Consensus of Chinese experts on the work and demonstration of online Balint groups working committee on doctor-patient relationship, Chinese psychiatrist association, Chinese medical doctor association.

Balint group helps health professionals to get emotional support and different perspectives of feedback, inspire reflection, and alleviate job burnout. During the outbreak of COVID-19, it was difficult for medical staff to carry out the traditional form of in person Balint group. Referring to the work of international pilot online Balint group, leaders of Balint group all over China have accumulated some experience and encountered new problems by using the internet to carry out discussion. In order to assist and standardize the work of online Balint group and enrich the ways of expanding Balint work, the Working Committee on Doctor-patient Relationship, Chinese Psychiatrist Association, Chinese Medical Doctor Association organized experts to have two rounds of discussion, and developed the consensus on: Principles and forms of online Balint group, the way of using web platforms for demonstration and learning, matters needing attention, the future development, and so on.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Tele-Balint under the microscope: What really happens in Tele-Balint groups?

OBJECTIVE: Balint groups provide a safe space for clinicians to discuss difficult cases, with the aim of deepening the clinician-patient relationship and providing space for self-introspection and personal development. During this COVID-19 period, mental health clinicians need a platform to undergo professional supervision and peer learning sessions, which can be provided for by Tele-Balint sessions. This study aims to understand the workings of Balint groups in a multi-disciplinary team, through exploring the experience and perceptions of mental health clinicians in a tertiary obstetrics- and paediatrics-focused hospital in Singapore towards Tele-Balint groups, and examining if these groups can address their professional needs. METHOD: A mixed-methods study was conducted. 26 mental health clinicians who had participated in Tele-Balint groups since March 2020 completed a semi-structured questionnaire, and 12 of them were interviewed. Qualitative analysis of interview transcripts was performed. RESULTS: Qualitative analysis revealed 5 themes. The first 4: professional and personal growth of clinicians, providing emotional support to clinicians, burnout in clinicians: what contributes and what helps, and psychological safety, address whether Tele-Balint groups meet clinicians' needs. The last theme, evolution of nature of Balint groups, addresses whether Tele-Balint groups meet clinicians' needs during the time of a pandemic. CONCLUSIONS: Tele-Balint group participation was found to be beneficial in facilitating personal and professional growth, providing emotional support and preventing burnout, despite some limitations. Members should maintain flexibility towards the Balint process, in order to accommodate others who have differing needs, especially in a multi-disciplinary group.

Psychosocial aspects of current civilization challenges from the perspective of a Balint group leader

This study discusses psychosocial aspects of current civilizational changes from the perspective of Balint group leaders. This difficult period of transformation poses difficult challenges for health professionals who require a toolbox of supports, of which an important one is that provided by the Balint movement through its group activities. Leaders, who moderate meetings of health professionals must have an enhanced understanding of the psychosocial aspects of the turbulence within our civilization including those due to the health impact of COVID-19. The author anticipates that some theses may not be fully accepted, because of the relative novelty and complex nature of the material, but it is presented to stimulate critical discussion in the hope that it will facilitate the efforts of Balint group leaders.

Effect of Online Balint Group and Pharmacotherapy on COVID-19 Anxiety in Iranian Healthcare Workers: A Randomized Controlled Trial

Background: Anxiety persists following coronavirus disease 2019 (COVID-19) and has caused dysfunction. Objective(s): We compared the effect of the online Balint group and pharmacotherapy on COVID-19-induced anxiety in Iranian health-care workers (HCWs). Method(s): In the current clinical trial in the north of Iran in 2021, the participants were randomly assigned to two groups, including the Balint group (eight 60-minute online sessions) and the pharmacotherapy group (sertraline), following a phone screening pro-cedure by a psychiatrist. The groups filled out two questionnaires, namely the Connor-Davidson Resilience Scale and Corona Disease Anxiety Scale, at baseline and after the intervention (fourth week). Result(s): Forty-five HCWs were assessed. There was a significant difference in total anxiety score and also in sub-component in each group (P <= 0.001). No significant differences were observed regarding the effectiveness of both interventions in anxiety (P = 0.52);however, the pharmacotherapy interventions significantly affected the resilience and related subscales (P <= 0.05). The domain of spiritual influences significantly increased in the pharmacotherapy group (P = 0.031). Conclusion(s): Balint group and pharmacotherapy can improve COVID-19-induced anxiety and boost resilience in HCWs. Copyright © 2022, Author(s).

Reflective practice in psychiatric training: Balint groups during COVID-19.

Reflective practice is increasingly being recognized as an important component of doctors' professional development. Balint group practice is centered on the doctor-patient relationship: what it means, how it may be used to benefit patients, and why it commonly fails owing to a lack of understanding between doctor and patient. The COVID-19 pandemic led to unprecedented disruption to postgraduate medical training programs, including the mandatory Balint groups for psychiatric trainees. This editorial reports on the experience of online Balint groups in the North West of Ireland during the COVID-19 pandemic, and furthermore provides guidance for online Balint group practice into the future.

