Abstract
Health professionals are experiencing increased stress, isolation, and burnout that directly affect the quality and safety of patient care. To address these issues, one graduate health professions institution implemented Balint groups—structured reflective sessions focused on perspective-taking and the humanistic aspects of care. This article examines how Balint groups can be integrated into health professions education and employee wellness programs, including challenges and sustainability strategies. Outcomes included increased empathy, improved communication, reduced feelings of isolation, and renewed motivation, which help build resilience. Groups highlighted the importance of community formed through shared vulnerability and reflection facilitated by Balint—experiences often missing in fast-paced academic and clinical environments. By linking the well-being of health professional students, clinicians, and educators to patient experience, Balint groups can serve as an impactful approach to fostering a culture of reflection, compassion, and resiliency in the health professions. Establishing this culture early in students’ training creates a foundation for prioritizing the humanism of care alongside the technical skills needed for quality care delivery.
Introduction
Stress and burnout are significant issues in health professions education. Students begin training eager to care for patients, yet encounter intense cognitive demands, fragmented support systems, and emotionally charged experiences. 1 Research indicates that empathy declines during the classroom-to-practice transition, just when learners are expected to build trust with patients and colleagues in complex, often vulnerable situations. These pressures are compounded by external factors, such as food and housing insecurity, and feelings of isolation. 1 The outcome is a generation of students at risk of burnout before they even enter the workforce, directly impacting the quality of patient care. 2
Faculty and staff are also vulnerable to stress and burnout. Increasing workloads, administrative responsibilities, and the emotional toll of addressing student needs have created an environment where over 60% of educators express concerns about their own mental health.1,3 Left unaddressed, faculty burnout jeopardizes workforce retention and the quality of teaching offered to future clinicians.
Increased stress and burnout are not solely workforce issues. They directly affect patient safety, quality, and trust. Clinicians experiencing chronic stress are more likely to make errors, communicate poorly, and struggle to remain present with patients. 3 Creating a healthcare culture that cares well for patients requires intentional effort in education to foster an environment that promotes reflection on patient experiences and holds space for vulnerability. 4
Balint groups provide a practical, evidence-based approach to address these challenges. Originally created for physicians in post-World War II Britain, Balint groups are facilitated discussions that focus on the clinician–patient relationship. 5 Unlike problem-solving groups, Balint sessions invite participants to reflect specifically on the emotional and relational dimensions of a clinical encounter. A typical session follows a structured reflective process: a participant presents a case, the group asks clarifying questions, and members then reflect together on the perspectives and emotional dynamics involved while the presenter listens. Facilitators guide the discussion to ensure psychological safety and prevent advice-giving (see Figure 1). 6
The Balint Group Process.
In 2019, our institution piloted Balint groups for physician assistant (PA) students during clinical rotations. The initiative grew quickly, expanding to physical therapy (PT), occupational therapy, and genetic counseling, as well as interprofessional faculty and staff groups. Over 15 facilitators have now been trained through the American Balint Society (ABS), and Balint has become embedded in multiple interprofessional curricula. This article distills lessons from our experience for educators, leaders, and clinicians seeking to strengthen both workforce well-being and the patient experience.
Actionable Insights
Leadership Support Enables Sustainability and Patient Impact
Our Balint work was possible because administrative academic leaders recognized its alignment with institutional values. Senior champions, including program chairs and deans, secured protected time and supported facilitator training. This leadership support was essential in operationalizing Balint groups. It clarified the connection between supporting workforce resilience and improving patient care: leaders could appraise how reflective, empathetic clinicians are safer, more effective, and more trusted by patients.
Outcomes for Students, Faculty, and Staff Lead to Better Patient Relationships
Program evaluation data were collected from second-year PA (n = 15) and PT (n = 64) Balint group participants during their clinical education rotations through faculty-developed post-experience surveys and discussion board reflections. Program evaluation data from a 6-month pilot of Balint groups for faculty and staff (n = 12) from various health professions and departments were collected through post-experience focus groups. Surveys were created by Balint group leaders using existing Balint literature, including Likert scale agreement items and open-ended questions. As an Industry Insights article, these data reflect locally developed program evaluation and do not constitute a methodologically rigorous research protocol.
