Sexual harassment at medical schools: barriers to reporting and strategies for improvement - a nationwide, cross-sectional, multi-method study from Germany.

objectivesTo examine the association between institutional reporting and support structures and the reporting behaviour, perceived support and satisfaction with the handling of sexual harassment among medical students in Germany.

designCross-sectional multi-method study combining a nationwide student survey with a structured survey of medical school deaneries and a structured documentary analysis of publicly available institutional information.

settingAll medical faculties offering a full undergraduate medical curriculum in Germany.

participantsA total of 5681 medical students from 44 faculties participated in an anonymous online survey (77.8% women). Additionally, 34 of 42 medical faculties (81.0%) responded to a structured questionnaire regarding institutional support and reporting structures. Publicly accessible documents and faculty websites were analysed using a structured documentary analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcomes included (1) availability and visibility of reporting structures, (2) reporting of sexual harassment and (3) satisfaction with the reporting process. Secondary outcomes included perceived accessibility of reporting pathways, awareness of support structures, psychosocial support and perceived institutional consequences. Associations between student-reported outcomes, deanery responses and institutional characteristics were examined using multiple logistic and linear regression analyses.

resultsMost medical faculties (88.2%) indicated the presence of a dedicated advisory service for medical students. However, only a minority provided online reporting forms (29.4%) or chat-based options (8.8%). Institutional guidelines were available at almost all (97.6%) faculties. 44.2% of students reported having experienced sexual harassment during medical training, but only 12.7% of affected students reported an incident. Nearly half of the affected students (48.5%) indicated that they did not know where or how to report. Reporting behaviour was strongly associated with the perceived psychological burden (OR 3.48; 95% CI 1.67 to 7.27), and secondarily with prior non-medical vocational experience or later stage of study. Satisfaction with the reporting process and willingness to report again in the future were positively associated with perceived consequences (β=0.49; p<0.001) and psychosocial support (β=0.35; p<0.001). Awareness and perceived accessibility of structures were particularly low among those affected.

conclusionsMost medical faculties provide counselling and reporting services, yet students, particularly those affected, often do not perceive them as visible, accessible or effective. We propose four additional strategies for medical faculties: (1) Awareness and Competence-Building, (2) Visibility and Active Communication, (3) Psychosocial Support as a Core Function and (4) Transparent Processes and Feedback. Transparent processes, clear communication of consequences and accessible psychosocial support are key to increasing trust and reporting willingness. Faculties should therefore ensure low-threshold access to advisory services, actively communicate reporting pathways, raise awareness and systematically monitor the effectiveness of institutional responses. Future research should evaluate whether implementing and strengthening these measures improves student satisfaction, institutional trust and ultimately contributes to reducing sexual harassment in medical education.