̽��ֱ�� of Cambridge - Sarah Steele

Over a third of UK medical students do not receive sexual misconduct training

cjb250 — Tue, 12 Sep 2023 12:50:23 +0000

̽��ֱ��study, published today in JRSM Open and based on responses by the UK’s 34 medical schools to Freedom of Information requests, shows there is no standardisation of training on sexual misconduct across medical universities.

Almost half of medical schools offered no training, or only generalised harassment training that was not specific to sexual misconduct or that was wholly outside the context of being a doctor.

̽��ֱ��researchers point to research findings earlier this year that showed training for NHS staff on sexual harassment intervention is lacking, while other reports highlighted 20,000 incidents of sexual misconduct in the NHS, leading to healthcare workers leaving their professions. In August 2023, the General Medical Council issued new professional standards for doctors which, for the first time, included explicit rules on sexual misconduct.

Medical students, as future clinicians, have a crucial and strategic need for education that allows them to perform a critical role in exhibiting good behaviour, and intervening, identifying, assessing and reporting sexual misconduct when they see it happening at work or in wider society, say the researchers.

Lead researcher Dr Sarah Steele of the ̽��ֱ�� of Cambridge and Jesus College, Cambridge, commented: “Our study shows it cannot be assumed that graduates who are working as junior doctors have received training on sexual misconduct before starting their roles. Considering the magnitude of this issue, universities and professional bodies should urgently address this problem.”

̽��ֱ��researchers point to serious shortcomings within the health sector in preventing and addressing sexual misconduct, with costs in damages to address sexual misconduct in the NHS exceeding £4 million in the last five years.

In the medical schools where compulsory sexual misconduct training was provided, a wide range of delivery methods were adopted, with workshops and lectures being the main delivery approach.

Dr Steele said: “With such significant variations in the context and format of teaching, it is important to research which methods and content are most effective in improving these future clinicians’ responses to this form of abuse and discrimination.

“ ̽��ֱ��latest GMC professional standards make it imperative medical schools offer this training. Tomorrow’s doctors need to be trained properly if we are to put in place the zero-tolerance approach.”

According to the study, the curriculum analysis within the study was significantly hampered by several medical schools refusing to provide information on the basis of it being proprietary knowledge. “ ̽��ֱ��idea that public universities offering medical education in accordance with the General Medical Council requirements are in competition, such that they do not share curricular and do not engage in knowledge exchange, is concerning to say the least,” added Dr Steele.

Reference
Dowling, T and Steele, S. Is sexual misconduct training sufficient in the UK’s medical schools: Results of a cross-sectional survey and opportunities for improvement. JRSM Open; 12 Sept 2023; DOI: 10.1177/20542704231198732

Press release from the Royal Society of Medicine

More than a third of newly qualified doctors are leaving UK medical schools without any education on sexual misconduct specifically relating to the medical profession according to new research led by researchers at the ̽��ֱ�� of Cambridge.

Our study shows it cannot be assumed that graduates who are working as junior doctors have received training on sexual misconduct before starting their roles

Sarah Steele

sturti (Getty Images)

Nurses walking down a corridor

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Majority of NHS Trusts do not offer training to prevent sexual harassment, study finds

cjb250 — Fri, 05 May 2023 00:00:33 +0000

An analysis of data from Freedom of Information (FOI) requests found that fewer than one in five NHS Trusts in England provided active bystander training to address workplace harassment, sexual harassment and other forms of unacceptable behaviour like bullying and racism.

It found of those that did – the majority of which were in London – most did not deliver content specific to sexual misconduct and participation was voluntary.

Since 2017, when the #MeToo movement gained momentum around the world, sexual harassment in medicine has been recognised as both pervasive and harmful. This form of harassment – which includes a range of verbal, online and physical acts, ranging from poor taste jokes to unwanted touching to rape – can have a major impact on the individuals it affects and on the healthcare workforce itself.

In 2019, a survey by UNISON found that 8% of respondents had experienced sexual harassment while at work during the last 12 months, with more than half (54%) of these acts being perpetrated by co-workers.

Active bystander training encourages individuals to recognise and respond to poor behaviour, by equipping people with skills to intervene. Workshops and training programmes typically involve role-playing, case studies, and group participatory discussions.

To assess the extent to which such training programmes are being used within the NHS, researchers from Cambridge Public Health and the Intellectual Forum at Jesus College, Cambridge, submitted FOI requests to 213 NHS Trusts across England in December 2021. Their analysis is published today in JRSM Open.

