Sexual Misconduct in UK Surgical Medicine

Written By Esha Amjad

Introduction:

Surgery is a discipline which does not tolerate imprecision. Whether it be a misplaced incision or a lapse in sterile technique, such error carries considerable consequences for both the patient and the surgeon. The speciality prides itself on this rigour; it has built its entire professional identity around the principle that standards exist for a reason, and that those who cannot meet them have no place in the operating theatre. It is therefore worth questioning why those same standards do not apply to the behaviour of the people inside it.

The Numbers:

In 2023, the Working Party on Sexual Misconduct in Surgery published findings from a survey of over 1700 surgical workforce members (doctors at all grades, from foundation years through to consultancy) across the UK; 63.3% of women reported being the target of sexual harassment by a colleague in the preceding five years. Nearly one in three reported sexual assault.¹ In 2024, the General Medical Council’s National Training Survey found that 16% of women in surgical training had received unwanted sexual comments or advances.² These numbers extracted from population-level data by NHS England’s own workforce statistics are highly alarming when considering the fact that female consultants make up just 16.9% of the surgical workforce as of 2024.³ Beyond statistical evidence, accounts from within the specialty have gradually surfaced in public discourse – a recent example being The Observer’s investigative podcast The Slow Newscast dedicating a two-part series to sexual misconduct in surgery, where female surgeons talked about their experiences of sexual harassment being unjustly and callously dealt with.⁴

Anatomy of a hierarchy:

It is integral to recognise that this problem within the surgical field is not incidental, but structural. The operating theatre acts as a closed, hierarchical space in which the consultant’s authority is near-absolute, meaning a trainee’s progression, their references, their reputation and ultimately their career are all filtered through the judgement of the person above them. This allows for a power imbalance; a trainee who reports a supervisor risks not just their mental health but also their career. This is reflected in a paper on the topic which states how 

under-reporting is not just a matter of indifference but of rational self-preservation in an environment where the consequences of speaking out routinely outweigh the consequences of staying silent.⁵ This culture that valorises a structured/institutionalised sense of authority has been developed over many years. Largely unchecked, this calcifies into something else entirely in which distinguishing between a demanding surgeon and a dangerous one can become difficult to name, much less report. 

A system designed to forget:

In October 2024, NHS England launched an anonymous reporting system for sexual misconduct in healthcare – a development that, in practice, has proven insufficient. Reports submitted through this system are handled via internal employer mechanisms. This is fundamentally harmful as the person most likely to investigate a complaint is frequently embedded in the same hierarchy as the person being reported. Hence, anonymity at the point of submission offers little protection when the pool of potential complainants is small enough to make identification straightforward. The Royal College of Surgeons of England and the Working Party on Sexual Misconduct in Surgery have jointly called for a national independent reporting mechanism modelled on the NHS fraud reporting system which is separated from individual trusts and allows for investigations free from institutional conflicts of interest. However, this has not been implemented.⁶ This is ironic considering how surgery as a speciality has high expectations in terms of speed and effectiveness of root cause analysis, incident reporting and mortality reviews. If there were to be an error in the operating theatre, there would be mandatory processes to ensure it is examined, understood and not repeated. Yet, no equivalent infrastructure exists for the conduct of the people performing those operations. 

The Cost:

Furthermore, those who have experienced sexual misconduct are significantly more likely to suffer burnout, withdraw from work and, in more serious cases, experience depression, self-harm and suicidal ideation. This demonstrates how the consequences of this culture are not abstract, but tangible in the victim’s daily functioning and mental health.⁵ 

The professional costs are equally significant; the proportion of female consultant surgeons in the UK has increased by only 2%, to rest at 15%, since 2015.⁵ Although numbers have risen in the specialty trainee grade, women still comprise only 31% of current trainees ⁸, despite consistently outnumbering men at UK medical schools since 1996.⁹ Thus, it is reasonable to suggest that sexual misconduct, alongside other factors, such as lack of senior female role models and childcare support, all contribute to poor retention of women in surgical training.³ Moreover, the implications for patient safety are equally direct, as dysfunctional surgical teams are associated with poorer patient outcomes ⁵, a direct contradiction of the NHS values of “working together for patients” and “commitment to quality of care”.¹⁰ 

