Balint groups in undergraduate medical education: a systematic review

Reflective practice in psychiatric training: Balint groups during COVID-19

Reflective practice is increasingly being recognized as an important component of doctors' professional development. Balint group practice is centered on the doctor-patient relationship: what it means, how it may be used to benefit patients, and why it commonly fails owing to a lack of understanding between doctor and patient. The COVID-19 pandemic led to unprecedented disruption to postgraduate medical training programs, including the mandatory Balint groups for psychiatric trainees. This editorial reports on the experience of online Balint groups in the North West of Ireland during the COVID-19 pandemic, and furthermore provides guidance for online Balint group practice into the future.

'Things we are expected to just do and deal with': Using the medical humanities to encourage reflection on vulnerability and nurture clinical skills, collegiality, compassion, and self-care

The Vulnerability in Medicine (ViM) program was developed to provide protected time and psychologically safe spaces for third-year medical students to consider challenges in the doctor-patient relationship and the clinical workplace. A suite of discussion-prompts presented in a small-group learning environment provides a springboard for students to reflect on their development as clinicians, understand the personhood of their patients, explore the therapeutic relationship, and consider emotional responses and personal, cultural, and social assumptions that impact on care. The program supports students to recognise vulnerability in themselves, the patient, their tutors, and the wider clinical team, as they face the challenge of aligning the clinician they want to become with ideals of professionalism and the imperfect clinical workplace. This 6‑week program focuses on the vulnerability of patients, students, and doctors in a weekly tutorial interposed with clinical placements primarily in geriatric, rehabilitation, or palliative medicine. The tutorials draw from the medical humanities and use experiential, reflective, and narrative learning techniques. They are facilitated by generalist clinicians who model their own vulnerability, humanity, and reflective practice by sharing tutorial tasks equally with students. Students report feeling supported, and appreciate the opportunity to discuss ethical, psychosocial, and emotional aspects of medicine whilst reflecting on what medical practice means to them. Tutors experience a deeper appreciation of student journeys and their own vocations as clinicians and teachers. The sharing of vulnerability exposes the humanity of patients, students, and clinicians, and sustains our whole-person approach to the care of patients, students, and ourselves.

PsychStart: a novel mentoring scheme for supporting and valuing medical students interested in psychiatry

We describe the establishment and evaluation of a career-based mentoring scheme (PsychStart) for medical students interested in psychiatry. Medical students reported multiple benefits of mentoring, including enhanced personal and professional development, increased career and clinical knowledge, and broadened exposure to psychiatry. The mentoring scheme was also found to promote and sustain interest in the specialty. Further evaluation is required to determine the long-term effects of mentoring and how this may compare with other undergraduate enrichment activities. We conclude that mentoring in psychiatry could offer innovative solutions for improving recruitment and retention, and for supporting and valuing medical students who demonstrate an early interest in the specialty.

Teaching Style, Coping Strategies, Stress and Social Support: Associations to the Medical Students’ Perception of Learning during the SARS-CoV-2 Pandemic

This study assessed the learning perception of undergraduate medical students on three types of teaching (classical/online/hybrid), in relation to coping strategies, stress, and social support, in the context of the SARS-CoV-2 pandemic. Additionally, we explored gender differences and the perceived usefulness of teaching. 201 students (48 men, 153 women; mean age = 22.900, SD = 2.830) participated in the study. They answered a Multidimensional Scale of Perceived Social Support, a Brief Cope Scale, a Student-life Stress Inventory, a visual analog scale for usefulness, and a survey collecting their perceptions about learning across teaching types. Results point out a preference for classical teaching, followed by the hybrid and online formats. Online teaching was identified as more advantageous in terms of time management and seeking information. Denial and substance use were statistically associated with poor communication, bad time using, and impaired learning. Both stress and social support had ambivalent associations with learning perceptions. Gender differences were limited to behavioral disengagement and higher social support perceived by women. Although classical teaching was globally perceived as the most useful, online teaching was considered desirable by male urban respondents. These data may contribute to the strategic growth and refinement of web-based teaching methods in medical universities.

Why shouldn't we do that on placement if we're doing it in the real world? Differences between undergraduate and graduate identities in speech and language therapy

Healthcare graduates are often characterised as ill-prepared for workplace entry. Historically, research on health professional's work preparedness has focused on the quality of graduates' clinical knowledge, skills and problem-solving. This ignores the role of professional identity formation in determining readiness for clinical practice. Yet, professional identity defines graduate self-perception, how others perceive them and informs clinical behaviour. The scholarship of identity formation at the transition from undergraduate to graduate is characterised by individual (cognitive) rather than relational (sociocultural) perspectives. Yet there is growing recognition that identity formation is not just individually mediated, but is also constructed between individuals and social context. The aim of this study was to explore professional identity formation among undergraduates and graduates from one healthcare profession (speech and language therapy-SLT) using a sociocultural theoretical standpoint. A qualitative descriptive methodology was used. Final (4th) year SLT undergraduate students and graduate SLTs with less than 2 years' clinical experience participated in individual semi-structured interviews. Thematic analysis was used to describe patterns in the data, which were subsequently subjected to interpretation informed by the constructs of Figured Worlds. Data analysis revealed that undergraduate professional identity was characterised by dependency, self-centredness (as opposed to patient-centredness), and a naïve role concept. Graduate identity on the other hand included expectations of self-sufficiency, patient-centredness and a more nuanced perception of the professional role. Undergraduates have naïve, prototypical understandings of what it is to be a graduate practitioner. The nature of undergraduate clinical placement hinders meaningful identity development. This suggests that curriculums should facilitate undergraduates to act with meaningful autonomy and to be positioned in more patient-centred roles, e.g. involvement in the decision-making process for patients. Graduates may then feel more authentic as autonomous professionals in their early graduate posts. This leads to better graduate, patient and service outcomes.

Balint-style reflective practice groups in a year 4 undergraduate general practice attachment: experience of the first two years

BACKGROUND AND AIMS

Many undergraduate medical curricula include reflective practice sessions based on traditional Balint-groups. Those sessions can help students to acknowledge that experiencing 'negative' feelings in relation to patients is normal and may contain important information about the clinical encounter. They may also help to protect students from some of the emotional challenges of studying medicine. The Edinburgh University scheme provides all students in their first clinical year with two dedicated reflective practice sessions. Here we report on experience of the first two years.

METHODS

Students' attitudes to the sessions were ascertained using a questionnaire, and views of the group leaders were assessed using a questionnaire and through informal verbal and email discussions. Practical difficulties were recorded as they arose.

RESULTS

Students generally rated the sessions positively with regard to exploring relationships and self-reflection, and they found the sessions interesting and helpful. The sessions did not seem to affect career choice. The free-text comments suggested four positive themes and four areas for future modification.

CONCLUSION

We have succeeded in providing all undergraduate students with an opportunity to take part in a reflective practice. We have highlighted aspects which have been successful and suggested future improvements.