Balint participation promoted empathy, reflection, and resilience among students and faculty—qualities that directly influence patient experience. Survey responses among PA students indicated that 87% agreed or strongly agreed that “Balint groups were a valuable addition to clinical rotations,” and 93% reported they could “apply the experience to future practice.” Items assessed among PT students included improved empathy for patients and families (76%), increased confidence in managing difficult patient relationships (79%), greater awareness of personal biases (85%), and increased focus on the emotional aspects of illness and injury (79%).
Participants’ reflections brought the data to life. One PT student shared: I feel my perspective has greatly changed … especially when dealing with difficult cases. Listening to others account for all viewpoints during our sessions has challenged … my own process of reflection, allowing me to validate some of the hardships working in a health care setting, which in turn has given me the chance to develop meaningful and empathetic relationships with my patients. (PT student participant, 2023)
Patient Experience Connection Is Direct and Tangible
Although patients themselves are not engaged in group discussions, the benefits of Balint are felt at the bedside. One PT student shared, “Participating in Balint groups helped me be more mindful of others’ perspectives in the clinic, especially others’ emotional reality. Part of this is slowing down, which can be hard in a fast-paced, highly stimulating hospital environment.” Slowing down is not incidental—mindful, present-moment attention is foundational to accurate clinical judgment, effective listening, and compassionate care. 7 These relational shifts are linked to improved communication, greater patient satisfaction, and fewer errors.3,7,8 In this way, Balint groups serve both as a workforce well-being strategy and a patient experience intervention. Focusing on patient experiences, reflective conversations improve care and outcomes.
Challenges: Scheduling, Format, and Group Dynamics
Logistical challenges included coordinating schedules across various programs and clinical placements. For students, fatigue after lengthy clinical days sometimes affected engagement. For faculty, despite “unopposed” scheduled time, they could not always avoid conflicts.
Format also mattered. Group leaders found that in-person groups fostered stronger engagement and community, while virtual groups enabled broader participation, including students in remote clinical placements and site preceptors.
Finally, for some, adopting a Balint mindset was challenging. Since health professionals are trained to solve problems, participants occasionally defaulted to problem-solving or advice-giving instead of reflective inquiry. Facilitators consistently reiterated Balint principles, emphasizing that the group's goal was not to “fix” but to sit with complexity and ambiguity. 5
Practical Recommendations
Based on our institutional experience, we offer the following guidance to those interested in implementing Balint in the health professions:
Secure Leadership Support
Train Facilitators
Recruit faculty and staff who share Balint's values and practices.
Provide training through the American Balint Society (ABS), since skilled facilitation ensures Balint discussions foster empathy that can be applied to patient care. 5
Ensure that Balint resources are accessible, ie, “Restoring the Core of Clinical Practice: What is a Balint Group?” 6
Integrate into curricula and programming
Integrate Balint into clinical rotations, courses, or faculty development.
Connect competencies to patient experience (eg, empathy, communication, professionalism). 9
Develop interprofessional groups to prepare learners for team-based, patient-centered care. 10
Prioritize Scheduling and Format
Protect academic time to demonstrate commitment to patient experience and workforce well-being. 1
Offer in-person format, when possible, but utilize virtual platforms for inclusivity and scalability.
Prepare Participants
Provide orientation sessions to explain Balint's purpose and its connection to patient care.
Host mock groups to support understanding of how reflective practice translates into empathetic clinical encounters. 6
Collect and Use Feedback
Gather data on participant or facilitator experiences, learner outcomes, or particular foci, ie, empathy, resilience.
Track workforce outcomes and patient-centered measures to improve program delivery. 8
Strategically Expand Participation
Expand access to alumni and preceptors to encourage a culture of reflection across the continuum of care, ultimately benefiting patients.
Conclusion
Our health professions institution's experience shows that Balint groups can be effectively used outside traditional settings such as medical schools and healthcare environments. We demonstrated that Balint groups are more than just reflective exercises—they are a practical workforce strategy with direct benefits for patient experience. Students gained empathy, resilience, perspective-taking, and a sense of belonging; faculty found renewed purpose and modeled reflective practice; and the institution fostered a culture of connection that crossed organizational boundaries.
By integrating Balint groups into curricula, clinical experiences, and professional development, health professions educational programs can reduce stress, combat burnout, promote humanistic care, and enhance the relational skills that support safe, compassionate, and effective patient care. Ultimately, Balint groups serve as a bridge: clinicians, staff, students, and educators are better supported, and patients encounter present, empathetic, and collaborative care providers.
Footnotes
Declarations
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval
This initiative was reviewed and approved by the institution's IRB.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
