目的 探索巴林特小组对住院医师在规范化培训期间的情绪稳定及提升处理医患关系和沟通能力的作用，为将巴林特小组活动纳入住院医师规范化培训的日常管理，作为岗位胜任力中的重要课程提供依据。方法 2021年2月至12月，采用简单随机对照研究法，将苏州大学附属第一医院40名住培医师分为2组。其中20名进入"试验组"，参与封闭性巴林特小组活动;另外20名不参与巴林特小组活动，作为"对照组"。使用焦虑自评量表(generalized anxiety disorder-7，GAD-7)、抑郁自评量表(patient health questionnaire-9，PHQ-9)和医患沟通技能评价量表(set the stage，elicit information，give information，understand the patient's perspective，and end the encounter，SEGUE)，评估两组住培医师在参加巴林特小组第3个月、第6个月及第9个月时的情绪状态、医患关系处理及医患沟通能力。采用SPSS 22。0软件进行t检验，对3组及以上的组间比较采用方差分析;对于涉及2个因素的重复测量数据，采用重复测量方差分析。结果 在焦虑状态评估中，试验组住院医师在第6个月至第9个月评分逐渐下降，时间和组别的交互效应(F=14。57，P<0。001)差异均具有统计学意义。在抑郁状态评估中，时间和组别交互效应(F=33。25，P<0。001)差异有统计学意义，试验组住院医师的抑郁自评分逐渐下降，且两组差异逐渐增加。相较于对照组，试验组在信息收集、信息给予、理解患者3个维度有更加明显的提升，差异均具有统计学意义;且与自身基线比较，随访9个月后，试验组SEGUE量表总分有明显提升[(107。20±2。16)vs。(92。55±4。37)，t=7。26，P<0。001]。重复测量方差分析显示，评估时间和组别的交互作用下，两组住院医师在信息给予(F=3。01，P=0。045)和SEGUE量表总分(F=6。29，P=0。002)上差异均具有统计学意义。结论 参与巴林特小组有助于改善住培医师焦虑、抑郁情绪，在维持稳定情绪方面有重要作用。巴林特小组对住院医师提高医患沟通能力有重要帮助，尤其是在信息收集、信息反馈给予、理解病人等方面。
Practical exploration of Balint groups in improving emotion management and doctor-patient communication skills of residents
Objective To explore the effects of Balint Group on the emotional stability of residents during the standardized training and the improvement of doctor-patient relationship and communication ability,so as to provide a basis for incorporating the activities of Balint Group into the daily management of the standardized training of residents and as an important course in post competency.Methods From February to December 2021,a simple randomized controlled study was conducted at the First Affiliated Hospital of Suzhou University,40 residents were selected and assigned to two groups.Twenty residents were enrolled in the"experimental group"to participate in the closed Balint group activities;another 20 residents did not participate in the Balint group activities and were treated as the"control group".Tools of Generalized Anxiety Disorder-7,Patient Health Questionnaire-9,and Set the stage,Elicit information,Give information,Understand the patient's perspective,and End the encounter(SEGUE)were applied to evaluate the emotional state,doctor-patient relationship management,and doctor-patient communication skills of residents in the two groups in the third month,sixth month and ninth month of participating in the Balint group.SPSS 22.0 software was used for t test,and comparison among three or more groups was conducted by analysis of variance.Repeated measures data involving two factors were analyzed by repeated measures analysis of variance.Results In the assessment of anxiety state,the scores in the experimental group decreased gradually from the sixth month to the ninth month,and there was a significant difference in the interaction effect between time and group(F=14.57,P<0.001).In the assessment of depressive state,there was a significant difference in the interaction effect between time and group(F=33.25,P<0.001),and the depression self-score in the experimental group decreased gradually,with an gradually increased difference between the two groups.Compared with the control group,the experimental group had significantly improvements in three dimensions of information collection,information giving,and understanding of patients.The total SEGUE score in the experimental group was improved significantly after nine months of training compared with the baseline value[(107.20±2.16)vs.(92.55±4.37),t=7.26,P<0.001].The repeated measures analysis of variance showed that there were significant differences between the two groups in terms of information giving(F=3.01,P=0.045)and total SEGUE score(F=6.29,P=0.002)under the assessment of interaction between time and group.Conclusions Balint groups can alleviate residents'anxiety and depression and play an important role in maintaining stable mood.Balint groups have an advance effect on improving residents'doctor-patient communication skills,especially in information collection,information feedback and giving,and understanding of patients.
Balint groupEmotion managementDoctor-patient communicationSet the stage,Elicit information,Give information,Understand the patient's perspective,and End the encounter
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