Complicity is a choice:

It is tempting to direct this problem onto individuals - the supervisor who propositioned their trainee or the consultant who reminded a junior that their career was in his hands. Nevertheless, such culture is not necessarily sustained by a few individuals, but is also enabled by complicity - every colleague who witnesses a micro-aggression and ignores it, every senior who hears a rumour and dismisses it, every institution that treats a complaint as a reputational risk to be managed rather than a harm to be addressed. As a future healthcare professional this is not a comfortable or entirely surprising thought. Despite medical school rigorously teaching us professional and compassionate values alongside clinical knowledge and procedural skill, it does not always teach us what to do when those values are tested not by a patient’s condition, but by the behaviour of a colleague in a position of power. That gap in itself is a failure, and one we have an obligation to close. As the future generation of doctors, we must encourage the implementation of independent reporting mechanisms, medical curricula that prepare students adequately for the realities of professional influence, and perhaps, most importantly, a collective willingness to call out what is happening rather than dismiss it.

Read the rest of the edition here.

References:

1. Newlands C, Jackson P, The Working Party on Sexual Misconduct in Surgery, Cuming T. An independent report on sexual misconduct by colleagues in the surgical workforce [Internet]. WPSMS; 2023 [cited 2026 Apr 1]. Available from: https://www.wpsms.org.uk/_files/ugd/db2313_6246937816244a589b4519284026586a.pdf
2. General Medical Council. National training survey 2024 [Internet]. Manchester: GMC; 2024 [cited 2026 April 1]. Available from: https://www.thefederation.uk/sites/default/files/uploads/National-training-survey-summary-report-2024.pdf
3. Ketley A, Morgan J. Breaking the scalpel ceiling: Persistent barriers faced by female surgeons in modern surgical practice. European Journal of Surgical Oncology [Internet]. 2025 Aug 30;52(2):110423. Available from: https://doi.org/10.1016/j.ejso.2025.110423
4. Sylvester R. The God Complex: Part 1 [podcast]. The Slow Newscast. The Observer; 2026 Jan [cited 2026 Apr 1]. Available from: https://observer.co.uk/listen/the-slow-newscast/the-god-complex-part-1
5. Begeny CT, Arshad H, Cuming T, Dhariwal DK, Fisher RA, Franklin MD, et al. Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights. British Journal of Surgery [Internet]. 2023 Sep 12;110(11):1518–26. Available from: https://doi.org/10.1093/bjs/znad242
6. Newlands C, Dhariwal D, Cuming T, Joubert T, Jackson P, Working Party on Sexual Misconduct in Surgery. Breaking the silence on sexual misconduct in surgery: two years on. Bulletin of the Royal College of Surgeons of England [Internet]. 2025 Aug 31;107(6):284–6. Available from: https://doi.org/10.1308/rcsbull.2025.103
7. General Medical Council. More female than male doctors for the first time ever in the UK [Internet]. Gmc-uk.org. 2024 [cited 2026 April 2] Available from: https://www.gmc-uk.org/news/news-archive/more-female-than-male-doctors-for-first-time-ever-in-the-uk
8. ‌UK Government Web Archive [Internet]. Nationalarchives.gov.uk. 2024 [cited 2026 Apr 2]. Available from: https://webarchive.nationalarchives.gov.uk/ukgwa/20240502190437/https://digital.nhs.uk/supplementary-information/2022/hchs-doctors-in-selected-surgical-specialties-by-gender-and-grade-jun-22
9. Moberly T. How women have outnumbered men at medical school entry for 25 years. BMJ. 2018;363:k4810.
10. NHS England. The NHS constitution for England [Internet]. London: NHS England; 2021 [cited 2026 Apr 1]. Available from: https://www.gov.uk/government/publications/the-nhs-constitution-for-england