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.

Online Balint Group Work Versus Pharmacotherapy in Treatment of Coronavirus Anxiety in Healthcare Workers in Iran: A Pilot Randomized Controlled Trial

Background: An increase in symptoms of anxiety is already being reported in relation to the COVID-19 pandemic.Objectives: We aimed to compare the effectiveness of Balint group work with pharmacotherapy in coronavirus related anxiety among healthcare workers (HCWs) in Iran.Methods: In This pilot clinical trial, after passing a phone screening procedure by a psychiatrist, subjects were quasi-randomly assigned to Balint (8 sixty-minute online sessions) or pharmacotherapy (Sertraline) groups. Both groups were asked to fill two questionnaires, including the Corona Disease Anxiety Scale (CDAS) and Connor-Davidson resilience scale (CD-RISC), at the beginning and the end of the 4-week intervention period.Results: A total of 45 HCWs enrolled in this study. The results showed a significant difference between the post-test and pre-test scores of both groups in the total scores of anxiety and its subcomponents (p≤0.001). There was no significant difference between the effectiveness of the two interventions on anxiety (p=0.52). Both interventions had a significant effect on the subjects' resilience and its subscales (p≤0.05) except for positive acceptance change. The spiritual influences domain had a significantly higher increase in the pharmacotherapy group (P=0.031).Conclusions: We showed Balint group work maybe can better to pharmacotherapy with Sertraline in management of COVID-19 related anxiety and boosting resilience in healthcare workers.

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.

Supporting Team Reflexivity During the COVID-19 Lockdown: A Qualitative Study of Multi-Vision Groups In-person and Online

Introduction: The professional self is often hindered by a lack of self-care and poor work-life balance, and cannot be considered an unlimited resource. Given this, the reflexive team is an important organizational tool for protecting workers' well-being. The non-profit organization Maestri di Strada (MdS) (“Street Teachers”) conducts action research (AR) in the area of socio-education. The main tool used by the group to protect the well-being of its members is a guided reflexivity group, inspired by the Balint Group and termed the Multi-Vision Group (MG). In March 2020, because of the COVID-19 lockdown, the MdS team had to quickly revamp its working model, and MGs were held online for the first time.Aim: Through qualitative research that takes a longitudinal approach, the aim of this study is to evaluate the efficacy of the MG in supporting the team's reflexivity in this new online format.Methods: This article considers MGs during two different time periods: pre-pandemic (T1) and early pandemic (T2). During T1, the MdS team met 18 times in person, while during T2 the team met 12 times through an online platform (always under the guidance of a psychotherapist). During all sessions in both time periods, a silent observer was present in the meetings, and they subsequently compiled narrative reports. The textual corpora of the reports were submitted for a Thematic Analysis of Elementary Contexts through T-Lab Plus, in order to examine the main content of the groups' discourse.Results: The results (five clusters in T1; and five in T2) show that, during T2, the group devoted considerable time to experiences tied to the pandemic (T21: schools facing the pandemic crisis; T2.2: the pandemic: death, inner worlds, and thought resistance; T2.3: kids' stories involving physical distancing and emotional proximity). The group also came up with innovative educational initiatives that defied the lockdown (T2.4: fieldwork: the delivery of “packages of food for thought”; T2.5: the MdS group: identity and separation). Based on these findings, the MG most likely contributed to the emergence of MdS as a “resilient community,” capable of absorbing the shock of the pandemic and realizing a fast recovery response.

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 UK-wide survey of Balint, support groups and psychotherapy training opportunities for SAS (Specialty Doctors and Associate Specialists) Psychiatrists

AimsTo investigate SAS Psychiatrists’ opportunities for Balint-type, support groups and psychotherapy training opportunities nationwide, for which there is a lack of existing literature or established framework.MethodAn online questionnaire was sent to UK-wide SAS psychiatry doctors with the support of the RCPsych Speciality Doctors and Associate Specialist Psychiatrists Committee (SASC). The survey enquired about location, work experience, future plans, Balint-type groups, psychotherapy opportunities and support.Result122 doctors completed the questionnaire, estimated to constitute approximately 8% of SAS psychiatry posts (or more if considering all vacancies), based on the RCPsych Census (2015), from across all UK nations.Time spent in an SAS role varied widely between months (10%) to over 20 years (5%), with the median and mode being 8–12 years (25%). Regarding future career plans 61% responded that they would be considering either the Certificate of Eligibility for Specialist Registration (CESR) route, or applying for future training or both.24% reported being part of a Balint-type group whilst almost double this number (47%) said they would be interested to join but none were available. 31% were part of a reflective practice or support group whilst 44% reported that they were interested in joining but none were available. Only 7% said that they were not participating or not interested in either a Balint group or a reflective group. Free-response comments suggested these opportunities were usually reserved for trainees and service commitments prevented attendance.76% of respondents reported access to an SAS Tutor, but only 21% confirmed access to a psychotherapy tutor.Half of respondents indicated they did not have access to information and guidance they needed regarding accessing psychotherapy opportunities, with only 27% thinking they did.24% reported managing to gain experience in at least one psychotherapeutic modality, 44% of whom received medical psychotherapist supervision; whilst 13% said they did not intend to pursue this.ConclusionThe results highlight that interest in joining Balint and reflective support groups significantly exceeds local provision. As these groups are not mandatory requirements for CESR application, the interest expressed (including amongst those reporting to be SAS by choice) suggests that SAS Psychiatrists value these opportunities for their recognised professional developmental and clinical benefits; these include peer support, understanding doctor-patient interactions and having a space to reflect on the emotional impact of clinical work. Trusts should consider supporting SAS doctors wishing to join new or existing Balint-type or other supportive reflective clinician groups.