Sexual boundary violation index: A validation study

This paper explores the psychometric properties of the Boundary Violation Index (BVI), a screening instrument designed to assess the attitudes, thoughts, and behaviors of physicians at risk of sexual misconduct with patients and staff. Items for the BVI were selected and validated using a two phase process of administration of the tool along with the Sexual Addiction Screening Test (SAST) to physicians referred to a CME course for boundary violating behaviors (n = 60 and 272) along with a control group (n = 118). Criterion-related validity in relation to the SAST was strong (r = 0.68, p \u3c 0.001) and construct validity was demonstrated by the difference between intervention and comparison group BVI scores (p \u3c 0.001). A BVI score of ≥6 for interpreting substantive risk had a sensitivity of 83% and specificity of 81%, and represented a greater than 20-fold greater risk (Exp B = 20.5, 95% CI 11.8-35.7, model p \u3c 0.001) for membership in the intervention group. The BVI offers promise as a preliminary tool for identification of physicians at risk for boundary violating behaviors and may have utility for medical education and/or monitoring purposes

A continuing medical education approach to improve sexual boundaries of physicians

Introduction: Physician sexual boundary violations are a public health problem. Few resources exist to address physicians who behave inappropriately with patients. In response, the Center for Professional Health at Vanderbilt University developed a three-day continuing medical education (CME) course about proper professional sexual boundaries in 2000. The mission of this CME course is to offer an educational intervention for those physicians whose professional sexual misconduct has required such education as part of a larger accountability sanction. Previous studies suggest that when such education is offered through non-traditional medical education, it is effective in promoting behavioral change. This paper describes the three-day intensive educational experience offered by a CME course with a particular focus on lessons learned from more than 7 years of experience working with these physicians. Methods: Over 381 physicians from 40 states and Canada have attended. Data about course participants was collected by self-report and aggregated into three categories: demographics, results of assessment tools administered, and quality of the experience. Assessment tools used include the Family Adaptability and Cohesion Evaluation Scale II (FACES II), the Trauma Symptom Inventory (TSI™) and the Sexual Addiction Screening Test (SAST). Results: Most physicians were referred to the course from physician health programs and boards of medical examiners. The majority of physician participants were male and in group or solo practice. A full range of medical specialties was represented with most physicians being internists, psychiatrists, obstetricians and surgeons. Results of assessment tools administered indicate that physicians referred for sexual boundary violations often come from dysfunctional families and demonstrate symptoms indicative of trauma related problems and possible sexual addiction. Physician attendees report being highly satisfied with the new knowledge attained in this course. Discussion: Curriculum aimed at addressing sexual boundary violations should address family of origin issues, trauma coping skills and sexual acting out. Satisfaction data continues to support a small group, experiential, and confidential format as an effective means for intervention. Conclusion: A CME course offers a model for future training experiences for faculty, residents, medical students and community physicians to teach skills that may help prevent and remediate professional boundary crossings