How can learning effects be measured in Balint groups? Validation of a Balint group questionnaire in China

Background Balint groups aim to reflect doctor-patient relationships on the basis of personal cases. This study reports the validation of a questionnaire aimed at the identification of learning processes among Balint group participants in China. Methods This multicenter cross-sectional study was conducted during Balint group sessions in Beijing, Guangzhou and Shanghai. A heterogeneous sample of different professional groups was intended to adequately capture the reality of Balint work in China. After a Balint group session, the participants were asked to complete the Mandarin version of the Balint group session questionnaire (BGQ-C) and the group questionnaire (GQ), an internationally validated instrument to assess central dimensions of therapeutic relationships during group processes. Results Questionnaires from n = 806 participants from 55 Chinese Balint groups, predominantly comprising individuals with a medical background, were analyzed. Most participants were female (74.6%), and the average age was 34.2 years old (SD = 9.4). The results indicated good to very good reliability (Cronbach’s α = .70 to .86; retest rs = .430 to .697). The verification of the construct validity of the BGQ-C showed satisfying convergent (rs = .465 to .574) and discriminant validity (rs = -.117 to -.209). The model was tested with a confirmatory factor analysis of a three-factor model (standardized root mean square residual = .025; comparative fit index = .977; Tucker-Lewis index = .971). The 3 empirically identified scales resulted in good model fit with the theoretical dimensions of Balint work postulated in the literature: “reflection of transference dynamics in the doctor-patient relationship”, “emotional and cognitive learning” and “case mirroring in the dynamic of the group”. Due to the high correlations between the factors, a single-factor model was possible. A group comparison between the German and Chinese samples showed different loadings across cultures. Conclusions The BGQ-C is a quick-to-complete, item-based measuring instrument that allows the relevant dimensions of Balint group work to be recorded. This study suggests good psychometric properties of the Chinese version. Nevertheless, it must be assumed that the composition of constructs in the two countries is different.

92 Balint Groups: An Initiative to Help Residents Better Understand the Clinician-Patient Relationship

Primary Subject area Medical Education Background A Balint group is an educational tool that allows residents to reflect on challenging experiences with the doctor-patient relationship. Guided by trained facilitators, residents consider these cases from the doctor, patient and doctor-patient perspectives together with their colleagues. Balint groups can support the recognition of the emotional complexity underlying these interactions, which in turn reduces burnout, improves patient care and team dynamics, and strengthens professional identities. Objectives 1) To evaluate the effect of Balint groups on trainees’ perceived comfort levels in navigating, debriefing, and supporting peers through challenging patient-physician encounters; 2) To evaluate the effect of Balint groups on the perceived culture of support within the paediatric residency program at the University of Toronto. Design/Methods The University of Toronto Pediatrics Residency Program incorporated Balint groups into the curriculum in 2018. Supported by faculty, residents led their introduction and improvement using Quality Improvement methodology. Outcome measures included perceived comfort levels in navigating and supporting peers through challenging patient-physician encounters, and the perceived culture of support within the program. Outcome measures were obtained using a 5-point Likert scale. Rates of group participation were collected as a process measure. Results All outcome measures improved between the first and second year of Balint group implementation. Residents’ comfort levels in navigating difficult patient-physician encounters increased from a mean of 2.5 (out of a 5-point Likert scale) to 3.0, in debriefing complex scenarios from 3.1 to 3.9, and in supporting peers from 3.2 to 3.8. The perceived culture of peer support improved from a mean of 3.5 to 4.2. Conclusion A Balint group is a reflective educational tool, which has a positive impact on residents’ experiences navigating patient relationships. Introducing these sessions at our institution has shown an encouraging trend in improving residents’ comfort levels with difficult clinical encounters and fostering a culture of support.

Guilt, shame and negative emotion in undergraduate medical education: is there a role for Balint groups?

Balint groups are a structured discussion which explores non-clinical aspects of the doctor–patient relationship. In this commentary piece we describe our experience of a Balint group for final-year medical students in a large regional hospital. We discuss that our participants reported a significant burden of negative emotion, primarily guilt and shame, in attempting to navigate the hospital environment as learners. We note how our participants perceived they would acquire the ability to manage these negative emotions simply by becoming doctors, despite being only a few months from qualification. A cultural shift in undergraduate training, combined with a challenging period for the medical profession in general, may leave new doctors isolated in the face of the emotional strain of medicine. We therefore encourage educators to consider using Balint groups as an adjunct to more traditional clinical training.

