The survey, which ran from November 20, 2024, to January 7, 2025, was distributed by email to 15,112 physician members of the JSGS aged 65 or younger. Responses were collected anonymously through a web-based questionnaire, and 1,967 surgeons completed the survey, a response rate of 13.0 percent. Respondents were asked about their experiences of and exposure to harassment over the preceding ten years, a deliberately broad recall window chosen because this was the first nationwide survey of its kind conducted by the society and was intended to establish a baseline for future repeated measurements. The cohort skewed heavily male, with 87.0 percent of respondents being men, mirroring the composition of the specialty itself. The median time since medical school graduation was 21 years, meaning that the sample captured surgeons well beyond the training years, from residents and research fellows to department chiefs, professors, and hospital directors.

The study assessed five distinct categories of harassment, defined with reference to guidance from Japan’s Ministry of Health, Labour and Welfare and adapted to the surgical context. These included power harassment, sexual harassment, maternity and paternity harassment, academic harassment, and a newly formulated category called surgery-related harassment, designed to capture inappropriate behavior occurring in intraoperative and perioperative settings that exceeds what is necessary and appropriate for work. All categories were assessed on the basis of each respondent’s subjective perception, and the categories were not treated as mutually exclusive.

Overall, 66 percent of respondents reported experiencing at least one type of harassment during the preceding decade. The figure was dramatically higher among women: 87 percent of female surgeons reported harassment compared with 63 percent of male surgeons. Power harassment and surgery-related harassment were the most common forms, each affecting slightly more than half of all respondents, at 52 percent and 51 percent respectively. Academic harassment was reported by 27 percent, sexual harassment by 11 percent, and maternity or paternity harassment by 6 percent. The seemingly low prevalence of the latter two categories reflects the overwhelmingly male sample; among female surgeons, 55 percent reported sexual harassment and 24 percent reported maternity or paternity harassment, compared with just 8 percent and 4 percent of men respectively. Even for surgery-related harassment, prevalence among women exceeded that among men by 16 percentage points.

Perhaps the most striking finding concerns witnessing rather than experiencing. Eighty-eight percent of respondents reported having seen or heard about at least one type of harassment in their workplace over the past ten years, including 87 percent of men and 94 percent of women. Power harassment was the most frequently witnessed category at 78 percent, followed by surgery-related harassment at 69 percent and sexual harassment at 52 percent. For every single type of harassment, the proportion who had witnessed it exceeded the proportion who had personally experienced it. The researchers interpret this pattern as evidence that harassment is embedded in, and normalized by, the culture of surgical workplaces rather than being confined to individual perpetrator-victim dyads. When abusive conduct is visible across an entire community, they argue, the problem must be treated as organizational rather than purely interpersonal.

The career consequences were equally alarming. Among surgeons who experienced harassment, 56 percent reported that it had driven them to consider leaving the profession, with nearly identical rates among men and women. For power harassment and surgery-related harassment specifically, 57 percent of affected surgeons had contemplated exit. The corresponding figures were 46 percent for maternity or paternity harassment, 37 percent for academic harassment, and 18 percent for sexual harassment. Timing mattered: surgeons who experienced power harassment within ten years of graduation were more likely to consider leaving than those harassed later in their careers, at 61 percent versus 50 percent. Most troubling of all, respondents who reported harassment across multiple career periods were the most likely of all to consider abandoning surgery, regardless of harassment type, suggesting that cumulative exposure compounds the damage.

These results land on a specialty already under demographic strain. Despite an overall increase in the number of medical interns in Japan, applications to surgical training programs have been declining, and the JSGS has documented year-by-year decreases in its own membership even as an aging society sustains demand for operations. A 2023 Health Labour Sciences Research report found that among residents who had originally intended to pursue surgery, one reason for ultimately choosing another path was the perception that harassment was likely to be common, alongside work-life balance concerns and the image of surgery as excessively demanding. An earlier nationwide survey by the Japan Surgical Society found that roughly 40 percent of young surgeons had experienced harassment from supervising surgeons and nearly 30 percent had considered leaving their training program, with harassment accounting for more than half of the reasons for contemplating withdrawal. The new data extend this concern beyond trainees to surgeons at every career stage, indicating that harassment persists throughout professional life rather than ending with residency.

The comparison with the general workforce is stark. In a recent nationwide survey of Japanese workers commissioned by the Ministry of Health, Labour and Welfare, 19.3 percent reported power harassment and 6.3 percent reported sexual harassment. Among gastroenterological surgeons, the corresponding figures were 51 percent and 11 percent. The authors attribute this elevated prevalence to the traditional hierarchical structure of surgical training, long working hours, high clinical demands, and strongly hierarchical organizational cultures, conditions that also make harassment less visible and more likely to persist implicitly. They note that while surgical education sometimes requires strict guidance and tension-filled situations, educational quality and a healthy work environment should not be regarded as mutually exclusive, and that behaviors presented as instruction or supervision may still be perceived as harassment by younger surgeons.

