Knowledge of Professional Boundaries: Initial Validation of a Measure

Abstract

ABSTRACT Purpose Despite growing concern over the prevalence and consequences of physicians violating professional boundaries, lack of a brief and reliable measure of physician knowledge in this area impedes assessment and intervention. Method A 25-item exam was developed to assess an array of topics related to professional boundaries in health care such as legal terms, risk factors for boundary violations, and responses to case vignettes requiring clinical judgment in health care situations. To establish its psychometric properties the exam was completed by three different groups: 46 physicians participating in a professional boundaries program (PBP), 42 university-affiliated family physicians, and 36 physicians participating in CME courses on practice improvement. Results Psychometric analyses revealed a one-factor structure with good internal consistency and temporal stability. The measure’s sensitivity to change was established by showing that while PBP physicians did not score significantly different from university-affiliated family physicians prior to program participation, they achieved significantly higher scores after participation (p <.05). Mean scores for these two groups were significantly higher than for those physicians completing required ‘practice improvement’ CME coursework (p <.05). Conclusion In order to promote the education of physicians across their career in the area of professional boundaries, a reliable measure of such knowledge was established. Identifying risk factors for crossing professional boundaries is of growing importance to maintain the public’s trust.