Teacher-student relationships in medical education: Boundary considerations

Background: Despite recent attention to the area of student mistreatment, there has been less emphasis on the problem of excessive or inappropriate intimacy between teachers and students. Although a certain amount of closeness to faculty is important to the professional socialization of students, excessive or inappropriate closeness can be coercive because of the power differential between teacher and student. This can cause discomfort, discrimination, or psychological and academic harm to students, who often feel too intimidated to express concern. Aims: We provide a framework that allows both faculty and students to discuss these issues more openly and to consider constructive strategies in their own settings. Method: We collected examples of boundary issues that individuals had experienced or knew that others had experienced in teacher-student relationships. Results: Examples of excessive intimacy include patterns of expressing favoritism for personal reasons, disclosure about personal or academic problems experienced by the teacher, and socializing with selected students, up to and including dating and consensual sexual involvement. Conclusions: Personal and situational risk factors may make teachers or students more prone to cross healthy boundaries. Education about boundary issues, including discussion of case vignettes, may help build awareness and thus help foster more balanced teacher-student relationships.