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“Juggle the different hats we wear”: enacted strategies for negotiating boundaries in overlapping relationships

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Abstract

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.

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Acknowledgements

The authors wish to thank Kevala Van Volkenburg for her assistance as research manager, Talise Lindenbach for her involvement with interviews, and all participants for sharing their experiences with us.

Funding

This study was funded by a University of British Columbia Distributed Medical Education grant awarded through the Centre for Health Education Scholarship in 2019.

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Authors and Affiliations

  1. Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada

    Andrea Gingerich, Robin Roots & Sean B. Maurice

  2. Department of Bioethics, Dalhousie University, Halifax, Nova Scotia, Canada

    Christy Simpson

  3. Department of Physical Therapy, University of British Columbia, Halifax, Nova Scotia, Canada

    Robin Roots

  4. Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Sean B. Maurice

Authors
  1. Andrea Gingerich
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  2. Christy Simpson
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Contributions

All authors contributed to the study design. A.G. and S.M led participant recruitment. A.G. led data collection, analysis, and manuscript preparation in consultation with S.M. and with regular contributions from all other authors. All authors edited and reviewed the manuscript.

Corresponding author

Correspondence to Andrea Gingerich.

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Ethical approval

This study received approval (H19-01498) from the University of British Columbia and the University of Northern British Columbia in 2019.

Competing Interests

Christy Simpson receives royalties from the sale of her and F. McDonald’s book, Rethinking Rural Health Ethics.

Other disclosures

Christy Simpson receives royalties from the sale of her and F. McDonald’s book, Rethinking Rural Health Ethics.

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Previous presentations

BC Rural Health Research Exchange conference on November 23, 2021; Northern BC Research and Quality Conference on December 9, 2021; Canadian Conference on Medical Education, April 2022, Calgary, Alberta, Canada; Association for Medical Education Europe conference August 2022, Lyon, France.

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Gingerich, A., Simpson, C., Roots, R. et al. “Juggle the different hats we wear”: enacted strategies for negotiating boundaries in overlapping relationships. Adv in Health Sci Educ (2023). https://doi.org/10.1007/s10459-023-10282-3

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