Applying Organizational Change Theory to Address the Long-Standing Problem of Harassment in Medical Education

Issue: Harassment is a common experience for medical and healthcare trainees. Experiencing harassment can have significant consequences for trainees in multiple domains, including mental, physical, social, and occupational well-being. Harassment remains entrenched in medical education despite efforts to address it. Evidence: Many articles have documented the prevalence of harassment in medical education. Likewise, articles have provided recommendations for how individuals or hospitals can attempt to reduce harassment. However, despite calls for reform, harassment persists, largely due to the hierarchical, paternalistic, high-pressure, and evaluative nature of medical culture. Most literature has emphasized the need for policies and reporting structures, yet such top-down initiatives have not had a sufficient impact on the attitudes and beliefs that drive culture change. Instead, change requires intervention at every level of an organization. Little, if any, literature has proposed applying a change management model to change the culture of medical training and therefore decrease harassment. Implications: This paper applies principles of organizational change theory, and in particular, the ADKAR model, in conjunction with a summary of the existing harassment literature, to propose a framework for addressing harassment by facilitating organizational culture change. Intervention is needed at all levels of the medical education system (the healthcare system, the supervisor or training program, and the individual), and the ADKAR framework can guide what interventions are offered and when to capitalize on the current level of change readiness. Recommendations go beyond the typical focus on formalized policies and procedures, which are necessary, but not sufficient, components of culture change. Implementation of these practices, as well as ongoing evaluation and refinement through research, should foster cultural change in medical education to address harassment.