Becoming the kind of doctor that you want to be. A qualitative study about participation in Balint group work

Objective Although wide-spread and appreciated, the benefit of Balint group work has been difficult to determine. Qualitative studies provide new angles for research. The aim of this study is to explore how participants in a Balint group for at least 1.5 years experienced the group work and how they were affected by their participation. Method Focus group interviews were conducted with a total of 19 members of four different Balint groups. The participants were experienced residents or younger specialists in general practice as well as from hospital specialities. A thematic analysis was performed. Results The main themes that emerged were: Investigating emotions, Development of the physician’s identity as well as Safety in the group and with the leader. The participants reported relief from stress as well as increased ability to understand the emotional side of patient encounters. They struggled to find their identity as doctors and specialists, often gaining a sense of pride in their work and becoming more secure. The group with a certified Balint leader felt like a safe place. Conclusions For younger doctors, participation in a Balint group for at least 1.5 years can help them build their professional identity by means of a deeper understanding of doctor-patient relationships. The role of Balint group work in relation to professional identity warrants further study.

The lived body (Der Leib) as a diagnostic and therapeutic instrument in general practice

SummaryBased on vignettes from clinical cases, supervision and Balint groups this article presents a neo-phenomenological perspective on the lived experience of healthcare professionals in interactions with patients and relatives. Specifically, the familiar phenomenon of “something in the air” between two persons will be analyzed.Constellations and situations are presented as fundamental and generic (ontological) categories that can be differentiated to understand the details and the whole (die Gestalt) of an interaction.The term atmosphere is introduced to investigate the material carrier of something that “colors the air” between healthcare provider and patient.The neo-phenomenological taxonomy of the lived body (der Leib) is used to describe the recipient structure of atmospheric mood.Finally, the potential of these concepts for a more comprehensive diagnosis and for therapeutic use in general practice will be elucidated.

The Art of Medicine

The author’s medical training. Hippocrates and the Hippocratic oath, but the shift from ‘First, do no harm’ to modern medicine’s mantra, ‘First, do something’. Modern medical education, and patient contact throughout. A consultant physician’s ward round in the bad old days. The film Patch Adams, based on the life of the maverick Dr Hunter ‘Patch’ Adams, founder of The Gesundheit Institute, and his vision of patient-centred care. The shift from ‘the cholecystitis in bed 3’ to patient-centred care—and patient-centred medical training. The RCGP’s vision statement of 2019, Fit for the Future. Ivan Illich’s 1974 critique of medicine in Medical Nemesis. His term iatrogenesis (clinical, social, cultural). RACP’s EVOLVE initiative seeking evidence of efficacy. Dr John Powles’ 1973 paper ‘On the limitations of modern medicine’. Pain management and the opioid epidemic. The social determinants of health explained. The biopsychosocial model compared with the reductionist medical model. Medically unexplained symptoms and the difficulty of diagnosis. Buck-passing. The purpose and use of Balint groups. Medically unexplained symptoms and chest pain.

Front-Line Medical Staff Experience About the Novel Psychological Intervention of Brief and Online Balint Group: A Qualitative Study in Iran During the COVID-19 Outbreak

Background: During coronavirus (COVID-19) pandemic, frontline medical staff were exposed to numerous psychological problems due to unpredictable conditions. A psychological intervention for medical staff is the provision of a group where emotions and feelings are shared. Objectives: The purpose of this study was to evaluate the experiences of front-line medical staff about virtual Balint group. Methods: Eight sessions of virtual Balint group were held through Skype. Participants were the frontline medical staff involved in the treatment of COVID-19 patients. The group leader was a psychiatrist and an analytical psychotherapist. The group had two co-leaders, a clinical psychologist and a psychiatrist. They were both experienced conductors who had a background of participation in Balint groups. Finally, eight in-depth semi-structured interviews were performed. Interpretative phenomenological analysis (IPA) was carried out to analyze the obtained data. Results: Three themes were extracted, including the effects of Balint group, Balint group structure, and virtuality of Balint group. Each theme included several categories, and each category had some codes. Conclusions: Leaders in the Balint group were active and had a supportive role. Some participants did not share their faces, and this made others feel insecure. Body language is an important issue in empathy and understanding of others that is overlooked in virtual Balint groups.

