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Objective:To explore the application of Balint group activities in the doctor-patient communication skills training for standardized residency training of internal medicine.Methods:The students from Batch 2018 and some from Batch 2019 participating in the standardized residency training in Renmin Hospital of Wuhan University were selected as the research subjects. SPSS 22.0 was used to perform paired t test for comparison before and after training, and the SEGUE scale was used to evaluate the doctor-patient communication ability of the physicians before and after the training of the Balint group. A questionnaire survey was performed to collect their understanding of doctor-patient communication status and evaluate the training activities. Results:All the residents recognized the importance of doctor-patient communication and clarified the main reasons for the communication of doctors and patients. After receiving the training of doctor-patient communication focusing on group activities, the total score of SEGUE scale increased from (15.40±5.65) to (19.84±1.92), and the residents significantly improved their ability in such five dimensions as stopping inquiry, understanding patients, passing information, collecting information and ready to start ( P<0.001), with a satisfaction rate of 92.00% (69/75) for training methods and contents. Conclusion:The doctor-patient communication ability of the residents needs to be further improved. Balint group activities have enriched the form of doctor-patient communication training, which is helpful for doctors to strengthen their professional confidence and build a harmonious doctor-patient relationship.
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RESUMO A síndrome de burnout (esgotamento) atinge mais de 70% dos médicos residentes em todo o mundo. Apesar dos dados alarmantes, ainda podemos caracterizá-la como uma doença negligenciada. Alguns trabalhos descrevem estratégias de enfrentamento do problema, porém poucos serviços as adotam na prática. Objetivo Determinar a prevalência da síndrome entre residentes de Pediatria de um hospital terciário brasileiro e descrever a estratégia de grupo psicodinâmico implementada localmente com base nos resultados. Metodologia Estudo de prevalência transversal com aplicação da escala Maslach Burnout Inventory aos residentes, seguida de planejamento e execução de um projeto piloto de intervenção, de grupo, na perspectiva Balint. Resultados De 23 residentes de primeiro e segundo ano de Pediatria em dezembro de 2016, 95% eram do sexo feminino, a média de idade era de 27 anos, e a média da carga horária trabalhada era de 75 horas semanais, sendo que apenas três residentes se dedicavam exclusivamente à residência médica. Encontramos uma prevalência de 87% de residentes que apresentavam critérios para síndrome de burnout, sendo 74% com exaustão, 57% com baixa realização profissional e 39% despersonalizados. O grupo de intervenção ocorreu entre maio e dezembro de 2017 com outros seis residentes de primeiro ano que atendiam no Ambulatório Geral de Pediatria às sextas-feiras. A periodicidade foi de uma hora a cada 15 dias. A participação foi voluntária, e os encontros aconteciam segundo o conceito de "espaço protegido". As discussões eram baseadas em casos clínicos e abordavam também a relação médico-família e as dinâmicas hospitalares. Conclusão A elevada prevalência da síndrome de burnout deste trabalho não foi uma novidade frente aos dados da literatura nacional e internacional. Estabelecemos, porém, uma discussão local que resultou numa estratégia que visa ao bem-estar dos residentes e proporciona oportunidade de aprendizado do reconhecimento das reações pessoais, dos pacientes e de toda a equipe de saúde. Entendemos que os benefícios se dão, finalmente, na qualidade da assistência oferecida aos pacientes.
ABSTRACT Burnout syndrome affects more than 70% of resident physicians worldwide. Despite his alarming statistic, it can still be characterized as a neglected disease. Some studies have described coping strategies, but few services adopt them in practice. The aims of this study were to determine the prevalence of Burnout syndrome among pediatric residents of a Brazilian tertiary hospital, and to describe a psychodynamic group strategy that was implemented locally, based on the results. Methodology a cross-sectional prevalence study using the Maslach Burnout Inventory scale, followed by the planning and execution of a pilot intervention group, from the Balint perspective. Results of 23 first and second year pediatric residents in December 2016, 95% were female; the mean age was 27 years, and the average workload was 75 hours per week. Only 3 residents were exclusively dedicated to the medical residency. The prevalence of burnout syndrome was 87%, with exhaustion in 74%, low professional achievement in 57%, and depersonalization in 39%. The intervention group took place between May and December 2017, with six other first-year residents attending the General Pediatric Outpatient Clinic on Fridays. Meetings of the group took place every 15 days, lasted one hour, and adhered to the concept of "protected space". Participation in the meetings was voluntary. The discussions were based on clinical cases, also addressing the doctor-family relationship and the hospital dynamics. Conclusion The high prevalence of burnout syndrome found in this study was comparable to data from national and international literature. However, our study established a local discussion that resulted in a strategy aimed at the well-being of residents and provided an opportunity to learn to recognize personal reactions, as well as those of patients and the whole healthcare team. We also hope this study will bring benefits for the quality of care provided to patients.
