Fleurant Marshall, Lasser Karen E, Quintiliani Lisa M, Liebschutz Jane
Assistant Professor of Medicine, Grady Section, Department of General Medicine and Geriatrics, Emory University School of Medicine.
Assistant Professor of Medicine, Grady Memorial Hospital.
MedEdPORTAL. 2017 Dec 21;13:10663. doi: 10.15766/mep_2374-8265.10663.
Inadequately supported clinicians risk burnout, which is prevalent among them. Balint-like groups can be utilized to address clinician stressors and augment interpersonal skills by exploring the clinician-patient relationship.
In January 2012, we initiated the Clinical Case Discussion Group (CCDG), based on Michael Balint's Balint group, at the Boston University School of Medicine Section of General Internal Medicine. The CCDG is an interprofessional group discussion founded on self-reflection of patient cases designed to tease out ethical, psychosocial, and medical issues that impact the clinician-patient relationship. The format consists of a facilitator-led small group session including 5-10 minutes of case discussion followed by open group discussion. In April 2014, we conducted a cross-sectional survey of clinicians who participated in the CCDG to evaluate the group's ability to foster skills in self-reflection, empathy, response to patient challenges, personal awareness, and tolerance of uncertainty, and to address clinicians' personal and professional stressors.
More than 75% of clinicians surveyed agreed that participation fostered skills in tolerating uncertainty, increasing empathy, and navigating difficult patient relationships. All respondents agreed the group developed skills in self-reflection. At least 40% of clinicians reported some degree of isolation, professional stress, and personal stress; group participation addressed these issues at least 70% of the time.
This self-reflection case discussion group, incorporated into academic clinical practice, supports the professional development of a broad cadre of clinicians and addresses both personal and professional stressors. Clinical departments should consider systematically implementing similar groups in practice.
缺乏足够支持的临床医生面临职业倦怠的风险，这种情况在他们当中很普遍。类巴林特小组可用于应对临床医生面临的压力源，并通过探索临床医生与患者的关系来增强人际交往能力。
2012年1月，我们在波士顿大学医学院普通内科部门发起了基于迈克尔·巴林特的巴林特小组的临床病例讨论小组（CCDG）。CCDG是一个跨专业小组讨论，基于对患者病例的自我反思，旨在梳理出影响临床医生与患者关系的伦理、心理社会和医学问题。其形式包括由主持人引导的小组会议，其中包括5 - 10分钟的病例讨论，随后是小组自由讨论。2014年4月，我们对参加CCDG的临床医生进行了一项横断面调查，以评估该小组培养自我反思、同理心、应对患者挑战、个人意识和容忍不确定性等技能的能力，以及解决临床医生个人和职业压力源的能力。
超过75%的接受调查的临床医生同意，参与该小组培养了容忍不确定性、增强同理心以及处理困难患者关系的技能。所有受访者都同意该小组培养了自我反思的技能。至少40%的临床医生报告存在一定程度的孤立感、职业压力和个人压力；小组参与至少在70%的时间里解决了这些问题。
这个纳入学术临床实践的自我反思病例讨论小组，支持了广大临床医生的专业发展，并解决了个人和职业压力源问题。临床科室应考虑在实践中系统地实施类似的小组。
