Physician-Patient Boundaries: Professionalism Training Using Video Vignettes

Abstract

Introduction The concept of professional boundaries is often not included in medical training. Historically, the field of psychiatry has given much consideration to the topic of boundaries, partially due to the high incidence of sexual boundary violations in psychotherapy practice. And while there is a perception that more formal education is needed in psychiatry, the pressure to adjust the frame of a treatment in clinical practice is ubiquitous. We developed this presentation and discussion, using stimulus videos to depict common boundary issues that crop up in everyday outpatient medical practice. Methods This 90-minute session consists of a 20-minute PowerPoint presentation introducing the concept of professional boundaries and identifies the nine boundary domains as defined by Gutheil and Gabbard. Then the class views and discusses six brief video vignettes (allowing 10 minutes per vignette) with a 10-minute break. Faculty panelists from different specialties and at different stages of training are present to discuss the video vignettes and give examples from their own practice. Results This curriculum was implemented in 2009 at the University of Vermont College of Medicine and has been held annually since. Pre and post data were obtained in March 2009 from third-year medical students who participated in the seminar just prior to beginning their clinical clerkships. Statistically significant changes between pretest and posttest means were observed in five of the 10 questionnaire items, including one knowledge-based question about prescriptions to nonpatients Discussion The two learner groups we targeted were medical students during their clerkship year and residents in their first year of training. However, this material could easily be extended to other disciplines in medicine such as nursing.

Medical Students’ Awareness and Attitudes Regarding Boundary Issues

“…A few studies have proposed ways to educate medical students in a way that is engaging and effective. Video vignettes have demonstrated success in teaching 3rd year medical students about the 'greyer' areas of boundary crossings, with a statistically signi cant improvement in students' understanding of grey areas after watching the video vignettes (19) and improved student con dence approaching grey, or subtle, boundary issues (20).…”

Trainees on Technological Terrain: a Video Vignette-Based Tool to Teach E-Professionalism

“…By transcending the limitations of spoken and written didactics, videos allow educators to create and share educational content that is accessible to all learners, regardless of reading comprehension, mentalization, or auditory processing abilities [12]. They are valuable teaching tools [13] that generate learners' interest [14], effectively capture audience attention [14,15], provide more information in a limited amount of time, and stimulate discussion during didactics. Use of technology additionally increases peer-to-peer interactions [16], which enhances learning through collaborative problem-solving and engaged discussion and promotes interactive learning beyond simply reading or watching content in isolation.…”

“Should I Say Something?”: A Simulation Curriculum on Addressing Lapses in Professionalism to Improve Patient Safety

“…Current published curricula for teaching professionalism in undergraduate medical education include self-study modules, facilitated discussion, didactic lectures, and video vignettes. 28 – 30 To our knowledge, there are no published simulation curricula for teaching professionalism for medical students, and our curriculum addresses this gap.…”