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Objective To examine the effects of participating in Balint group ( PBG) for reducing occupational burnout among primary care physicians (PCPs). Methods In this randomized controlled trial, 240 PCPs were randomly assigned to PBG (n=70) and control group (n=240) in propotion of 1 ∶ 2. Sub-jects of PBG received Balint group intervention for one year,while control group received natural observation. Maslach Burnout Inventory ( MBI) was used to assess the severity of occupational burnout. Results At baseline all three subscales of MBI had no significant difference between PBG and cotrol group(P>0. 05). After the intervention,PBG had statistically lower subscale scores in emotional exhaustion ((20. 1±8. 3) vs (22. 6±8. 7),t=1. 993,P=0. 048) and depersonalization (( 6. 8± 4. 9) vs ( 10. 8 ± 5. 2),t=5. 355,P<0. 001) than the control group, while had statistically higher score in personal accomplishment subscale ((38. 3±7. 5) vs (34. 6±7. 7),t=3. 311,P=0. 001) than the control group. Conclusions PBG is effective in reducing occupational burnout among PCPs.
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Objectives Toexplorethe effect of the Balint group on improving the empathy and doctorpatient communication skills among medical students in clinical practice.Methods We investigated 500 clinicalmedicalstudentsin fourth grade by JSE-HP and SEGUE framework scalein Shanghai Jiao Tong university school of medicine between July 2016 and December 2016.60 students with insufficientempathy and doctor-patient communication skills were selected randomly.These students were thanrandomly divided into the Balint group (experimental group) and the routine clinical practice group(control group).The experimental group participated inthe Balint group activitiesin addition to routine clinical practice,whilethe control group only participated in routine clinical practice.After 20 weeks of the Balintgroup intervention,the two groups were invited to assess theempathy and doctor-patient communication skills again to analyze the effect of the Balintgroup on improving the empathy and doctor-patient communication ability among intern students.The evaluation result was analyzed by SPSS 22.0 software.Data comparison was conducted using pair t test,independent sample t test and x2 testing.Results There were no statistically significant differences in age,sex,whether only child or class leader and previous year theoretical exam scoresbetween the two groups (all P＞0.05).For empathy,there was no statistically significant difference in terms of opinion,emotional care,empathy,and total scorebefore the routine clinical practicebetween the two groups (P＞0.05) and they all improvedsignificantly after the routine clinical practice (all P＜0.05).But the experimental group had higher scoresin all above scalesthan the control group (all P＜0.05).For communication skills with patients,there were no statistically significant differencesbetween the two groupsin communication initiation,information collection,understanding of patients,information giving,end questioning,and SEGUE scoresbefore the routine clinical practice (all P＞0.05),and they allimprovedsignificantly in all above 5 scales after the routine clinical practice (all P＜0.05).While except for understanding of patients,the experimental group had higher gains in other scales than the control group (all P＜0.05).Conclusion Use of the Barring group activities on the basis of routine clinical practice canimprove the empathy andthedoctor-patientcommunication skills in medical students.
