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新冠疫情期间的虚拟巴林特小组:在以社区卫生中心为基础的家庭医学住院医师培训项目中探索种族和公平问题。

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

机构信息

Lawrence Family Medicine Residency, 187520Greater Lawrence Family Health Center, Lawrence, MA, USA.

出版信息

Int J Psychiatry Med. 2022 Nov;57(6):547-553. doi: 10.1177/00912174221122862. Epub 2022 Aug 21.

Abstract

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.

摘要

劳伦斯家庭医学住院医师培训计划始于 20 世纪 90 年代,是首个由社区健康中心主办的住院医师培训计划,旨在减少健康差距。巴林特小组多年来一直是健康和行为健康课程的一部分。马萨诸塞州劳伦斯市的人口主要是资源匮乏、拉丁裔、移民人口。2020 年 3 月,新冠疫情凸显了该社区的健康差距。2020 年病例的激增也对住院医师社区造成了影响,新设立的由住院医师和教师管理的新冠病房中挤满了患病和垂死的患者,他们的需求巨大。我们早期对传播、预防、治疗甚至预后的认识不足,使得这项工作异常困难。乔治·弗洛伊德的谋杀案增加了社会动荡的额外压力,这是对持续存在的种族主义和不平等司法的回应。为了帮助处理居民在可怕的环境中工作时感到的创伤,在经常处于医疗无效的情况下,患者在没有家人陪伴的情况下度过了最后几个小时,我们每周两次组织巴林特小组,并在非工作周增加额外的住院医师支持会议。住院医师无缝采用视频会议作为巴林特小组的平台,使他们能够在没有感染风险的情况下参加小组会议。这些住院医师是一个多元化的群体,能够提供多种观点,并处理患者遭受不成比例的痛苦、对新冠疫情和系统性种族主义的不确定性和沮丧等创伤性问题。我们发现,视频巴林特小组允许住院医师在非常不确定的时期探索他们不同的经历和感受,并相互提供支持。

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