Friday 23 May 2025
Blog by Gordon Miles, CEO, RCEM
I am very concerned to see sexual safety in emergency medicine has been highlighted by the General Medical Council’s (GMC’s) 2024 National Training Survey. I am appalled to hear that female trainees are having significant issues. Across a range of our Committees we have been exploring this. In this blog I reflect on the issues as I see it and share some College plans designed to try and help the specialty address this.
The GMC report makes uncomfortable reading for emergency medicine and triangulates with the regular drumbeat of our own annual Emergency Medicine Trainee Association (EMTA) Survey which finds that there are challenges for emergency medicine across a range of behavioural issues. In the GMC survey, in relation to sexual safety emergency medicine does poorly compared to other specialties: we are second worst. Sexual safety in this context refers to the question in the survey is about sexual comments or advances that have an impact. The survey found that this was an issue in colleague to colleague relationships because it asked directly if respondents ‘experience micro-aggression, negative comments or oppressive body language from colleagues’.
The pioneering work by the Surviving in Scrubs campaign provides some additional harrowing testimonies that support the quantitative data.
So, in this blog I seek to unpack the Sexual Safety issue and share some of the current plans the College is forming on what we can do to help those working in emergency medicine with this.
My thoughts
I think it would be a mistake to think behaviour that compromises sexual safety is going on in just a few isolated places. This has been reported for years and it is not improving. I know from experience, and can see from the survey results, that this is a widespread issue.
My personal experience of raising this is that senior clinicians often comment that it is not something that they see as a problem in their department. That may be because those I have talked to about it are not personally impacted or it is not evident to them. However the evidence is clear that it IS a problem in far more departments than recognise it. It may be that it does not happen in front of the senior clinicians, that senior clinicians do not recognise it for what it is or, most unpalatably, that some senior clinicians perpetuate it. None of these is acceptable.
However, the GMC survey is finding unaddressed issues in the specialty, just not granular as to location. Perhaps there is an element of unconscious incompetence on this issue or another reason why the specialty hasn’t managed to tackle this issue?
This issue has wider implications that go beyond the victim. Research as shown that poor working cultures, such as those where employees don’t feel safe, lead understandably to absenteeism, staff sickness and ultimately poor patient care.
The College Council, rather than simply calling for something to change, is determined that we help our Emergency Departments deal with the issues raised in the survey. This is an issue for all employers not just the NHS because under the Equality Act 2010 amongst an employer’s duties is the requirement to take active steps to prevent discrimination from occurring within the workplace. I think NHS employers need our help. Whilst the legal duty is on employers, the College as the professional body is not going to stand by which is why we are focussing on this issue as a priority.
What does the Survey tell us?
The GMC survey data indicates that there is an issue here for emergency. Take this question: (question number GENHQ241) In your current post how often, if at all, do you experience unwelcome sexual comments or advances causing you embarrassment, distress, or offence? The answer for emergency medicine is 15% of females and 5% of male trainees as Figure 2 of the report (below) shows. This question does not differentiate between who is perpetrating this, whether it is patient, colleague or someone else.
This issue is experienced in patient as well as colleague interactions. However, I think it would be a mistake to interpret the GMC survey results as indicative solely of patient behaviour as in talking to a wide range of females working in emergency medicine, I know that colleague behaviour in Emergency Medicine and other specialties is also an issue, which is what I am focussing on here.
This question brings the issue out more clearly: (question number GENHQ246) In your current post how often, if at all do you experience micro-aggressions, negative comments or oppressive body language from colleagues?
The results below compare Emergency Medicine to the UK Wide all trainee survey data:
So we can see that 3.17% of EM trainees are experiencing this negative behaviour daily as compared with 1.84% of all England trainees across all specialties. There are 60.56% of EM trainees who have never experienced this compared to 71.01% of all England trainees across all specialties. Emergency Medicine is doing poorly compared to other specialties.
So what can be done to tackle this?
The College is a signatory to this NHS Sexual Safety Charter: https://www.england.nhs.uk/long-read/sexual-safety-in-healthcare-organisational-charter/#organisations-that-have-signed-the-charter
The GMC has updated their standards that they expect the medical profession to uphold. Good Medical Practice (Paragraph 57) says: “You must not act in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress. What we mean by acting ‘in a sexual way’ can include – but isn’t limited to – verbal or written comments, displaying or sharing images, as well as unwelcome physical contact. You must follow our more detailed guidance on ‘Maintaining personal and professional boundaries’.”
At the College we have developed an RCEM Action Plan, however it is at the early stages so we are in the processing of setting deadlines for these actions. Your feedback is welcome on this. The current list of actions is as follows:
RCEM Website Updates
RCEM Learning Resources
We would like to see more resources in RCEM Learning supporting this. We acknowledge that developing a dedicated section on RCEM Learning will take longer, depending on resources. RCEM Learning content is mapped to our curriculum, and this content will map to the Domain 1: Professional values and behaviours
Developing a ReportED Form
We are exploring if there could be a role for the College in dealing with anonymised complaints. We acknowledge that anonymised complaints often, because they are anonymous, are hard for employers to investigate. However, creating a mechanism for reporting through the College would enable us to gather more information on the issues and location of them as reported. This is being explored currently and requires extensive discussion on the challenges of managing disclosures if a significant report is made.
Survey Collaboration
We are also exploring if we can widen the data collection to build on the work EMTA has done with their survey and see if our colleagues in EMSAS – Emergency Medicine Specialty and Specialist Doctors – are able to do something similar.
Cultural Change through awareness raising
We are working on a relaunch of our RespectED campaign and this is expected to include posters and other materials identifying inappropriate behaviour. Separately we are also looking to widen our promotion of emergency medicine as a career, incorporating demographic data on the changing workforce and working patterns, which could help shift attitudes and foster cultural change. It might also be useful as a tool which can target patients and those working in EDs.
Leadership
We are additionally looking at guidance and our stance on leadership in the profession and how cultural change can be made through effective leadership.
Engagement with RCS
We know that the Royal College of Surgeons (RCS) is committed to a zero tolerance approach to sexual misconduct as set out here: https://www.rcseng.ac.uk/about-the-rcs/about-our-mission/diversity/sexual-misconduct-in-surgery/ We will seek to learn from their approach. The issue with relying on a strong Code of Conduct to solve the issue is that action can only be taken if someone comes forward to complain. One of the problems in this field appears to be a reticence to speak up, which in itself speaks to a need for cultural change.
Lobbying for change
We shall be developing our approach for lobbying directly for change on this issue across the UK. The NHS in England has made public statements in a Charter which we understand also binds Trusts. The College can additionally seek to hold the NHS to account on this issue.
If you are wondering what we do about this ourselves with our own employees, we have established clear rules and guidance. We train and survey our employees regularly to make sure we are an employer of choice. Our data shows we are not facing these issues in the way that the NHS is experiencing.
The College is keen to play its part in supporting all in the specialty create a working environment where colleagues can thrive, be safe and feel supported at work.
I’m interested to hear from you if you have suggestions or comments on this issue as we develop our approach to support the specialty.
Gordon Miles
CEO
RCEM
