Lewis Judith, Allan Scott
Associate Professor of Psychiatry, University of Vermont College of Medicine.
Director of Residency Training, University of Vermont Medical Center.
MedEdPORTAL. 2016 Jun 10;12:10412. doi: 10.15766/mep_2374-8265.10412.
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.
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.
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.
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.
专业界限的概念在医学培训中常常未被涵盖。从历史上看，精神病学领域对界限这一主题给予了诸多关注，部分原因是心理治疗实践中存在较高的性界限侵犯发生率。尽管人们认为精神病学需要更多的正规教育，但在临床实践中调整治疗框架的压力却无处不在。我们制作了这个演示文稿并进行讨论，使用刺激视频来描绘日常门诊医疗实践中出现的常见界限问题。
这个90分钟的课程包括一个20分钟的PowerPoint演示文稿，介绍专业界限的概念，并确定古特海伊尔和加巴德所定义的九个界限领域。然后，学员们观看并讨论六个简短的视频小品（每个小品留出10分钟），中间休息10分钟。来自不同专业和不同培训阶段的教员小组成员会参与讨论视频小品，并分享他们自己实践中的例子。
该课程于2009年在佛蒙特大学医学院实施，此后每年都会举办。2009年3月，在三年级医学生开始临床实习前参加该研讨会时收集了前后数据。在10个问卷项目中的5个项目中，观察到了前测和后测平均值之间具有统计学意义的变化，其中包括一个关于给非患者开处方的知识型问题。
我们针对的两个学习群体是实习年的医学生和第一年培训的住院医师。然而，这些材料可以很容易地扩展到医学的其他学科，如护理。
