Commentary: Doctors without Boundaries: The Ethics of Teacher-student Relationships in Academic Medicine

Larkin, Gregory Luke MD, MA, MSPH; Mello, Michael J. MD, MPH

Disclosures

Academic Medicine. 2010;85(5):752-755. 

In This Article

Abstract and Introduction

Abstract

Possessed of both instinct and intellect, physician teachers are required to be respectful exemplars of professionalism and interpersonal ethics in all environments, be it the hospital, classroom, or outside the educational setting. Sometimes, even while protecting the sanctity of the teacher–student relationship, they may surreptitiously find themselves in the throes of consensual intimacy, boundary violations, student exploitation, or other negative interpersonal and/or departmental dynamics. One may question how an academic can consistently resolve this tension and summon the temperance, humility, charity, and restraint needed to subdue lust, pride, abuse, and incontinence in the workplace. One important answer may lie in an improved understanding of the moral necessity of social cooperation, fairness, reciprocity, and respect that is constitutive of the physician–teacher role. Although normative expectations and duties have been outlined in extant codes of ethics and conduct within academic medicine, to date, few training programs currently teach faculty and residents about the ethics of appropriate pedagogic and intimate relations between teaching staff and students, interns, residents, researchers, and other trainees. This essay highlights examples from history, literature, and medical ethics as one small step toward filling this void.

Introduction

Even the best pedagogical and interpersonal relationships can be challenging. In graduate medical education (GME), as elsewhere in academe, teachers and their charges have numerous close interpersonal interactions over the course of training, creating the possibility for both good and bad results. Although the professional roles of learners and faculty are interdependent, there are obvious asymmetries in power and position within the academic medical ecosystem that create the potential for mistreatment, abuse, and even sexual trespass between mentor and mentee. In this commentary, we use examples from history, literature, and scholarship to underline some of these interpersonal pitfalls and describe the professional norms under which teacher–learner mistreatment may be minimized and positive pedagogical relationships can prosper.

Comments

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