Reexamining the Call of Duty: Teaching Boundaries in Medical School

Academic Medicine : Journal of the Association of American Medical Colleges
Justin A ChenRobert J Waldinger

Abstract

Although healthy physician-patient boundaries are essential to medical practice, published research on how to teach this important topic to medical students is lacking. Physician-patient boundaries, the interpersonal limits placed on behavior within a clinical relationship, protect providers and patients alike, and they represent a key component of professionalism. However, these boundaries may be difficult to teach and frequently are not presented as part of the formal curriculum, except in communication-focused specialties such as psychiatry and palliative care. Medical students may be particularly susceptible to boundary concerns due to the inherent ambiguities of their role within the medical team. In this Perspective, the authors present the adapted, anonymized case of a medical student who encountered a boundary issue during a clinical rotation. Following a brief review of the limited published literature regarding the teaching of boundaries during medical school, the authors define key concepts, including the clinical frame, boundary crossings and violations, fiduciary duty, and dual relationships. Next, they provide examples of common boundary challenges that arise during the course of undergraduate medical education an...Continue Reading

References

May 10, 1995·JAMA : the Journal of the American Medical Association·G O Gabbard, C Nadelson
Jan 1, 1994·Harvard Review of Psychiatry·K S DuckworthT G Gutheil
Oct 31, 2001·Psychiatric Services : a Journal of the American Psychiatric Association·UNKNOWN Psychopathology Committee of the Group for the Advancement of Psychiatry
Sep 18, 2002·The Psychiatric Clinics of North America·Thomas G Gutheil, Robert I Simon
Dec 7, 2002·Theoretical Medicine and Bioethics·Carol Nadelson, Malkah T Notman
Apr 27, 2004·Medical Education·Wayne WoloschukWalley Temple
Dec 10, 2009·Journal of Palliative Medicine·Sandra M NasrallahLara M Skarf
Dec 8, 2011·Journal of Palliative Medicine·David E Weissman
Aug 24, 2013·The Journal of Supportive Oncology·Sandra Sanchez-ReillyJane de Lima Thomas
Jan 7, 2016·Frontiers in Pediatrics·I Federico Fernandez Nievas, Danyal Thaver
Feb 15, 2017·JAMA : the Journal of the American Medical Association·Tait D ShanafeltColin P West

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Citations

Nov 14, 2019·The New England Journal of Medicine·Joshua Wales
Dec 4, 2019·Medical Education·Martina KellyTim Dornan
Nov 23, 2019·Journal of General Internal Medicine·Harry Reyes NievaGordon D Schiff
Jan 17, 2020·BMC Medical Education·Christel Grau Canét-WittkampfEsther de Groot
May 6, 2021·Patient Education and Counseling·Susan H McDanielShmuel Reis

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