medic series overly attending sexual assaultWelcome to season 4, episode 2 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine!

In this month’s case, a junior resident feels violated and shamed after a sexually aggressive encounter with an orthopedic attending physician.

[su_spoiler title=”MEdIC Series: The Concept” style=”fancy” icon=”caret”] Inspired by the Harvard Business Review Cases and initially led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the last Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are made available for download in PDF format – feel free to use them! If you’re a medical educator with a pedagogical problem, we would love for you to get involved in the MEdIC series! Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.[/su_spoiler]

MEdIC: The Case of the Overly Attentive Attending

By Dr. Dara Kass and Dr. Stacey Poznanski

Samantha had always been a model student. She was top of her class in medical school and was thrilled when she matched in her top choice of Emergency Medicine residency programs. The city was far away from her family but she felt it was the best fit for her and she knew she would receive quality training.

Shortly after starting residency, Samantha began dating an orthopedic resident. They had a brief, casual relationship and after three months, it ended amicably. A few months into her second year of residency Samantha joined the orthopedic team as a required core rotation. She was excited to start ortho, as it had been one of her favorite rotations in medical school and she knew the experience would enhance her abilities as an EM physician. Her ex-boyfriend was on rotation at a different hospital so she was not concerned about any conflict affecting the team dynamic.

The first two weeks of her rotation were rather uneventful. She alternated between consults and clinic, putting forth her best effort. At night, even when post call, she took extra time to read about fractures and splinting so she could be useful to the team. She was learning, enjoying her time, and had no idea that her life was about to change.

At the start of her third week of the rotation, Samantha was in clinic seeing a patient for follow-up of a fracture reduction in the ED. She asked the attending to come into the room and confirm that the fracture was healing well. As he reviewed the images over Samantha’s shoulder, he hovered close. Closer than he had before. As the patient was in the room, Samantha was certain she was imagining things and decided to think nothing of it. The attending agreed that the patient could be seen again in 2 weeks, and he dismissed the patient to the waiting room to wait for final instructions. As Samantha got up to leave, the attending asked her to stay. There was something he wanted to review with her. Again, slightly out of the norm, but she did as she was told.

He closed the door and stood in front of it. He told Samantha he had noticed her. Noticed how hard she was working on the rotation. “A girl so pretty doesn’t need to work so hard,” he said. He asked if she had dated anyone since breaking up with the orthopedic resident. She was taken aback and hesitated for a moment, then stated that this was not his business and that they should move on to the next patient. But he persisted.

His language was explicit. He described intimate details of relations she had had with her ex-boyfriend. He told her she needed to be with a real man and graphically described how he would satisfy her.

Samantha politely refused and commented on the inappropriate nature of their interaction. The attending physician dismissed her remarks and continued to pursue the issue.

He hovered close to her and whispered into her ear while casually brushing over parts of her body with his hand. She stood there, frozen, until a knock on the door ended the interaction. It was the nurse, asking about a new patient in the waiting room.

After he left the room, Samantha ran out of the clinic and began to sob uncontrollably when she reached the parking lot. Everything was a blur, but somehow she felt like she had brought it on herself. Perhaps she had developed a reputation because of her casual relationship with his ortho resident. Or was she being flirtatious in clinic? Were her clothing too revealing? Samantha couldn’t make sense of what had just happened. She felt ashamed and didn’t know what to do next.

Discussion Questions

  1. As a resident on an off service rotation, what should Samantha do next? Should she go back to the clinic and see patients, but ask for a new attending? Does she activate sick call and go home? Should she tell someone?
  2. What steps should be taken once program directors or emergency staff are made aware of this situation?
  3. Are there any legal actions that should be taken at this point? Where is the line between aggressive flirtation and assault?

Weekly Wrap Up

As always, we will post the expert responses and a curated commentary derived from the community responses 2 weeks after the case is published.

This month, our two experts are:

  • Dr. Christopher Doty
  • Cindy Caplan

On November 11,  2016 we will post the curated commentary and expert responses to this case! After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary. That said, we’d love to hear from you, so please comment below!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

Tamara McColl, MD FRCPC

Tamara McColl, MD FRCPC

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba