Sexual Harassment in Operating Theatres and Surgical Environments Among Working Professionals: A Scoping Review of...

Sexual harassment is being widely acknowledged as a widespread problem in terms of threatening safety, health, and career growth in the fields of surgery and perioperative care, with the operating theatre often being noted as a place of high risk. Furthermore, for surgical trainees, the operating theatre functions simultaneously as a workplace and a critical learning environment. There is still an unfinished picture in the available evidence in terms of professions, settings and study designs, and no previous scoping review has systematically charted the area of sexual harassment in operating theatres and other surgical working environments amongst the working professionals.

To chart and synthesize the evidence regarding the prevalence, types, risk factors, barriers to reporting, effects and prevention methods of sexual harassment in operating theatres and surgical settings among working professionals and to determine gaps in the literature that will shape future studies and policy.

A scoping review using the Arksey and O'Malley framework, methodology revisions, advice from the Joanna Briggs Institute (JBI), and the PRISMA-ScR checklist was conducted. Eligible English-language studies (January 2010- August 2025) were working professionals in the field of healthcare (e.g., surgeons, anesthetists, perioperative and surgical ward nurses, surgical trainees) who reported primary data or syntheses of sexual harassment or other forms of related mistreatment in surgical settings. Embase, CINAHL, PsycINFO, MEDLINE/PubMed were searched using sexual harassment terms, surgery, operating room, and healthcare workers; searches were supplemented through citation tracking and grey-literature screening. Records were screened and data charted by 2 reviewers. JBI checklists and survey and review adapted criteria were used to assess risk of bias; summary certainty of key outcomes was summarized in a GRADE-informed method.

The total number of studies was nineteen, and the sources were cross-sectional surveys, qualitative research, systematic reviews, and policy and intervention reports. These were conducted in Australasia, Europe, Asia, Africa, and North America. For the surgical trainees and surgeons, the prevalence ranged from a third to two-thirds. However, the prevalence was higher in females. For the operating room nurses, the prevalence ranged from 40 to 60 percent. Gender harassment and unwanted sexual attention were the most common. Younger age, female gender, junior status, hierarchical culture, bystander effect, and closed environment were the risk factors. For the surgical trainees, the reliance on the senior surgeon for job and educational evaluation created a "profound dual vulnerability." Reporting was low due to fear of retaliation, distrust in the reporting process, and the acceptability of wrongdoing. However, the synthesis also showed the impact of different socio-cultural contexts on the experience and reporting of harassment globally. These contexts included different patriarchal values and the presence or absence of a reporting system.

Sexual harassment in surgical environments has been found to be both gendered and structurally institutionalized, and highly underreported. As the surgical environment is inextricably linked with the surgical learning environment, safety issues in the former represent a failure in the latter from an educational perspective. Descriptive studies have dominated the literature, thus highlighting the need for longitudinal studies. Multilevel prevention will require policy, culture, training, and accountability interventions, each addressing the unique socio-cultural and infrastructural challenges of different global settings.