The effectiveness of Balint group work on the quality of work life, resilience, and nurse-patient communication skills among psychiatric nurses: a randomized controlled trial

Background

Balint group training has gained popularity in medical practices as an intervention designed to enhance the quality of life, well-being, and communication skills of healthcare practitioners. Psychiatric nurses, in particular, encounter distinct challenges and stressors inherent in their profession, necessitating the development and implementation of effective interventions to assist them in coping with the difficulties they experience. In this vein, the current study aimed to investigate the effectiveness of Balint group training on quality of work life, resilience, and nurse-patient communication skills among psychiatric nurses.

Methods

Thirty psychiatric nurses from Razi Hospital in Tehran were recruited via the purposeful sampling method in 2022 and were randomly assigned to either the Balint group, consisting of eight weekly one-hour training sessions, or a control group. Participants completed the Walton Quality of Work Life Questionnaire, Connor-Davidson Resilience Scale, and Communication Skills Scale before and after the intervention. The data were analyzed using the Analysis of Covariance (ANCOVA).

Results

The study found no significant differences between the Balint group and the control group in terms of quality of work life, resilience, and nurse-patient communication skills.

Conclusion

Findings suggest that Balint group training was not an effective intervention for improving the well-being and communication skills of psychiatric nurses. However, the study highlights the need for further investigation into the potential factors that may explain the lack of significant gains and offers insights for future research in this area.

Positive effect of Balint group on burnout and self-efficacy of head nurses in China: a randomized controlled trial

Background

Burnout is common among nurses and can lead to negative outcomes of medical care. This study aimed to explore the effectiveness of Balint groups to reduce burnout in head nurses in a Chinese hospital.

Methods

This was a randomized controlled trial with a pre- and post-test. A total of 80 head nurses were randomly assigned to either a Balint group (n = 40) or a control group (n = 40). Participants participated in Balint group for a period of 3 months. Participants in both groups completed the Maslach Burnout Inventory-Human Services Survey and the General Self-Efficacy Scale at the beginning and end of the study. Balint group members also completed the Group Climate Questionnaire-Short Form.

Results

In the Balint group, 33 participants attended all Balint groups, while the 40 participants in the control group had no intervention. Analysis of variance with repeated measures demonstrated a statistically significant difference on the Maslach Burnout Inventory subscale of sense of personal achievement (F = 9.598, p = 0.003) between the Balint and control groups. However, there were no significant differences between the groups on the subscales of emotional exhaustion (F = 0.110, p = 0.740) and depersonalization (F = 0.75, p = 0.387), and the General Self-Efficacy Scale (F = 0.709, p = 0.403).

Conclusions

Balint groups helped reduce burnout among head nurses in terms of personal achievement.

The Juice is Worth the Squeeze: Psychiatry Residents' Experience of Balint Group

INTRODUCTION

Balint Groups provide physicians with a forum to develop their capacity to empathically engage with patients, through exploring patient-provider relationships. The Dalhousie University Department of Psychiatry implemented a mandatory Balint Group as part of the junior resident curriculum. The purpose of this study is to explore how residents describe their experience of participating in this Balint Group.

METHODS

Psychiatry residents in their first year of training participated in a focus group to discuss their experiences of the Balint Group. Data was analyzed using content analysis.

RESULTS

Three main categories were identified: the purpose of, the process of, and participation in the Balint Group. Process was subdivided into Balint Frame and Institutional Factors. Participation was further subdivided into vulnerability, reflection, fellowship, and validation.

CONCLUSION

Residents attributed fellowship with their peers, self-efficacy and hope in their work to their participation in the Balint Group. While there was an adjustment period, residents grew to accept, and even appreciate the group. Lack of problem-solving became accepted as part of the purpose of the group and this acceptance was attributed to having other avenues within the program to address problems raised in the discussion. Feeling disconnected when the session ended was described and was related to the abrupt termination of the virtual session or having to exit the group early to return to clinical duties. While the virtual nature of the group was not explicitly identified as a challenge, having to leave early was. While these institutional factors can be mitigated through programmatic implementation, they are not a deal breaker to implementing a Balint Group in a residency training program. Even in a lunch hour or virtual environment our data suggests that the juice is worth the squeeze.

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.

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.

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 r_s = .430 to .697). The verification of the construct validity of the BGQ-C showed satisfying convergent (r_s = .465 to .574) and discriminant validity (r_s = -.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.

Personality traits are associated with cognitive empathy in medical students but not with its evolution and interventions to improve it

OBJECTIVE

Cognitive empathy might decrease during medical school. Factors associated with its evolution remain poorly understood, as well as whether such factors could moderate the effect of an intervention to preserve cognitive empathy. The aim was to explore the associations between personality traits and both cognitive empathy at baseline and its changes at follow-up. The possible effect of an intervention depended upon personality traits was also examined.

