The following literature review from the Journal of the Association of American Medical Colleges examines the prevalence of sexual harassment in medical schools since Title IX was enacted and the cultural and legal changes that have occurred during that period that have affected behaviors. The authors discuss persisting barriers to reporting sexual harassment, including fears of reprisals and retaliation, especially covert retaliation. It concludes by highlighting institutional and organizational approaches to decreasing sexual harassment and overt retaliation, and proposing other approaches to decreasing covert retaliation.