Harvard Medical School

Teaching Professional Boundaries to Medical Students & Residents

Purpose: To enhance students’ and residents’ ability to maintain appropriate professional boundaries, which is essential to the development of trusting and effective relationships between a physician and his or her patients and colleagues.  

Objectives: The trainee will: 1) Formulate a concept of their professional role in relation to patients, patient family members, other health care professionals, and non-patients who may attempt to place the trainee in a care-providing role; 2) Recognize and anticipate commonly encountered boundary challenging situations; 3) Demonstrate effective problem solving strategies around boundary challenging situations, and be able to model this with trainees; 4) Demonstrate effective communication skills in boundary challenging situations. 

Educational Methods: Ten audio-visual “trigger tapes” depicting common boundary challenges with accompanying discussion questions and teaching points; topics include: gift-giving, self-disclosure, social/financial interactions with patients, request of care by non-patient, interviewing the bigoted patient. Professional Boundaries OSCE Station, in which student must use problem solving skills and language to negotiate a boundary challenge (e.g. standardized “nurse” asks intern for a prescription for narcotics for her aching back).  

Applications: HMS Patient-Doctor III Course (plenary and tutorial sessions, case discussion & role play), GME teaching sessions (transitional internship, primary care internal medicine residency, psychiatry residency); Annual Intern OSCE; Faculty Development Workshops; Self-study (tapes posted on HMS My Courses Intranet)