Player Marty, Freedy John R, Diaz Vanessa, Brock Clive, Chessman Alexander, Thiedke Carolyn, Johnson Alan
1 Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA.
Int J Psychiatry Med. 2018 Jan-Mar;53(1-2):24-38. doi: 10.1177/0091217417745289. Epub 2017 Dec 13.
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.
本文介绍了一项基于PGY2和PGY3家庭医学住院医师参与巴林特研讨会的研究,该研讨会每月举行两次,为期24个月。巴林特小组由熟悉巴林特方法的领导者搭档共同主持。在住院医师毕业前,19名符合条件的住院医师中有18名(94.5%)完成了由一名研究助理进行的30至60分钟的半结构化访谈。住院医师被告知,这些个人访谈涉及“……我们在住院医师培训中如何教授沟通”。这些访谈的去识别化记录形成了原始数据,由四名教员编码员根据扎根理论采用迭代过程对积极(n = 9)和消极(n = 3)价态主题进行编码。一致的积极主题包括先前在关于巴林特小组性质的已发表文献中讨论过的几个要素(例如,成为患者需要的医生、反思、同理心、盲点、联系、发泄、接纳、换位思考以及对个人经历的欣赏)。消极主题指出了在住院医师培训环境中可能改进未来巴林特培训的方法(重复性、不安、影响不确定)。这些发现似乎与迈克尔和伊妮德·巴林特关于有效管理棘手医患关系所需的内心和人际技能的复杂性的开创性著作一致。讨论了研究结果对医学教育(课程)发展以及未来研究工作的启示。