Despite agreement that teaching on professional boundaries is needed, the design of health profession curricula is challenged by a lack of research on how boundaries are maintained and disagreement on where boundaries should be drawn. Curricula constrained by these challenges can leave graduates without formal preparation for practice conditions. Dual role or overlapping relationships are an example: they continue to be taught as boundary crossings amidst mounting evidence that they must be routinely navigated in small, interconnected communities. In this study, we examined how physicians are navigating overlapping personal (non-sexual) and professional relationships with the goal to inform teaching and curricula on professional boundaries. Following constructivist grounded theory methodology, 22 physicians who had returned to their rural, northern and/or remote hometown in British Columbia, Canada or who had lived and practised in a such a community for decades were interviewed in iterative cycles informed by analysis. We identified four strategies described by physicians for regulating multiple roles within overlapping relationships: (a) signalling the appropriate role for the current context; (b) separating roles by redirecting an interaction to an appropriate context; (c) switching roles by pushing the appropriate role forward into the context and pulling other roles into the background; and (d) suspending an interfering role by ending a relationship. Negotiating boundaries within overlapping relationships may involve monitoring role clarity and role alignment, while avoiding role conflict. The enacted role regulation strategies could be critically assessed within teaching discussions on professional boundaries and also analyzed through further ethics research.

中文翻译：

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“兼顾我们所戴的不同帽子”：制定了在重叠关系中协商边界的策略。

尽管人们一致认为需要进行专业界限教学，但由于缺乏对如何维持界限的研究以及在何处划定界限方面存在分歧，卫生专业课程的设计面临着挑战。受到这些挑战限制的课程可能会使毕业生无法为实践条件做好正式准备。双重角色或重叠关系就是一个例子：越来越多的证据表明，它们必须在小型、相互关联的社区中进行例行导航，但它们仍然被视为边界交叉点。在这项研究中，我们研究了医生如何处理重叠的个人（非性）和职业关系，目的是为专业界限的教学和课程提供信息。遵循建构主义扎根理论方法，22 名回到加拿大不列颠哥伦比亚省农村、北部和/或偏远家乡的医生，或者在这样的社区生活和实践了几十年的医生，在分析的基础上进行了迭代循环采访。我们确定了医生描述的四种在重叠关系中调节多重角色的策略：（a）针对当前情况发出适当的角色信号；(b) 通过将交互重定向到适当的上下文来分离角色；(c) 转换角色，将适当的角色推入背景，将其他角色拉入后台；(d) 通过结束关系来暂停干扰角色。在重叠关系中协商边界可能涉及监控角色清晰度和角色一致性，同时避免角色冲突。可以在关于专业界限的教学讨论中严格评估所制定的角色调节策略，并通过进一步的伦理研究进行分析。