Letters to the Editor
We appreciate Watts and Parker joining us to advocate more curricular attention on professional boundary-setting as an aspect of professionalism. We applaud their implementation of rural clinical ethics ward rounds. The opportunity to observe rural professional boundary management being modeled, to debrief this experience with a trusted longitudinal preceptor, and then to process with peers and trained faculty facilitators addresses three of the four main goals for physicians’ education presented in the 2010 report of the Carnegie Foundation for the Advancement of Teaching.1 First, the authors’ above-mentioned rounds process specifically allows the integration of formal knowledge about ethics and clinical experience. By creating context to understand ethical dilemmas through facilitated introduction of formal knowledge, the student’s moral distress when facing such experiences may be lowered. Second, the process helps develop habits of inquiry and improvement, allowing students to explore individualization of boundary-setting. Finally, such work clearly focuses on professional identity formation as students develop their professional values.
As more students engage in longitudinal rural placements, it is imperative that schools ensure that their rural clinicians have a solid ethical foundation to pass on to students. Most would agree that students engage in this education through role modeling. How do schools ensure that their clinicians are good ethical facilitators? Even the best clinicians can have unprincipled ethical views and behaviors that may be damaging or confusing to students. This is a challenge to be addressed. Thus, perhaps we return to our main point of agreement on individualized approaches to professional boundary management and education, which is that rural medical education cannot be a “one size fits all” scenario. Each combination of community, preceptors, and students may require a different educational approach. We welcome further discourse on this topic.
Kathleen D. Brooks, MD, MBA, MPA
Assistant professor, Department of Family Medicine and Community Health, and director, Rural Physician Associate Program, University of Minnesota Medical School, Minneapolis, Minnesota; firstname.lastname@example.org.
Diann S. Eley, MSc, PhD
Associate professor and MBBS research coordinator, School of Medicine, University of Queensland, Brisbane, Australia.
Rebekah Pratt, PhD
Assistant professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.
Therese Zink, MD, MPH
Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota.
1. Cooke M, Irby DM, O’Brien BC Educating Physicians: A Call for Reform of Medical School and Residency. 2010 San Francisco, Calif Jossey-Bass