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.

Technology Use to Deliver Faculty Development: A CERA Study.

INTRODUCTION: Technology provides a platform to help address individualized training needs for community preceptors who are separated from the campus and pressured to achieve clinical productivity goals. This study explores technology use and support for delivering faculty development to community preceptors. METHODS: This cross-sectional study was part of the 2017 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) annual survey of family medicine clerkship directors in the United States and Canada. RESULTS: The majority of respondents (n=62, 68.9%) agreed or strongly agreed that "using technology is critical to the successful delivery of faculty development to community preceptors." Only one-third (n=31) agreed or strongly agreed that their institution offers them adequate support to create and deliver technology-mediated faculty development or offers adequate support to community preceptors for accessing and using technology. CONCLUSIONS: Clerkship directors need institutional support to provide effective faculty development to preceptors via technology. The opportunity exists for institutions, national organizations, and professions to collaborate across disciplines and health professions on technology-based faculty development to support a level of quality and engagement for faculty development that is consistent with the levels we bring to student education.

Faculty Development for Medical School Community-Based Faculty: A Council of Academic Family Medicine Educational Research Alliance Study Exploring Institutional Requirements and Challenges.

PURPOSE: Community-based faculty play a large role in training medical students nationwide and require faculty development. The authors hypothesized that positive relationships exist between clerkships paying preceptors and requiring faculty development, and between protected clerkship directors' time and delivering face-to-face preceptor training, as well as with the number or length of community-based preceptor visits. Through under standing the quantity, delivery methods, barriers, and institutional support for faculty development provided to community-based preceptors teaching in family medicine clerkships, best practices can be developed. METHOD: Data from the 2015 Council of Academic Family Medicine's Educational Research Alliance survey of Family Medicine Clerkship Directors were analyzed. The cross-sectional survey of clerkship directors is distributed annually to institutional representatives of U.S. and Canadian accredited medical schools. Survey questions focused on the requirements, delivery methods, barriers, and institutional support available for providing faculty development to community-based preceptors. RESULTS: Paying community-based preceptors was positively correlated with requiring faculty development in family medicine clerkships. The greatest barrier to providing faculty development was community-based preceptor time availability; however, face-to-face methods remain the most common delivery strategy. Many family medicine clerkship directors perform informal or no needs assessment in developing faculty development topics for community-based faculty. CONCLUSIONS: Providing payment to community preceptors may allow schools to enhance faculty development program activities and effectiveness. Medical schools could benefit from constructing a formal curriculum for faculty development, including formal preceptor needs assessment and program evaluation. Clerkship directors may consider recruiting and retaining community-based faculty by employing innovative faculty development delivery methods.

Bilateral heel pain in a patient with Diamond-Blackfan anaemia.

A rare case of bilateral calcaneal stress fractures in a patient with Diamond-Blackfan anaemia is described. This has not been previously reported in the literature. A calcaneal stress fracture is an important differential diagnosis in a patient presenting with heel pain. Bilaterality of symptoms should not exclude this diagnosis and clinicians should be especially vigilant with predisposed patients.

Epidural collection following a late infected total knee replacement--a case report.

Prosthetic joint infection is a well-described complication following primary joint replacement. The association between an epidural abscess and joint replacement surgery following the use of epidural anaesthetics has been previously documented. There is however, no report in the literature of an epidural abscess forming as a result of haematogenous spread from an infected prosthetic joint. This case report presents such a scenario and highlights the importance of early diagnosis and treatment of infected prosthetic joints to avoid further systemic complications.

Medicine, law, ethics: teaching versus learning.

PURPOSE: Doctors' anxieties about the legal environment begin during medical school. The signals faculty members send to medical students contribute to this anxiety. A pilot study was conducted to examine signals sent by faculty members to students regarding the relationship of legal risk management and ethical patient care at one medical school. It was also intended to determine the agreement between the messages faculty staff believe they are transmitting and those that students think they are hearing from faculty mentors. METHODS: A survey with six multiple-choice questions was sent electronically to clinical faculty staff of one medical school to elicit the signals faculty members send students regarding the relationship of legal risk management and ethical patient care. A complementary survey instrument was sent to all 240 third- and fourth-year students to elicit their perceptions of what they were being taught by their mentors about the legal environment. Responses were tabulated, analysed, and interpreted. RESULTS: Faculty staff and student responses to six questions regarding teaching and learning about the relationship of legal risk management and ethical patient care revealed, for four of the six questions, statistically significantly different perspectives between what faculty members thought they were teaching and what students thought they were learning. CONCLUSIONS: Medical schools should be teaching patient-centered medicine, reconciling an awareness of the legal environment with the provision of ethically and clinically sound patient care. To improve performance, we must address the messages faculty members send students and reduce the disparity between perceived faculty teaching and claimed student learning in this context.

Obstructive jaundice due to autoimmune cholangiopathy.

A 59-year-old man presented with upper abdominal pain, cholestasis and radiological evidence of common hepatic duct hilar stricture which was suggestive of cholangiocarcinoma. The patient initially underwent percutaneous drainage and a laparotomy. No evidence of malignancy was identified. He was noted to have retroperitoneal fibrosis, which was confirmed on histology. The combination of cholangiopathy and retroperitoneal fibrosis suggested an underlying autoimmune process. Although the investigations did not show any evidence of IgG4 related disease, the combination of a cholangiopathy and retroperitoneal fibrosis is in keeping with autoimmune cholangiopathy and a steroid regimen was commenced. Our patient is now symptom-free with no further episodes of cholangitis. He has commenced azathioprine to maintain long term remission.