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

2. 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.

3. 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

4. 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)

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

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

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

8. 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,

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

10. 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

11. 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)

12. 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.”

13. 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

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