Think globally, act locally: understanding sexual harassment from a cross-cultural perspective.

Objectives: Sexual harassment in medical education has been studied in the Americas, Europe and Asia; however, little is known about sexual harassment in Middle Eastern cultures. Our initial aim was to describe the sexual harassment of female doctors-in-training by male patients and their relatives in Turkey. During our analysis of data, we expanded our objectives to include the formulation of a framework that can provide a theoretical background to enhance medical educators' understanding of sexual harassment across cultures.

Methods: Questionnaires were provided to female resident doctors. Respondents were asked about their experiences of sexual harassment, about their reactions and about any precautionary measures they had used. Descriptive statistics were generated using SPSS software. Qualitative data were analysed using content analysis.

Results: Forty-nine (51.0%) of 96 distributed questionnaires were completed. Thirty-three (67.3%) participants stated that they had been sexually harassed by a patient or patient's relative at some point in their career. 'Gazing at the doctor in a lewd manner', selected by 25 (51.0%) participants, was the most common form of harassment. The methods of coping selected by the highest numbers of respondents involved seeking the discharge of the patient (24.2%), avoiding contact with the patient or relatives (24.2%) and showing rejection (21.2%). Participants' comments about the prevention of sexual harassment revealed a deep sense of need for protection. The interface between quantitative and qualitative findings and a review of the literature supported the development of a value-based, cross-cultural conceptual framework linking the valuing of hierarchy and conservatism with the occurrence of sexual harassment.

Conclusions: We relate our findings to issues of patriarchy, power and socio-cultural influences that impact both the perpetrator and the target of sexual harassment. Medical educators are responsible for the control and prevention of sexual harassment of students. The globalisation of medical education requires that medical educators use a multi-cultural approach which considers socio-cultural influences and the diversity of female and male students' actions and perceptions of sexual harassment.