Nearly half the participants in a required course on physician-patient sexual misconduct and teacher-student mistreatment at the University of Toronto in Ontario said afterward they planned to change their clinical and teaching practices.

The findings published in the April 1 issue of the Canadian Medical Association Journal showed that 54 percent of the faculty participants (15 of 28) in the initial course and 39 percent of participants including faculty in subsequent courses (133 of 345) were likely to change their behavior as a result of the course. Thirty-eight percent of the 345 participants said they already behaved in the manner taught in the course.

"The results underline the limited teaching on boundary violations available in universities and point to the need for ongoing training of physicians," according to Gail Robinson, M.D., a professor of psychiatry and obstetrics and gynecology and codirector of the Women's Mental Health Program at the University of Toronto. She designed and evaluated the half-day course with Donna Stewart, M.D., chair of Women's Health at the Toronto Hospital and professor of psychiatry, obstetrics and gynecology, anesthesia, surgery, and family and community medicine at the University of Toronto. Stewart is also codirector of the Women's Mental Health Program in the university's department of psychiatry.

Stewart commented, "The findings indicate that with education physicians are willing to change their habits and practices related to patients and students."

Planned changes by physician participants included more teaching about boundary issues or greater awareness of these issues in practice, more formal and professional manner of dress, more care in dealing with patients and students, and more care in explanations given about intimate inquiries or discussion of physical examination, according to the article.

Stewart and Robinson developed the course after task forces established by the Ontario College of Physicians and Surgeons, a licensing body, recommended that medical training at all levels include education about physician-patient boundary issues.

The college has received and investigated numerous patient complaints in the last decade about physicians' sexual misconduct, including psychiatrists and family practitioners, who are permitted to do psychotherapy in Canada.

"Unless physicians are aware of the intense feelings that can be stirred up in a therapeutic relationship, they may not realize their own vulnerabilities and act on those feelings," said Robinson.

The course on physician-patient sexual misconduct and teacher-student mistreatment consists of a one-hour didactic portion and a two-hour workshop. Reprints and handouts are distributed to participants two weeks before the course. Lectures cover the causes and consequences of sexual misconduct by physicians and mistreatment and harassment of students by teachers. Relationships after termination of treatment are also addressed, stated the article.

Student mistreatment and harassment are defined as known or reasonably known conduct and comments that are offensive, unwanted, intimidating, hostile, or inappropriate, notes the article.

The workshop consists of a discussion of vignettes involving patients or students to address touching, appropriate meeting places, use of language, personal disclosure, sex-role socialization, dating of trainees, uncomfortable atmospheres for students and staff, and power differentials. Physicians are taught to watch for warning signs that show they are moving toward boundary violations.

Robinson and Stewart said a key factor in ensuring maximum participation in the course was a university committee chaired by the director of postgraduate programs in medicine and supported by the medical school dean. The course was taught first to directors of undergraduate and postgraduate education and then to faculty, residents, and medical students.

The curriculum can be adapted to train different specialty groups and has already been presented to psychiatrists, various other medical specialists, allied health care professional groups, and other universities in Canada, the United States, and Europe, according to Robinson.

More information on the course is available from Robinson or Stewart by writing to them at the Department of Psychiatry, The Toronto Hospital, 200 Elizabeth Street, Toronto, Ontario M5G-2C4.

(Psychiatric News, December 6, 1996)