours are observed, tolerated, or subtly encouraged at the foundational stage or medical school, they can fester and perpetuate into professional lives.


Tyler: And why do you think it is that we must do at these foundational stages?


Sarah: Long before becoming a consultant in the NHS, a healthcare professional’s ethical beliefs and stance on issues such as sexual misconduct have already taken shape. This groundwork is laid much earlier in their education, setting the tone for their future professional behaviour. We therefore need to look across the whole initial foundation.


Tyler: Based on your research, where do you think this should begin to make an impact?


Sarah: Our schools are the crucibles of early social interaction. Here, young people learn not just about academic subjects but also about relationships, boundaries, and power dynamics. The Guardian highlighted that incidents of peer-on-peer abuse in schools rose by 71% from 2013 to 2018. Schools must take the lead in fostering a culture where respect and understanding are paramount. A YouGov survey found that 1 in 4 students experienced unwanted sexual behaviour. Comprehensive education on consent and respect and open dialogue on power dynamics can serve as early interventions, reshaping how young minds perceive and respond to sexual misconduct. Training on intervening and being active bystanders, as well as how to report and support, are also critical.


Tyler: And what about at the university and medical school level?


Sarah: For many, university is a transformative period characterised by newfound freedoms and complex relationships. However, it’s also a hotspot for misconduct. Universities, especially medical schools, must proactively address these issues, incorporating robust training modules on ethics, consent, and professional behaviour. Remember, the behaviours internalised here, for good or bad, will inevitably spill into their professional lives. Universities and medical schools are therefore key sites, but training is somewhat patchy as my research published with the Royal Society for Medicine reveals.


Tyler: Notably though, just focusing on medical students will mean it takes awhile for this to filter into the NHS, so what must healthcare services do?


Sarah: For doctors who’ve transitioned into the NHS, both from the UK and abroad, lifelong learning is key. Regular workshops, revisiting ethics in the light of contemporary challenges, and ensuring mechanisms to address grievances without fear are essential. Such continuous education deters potential misconduct and empowers bystanders to intervene and act. Moreover, by fostering a culture of mutual respect, trust, and zero tolerance for misconduct, the NHS can ensure patient safety and a harmonious working environment for its professionals. Wide benefits were highlighted in the recently announced NHS England Sexual Safety Charter.


Tyler: How might we make all these changes, when finances are a challenge?


Sarah: It’s clear that our fight against sexual misconduct in the healthcare professions is not a sprint but a marathon. Addressing it requires a systemic, long-term approach, beginning in schools and continuing throughout medical careers. By fostering a holistic, continuous, and rigorous education on the topic, we can ensure that the future of the NHS is not just skilled but also ethical, compassionate, and respectful. To truly change the narrative, we must recognise that this lesson is not just for a stage but for a lifetime. There are costs, but there will also be savings. The NHS spends a lot on settling sexual misconduct claims but it also loses well-trained staff to sexual misconduct. For individuals and the sustainability of the service, as well as the safety of patients, this must be addressed and training is key!