Of the 199 Trusts (93%) that responded, only 35 offered active bystander training. Just five of the Trusts said their training addressed sexual harassment in some form, with the remaining 30 Trusts saying their training taught participants to challenge antisocial behaviour only in a general context. Only one Trust delivered content that specifically tackled sexual harassment in the workplace as its focus.

̽��ֱ��majority of the Trusts that offered active bystander training were in London – 22 out of the 35. But even 14 of London’s NHS Trusts offered no training, despite the training being paid for by NHS England, not individual Trusts.

Among the 164 Trusts not offering active bystander training, only 23 Trusts had plans to implement it in the future. One Trust stated that they were actively developing plans to develop sexual safety training that will incorporate active bystander training. Several Trusts suggested they would consider implementing it if there was, to quote one of these Trusts, a “need for this form of training”, while other Trusts suggested implementation would occur if members of staff or working groups within the Trusts’ organisation advocated for it.

Dr Sarah Steele from Cambridge Public Health and Jesus College, Cambridge, said: “ ̽��ֱ��NHS is failing to take advantage of a very effective training tool to address workplace harassment, sexual harassment and other forms of unacceptable behaviour such as bullying and racism. It’s a tool well used by the military, universities and educators, and which even the UN and UK government promotes.

“We found low uptake of active bystander training among NHS Trusts in England, particularly outside of London, and very little of the training that was on offer focused on sexual harassment. This is deeply worrying, given the continued problem of sexual harassment in the healthcare sector.

“Organisations need to encourage active bystander training from the very first days of undergraduate degrees through to the day of retirement. Without this, the problems of sexual harassment will continue to be a problem in the NHS and across wider society.”

Most of the Trusts used training programmes delivered by external companies – 27 out of the 35, with three Trusts not providing data. This meant that the researchers were unable to assess the content or effectiveness of the training programmes as they were commercial in confidence. While outsourcing training is meant to increase competition, the researchers found that one provider dominates.

Dr Ava Robertson, who carried out the research while part of the Population Health Sciences Partnership at the ̽��ֱ�� of Cambridge ̽��ֱ��, said: “ ̽��ֱ��problem with turning to private providers is that training materials can’t be externally audited, making it extremely difficult to evaluate how effective the programmes are. In some cases, it also meant that attendees of the workshops weren’t allowed to share the toolkits they received with other colleagues, so the knowledge isn’t more widely disseminated.”

̽��ֱ��Home Office has been actively promoting active bystander training interventions to reduce sexual harassment and violence against women and girls more widely. Dr Steele, who sat on the campaign advisory group said cross-departmental learning from this campaign would support the Department of Health and Social Care, and the NHS, in thinking about behaviour change interventions amongst healthcare staff.

In 2021, on the back of the researchers’ work, Jesus College partnered with learning platform edX to offer free, online active bystander training available to anyone anywhere in the world.

Dr Steele who leads the course, and is Deputy Director of Jesus College’s Intellectual Forum said: “This course draws on up-to-date research and evidence on action and inaction, and offers real-world examples to help people respond at work, in public, and even at home. It can be accessed by anyone in the world for free so in the face of a lack of workplace training, individuals can still equip themselves with these essential skills.”

Reference
Robertson, A, and Steele, S. A cross-sectional survey of English NHS Trusts on their uptake and provision of active bystander training including to address sexual harassment. JRSM Open; 5 May 2023

Failure to implement active bystander training could thwart NHS attempts to tackle sexual harassment, say researchers at the ̽��ֱ�� of Cambridge.

̽��ֱ��NHS is failing to take advantage of a very effective training tool to address workplace harassment, sexual harassment and other forms of unacceptable behaviour such as bullying and racism

Sarah Steele

sturti (Getty Images)

Medical team strategy planning

Yes

Food and drinks industry uses non-profit organisation to campaign against public health policies, study finds

fpjl2 — Mon, 03 Jun 2019 08:07:13 +0000

̽��ֱ��study, published today in the journal Globalization and Health, analysed over 17,000 pages of emails obtained through Freedom of Information requests made between 2015 and 2018. ̽��ֱ��documents captured exchanges between academics at US universities and senior figures at a non-profit organisation called the International Life Science Institute, or ILSI.

Comprising of 18 bodies, each of which covers a specific topic or part of the globe, ILSI has always maintained its independence and scientific rigour, despite being funded by multinational corporations such as Nestle, General Mills, Mars Inc, Monsanto, and Coca-Cola.

Founded by former Coca-Cola senior vice president Alex Malaspina in 1978, ILSI states on its website that none of its bodies “conduct lobbying activities or make policy recommendations”. As a non-profit organisation, ILSI is currently exempt from taxation under US Internal Revenue codes.