Balint style case-based discussion group for medical students in Bassetlaw Hospital

AimsTo evaluate feedback from Balint style case based discussion groups and to reflect on learning points.We have three medical students from Sheffield University on six week psychiatry placements at Bassetlaw Hospital and we get eighteen students in a year. In order to further develop their approach towards reflection and their understanding towards the doctor patient relationship we developed the Balint style case based discussion group, and each group of students attend three sessions during their placement.MethodThe groups are held on a weekly basis and consist of the three medical students and 1-2 facilitators. As the group is small one of the facilitators may participate with the students for the Balint process and to help encourage the students. Following completion of the third session of the discussion group we gain written feedback from the students. A total of 17 feedbacks have been reviewed over the period of November 2018 -November 2019.Result16 students stated that this was their first experience at Balint Group and all except one student felt that they were given a good introduction about Balint groups before starting. When asked about the most significant thing that they have learnt in the group, the majority of students marked reflecting feelings to improve relationships with patients, exploring why they feel a certain way with patients and that the doctor patient relationship can affect the consultation.One student stated that they would not recommend it to colleagues as they felt it was relevant more to doctors rather than medical students. Another student recommended having more people in a group.ConclusionOverall, it has been a positive experience with the medical students during the groups and with feedbacks. We have reflected on difficult topics like bereavement, fantasized about the purpose of a patient's delusion and shared the joy of a patient who was discharged after a long stay. While we think we have been able to teach the students some tips on reflection, we ourselves have been able to reflect on certain topics we would not have if not raised by the students. Some medical students have contacted the larger Balint Group in Sheffield for further sessions. Considering our experience, we will continue with the sessions at Bassetlaw Hospital.

A survey of Irish psychiatric trainees attitudes to balint groups

Aims1. To compare the experience of psychiatric trainees in Ireland of online Balint Groups (BG) in contrast to face to face groups.2. To assess the general attitudes of trainees to BG using the Psychological Medical Inventory (PMI) (Ireton and Sherman, 1988) scale.MethodAn online survey comprising two sections: 1. A questionnaire exploring participants experience, effectiveness and obstacles to attending the two formats of BG with a free text box response. 2. General attitude of trainees towards BG using PMI scale.An online cross-sectional survey using Survey Monkey. An invitation to participate in the survey was emailed to all trainees by the College of Psychiatrists in Ireland. All data were anonymised, and all data processing was conducted in line with GDPR. Statistical analysis was undertaken using Microsoft Excel. Thematic analysis was applied to the free-text box responses.Result16.49% (64/388) responded to the survey. Responses were uniform across all stages of training. 97% of respondents attended BG; 72% attended both formats, 25% attended only face-to-face and 3% online only. 65% of respondents preferred face to face compared to 18% online, whilst 11% stated no preference.On thematic analysis, trainees asserted a preference for face-to-face, describing better group cohesion, feeling safer to share, increased ease of interpreting non-verbal communication, and that conversation was more fluid. They described greater ease of engagement with the group/facilitator and preferred direct social interaction with peers.Conversely, most trainees acknowledged that online groups were convenient to attend, less time consuming & mitigated COVID risk associated with face-to-face meetings. Common themes against the use of online groups were: less psychotherapeutic in nature, technical issues, silences, unable to see participants faces and as though speaking “into the void”.Regarding trainees' attitudes to attending BG, most of the trainees found BG had been beneficial in developing more interest and confidence in dealing with the psychological aspects of patient care. Trainees agreed that skills improved in developing an excellent doctor-patient relationship, recognising patients under stress/ in distress, systemically obtaining psychological information and making treatment decisions based upon psychological needs and psychotherapeutic engagement. They agreed that they could better understand the influence of doctors' emotions on the doctor-patient relationship.ConclusionThis survey showed that most trainees find BG beneficial in developing better doctor-patient relationships, preferring face-to-face rather than online BG. However, they found online more convenient. A blended learning approach could provide trainees with the benefits of both formats of BG.