Mutiny on the balint: balancing resident developmental needs with the balint process.

BACKGROUND AND OBJECTIVES Many residency training programs offer Balint groups as a means of encouraging residents in reflective practice. Residency Balint groups around the country are variable with regard to format when compared to the recommended structure. This paper describes a resident Balint group in which the residents initially expressed strong dissatisfaction with the group, although they understood its purpose and expected format and were committed to the group process and goals. The seminar was modified to address their concerns, and the subsequent group process was studied to evaluate the effect of the changes. METHODS The subjects were 11 second-year residents in a 13-13-13 program in the northeastern United States. A needs assessment using a qualitative survey and focus group-style discussion was performed. The immersion-crystallization method was used at all stages. Field notes from subsequent sessions, combined with leader reflections, captured the group process. RESULTS The first sessions addressed requested professional development topics. The residents then spontaneously returned to a process more consistent with traditional Balint, although discussion of the patient perspective was infrequent. CONCLUSIONS Our experience suggests that modification of Balint group structure and process may be necessary with some groups of learners to pave the way for a more meaningful Balint experience over the course of training.