Psychodynamic approaches to teaching medical students about the doctor-patient relationship: Randomised controlled trial

Aims and method: To evaluate the effectiveness of two psychodynamic psychotherapy teaching methods, a student psychotherapy scheme (SPS) and participation in a Balint group, in teaching first-year clinical medical students about doctor-patient communication and the doctor-patient relationship. The 28 students, who were randomly allocated to three groups (SPS group, Balint group starting at baseline and Balint group starting at 3 months and acting as partial controls), were rated on a questionnaire testing their knowledge of emotional and psychodynamic aspects of the doctor-patient relationship administered at baseline, at 3 months and at 1 year. Results: At 3 months, students in the SPS and Balint groups scored higher than the partial control group, the difference approaching significance at the 5% level. At 1 year, participation in either teaching method led to significantly higher scores compared with baseline. Clinical implications: Psychodynamic psychotherapy teaching methods are effective in increasing students’ knowledge of the doctor-patient relationship and potentially also improving their communication skills

Balint Groups as a Driving Force of Ego Development

This paper gives an overview of one of the main components in the process of Balint groups. The paper is based on the authors\u27 research on the work of Balint groups and the study of literature which deals with the development of ego and the role of Balint groups in the development of participants’ ego. This field is of great interest to the Balint movement and education in medicine. The special place in the discussions on the Balint method is given to the issue of benefit and the nature of influence of the Balint groups on participants. The Balint movement is of special interest for Croatia since it was perhaps among the first in the world to introduce Balint seminars as an official part of education of family doctors. The Croatian Society of Balint Groups as early as in 1970\u27s became a part of the International Federation of Balint Groups. Professor Betlheim was Michael Balint\u27s friend and his followers introduced the method not only in medicine but also in other professions: social work, pedagogy, psychology, sociology etc. The Balint’s method is also very interesting and useful to stomatologists, orthopedists and physiotherapists. Croatian dentists joined the Balint Groups in 1983 and orthopaedists in 1987. These were the unique cases in the European context. The Balint groups are very efficient and necessary in the process of strenghtening ego and selfawarness of these professionals. The paper also discusses the increase of the doctor\u27s self-awareness and selfconsciousness during the process of training in the Balint Groups. The Balint Groups only insist on the doctor-patient relationship and do not interfere with the unconscious of the doctor’s preoccupations. The approach of Enid Balint strives to find harmony between the Balint’s approach and the psychoanalytic approach to the object of the research. According to her understanding, the development of the group atmosphere is similar to the one in the family. The authors reach a similar conclusion in their research

Balint groups: a doctor-student mutual investment company

Balint Groups were traditionally established as reflective groups by psychoanalyst Michael and Enid Balint for general practitioners to reflect on the doctor-patient relationship. Balint described components of this relationship between doctor and patient including the collusion of anonymity, the doctor as a drug and the mutual investment company. This paper discusses 2 case examples from the perspective of a junior doctor facilitating medical student Balint groups and from the junior doctor participating in a peer group. Comparisons between the doctor and student emotional expression, empathic ability and apparent preconceived ideas of the “doctor role” are discussed, with reflection on potential origins and contributing factors to such internalised views and responses. The author explores potential professional benefits of medical student Balint groups facilitated by junior doctors in influencing empathic response and internalised personas, as discussed through the eyes of Balint’s components of the interpersonal doctor-patient relationship

A Lacanian view on Balint group meetings : a qualitative analysis of two case presentations

Background: GPs'subjectivity is an intrinsic instrument in their daily work. By offering GPs a platform to present and discuss difficult interactions with patients, Balint group work be might provide them an opportunity to explore and articulate aspects of their subjectivity. In order to get a more profound understanding of what participation in a Balint group can offer, we focused on the process of change that can be observed during Balint group meetings. To that end, this study scrutinized two Balint group case discussions on a micro-level. Method: Two cases were selected from a larger data set of 68 audio-taped case discussions in four Balint groups. In order to shed light on the type of change that characterizes the presenter's narrative, we used Lacan's theoretical distinction between imaginary and symbolic modes of relating to the other. Results: In both case discussions, the GPs presenting the case initially appeared to be stuck in a fixed image of a situation, referred to as ` imaginary relating to the other.'Through a range of interactions with the group, the presenters were encouraged to explore different subject positions, which allowed them to broaden their initial image of the situation and to discover other issues at stake. This was referred to as a more symbolic way of relating to the other. Conclusion: This study throws light on the type of change Balint group participation allows for and on the way this might be achieved. We conclude that Balint group work is potentially beneficial to the participating GPs as well as to the relationship with their patients

Is Balint training associated with the reduced burnout among primary health care doctors?

The aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22- item version of the Maslach Burnout Inventory – Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis. Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors.Keywords: Doctor-patient relationship; Balint groups; burnout; primary health care; patientcentered; approac

Building a Literature Review: A Citation Analysis of Medical Educator’s Research Patterns in Balint Group Studies

OBJECTIVE: This study analyzes how medical educators search literature, using as an example Balint Groups. Balint Group theory is rooted in psychiatry/psychoanalysis. Drawing from literature on medical educator’s search skills, the authors hypothesize that they have not used a systematic approach in their pre-intervention reviews. Instead, it is expected that researchers use literature conveniently found and readily available. Using a citation analysis, this hypothesis will be explored. METHODS: Balint Groups began in England in 1950s as a means of teaching students and residents “patient-centered” communication skills. In the U.S., it was first adopted in Family Medicine, then later in different specialties. Due to its international and cross-discipline scope, it is hypothesized that searching for existing literature on Balint Groups can pose a challenge to medical educators. In this study, an exhaustive literature review on Balint Groups will be conducted using the MEDLINE, CINAHL, PsycINFO, EMBASE and ERIC databases. 334 citations were retrieved. A validated inclusion criteria (Robinson et. al., 2011) will be used to select papers from this cohort of results. The authors will then create a comprehensive list of citations used by the selected papers. The analysis will focus on identifying and examining citation patterns to explore factors such as origin of publication and level of evidence of the most highly cited references. RESULTS: In selecting citations, the authors excluded articles that were a) older than 2003, b) bibliographies only, c) opinion-based letters to the editor (with no citations), and d) meeting abstracts. 112 papers were selected. Citations from these papers were reviewed and Balint-specific citations were selected. The resulting list contained 314 citations, 283 from journal literature and 31 from books. References to primary Balint literature (e.g., books originally published by Michael & Enid Balint who defined Balint Group process) equaled just under 25% of the total citations. The top ten cited journal articles equaled 30% of the total citations. Of these top ten, five were published in the 2000’s, three in the 1990’s and two in the 1980’s. Psychiatry, primary care and doctor-patient relationships where the areas most widely studied using Balint Group practice. CONCLUSIONS: The authors conclude that the hypothesis is correct. Of the 334 total citations retrieved in the initial search, the cited output equals approximately 30% of the available research on Balint Groups. Of this, only 6% is from the top primary resources (Balint-authored books) and top ten cited papers

Balint groups and the significance of the relationship: doctors’ motivational development

!e doctor-patient relationship has assumed varied importance throughout history. However, a good relationship will always be essential to medical performance, both the human and technical aspects. Whereas these aspects are determined by di%erent factors, we examine Balint Groups in relation to knowledge, skills and especially to motivation. We conclude that Balint groups promote the development of emotional competence. We discuss self-determination theory and suggest that Balint work is a process of professional development that promotes the internalization of motivation to work inherent in the doctor-patient relationship

Balint Groups as a Driving Force of Ego Development

This paper gives an overview of one of the main components in the process of Balint groups. The paper is based on the authors\u27 research on the work of Balint groups and the study of literature which deals with the development of ego and the role of Balint groups in the development of participants’ ego. This field is of great interest to the Balint movement and education in medicine. The special place in the discussions on the Balint method is given to the issue of benefit and the nature of influence of the Balint groups on participants. The Balint movement is of special interest for Croatia since it was perhaps among the first in the world to introduce Balint seminars as an official part of education of family doctors. The Croatian Society of Balint Groups as early as in 1970\u27s became a part of the International Federation of Balint Groups. Professor Betlheim was Michael Balint\u27s friend and his followers introduced the method not only in medicine but also in other professions: social work, pedagogy, psychology, sociology etc. The Balint’s method is also very interesting and useful to stomatologists, orthopedists and physiotherapists. Croatian dentists joined the Balint Groups in 1983 and orthopaedists in 1987. These were the unique cases in the European context. The Balint groups are very efficient and necessary in the process of strenghtening ego and selfawarness of these professionals. The paper also discusses the increase of the doctor\u27s self-awareness and selfconsciousness during the process of training in the Balint Groups. The Balint Groups only insist on the doctor-patient relationship and do not interfere with the unconscious of the doctor’s preoccupations. The approach of Enid Balint strives to find harmony between the Balint’s approach and the psychoanalytic approach to the object of the research. According to her understanding, the development of the group atmosphere is similar to the one in the family. The authors reach a similar conclusion in their research

A Balint curriculum's effect on family medicine resident empathy and psychological skills

Balint groups are comprised of physicians who regularly gather to present and reflect on clinical cases with the goal of improving the physician-patient relationship by enhancing the physician's interpersonal and communication skills, patient care, and professionalism. The goal of this study was to assess the effect on empathy and psychological skills of a voluntary Balint curriculum in the University of Missouri Family Medicine Residency program since initiation in 2010

Compassion fatigue and burnout - the role of Balint groups

Copyright © 2005 Royal Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.General practitioners are often the ‘first port of call’ for patients with a range of mental health problems, many of whom have a history of trauma or loss. Exposure to emotionally difficult situations puts them at risk of burnout and compassion fatigue. Balint groups are groups of GPs, usually facilitated by a psychiatrist, who discuss the doctor-patient relationship and provide peer support. Participation in Balint groups, along with other professional and personal activities, has the potential to prevent compassion fatigue and burnout in participants.Jill Benson; Karen Magrait