Demand for institutional action proved overwhelming. Fifty-eight percent of respondents strongly agreed and 34 percent agreed that the JSGS should implement countermeasures against harassment, meaning 92 percent supported society-level intervention, while only 5 percent disagreed. The authors argue that professional societies are uniquely positioned to act in hierarchical specialties such as surgery, where institutional responses within hospitals may be constrained by power structures and conflicts of interest. Potential initiatives include structured anti-harassment education for trainers and department leaders, periodic nationwide monitoring, video-based and simulation-based training programs of the kind being explored internationally, and systems to recognize and promote institutions that maintain healthy educational environments. Japan’s Japanese Medical Specialty Board has already established a consultation pathway for trainees who suspect harassment, and international bodies have developed formal professional-society resources addressing harassment-related behaviors, although evidence for real-world effectiveness in surgery remains limited.

The researchers acknowledge limitations, including the possibility of self-selection bias among voluntary respondents, the reliance on subjective perception rather than legal determination, the unavoidable recall bias of a ten-year window, the cross-sectional design that precludes causal inference, and the exclusion of surgeons who had already left practice or the society, including those who may have departed because of harassment. Nevertheless, the large nationwide sample and the inclusion of surgeons across career stages provide an unusually comprehensive view. The survey has already fed into policy: on July 17, 2025, the JSGS issued a formal Declaration for the Eradication of Harassment, and the study’s authors say the findings underscore the importance of translating that declaration into concrete action rather than leaving it as a statement of principle. With the future of the surgical workforce at stake, they argue, harassment must be recognized not merely as an ethical failing but as a workforce policy problem that threatens the sustainability of surgical care in Japan.

Subject of Research: Prevalence and consequences of workplace harassment among gastroenterological surgeons in Japan

Article Title: Workplace Harassment and Consideration of Leaving Surgical Practice: A Nationwide Survey by the Japanese Society of Gastroenterological Surgery

Article References: Kurimoto, K., Fujii, T., Shirai, Y., Fujinaga, A., Fukumoto, M., Ishida, S., Hida, K., Tanaka, C., Mizushima, T., Nomura, S., & Shirabe, K. (2026). Workplace Harassment and Consideration of Leaving Surgical Practice: A Nationwide Survey by the Japanese Society of Gastroenterological Surgery. Annals of Gastroenterological Surgery, Article ags3.70274. https://doi.org/10.1002/ags3.70274

Image Credits: AI Generated

DOI: 10.1002/ags3.70274

Keywords: workplace harassment, gastroenterological surgery, power harassment, sexual harassment, surgeon burnout, workforce sustainability, gender disparity, surgical training, Japan, professional societies, physician attrition, organizational culture

The choice of population was deliberate. Students training to become teachers occupy a unique position in the public health landscape: they are future educators who can disseminate life-saving knowledge through schools and communities, multiplying the impact of any single training program. By assessing their preparedness, the researchers hoped to gauge the potential for a self-renewing generation of first responders in a country where sudden cardiac arrest remains one of the most urgent and under-recognized public health crises. The study, published in the Journal of Emergency and Disaster Medicine, was conducted between April and May 2024 using a convenience sample with a calculated minimum requirement of 128 participants, ultimately enrolling 134 students with no missing data.

Demographically, the cohort was dominated by 23-year-olds, who made up 41 percent of respondents, followed by 22-, 24-, and 25-year-olds. Slightly more than half of the participants, 56.7 percent, were male, and nearly two-thirds were postgraduate students. Data were collected through a structured, self-administered questionnaire covering demographic variables, CPR awareness, self-rated ability, prior training, and barriers to intervention. Researchers scored five domains: confidence in performing specific skills such as checking responsiveness, assessing breathing, delivering chest compressions, using an automated external defibrillator, and providing wound care; recognition of situations indicating CPR, including unconsciousness, drowning, burns, and choking; correct response actions; symptom recognition during resuscitation; and overall perceptions of CPR’s importance.

The psychometric properties of the instrument were examined in detail. The confidence domain showed strong internal consistency, with a Cronbach’s alpha of 0.808 across its five items, while the indication, support, and symptom recognition domains demonstrated moderate reliability suitable for exploratory research, with alphas of 0.640, 0.649, and 0.630 respectively. The perception domain, by contrast, showed low internal consistency at 0.201, prompting the authors to analyze those items individually and interpret them cautiously. The overall instrument achieved an acceptable alpha of 0.645. Descriptive statistics revealed that confidence was the most variable measure, ranging from 0 to 17 with a mean of 9.22 and a standard deviation of 3.70, while perception scores were the most tightly clustered.