METHODS

The cohort consisted of fourth year medical students and the associations between personality traits, using the Short Big Five Inventory, and cognitive empathy changes at 3-month, using the Jefferson Scale of Empathy-Student version (JSE-S), were examined. A randomization in two groups (Balint groups versus no intervention) allowed examining whether the effect of the intervention depended upon personality traits. Linear regressions were adjusted for gender, anticipated specialty choice, parental education, living status, financial insecurity, randomization group and baseline JSE-S.

RESULTS

The cohort included 311 participants from October 2015 to December 2016 at Paris Diderot and Paris Descartes University. At follow-up, there was a JSE-S total score increase of 1.22(SD:9.10) in the intervention group, compared to a decrease of 1.64(SD:10.74) in the other group. Baseline JSE-S was positively associated with Extraversion and Conscientiousness and negatively with Neuroticism. In contrast, we found no associations between baseline personality traits and JSE-S change. There were no interactions between personality traits and randomization group.

CONCLUSION

Although personality might be linked with cognitive empathy, medical students may benefit from strategies designed for improving cognitive empathy regardless of their personality.

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.

[Intervention of Balint group on the emotional labor and job burnout of nurses in cardiology]

Objective: To explore the effect of Balint group on the emotional labor and job burnout of nurses in cardiology, to provide a reference for improving the mental health of nurses in cardiology. Methods: A total of 78 pediatric nurses were randomly divided into observation group and control group by the random number table, 39 observation group nurses were received general nursing training and the intervention of 8- week Balint group, 39 control group nurses were not received anything intervention. Before and after the intervention of 8 weeks, The Emotional Labor Scale(ELS) and Maslach Burnout Inventory(MBI) were used to evaluate the emotional labor and job burnout of nurses. Results: The age of the nurses in the observation group was(26.3±2.7) years old, with 13 undergraduates and 26 specialists; the age of the nurses in the control group was (25.8±2.1) years old, with 14 undergraduates and 25 specialists. After 8 weeks intervention, the surface action score of ELS of observation group was significantly lower than the control group, the deep action and emotional display requirement scores of ELS of observation group were significantly higher than the control group, the differences were statistically significant (P<0.05). The emotional exhaustion and depersonalization factor scores of MBI of observation group were significantly lower than the control group, the personal accomplishment factor score of MBI of observation group was significantly higher than the control group, the differences were statistically significant (P<0.05). Conclusion: The use of Balint group may have contributed to improving emotional lab and job burnout of nurses in cardiology in a large degree.

Developing institutional infrastructure for physician wellness: qualitative Insights from VA physicians

BACKGROUND

The prevalence and detrimental effect of physician burnout requires new strategies for supporting physicians. In this project, we describe the development, and assessment, of a "Balint-like" physician support group that provided social cohesion and delivered novel didactic curricula for building resilience.

METHODS

The project began with a nine-month facilitated peer-support group for physicians that met every other week. Based on input from the first group, tailored content was developed to address physician wellness needs. These curricula were delivered to participants in the second nine-month Balint-like group. We then conducted semi-structured interviews with 7 hospitalists and 2 outpatient primary care physicians who participated in the Balint-like groups to explore the intervention's value and to identify remaining unmet physician wellness needs. Using an inductive thematic analysis approach, we identified a set of institutional-, community- and individual-level factors affecting physician wellness and corresponding intervention opportunities.

RESULTS

Physicians spoke of systems-level factors that contributed to distress, and proposed infrastructure, both physical and procedural, that they felt could better support physician wellness. They highlighted the emotional challenges of daily work, and the need for a forum by which to process these interactions in order to maintain their own wellness. Participants reported that participation in Balint-like groups provided this forum and served to help the physicians normalize struggles, reduce isolation and provide new strategies for navigating challenging interactions.

CONCLUSIONS

Institutional infrastructure, in the form of regular, psychologically-safe forums for processing with peers and learning relational strategies for preserving wellness, may mitigate physician distress. This project provides a model for how to develop and deliver a low-cost physician wellness program that can be tailored to the needs of individual clinical units.

Effect of group leaders on doctors' learning in Balint groups

OBJECTIVE

Although effective Balint leadership is viewed as essential for good Balint practice, nearly no quantitative research is available regarding the importance of the person of the group leader in Balint group outcome. This study aims to identify Balint group leaders' impact on "typical Balint" learning processes in Balint groups.

METHOD

A total of 1460 medical doctors in 352 Balint groups in Germany, Austria, and Switzerland were investigated. Based on the three learning dimensions of the Balint Group Session Questionnaire, statistical analyses were conducted to identify differential effectiveness in Balint leadership.