Virtual Balint Groups During COVID-19: Exploring Race and Equity in a CHC-Based Family Medicine Residency Program.

The Lawrence Family Medicine residency was created in the 1990s as the first community health center- sponsored residency with the goal of reducing health disparities. Balint groups have been a part of the wellbeing and behavioral health curriculum for many years. The population of Lawrence, MA is primarily a resource-poor, Latinx, immigrant population. In March of 2020, the Covid pandemic highlighted health disparities in this community. The spike in cases in 2020 also impacted the residency community with overwhelming needs of sick and dying patients in newly created, resident and faculty-run Covid units. Our early ignorance about transmission, prophylaxis, treatment and even prognosis made the work incredibly difficult. George Floyd's murder added the additional stress of social unrest in response to a persistent pattern of racism and unequal justice. To help process trauma residents felt working in terrifying conditions, often in medically futile situations with patients who spent their last hours without family at the bedside, we turned to biweekly Balint groups and added additional resident support sessions on the off weeks. Residents seamlessly adopted videoconferencing as the Balint platform, allowing them to attend a group session without risk of infection. The residents, being a diverse group, were able to offer multiple perspectives and process the traumatic issues of disproportionate suffering for their patients, uncertainty and frustration of the COVID-19 pandemic and systemic racism. We found a video Balint group permitted residents to explore their divergent experiences and feelings and offer support to each other in a very uncertain time.

Balint in the time of COVID-19: Participant and facilitator experience of virtual Balint groups compared with in-person.

BACKGROUND: Current literature highlights peer and psychological support as important for staff well-being, to cope in pandemic conditions. AIMS: Our organisation increased Balint group provision during unfamiliar challenges of COVID-19. This unique context allowed comparison of multiple new virtual and face-to-face (F2F) Balint experiences. METHOD: Following March 2020 lockdown, four existing Balint groups for doctors in psychiatry moved to online, with two new groups established virtually in specific response to the pandemic. All participants and facilitators of these virtual Balint groups were sent a questionnaire to anonymously rate their experience and provide qualitative feedback. RESULTS: The response rate was 89% for participants (51 respondents) and 100% for facilitators (5 respondents). Participants found both formats supportive; providing a space to talk, feel heard and validated, helping work feel less stressful. Participant ratings slightly favoured F2F, but some prefer to continue virtually. Facilitators felt virtual attendance was easier, but adherence to conventional Balint group structure and format more difficult. CONCLUSIONS: Participant and facilitator responses demonstrate Balint groups, when both F2F and virtual, were experienced as a source of support and connectivity, being valued across different psychiatry grades. Notable virtual benefits seem to be limited to more practical aspects, that is, time, flexibility, logistics and accessibility. There are expressed challenges of virtual Balint; however, some participants still favour this format going forward. Our findings endorse virtual Balint as a welcomed means of emotional well-being, peer support and developing psychotherapeutic competencies during pandemic-related restrictions, with potential to extend beyond COVID-19.

The medical treatment relationship and corona

What does the current COVID-19 pandemic teach us about the doctor-patient relationship? What terms and concepts are significant? Why is Balint work an ideal technique for exploring these multi-layered relationships in depth? The author explores these questions in her opening lecture of last year's 59th Sils Balint Study Week. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (German) Was lehrt uns die aktuelle Covid-19-Pandemie uber die Arzt- Patientenbeziehung? Welche Begriffe und Konzepte haben dabei eine Bedeutung? Warum ist Balintarbeit eine ideale Technik, diese vielschichtigen Verhaltnisse vertieft zu erforschen? Diesen Fragen geht die Autorin in ihrem Eroffnungsreferat der letztjahrigen 59. Silser Balint-Studienwoche nach. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Learning in peer teaching of patient relations and communication skills at the "Anamnesegruppen" Munich - proof-of-concept and lessons learned.

Background: Due to the ban on classroom teaching during the pandemic, the Munich "Anamnesegruppen" had to be switched to e-learning at short notice. There were no established concepts for this, which is why digitalization was piloted and evaluated for feasibility. Student "Anamnesegruppen": "Anamnesegruppen" have existed for over 50 years and are organized as independent student peer teaching. In small groups of medical and psychology students, interviews with patients are conducted once a week during the semester. This is followed by a feedback and discussion round, in which ethical and professional questions are discussed in addition to the patient's medical history. The goal is to train the participants' ability to communicate and reflect. Adaptation to digital methods: The anamnesis seminars have been moved to a virtual group room using video conference. Patients were mainly recruited from the participants' circle of acquaintances. The group size was set at eight people each in four groups and supervised by a pair of student tutors. Confidentiality and data protection declarations were obtained in writing. Results: By switching to digital anamnesis groups, all four groups were successfully completed. Both the final supervision of the tutors and the electronic evaluation of the participants yielded positive feedback. Compared to the two previous evaluations of the semesters in classroom sessions, there were no significant differences in the evaluation. Discussion: The continuously good evaluation results, which did not differ between the digital format and the classroom course of the previous semesters, show that an ad hoc conversion to digital teaching is possible. We want to stress the fact that elements reflecting the doctor-patient relationship were successfully preserved. For the similarly structured Balint groups, virtual sessions may also be considered. Further research, especially prospective, is desirable in order to better understand the possibilities of digital teaching in this area.

