Mayo Clinic, Psychiatry and Psychology, Rochester, MN 55905, USA.
Acad Psychiatry. 2009 Nov-Dec;33(6):461-9. doi: 10.1176/appi.ap.33.6.461.
Awareness of the privileges and limits of one's role as physician, as well as recognition and respect for the patient as a human being, are central to ethical medical practice. The authors were particularly interested in examining the attitudes and perceived needs of psychiatric residents toward education on professional boundaries and relationships given the heightened current focus on professionalism and ethics.
Residents from six psychiatric residencies provided views on professionalism and ethics education on a survey encompassing 10 domains of professionalism. The authors focus on residents' perceived need for education on boundaries in the psychiatrist-patient relationship and in peer-peer and supervisor-trainee interactions.
Respondents (N=134) felt that nine relationship and boundary issues arising during training should receive more education: being asked to work with inadequate supervision, resolving conflicts between attendings and trainees, resident health care, adequately caring for patients while adhering to work-hour guidelines, performing work beyond one's competence, mistreatment of residents, sexual/romantic relationships between faculty and trainees, mistreatment of medical students, and sexual/romantic relationships between residents and medical students (p<0.05 in all cases). In addition, 15 relationship and boundary issues arising during clinical practice were felt to warrant more education: responding to impaired colleagues, coping with mistakes in clinical care, reporting mistakes, balancing personal and professional life, resolving conflicts, writing prescriptions for friends or family, allocation of health care resources, providing medical advice to friends and family, physicians' social responsibilities, interacting with families, medicine as a profession, gender bias, being asked to falsify clinical information, accepting gifts from patients, and personal relationships with patients (p<0.05 in all cases).
The authors found a perceived need for more education for psychiatric residents for the majority of topics pertaining to boundaries and relationships. Residents who reported encountering ethical dilemmas more frequently wanted more education on these topics.
认识到作为医生的角色特权和限制，以及承认和尊重患者作为人的尊严，是道德医疗实践的核心。作者特别关注检查精神科住院医师对专业界限和关系教育的态度和感知需求，因为当前高度关注专业精神和道德规范。
来自六个精神科住院医师培训项目的住院医师在涵盖专业精神 10 个领域的调查中就专业精神和道德规范教育提供了意见。作者关注的是住院医师对精神科医患关系以及同行-学员和上级-受训者关系中界限问题的教育需求。
受访者（N=134）认为，在培训期间出现的九个关系和边界问题应该接受更多的教育：被要求在监督不足的情况下工作、解决主治医生和受训者之间的冲突、住院医生的医疗保健、在遵守工作时间规定的同时充分照顾患者、超越自己能力范围工作、虐待住院医生、教职员工和学员之间的性/浪漫关系、虐待医学生以及住院医生和医学生之间的性/浪漫关系（所有情况下 p<0.05）。此外，在临床实践中出现的 15 个关系和边界问题被认为需要更多的教育：应对受损的同事、应对临床护理中的失误、报告失误、平衡个人和职业生活、解决冲突、为朋友或家人开处方、分配医疗资源、为朋友和家人提供医疗建议、医生的社会责任、与家属互动、医学作为一种职业、性别偏见、被要求伪造临床信息、接受患者的礼物以及与患者的个人关系（所有情况下 p<0.05）。
作者发现，大多数与界限和关系相关的主题都需要对精神科住院医师进行更多的教育。报告遇到伦理困境更频繁的住院医师更希望在这些主题上接受更多的教育。