RESULTS

On the basis of the mean scores of the Balint Group Session Questionnaire items across all group participants of each group leader, the 80 certified Balint group leaders were clustered into two groups of more and less effective leaders by a hierarchichal cluster analysis. Mixed model analyses revealed that the effectiveness of the person of the Balint group leader was the most predictive factor for learning effects.

CONCLUSIONS

Training for Balint group leaders should take into account that effective learning processes in Balint groups are strongly related not only to the method itself but also to the person of the group leader.

A Randomized Controlled Trial of Balint Groups to Prevent Burnout Among Residents in China

INTRODUCTION

Burnout is highly prevalent among residents and is associated with negative outcomes for patients, organizations, and physicians. Balint groups have been shown to be an effective strategy to alleviate physicians' burnout. The purpose of this study was to examine the effectiveness and feasibility of Balint groups in preventing burnout among residents in training programs in China.

METHODS

36 resident physicians in their first year of residency at a comprehensive hospital in China were randomly assigned to two groups. Physicians in the intervention group participated in 2 lectures and 10 Balint sessions for 6 months, while participants in the control group were placed on a waitlist for future Balint sessions. All 36 participants completed burnout and job satisfaction measures pre and post-intervention.

RESULTS

The mean burnout subscale scores for EE and DP decreased, and the scores for PA and job satisfaction increased after Balint group participation. However, paired t-test results revealed there were no statistically significant differences between pre and post-test scores for EE (t = -1.323, p = 0.203), DP (t = -0.727, p = 0.477), PA (t = 0.716, p = 0.484, and job satisfaction (t = 0.282, p = 0.781) for the intervention group. For the control group, the burnout subscale scores for EE (t = 2.312, p = 0.034) and DP (t = 2.898, p = 0.019) increased, and there were statistically significant differences between pre and post-test. PA (t = -0.717, p = 0.483) and job satisfaction (t = -0.241, p = 0.812) scores decreased although there were no significant differences seen between the pre and post-test. Independent t-test results demonstrated statistically significant differences in scores for EE (t = -2.662, p = 0.013) and DP (t = -2.433, p = 0.020) between intervention and control group. However, there were not statistically significant differences between groups for scores in PA (t = 1.013, p = 0.318) and job satisfaction (t = 0.367, p = 0.716). All 18 participants in the intervention group reported that Balint groups were helpful and that they would be willing to attend future sessions. Overall satisfaction with the Balint group program was over 80%.

CONCLUSION

Balint groups are an efficacious, feasible, standardized method of preventing resident burnout. Residents in China may benefit from Balint group implementation in residency training programs.

The Balint group and its application in medical education: A systematic review

INTRODUCTION

The Balint group's seminars were developed by Michael and Enid Balint for the purpose of a better understanding of doctor-patient relationships. This study aimed to introduce the Balint group and its application to the medical science educational program and to provide an up-to-date perspective on Balint group research.

MATERIALS AND METHODS

The study was carried out as a systematic literature search published from January 2008 to September 2018 in the databases of PubMed, Scopus, Science Direct, and Proquest, which were searched with keywords such as the Balint group and medical education along with numerous related terms. Duplicates, non-English language articles were discarded from the review.

RESULTS

A total of nine papers entered the study. Among included articles, four used a qualitative methodology, four used a quantitative methodology, and one applied a mixed methodology. Four main aims emerged from the content of papers: (1) to evaluate resident and medical student experiences in Balint groups, (2) to improve communication skills and reduce burnout level, (3) to assess the Balint group's effects on empathy, and (4) to explore the contexts and triggers of cases presented in Balint groups.

CONCLUSION

Our results help us to the achievement of a better planning and design of an efficient Balint group in medical education. The findings enable the policymakers to make better decisions on the topic. Balint groups may guide medical students (residents) to become more patient centered by improving their communication skills and empathic abilities and reducing the level of burnout.

[Intervention study of compassion fatigue of oncology nurses in Balint group activities]

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.

Engaging indigenous Maori and inward migrating Asian professionals into a Pakeha (White European)-dominated Balint community in New Zealand

This inquiry began with two questions: How can the established predominately Pakeha/Caucasian (White European) Balint community in New Zealand more successfully engage both indigenous populations of both Maori and Pacifica origin into Balint work? And what is the existing Balint community doing to address the lack of Asian members of the Balint community in New Zealand, at a time when Asian health professionals are being recruited into the health sector at an increasingly high rate in comparison to White European entrants to the profession? These questions, and their preliminary answers presented here, invite the reader to reflect on both the challenges and opportunities in reaching out to groups different from our own. The author hopes readers may begin to see what can be done to allow new entrants to benefit from all that participation in Balint work offers while not losing sight of the uniqueness which each person can bring. It is hoped that sharing such questions and their subsequent explorations will help Balint leaders feel more confident in reaching out to a wider ethic and cultural mix within their local populations and encouraging them to enter the exciting world of the Balint group.