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.

Addressing Well-being, Burnout, and Professional Fulfillment in Child and Adolescent Psychiatry Trainees During the COVID-19 Pandemic Through Implementation of a Virtual Balint-Like Group: a Pilot Study.

OBJECTIVE: Physicians, including psychiatrists and psychiatry trainees, are at higher risk of burnout compared to the average working population. The COVID-19 pandemic heightens this risk. This pilot aims to enhance professional fulfillment and support while decreasing risk and prevalence of burnout in Child and Adolescent Psychiatry (CAP) trainees through virtual delivery of a Balint-like group incorporating brief emotional awareness modules. METHODS: Six CAP trainees participated. Eight 60-min sessions held every 2 weeks were co-facilitated by a psychologist and psychiatrist who developed the curricular content. Five of the eight semi-structured sessions combined a brief emotional awareness enhancing module with a Balint-based approach to case review. The authors assessed trainee well-being, professional fulfillment, and sense of professional support pre- and post-intervention with the Well-being Index (WBI), Stanford Professional Fulfillment Index (PFI), and the authors' own supplemental survey. Descriptive statistics were reported. RESULTS: Trainees found the curriculum feasible and useful. Surveys showed a reduction in burnout from three to zero participants (p = 0.03) and specific improvements in enthusiasm (p = 0.013), empathy with colleagues (p = 0.093), and connectedness with colleagues (p = 0.007) and patients (p = 0.042) at work. There were also improvements in happiness (p = 0.042) and valued contributions at work (p = 0.004). CONCLUSIONS: A novel well-being curriculum focused on combining brief emotional awareness enhancing modules with a Balint-like approach enhances professional fulfillment and a sense of professional support and decreases the risk and prevalence of burnout, even when delivered virtually to a group of CAP fellows. Results support the planned expansion of this low-cost, high-value intervention for trainee well-being.

The effect of a short-term Balint group on the communication ability and self-efficacy of pre-examination and triage nurses during COVID-19.

AIMS AND OBJECTIVES: To investigate the effect of a short-term Balint group on the improvement in communication ability and self-efficacy of pre-examination and triage nurses during coronavirus disease 2019 (COVID-19). BACKGROUND: Working on the front lines of COVID-19 has brought unprecedented psychological stress on pre-examination and triage nurses. Nurse-patient communication ability and the level of self-efficacy are both significant for nurses' psychosomatic health and work input. However, limited empirical evidence exists regarding nurse-patient communication and self-efficacy and specific psychological intervention effects. DESIGN: Cross-sectional research fulfilling the completed checklist of items that should be included in reports of cross-sectional studies (Appendix S1). METHODS: Nurses (n = 41) in the first layer of pre-examination and triage were engaged in a Balint group activity twice a week for two weeks. They were assessed with the General Self-Efficacy Scale (GSES) pre- and postintervention, and a nurse-patient communication survey form was developed for further postintervention evaluation. The sample was recruited from a class A third-grade hospital in Sichuan, China. RESULTS: Most of the subjects reported improvement in nurse-patient communication, increased cooperation between patients and their families, and a decreased missed examination rate after the intervention. Moreover, the total mean score of the GSES of nurses after the intervention was increased, but the difference was not statistically significant. The scores of all items in the GSES were improved, and the scores increase for item 4 (I am confident that I can effectively deal with any unexpected event) was statistically significant. CONCLUSIONS: During the COVID-19 pandemic, a short-term Balint group activity can improve the communication ability and self-efficacy level of front-line nurses to some extent. RELEVANCE TO CLINICAL PRACTICE: This information may provide some theoretical support for the development of early psychological interventions during major epidemic situations.

Who is really blind in the time of coronavirus: the patient or the doctor? A rare case of Balint's syndrome.

BACKGROUND: Selective bilateral lesions of the parietal-occipital lobes can lead to an uncommon and incompletely understood clinical entity, Balint' syndrome, which consists of simultanagnosia, oculomotor apraxia, optic ataxia and difficulty in perceiving distances between objects. CASE PRESENTATION: We herein report a rare presentation of Balint's syndrome in a 65-year-old woman suffering from stroke and SARS-CoV2 infection. CONCLUSION: During SARS-CoV2 pandemic, Italian physicians were forced to work with less instrumental diagnostic resources, relying on their clinical knowledge mostly. The aim of this case report is to highlight the importance of performing a precise neurological evaluation, particularly during these challenging times: it might avoid incorrect diagnosis and favour the discovery of rare clinical diseases.