Reflection and Connection Best practices of group reflective techniques for teaching relationship-centered skills STFM 41st Annual Spring Conference Baltimore, Maryland May 3, 2008

Participants Maria Devens, Ph.D., ABPP Mary Hall, M.D. Richard Addison, Ph.D. Laurel Milberg, Ph.D. Donald Nease, M.D. D. Todd Detar, D.O. Kristin Reihman, M.D. Katina Bonaparte, M.D. Michelle Plaster, MD.

Plan for Today -Introduction -Summary of RCC and two group reflective methods -Concurrent experiential sessions Balint Group Interactive Group Video Review   -Discussion and wrap-up

Physicians need knowledge and skills -Self-awareness and self-growth -Understanding the patient’s experience of health and illness -Developing and maintaining relationships with patients Health professions education and relationship-centered care: Report of Pew-Fetzer Task Force on Advancing Psychosocial Health Education (1994)

Strategies at Four Levels Introspection and Reflection Skills in Observation and Listening Interaction (experiential) Effective Practice Tresolini, C. and Pew-Fetzer Task Force, 1994

How Do Balint Groups and Group Video Reviews accomplish the Goals of Relationship–Centered Care?

Balint Group : The basics Typical size: 6-10 members 1-2 leaders Format: case presentation (memory) and discussion presentation clarifying questions group discussion All group discussion is confidential

Goals of Balint Groups The Presenter: The Group: Over time: To have a new helpful awareness, or insight about viewing and being with the patient The Group: To view the case from multiple perspectives especially (clinician, patient, relationship) Over time: To improve our ability to actively process and manage our relationship-centered care Analogy of the sphere and center of the sphere, how many rays can go through the center of the sphere,

Interactive Group Video Review Outcomes Improved interviewing skills Better clinical outcomes Decreased referrals and cost Increased patient satisfaction Gask, 1998

Facilitating Video Review Be sensitive to the vulnerability of presenter Anyone can pause recording at any time Reinforce positive behaviors Consider alternative responses Role model empathy and compassion for the patient & physician Foster long term development of positive and productive habits in our care of our patients

A Resident Experience Common factors Offer a chance to reflect on your ability to communicate—your level of “presence” in the encounter Emphasize the importance of a nonjudgmental learning environment (facilitator-learner and physician-patient parallel process)

A Resident Experience: Balint Group “The patient occupies your daily thoughts and until Balint you carry this burden of whether or not you did or said the right thing. Balint helps you not only release your own emotions but transfers the burden onto your colleagues to help you not to take so much of it on yourself. This helps you sleep at night.”

A Resident Experience: Videotape Review “I realized that I was watching ‘HOW’ I interacted with my patients…this allowed me to look from the outside in a very critical way. I tried not to think of myself on tape but as a physician on tape with her patient.” “Reality testing” – seeing difference between subjective recall of the encounter and actuality

Acknowledgements American Balint Society Frank Dornfest, M.D. John Freedy, M.D., Ph.D. Albert Lichtenstein, Ph.D.