In a recent blog I suggested that relationships between students and teachers will have been changed in those medical schools where students address the staff by their first names. As I saw it, the practice of addressing teachers using surnames and titles will have provided some sort of barrier between teachers and taught. Where this barrier has been lifted (first name terms are standard at my medical school), the greater equality that it will have brought will have been accompanied by a new closeness, and inevitably this will have brought new challenges. In my own experience the new relationships can lead to there being less respect, with rude and aggressive comments. Another outcome might be a greater ‘intimacy’ with the risk of suggestive behaviour and excessive familiarity. 

It seems to me important that this new relationship needs to be put into a context that we can all share, and a model I found to express this new relationship adopts the concept of ‘space sharing’.  Here the space refers not to space in a physical/ geographical sense (e.g. sitting a metre from someone in a room), but to space in a virtual sense and in which there are projections (bubbles) of the mind. It is in this virtual space that one can share, for example, sentiments, interests and opinions, 

As a general principle, at the beginning of any relationship we share ‘public’ space with little ‘mind’ interaction apart from awareness, respect and the normal courtesies. For those who wish to be closer, an agreement is struck to move from sharing such ‘public’ space, to sharing ‘personal’ space, so to meet together, talk together, spend time together, and inevitably to share virtual space and so ideas, aspirations, anxieties, etc. Such virtual space could be used to share ‘private’ or ‘intimate’ matters or simply to house ‘intellectual’ matters. And for intellectual matters this would mean, space containing for example, knowledge, ideas, concepts, understanding, and scholarly thoughts.

Turning then to tutorials as an example of where there is shared intellectual space. Here discussion between teachers and students is sometimes heated, often involves closeness, and certainly requires a particular form of sensitivity, but should remain on an intellectual level (i.e. occupy intellectual space) with no hint of an emotional (or sexual) occupancy. Similarly, when a teacher works closely with a student on a one-to-one basis, as is often the case with a BSc or a higher degree, although the relationship can be intense it must only be intense intellectually – again the two are occupying (sharing) a shared ‘intellectual’ space. Interestingly, occasionally teachers play a pastoral role and then the same rule can apply – the relationship should be confined to (and should not stray outside of) shared ‘pastoral’ space.

By adopting the intellectual space model we can clarify both relationships and personal boundaries. In my view, using this paradigm of sharing intellectual space should strengthen understanding of the student-teacher relationship and limit the potential for muddle and abuse. Moreover, if one or other side were tempted to move across boundaries into another (say emotional) space, all that is required is a simple reminder that the staff/student relationship is based on shared ‘intellectual’ space and transgression is unacceptable. Nothing could be simpler.

Joe Collier is emeritus professor of medicines policy at St George’s, University of London