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Balint Group Sessions for Medical Students: A Pilot Study
- Victoria Cowell, Chukwunwike Ayalogu, Annette Ros, Harvey Brown, Bayode Shittu, Anusha Akella, Adeolu Lasisi, James Bancroft, Holly Whitcroft, Indu Surendran, Christopher Bu, Abby Older, Eleanor Gaynor, Kathia Sullivan
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S16-S17
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Aims
The issue of health and well-being amongst the National Health Service (NHS) workforce has never been so prominent. Balint groups are facilitated discussion sessions aiming to help clinicians reach a better understanding of the emotional content of the doctor-patient relationship. Evidence suggests participation decreases rates of burnout and increases empathic ability. A Balint group pilot scheme for medical students was launched within Cheshire and Wirral Partnership NHS Foundation Trust (CWP), facilitated by both core and higher trainees in psychiatry, and supervised by a consultant psychotherapist. Feedback from both participants and facilitators was collected to gain a greater understanding of how these groups can shape our clinical interactions, and benefit the mental well-being of both patient and doctor.
MethodsWe approached the University of Liverpool School of Medicine, who did not have a formal Balint programme, and proposed a pilot scheme with 4th year medical students rotating through psychiatry in CWP.
Sessions were conducted in four week blocks, during a student's psychiatry rotation, and were facilitated by two psychiatry trainees. At the end of each block, anonymised feedback was collected, and small alterations were made to the programme during the course of the pilot in response to attendance rates, punctuality and feedback.
Results143 students participated in the programme in the first 11 cohorts, between September 2021 and December 2022, and 72 (50.3%) submitted feedback forms.
98.6% agreed that the programme helped them reflect more on their interactions with patients, and that it helped them gain insight into how others think and feel when caring for patients.
91.7% enjoyed the groups and 97.3% would use the skills learnt in Balint group in the future.
100% of students gave a positive response when rating their overall experience of the programme.
Facilitators reported increased confidence in their psychotherapeutic knowledge, and an improvement in leadership and communication skills.
ConclusionThe student experience of the Balint programme was positive for the vast majority, and from a facilitator perspective, we have found involvement to be very rewarding.
Psychiatry trainee group facilitation was well received by students, allowed a greater number of groups to run, and is beneficial for trainees’ professional development.
Before this pilot, approximately only 1/3 of University of Liverpool medical students had the opportunity to attend a Balint group.
However, our findings have contributed to a decision by the University of Liverpool to extend the scheme to all 4th year students on psychiatry placement from August 2023.
Case Study on an Ethical Dilemma
- Anusha Akella, Kyaw Moe
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S117-S118
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Mr AB is a 58-year-old male with diagnosis of Schizoid Personality disorder. An articulate and intelligent man, AB derived happiness and contentment from his work. Due to workplace conflicts, he was asked to resign several years ago and has not worked since. Mr AB then found a sense of purpose in life by looking after his elderly parents. His parents sadly died a few years ago and since then he has been living on his own. He has never married. AB has one brother who helps him with shopping and groceries. Prior to this admission, AB was admitted once a few years ago when he was diagnosed with Depressive Disorder.
MethodsMr AB was admitted last year with profound self-neglect. He was detained under Section 2MHA as he wasn't eating and drinking and wasn't engaging with services. With the initial diagnosis being Recurrent Depressive Disorder, AB was commenced on treatment for the same and eventually received ECT, for which he had strongly opposed. Following 6 sessions of ECT, AB bargained with the team that he would start eating and drinking if ECT was stopped and did so as well. He then requested a transfer to a different ward and consultant, with whom he shared that he doesn't agree with our diagnosis of depression or Schizoid personality disorder. AB expressed that he doesn't find his life worth living and wants to be left alone. He strongly believed that his liberty to take decisions about his life is being unfairly taken away by the NHS and accused professionals of trying to protect themselves. No evidence of SMI found at this stage. Following several discussions, AB was discharged home. He however was readmitted within a couple of days’ time by his brother following disengagement, self-neglect and again, no evidence of SMI.
ResultsA capacitous patient, in the absence of Serious Mental Illness puts forth an argument that purely because his way of living and his opinions on life and death differ from that of the society, doesn't mean that his rights over his life can be taken away from him. He, however, struggles to acknowledge that as fellow humans we are strongly inclined to intervene and try to stop anyone from taking their own life.
ConclusionA Challenging case that raises several questions surrounding Medical Ethics. The team is now looking into guardianship to ensure welfare of the patient.