However, researchers from the ̽��ֱ�� of Cambridge, London School of Hygiene and Tropical Medicine, ̽��ֱ�� of Bocconi, and US Right to Know, found emails explicitly discussing tactics for countering public health policies around sugar reduction, as “[T]his threat to our business is serious”.

These include exchanges with an epidemiology professor at the ̽��ֱ�� of Washington, as well as the US Centre for Disease Control’s then director of heart disease and stroke prevention, all strategising how best to approach the World Health Organisation’s then Director-General Dr Margaret Chan, to shift her position on sugar-sweetened products.

“It has been previously suggested that the International Life Sciences Institute is little more than a pseudo-scientific front group for some of the biggest multinational food and drink corporations globally,” said the study lead author Dr Sarah Steele, a researcher at Cambridge’s Department of Politics and International Studies.

“Our findings add to the evidence that this non-profit organisation has been used by its corporate backers for years to counter public health policies. We contend that the International Life Sciences Institute should be regarded as an industry group – a private body – and regulated as such, not as a body acting for the greater good.”

In one email, Malaspina, who also served as long-time president at ILSI, described new US guidelines bolstering child and adult education on limiting sugar intake as a “real disaster!”. He writes: “We have to consider how to become ready to mount a strong defence”. Suzanne Harris, then executive director of ILSI, was among the email’s recipients.

James Hill, then director of the Center for Human Nutrition at the ̽��ֱ�� of Colorado, was involved in a separate exchange on the issue of defending industry from the health consequences of its products. Hill argues for greater funding for ILSI from industry as part of “dealing aggressively with this issue”. He writes that, if companies keep their heads down, “our opponents will win and we will all lose”.

̽��ֱ��FOI emails also suggest ILSI constructs campaigns favourable to artificial sweeteners. Emails reveal Malaspina passing on praise from another former ILSI President to a former Coca-Cola employee and the Professor, describing both as “the architects to plan and execute the studies showing saccharine is not a carcinogen”, resulting in the reversal of many government bans.

̽��ֱ��FOI responses suggest that ILSI operates strategically with other industry-funded entities, including IFIC, a science communication non-profit organisation. “IFIC is a kind of sister entity to ILSI,” writes Malaspina. “ILSI generates the scientific facts and IFIC communicates them to the media and public.”

“ ̽��ֱ��emails suggest that both ILSI and IFIC act to counter unfavourable policies and positions, while promoting industry-favourable science under a disguised front, including to the media,” said Steele.

In fact, the emails suggest ILSI considers sanctioning its own regional subsidiaries when they fail to promote the agreed industry-favourable messaging. Correspondence reveals discussion of suspending ILSI’s Mexico branch from the parent organisation after soft drink taxation was debated at a conference it sponsored. Mexico has one of the highest adult obesity rates in the world.

Email conversations between Malaspina and the CDC’s Barbara Bowman are open about the need to get the WHO to “start working with ILSI again” and to take into account “lifestyle changes” as well as sugary foods when combatting obesity.

Further exchanges between Malaspina and Washington Professor Adam Drewnowski support ILSI’s role in this. Drewnowski writes of Dr Chan that “we ought to start with some issue where ILSI and WHO are in agreement” to help “get her to the table”.

In a further email, Malaspina points out that he had meetings with the two previous heads of the WHO, going back to the mid-90s, and that if they do not start a dialogue with Dr Chan “she will continue to blast us with significant negative consequences on a global basis”.

̽��ֱ��tide has begun to turn against ILSI in recent years. ̽��ֱ��WHO quietly ended their “special relations” with ILSI in 2017, and ILSI’s links to the European Food Safety Authority were the subject of enquiry at the European Parliament. ̽��ֱ��CDC’s Bowman retired in 2016, in the wake of revelations about her close ties with ILSI. Last year, long-time ILSI funder Mars Inc. stopped supporting the organisation. Much of the study’s correspondence precedes these events.

“It becomes clear from the emails and forwards that ILSI is seen as central to pushing pro-industry content to international organisations to support approaches that uncouple sugary foods and obesity,” added Steele.

“Our analysis of ILSI serves as a caution to those involved in global health governance to be wary of putatively independent research groups, and to practice due diligence before relying upon their funded studies.”

Reference
Are industry-funded charities promoting “advocacy-led studies” or “evidence-based science”?: a case study of the International Life Sciences Institute. Globalization and Health; 3 June 2019; DOI: 10.1186/s12992-019-0478-6

A new study shows how a non-profit research organisation has been deployed by its backers from major food and beverage corporations to push industry-favourable positions to policymakers and international bodies under the guise of neutral scientific endeavour.