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Objective@#To explore the effectiveness of Balint group on compassion fatigue among oncology nurses.@*Methods@#From January to December 2016, 35 oncology nurses from one general hospital were enrolled. 18 cases were allocated in the observation group and 17 cases in the control group by computer randomization. Nurses in the observation group were received a total of 8 times Balint Group activities, with 2 times a month and 1.5 hours each time, which is aiming to discuss difficult cases encountered in the clinic to help nurses have a deeper experience and a better understanding of the emotions and behaviors, fantasies and needs between nurse-patient interaction. Nurses in the control group without intervention. All the Participants were requested to complete the survey of the Professional Quality of Life (ProQOL) , the Jefferson Scale of Empathy-Health Professionals (JSE-HP) , and the General Health Questionnaire (GHQ) at pre and post intervention.@*Results@#Before intervention, two group of nurses in age, working years, marriage, and education were not statistically significant (P>0.05). There was no difference in the scores of empathy, compassion satisfaction, secondary traumatic stress, and General health (P>0.05). After intervention, the scores of JSE-HP and its three dimensions of perspective taking, emotional care, and trans-positional consideration in the observation group had significantly higher than the control group (P<0.05). The level of compassion satisfaction in the observation group was higher, and the general health status was lower (P<0.05). There was no statistically difference in the level of burnout and secondary traumatic stress between two groups (P>0.05) .@*Conclusion@#Balint group has a positive role in promoting nurses’empathetic skills, compassion satisfaction and mental health.
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Objective To explore the effect of Balint group training on the humanistic caring ability of junior nurses. Methods About 96 junior nurses from the department of oncology were randomly assigned to an intervention group and a control group equally.Balint group training was given to the intervention group every 2 weeks in a year.The control group completed the humanistic care training according to the regular procedure in the department of the hospital.At the beginning of the study and at the end of the study,the nursing staff from the two groups and the patients under their continuous nursing care for more than 3 days were surveyed by the care efficiency scale,nursing care behavior scale and patient care perception questionnaire.Results Before the intervention,there was no significant difference between the groups in the care performance and behavior of nursing staff and the patients'care perception (P>0.05).After the intervention there was significant difference in the care performance and behavior of nursing staff and the patients' care perception (P<0.05). Conclusions Balint group training can improve the caring performance of junior nurses.Their ability to express care and establish the caring nurse-patient relationship can be improved by this group training.They become more voluntary to integrate caring behavior into the daily care and their caring behaviors can be more likely to be felt and recognize by the patients.
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Objective To analyze the negative experience from medical practice of medical students by Balint group case study,and to explore new approach for training doctor-patient communication skills.Methods 10 times of Balint group activities were held in Zhongshan Hospital of Fudan University,with one case each time.Grounded theory approach were applied for analyzing discussion record.Results The cases were occurred in doctor-patient interaction,teamwork,conflict between one's personal life and vocational development planning.Trigger events involved doctor-patient conflict,conflict of values,decision making problem while conffronted with incurable patients,role ambiguity,unfair treatment.Topics of discussion included emotional experience with patients,career development orientation,medical teamwork,clinical education of medical student.Conclusion Through practice of Balint group,medical students in teaching hospital can improve their awareness of complicating psycho-social problem of patients and themselves,as well as handling it.And it can improve the professional identity,professional growth and professional self-identity.
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El objetivo de este artículo es mostrar cómo la técnica de grupo Balint es fundamental para la formación psicoterapéutica y psicoanalítica. Se basa en la revisión de aquellas experiencias emocionales que pueden interferir en la relación entre el terapeuta y el paciente, a través del análisis de casos clínicos presentados al grupo.En un contexto que debiera estimular la contratransferencia y su libre manifestación, se examinan particularmente los aspectos inconscientes que fomentan los automatismos. Estos evitan que el terapeuta pueda reconocer los signos transferenciales y contratransferenciales y se sienta coherente con sus propios sentimientos, con el fin de hacer un uso minucioso de ellos en la terapia, de manera que pueda optimizar sus propiedades terapéuticas.El artículo también resume el desarrollo de los grupos Balint, enfocándose en aquellos que son los rasgos del líder y del grupo. Se describen al menos tres ejemplos diferentes de grupos.
The articles aim is to show how the Balint group technique is fundamental for the psychotherapeutic and psychoanalytic training. It is based on the revision of those emotional experiences that may interfere with the relationship between the therapist and the patient, through the analysis of clinical cases presented to the group.In a context that should stimulate the countertransference and its free manifestation, the unconscious aspects that encourage the automatisms are particularly examined. These avoid the therapist to recognize the transfers and countertransferences signs and to feel coherent with his own feelings, in order to be able to make use of them minutely in therapy, so that he can optimize their therapeutic properties.The article also sums up the Balint groups development, focusing on those which are supposed to be the leaders and the groups features. At least, three different examples of groups are described.