Professional boundaries: the perspective of the third year medical student in negotiating three boundary challenges

The negotiation and maintenance of professional boundaries is a central developmental challenge for medical students in clinical training. The purpose of this study is to assess problem solving strategies, decisions made, level of confidence, and language used by beginning third year medical students when faced with professional boundary challenges.

Forty-two students in the first quarter of their third year at Harvard Medical School viewed three brief audiovisual "trigger" tapes, each depicting a medical student faced with a boundary challenge (the offer of a gift, a personal question from a patient, an errand request by a supervisor).

There was a high degree of agreement and confidence among students about how to negotiate a monetary gift (reject) and how to respond to a patient's "too personal" question (not answer and/or redirect). However, the students were less confident and more divided on the issue of whether or not to run a personal errand for the team at the request of a superior.

Our findings have implications for medical professionalism curricula, especially regarding the importance of mentorship and role modeling in medical education. Effective professional boundaries curricula allow the student to problem solve and practice communication skills in boundary challenging situations.