Demystifying Balint culture and its impact: An autoethnographic analysis

Balint groups are a structured group process designed for physicians and other helping professionals to provide feedback to each other concerning troublesome patient encounters. The process of Balint groups has survived and even thrived for more than a half century since their inception, suggesting their inherent value. However, measuring the impact in order to communicate the nature of that value has been elusive. A recent literature review highlighted the equivocal nature of research results and suggested that well-designed qualitative research may be more effective in selecting target measures which could result in better evidence for this group process. This paper describes such an effort using a qualitative analysis of the author's own reflections about significant moments and learnings while participating in Balint groups.

Balint group leadership: Conceptual foundations and a framework for leadership development?

This article is based on a talk given at the International Balint Federation leadership congress in Warsaw (September 2016). It explores the conceptual foundations of Balint group leadership and starts by emphasizing the mutuality between psychoanalysts and medical practitioners working together. The parallel process between consulting room and group, and subsequently from group back to the consulting room, is delineated as the central construct in understanding the role of the leader. Having proposed a conceptual model for thinking about leadership interventions, the article discusses developments in some contemporary approaches to leadership: coleadership, the use of role play, psychodrama, pushback, and morale. It concludes by introducing Keats' notion of negative capability as a way of thinking about creativity in Balint group leadership.

Reading Balint group work through Lacan's theory of the four discourses

In Balint groups, (para)medical professionals explore difficult interactions with patients by means of case presentations and discussions. As the process of Balint group work is not well understood, this article investigates Balint group meetings by making use of Lacan's theory of the four discourses. Five Balint group case presentations and their subsequent group discussion were studied, resulting in the observation of five crucial aspects of Balint group work. First, Balint group participants brought puzzlement to the group, which is indicative of the structural impossibility Lacan situates at the basis of all discourse (1). As for the group discussion, we emphasize 'hysterization' as a crucial process in Balint group work (2), the supporting role of the discourse of the analyst (3) and the centrality of discourse interactions (4). Finally, the potential transformation of the initial puzzlement is discussed (5). We conclude by putting forth the uniqueness of Balint group work as well as the potential usefulness of our analysis as a framework for Balint group leaders and professionals in charge of continuing medical education.

Research on Balint groups: A literature review

OBJECTIVE

As the scientific literature on Balint groups (BGs) is scattered, this paper provides an overview of the literature on BGs published in peer-reviewed journals. Study characteristics are analyzed and the principal research topics are discussed.

METHODS

'Web of Science' and 'Pubmed' databases were searched and all English-language studies on BGs (empirical and non-empirical) were included.

RESULTS

Of the 94 articles included, 35 are empirical studies adopting a qualitative, quantitative or mixed methodology. The research topics that emerged include outcome, characteristics of BG participants, themes addressed in BGs, BG processes, leadership and BG evaluations. The remaining articles were classified as historical articles, reports and reflective articles, for which the main discussion themes are presented.

CONCLUSION

Research on BGs proves to be diverse, scarce and often methodologically weak. However, indications of the value of BG work were found. Therefore, further research is strongly indicated.

PRACTICE IMPLICATIONS

Points of interest that could to be further considered by BG workers and researchers are for instance long-term BG participation and 'modified Balint groups'. Recommendations for future research on BGs are provided.

Reflecting on our practice: an evaluation of Balint groups for medical students in psychiatry

OBJECTIVE

This paper qualitatively evaluates a one-year trial of Balint clinical reflection groups for medical students in psychiatry at a large Australian tertiary referral hospital. The trial considered whether clinical reflection groups following the Balint process would be perceived as useful and relevant to the learning needs of the student participants.

METHOD

A grounded theory approach was undertaken. This included survey data, thematic analysis of written feedback, and facilitator reflection on the process. Facilitators adapted the group process in response to participants' needs. These modifications included: increased education regarding the Balint process; the introduction of co-presenters; and the inclusion of a didactic summary following each session.

RESULTS

The evaluation suggested that fidelity of the Balint group experience was achieved and that student attitudes were neutral to mildly positive regarding the educational experience.

CONCLUSIONS

Balint groups are potentially useful to medical students in the Australian context. We suggest that Balint groups may be more useful when applied in less alienating learning environments, such as during general practice rotations. Emphasis is placed on the need to maintain a dynamic approach by adapting the group and the educational processes as the work unfolds.