No abstract

This paper presents a study based on the participation of PGY2 and PGY3 family medicine residents in Balint seminars that occurred twice monthly for 24 months. Balint groups were cofacilitated by leader pairs experienced with the Balint method. Prior to residency graduation, 18 of 19 eligible resident physicians (94.5%) completed 30- to 60-min semistructured interviews conducted by a research assistant. Resident physicians were told that these individual interviews concerned "…how we teach communication in residency." The deidentified transcripts from these interviews formed the raw data that were coded for positive (n = 9) and negative (n = 3) valence themes by four faculty coders utilizing an iterative process based on grounded theory. The consensus positive themes included several elements that have previously been discussed in published literature concerning the nature of Balint groups (e.g., being the doctor that the patient needs, reflection, empathy, blind spots, bonding, venting, acceptance, perspective taking, and developing appreciation for individual experiences). The negative themes pointed to ways of possibly improving future Balint offerings in the residency setting ( repetitive, uneasiness, uncertain impact). These findings appear to have consistency with seminal writings of both Michael and Enid Balint regarding the complex nature of intrapsychic and interpersonal skills required to effectively manage troubling doctor-patient relationships. The implications of findings for medical education (curriculum) development as well as future research efforts are discussed.

Balint Group seminars were developed by Michael and Enid Balint based on the application of psychological principles in a group setting for the purpose of developing an improved understanding of the doctor-patient relationship. This article focuses on the development and application of the Balint method to the training of resident physicians (particularly Family Physicians) within the United States. An effort is made to describe the practicalities of resident physician Balint training (e.g., size, frequency, duration of such groups), conceptual underpinnings (e.g., biphasic nature of patient identification, disease versus illness concept, transference/counter-transference, over-identification, under-identification, biphasic nature of physician empathy), and pedagogic goals (mastering empathic skills inherent in being a good doctor) of residency-based Balint groups. In aggregate, this article provides a useful framework for behavioral science educators interested in applying the Balint seminar method to resident physician training. The authors encourage both the continued study and educational application of the Balint seminar method in the training of physicians both within and outside of the United States.

Medical non-adherence is multifactorial: cost, convenience, side effect profile, and cognitive impairment are all implicated in medical nonadherence. We explore impaired executive function (EF) as a cause for medical non-adherence when other causes can be ruled out. EF describes the coordination and manipulation of higher-order cognitive processes involved in problem-solving, planning, and decision-making. EF has three components: working memory, mental flexibility, and inhibitory control. The latter, inhibitory control, when impaired will affect an individual's ability to make choices to produce long-term benefits, in favor of short-term gratification. When applied to adults with chronic diseases, like diabetes, that require lifestyle modification and, at times, complicated medical regimens to forestall long term complications, an intact EF has a role in adherence. EF development is protracted with behavioral corollaries observable from early childhood. Thus, teachers, family physicians, and pediatricians will be the professionals to first encounter and manage such individuals. We suggest screening tests for children in the doctor's office to detect impaired EF, and postulate a cognitive behavioral therapeutic approach for adults with uncontrolled DM and impaired EF.

Videoconference Balint seminars offer a promising way to extend the activity to health care providers in other disciplines, states and countries. Moreover, this format has the potential to increase the number of trained Balint leaders.