Attitudes toward CPR were overwhelmingly positive. A striking 70.1 percent of participants considered first aid and CPR more important in light of recent health emergencies, and 71.6 percent strongly agreed with the importance of these skills overall. Yet actual exposure was limited: 20.1 percent had never witnessed a first aid or CPR event, only 9 percent had ever provided CPR, 40.3 percent reported lacking training, and 23.9 percent cited fear of infection as a deterrent. When asked why they might hesitate, 44 percent pointed to safety protocols, 25.4 percent to needed training modifications, and only 17.9 percent reported no hesitation at all. Confidence itself was uneven, with 29.1 percent very confident in performing CPR but 11.9 percent reporting no confidence at all in basic first aid.

The statistical core of the study produced its most important insight. One-way analysis of variance showed a significant relationship between exposure to real first aid or CPR events and total preparedness scores, with F equal to 3.466 and a p-value of 0.010. Students who had actually provided CPR scored dramatically higher, averaging 27.4 points against 20.4 for those with no prior exposure, a gap that dwarfed differences attributable to perception or self-reported barriers. Neither perceived impact of CPR on health emergencies nor reasons for hesitation showed significant score differences, suggesting that nothing substitutes for hands-on experience when it comes to building genuine readiness to act.

Gender emerged as a persistent fault line. Male students scored significantly higher than female students on overall CPR preparedness, with means of 23.8 versus 20.5 and a t-statistic of 3.319 with p equal to 0.002. Chi-square analysis reinforced the pattern, showing that 56.6 percent of males fell into the high-preparedness category compared with 36.2 percent of females, a difference that was statistically significant. In univariate logistic regression, sex was a significant predictor, with female students showing odds of high preparedness less than half those of their male counterparts. However, the association lost significance in the multivariable model, hinting that the disparity may stem from differences in training exposure and experience rather than inherent capability, echoing prior research showing that women often underestimate their skills despite performing comparably.

Age and training status also mattered. Participants aged 22 showed a disproportionate concentration in the low-preparedness group, and trained students were significantly more likely to demonstrate high preparedness, at 59.4 percent versus 35.4 percent for the untrained. Formal training showed a marginal positive association with high preparedness in the multivariable logistic regression, with an odds ratio of 2.21 and p equal to 0.051, while the overall model was statistically significant and passed the Hosmer–Lemeshow goodness-of-fit test. Notably, undergraduate students scored slightly higher than postgraduates, a marginally non-significant difference suggesting that academic progression alone does not translate into emergency readiness, and that practical skill-based education must be embedded deliberately within university life.

The barriers identified by the study extend beyond knowledge. Fear of causing harm, anxiety, and uncertainty have long been documented as psychological obstacles to bystander CPR, and the COVID-19 pandemic added infection risk to the calculus, particularly around mouth-to-mouth ventilation. International resuscitation bodies responded by promoting compression-only CPR and protective equipment, and evidence has since shown that trained laypersons can use automated external defibrillators safely and effectively within structured response systems. In India, cultural discomfort with physical contact with strangers and limited public awareness of the Good Samaritan law, which legally protects emergency helpers, compound the hesitation. The authors argue that training programs must therefore address emotional preparedness and confidence-building alongside technical instruction, using simulation-based learning and periodic refresher sessions to sustain competence over time.

The study’s authors conclude that universities should implement regular, hands-on CPR and first aid programs paired with targeted interventions to dismantle psychological barriers, with particular attention to groups reporting lower confidence. They envision Varanasi, with its massive student population, becoming a model city for bystander CPR readiness, generating scalable lessons for cardiac arrest response across urban and semi-urban India. The findings come with caveats: the cross-sectional design precludes causal claims, the convenience sample of education students from a single faculty limits generalizability, and self-reported questionnaires may not reflect actual CPR competency. Still, the central message is clear and actionable, aligning with expert calls to embed CPR and defibrillator training in schools and colleges nationwide. Communities with high bystander CPR rates see substantially better survival after out-of-hospital cardiac arrest, and young people, armed with practical experience rather than theory alone, are best positioned to become the life-saving bridge between collapse and definitive care.

Subject of Research: First aid and CPR confidence, training gaps, and preparedness among university students in Varanasi, India

Article Title: The state of first aid & cardio-pulmonary resuscitation: assessment of confidence, support, and perceptions in the wake of a health emergency among students of Banaras Hindu University, Varanasi

Article References: The state of first aid & cardio-pulmonary resuscitation: assessment of confidence, support, and perceptions in the wake of a health emergency among students of Banaras Hindu University, Varanasi. (n.d.). https://doi.org/10.1007/s44467-026-00016-x

Image Credits: AI Generated

DOI: 10.1007/s44467-026-00016-x

Keywords: cardiopulmonary resuscitation, first aid, bystander CPR, cardiac arrest, health emergency preparedness, CPR training, university students, gender disparity, basic life support, COVID-19, India, Banaras Hindu University