Surgeons must recognize that perceptions of sexual misconduct in surgical environments differ drastically among colleagues, impacting workplace culture and safety.

• 742 surgeons reported conflicting experiences; some saw minimal issues while others described pervasive harassment and inaction.
• The lateral view x-ray theory suggests awareness of misconduct depends on one’s exposure and experiences—those less affected are often unaware, while victims see a troubling reality.

Embedding this framework in surgical training can foster better awareness and promote a healthier, safer workplace culture.