We contend that the International Life Sciences Institute should be regarded as an industry group – a private body – and regulated as such, not as a body acting for the greater good

Sarah Steele

Photo by Peter Bond on Unsplash

High-angle photography of grocery display

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Contracts give Coca-Cola power to ‘quash’ health research, study suggests

fpjl2 — Tue, 07 May 2019 23:35:29 +0000

A study of over 87,000 documents obtained through Freedom of Information requests has revealed a contract mechanism that could allow Coca-Cola to “quash” findings from some of the health research it funds at public universities in the US and Canada.

̽��ֱ��study, published today in the Journal of Public Health Policy, identified several clauses in legal documents that give the company early sight of any findings, combined with the right to “terminate without reason” and walk away with the data and intellectual property.

Taken together, these clauses could suppress “critical health information”, and indeed may have done so already, according to the study’s authors. Much of the research Coca-Cola supports is in the fields of nutrition, physical inactivity and energy balance.

̽��ֱ��authors argue that the clauses contravene Coca-Cola’s commitments to transparent and “unrestricted” support for science, which came after criticism of the opaque way some major food corporations fund health research.

Researchers from the ̽��ֱ�� of Cambridge, London School of Hygiene and Tropical Medicine, ̽��ֱ�� of Bocconi, and US Right to Know, call on corporate funders to publish lists of terminated studies. They say scientists should publish agreements with industry to reassure the public that findings are free from influence.

“It is certainly true that the contracts we have found allow for unfavourable developments or findings to be quashed prior to publication,” said lead author Dr Sarah Steele, a policy researcher from Cambridge’s Department of Politics and International Studies.

“Coca-Cola have declared themselves at the forefront of transparency when it comes to food and beverage giants funding health research. In fact, our study suggests that important research might never see the light of day and we would never know about it.

“We are already hearing accusations from experts in nutrition that the food industry is copying tactics from big tobacco’s playbook. Corporate social responsibility has to be more than just shiny websites stating progressive policies that get ignored.”

Consumption of high calorie, low nutrient food and drink is believed to be a major factor in the childhood obesity epidemic. Last year, the UK government introduced a “sugar tax” on many soft drinks, including Coca-Cola’s flagship product.

US Right to Know, a non-profit consumer and public health research group, submitted 129 FOI requests between 2015 and 2018 relating to academics at North American institutions who received Coca-Cola funding.

̽��ֱ��research team combed through the vast tranche of resulting documents and discovered five research agreements made with four universities: Louisiana State ̽��ֱ��, ̽��ֱ�� of South Carolina, ̽��ֱ�� of Toronto and the ̽��ֱ�� of Washington.

̽��ֱ��funded work includes “energy flux and balance” studies and research on beverage intake during exercise. Coca-Cola’s own transparency website declares that scientists retain full control over their research and the company has no right to prevent publication of results.

However, while contracts show Coca-Cola does not control day-to-day conduct, the company retains various rights throughout the process. These include the right to receive updates and comment on findings prior to research publication, and the power to terminate studies early without reason.

̽��ֱ��documents yielded by the FOI requests contained no firm examples of Coca-Cola suppressing unfavourable research, although the study authors say “what is important is that the provision exists”. All documents relating to the contracts are now accessible on the US Right to Know website.

Emails show one scientist expressing uncertainty over his study termination (“…they have not communicated with us in several months”) and concern over intellectual property.

Another scientist is seen arguing that his contract is “very restrictive for an ‘unrestricted grant’”.

“These contracts suggest that Coke wanted the power to bury research it funded that might detract from its image or profits,” said Gary Ruskin, co-director of US Right to Know.

“With the power to trumpet positive findings and bury negative ones, Coke-funded science seems more like an exercise in public relations.”

̽��ֱ��researchers acknowledge that the food and beverage industry may be updating research contracts in line with new public commitments, but without seeing those contracts it is hard to know.

They say their Coca-Cola case study suggests a continued lack of transparency that should be remedied with “hard” information on funding, rather than relying on self-reported conflicts of interest.

“Journals should require authors of funded research to upload the research agreements for studies as appendices to any peer-reviewed publication,” said Steele.

“ ̽��ֱ��lack of robust information on input by industry and on studies terminated before results are published, makes it impossible to know how much of the research entering the public domain reflects industry positions.”

New study of FOI documents uncovers provisions that could allow the beverage giant to suppress findings from health science it funds at North American universities. Researchers argue that Coca-Cola’s contracts run counter to their public declarations of openness.

It is certainly true that the contracts we have found allow for unfavourable developments or findings to be quashed prior to publication

Sarah Steele

Meghan Schiereck

Untitled

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