Medical Students’ Awareness and Attitudes Regarding Boundary Issues

Abstract

Abstract Professional boundaries promote safe and effective healthcare. Whilst sexual boundary violations have been a research focus, it has been suggested that non-sexual boundary violations may represent a ‘slippery slope’, whereby crossing relatively minor boundaries can progress to serious boundary violations. Medical school presents an opportunity to support medical students with strategies to manage boundary challenges more effectively as doctors. The current study aimed to examine medical students’ awareness and confidence in managing boundary crossings and compare findings across year groups. Students in years 1, 3 and 5 of a five-year undergraduate program at one medical school in Australia, were invited to participate in an anonymous online survey which used multiple choice and free text questions to explore reactions to five scenarios demonstrating some level of boundary crossing. Students were asked about prior training and suggestions for future training. Quantitative data was analysed using omnibus chi-square tests and Kruskal-Wallis one-way ANOVAs for non-parametric data; free text data was analysed using coding and grouping similar themes. Final year students most accurately identified boundary crossings yet were somewhat more willing to cross ‘grey’ or less clear-cut boundaries. Year 3 students consistently reported the lowest levels of confidence in managing scenarios. Students reported little to no formal teaching relevant to the scenarios presented and supported inclusion of education regarding boundary issues in formal curricula. Our findings further suggest a need for education regarding management of the clinician-student power dynamic and there is demand from students for more teaching and support around ‘grey’ boundary crossings.