Saturday 10:0-11:15

A TRANSLATION OF A GROUP RELATIONS PERSPECTIVE TO MEDICAL EDUCATION AND CONSULTATION: THE REFLECTIVE PRACTICE & LEADERSHIP MODEL

 

Presenter:

 

Ernest Frugé, Ph.D.

Professor, Department of Pediatrics, Hematology/Oncology Section

Professor, Center for Medical Ethics and Health Policy

Baylor College of Medicine

Director, Psychosocial Division

Texas Children's Cancer & Hematology Centers

Houston, Texas, USA

www.txch.org/fruge

www.reflectivepracticeleadership.org

The group relations perspective emerged in the early 20thcentury as part of a larger shift in sciences towards more systemic views of biological, psychological and social processes.  The experienced-based and transformational insights of Wilfred Bion, formed in the crucibles of two wars, led to a medical application - more specifically a clinical trial (the “Northfield Experiments”) of an alternative method of treating shell shock and battle fatigue. This clinical trial and its translations into military and industrial applications was an important part of the foundation for what is now referred to as the Tavistock tradition of group relations theory and practice.  

The later work of Michael and Enid Balint, also based at the Tavistock Institute, with primary care physicians - can also be seen as a successful translation of this fundamental perspective to the practice of medicine. To this day, Balint groups have an enduring role in medical education around the world.  Like the translations of Bion’s original clinical trial to other types of work, the principles underlying Balint groups have been generalized to professional development activities for organizational consultants across a variety of settings.

Group relations conference designs have also been applied to medical education and general organizational development.1,2,3,4However, these efforts are relatively rare and difficult to sustain over time.  It is also noteworthy that these efforts have typically been hosted in sectors of academic medicine that are already aligned with the psychosocial facets of medicine. For example, a Google search of the websites of the top ten research and top ten primary care medical schools (as rated by U.S. News and World Report) for terms such as Balint and reflective practice yield most “hits” (if any) in two predictable locations: psychiatry and family medicine.  A search for the term “group relations” in the same set of websites will likely retrieve few if any results, most having no connection to the Tavistock tradition. This presentation will describe a translation of the group relations perspective for medical education that has demonstrated utility and long-term institutional sustainability outside of the predictable sectors mentioned above.  

The basic method, titled “Reflective Practice & Leadership”, was originally developed in 1996 as a part of the core curriculum for a fellowship in Pediatric Hematology/Oncology and has continued.5,6  Since that time, variations of the basic method have been successfully applied to a variety of medical subspecialties with learners at different stages of professional development from medical students to practicing physicians and across a variety of institutions.  The methods have also recently been proven to be feasible and effective in an application to graduate medical education across cultures (e.g., Sub-Saharan Africa). In addition, there is anecdotal evidence that successful implementation of these methods can create opportunities for consultation to broader challenges of organizational function, design and strategic planning.  

Throughout their training, physicians are encouraged to employ a disciplined, scientific approach to the analysis of complex biomedical problems that follows the classic hypothetico-deductive procedure. It is interesting to note that as physicians develop expertise they often move towards pattern recognition and only “resort” to hypothesis formation and testing when the data does not fit expected pattern.This approach can be influenced by unconscious or semi-conscious personal and organizational factors (e.g. time/production pressures) raising the risk of error, particularly in diagnosis, and thus risk to treatment efficacy and patient safety.  

In contrast to training in biomedical reasoning, physician have proportionately very little if any formal education in a disciplined approach to reasoning through the psychological and social aspects of their work – including factors such as their own or others’ emotions, role, group and inter-group relations and institutional context.  The success of the Reflective Practice & Leadership method and applications appears to hinge in part on two things: 1) applying a hypothetico-deductive clinical reasoning procedure to psychological and social data in case-based discussions, and 2) ensuring that the disciplined analysis, including the examination of emotions and role, is tied, when possible, to the development of plans for alternative strategic actions (leadership).  The presentation will review a variety of applications and outcome measures that include impacts on practice as well as physician well-being and collegial relations.  The presentation will also be interactive with the aim of engaging participants in critique of the proposed model and exploration of possible modifications to increase utility and generalizability.

  1. Heimburger, E.M. & Baxter, R.F. The group relations conference as a supplemental training experience for physicians and other health professionals. Journal of Personality and Social Systems. 1979, Vol. 2, pp 43-52.
     

  2. Lomax, J.W. & Webb, L.J.  Differential of A.K. Rice and national training laboratory experiential conferences for psychiatry residents.  Journal of Psychiatric Education.  1984, Vol. 7, pp 274-286.
     

  3. Menninger, R.W. A retrospective view of a hospital-wide group relations training program: Costs, consequences, and conclusions.  Human Relations. 1985, Vol. 38 (4), pp 323-339.
     

  4. Benson, M.C., Lundgren, J. & West, K.  Psychiatric residency training in the dynamics of groups and organizations. Journal of Psychiatric Education.  1988, Vol. 12 (2), pp 102-110.
     

  5.          Frugé, E.& Horowitz, M.Leadership dimensions of the physician’s role:  A transitional approach to training in Pediatric                            Hematology/Oncology.  In G. Amado & L. Vansina (Eds.)The Transitional Approach in Action: The Harold Bridger Transitional
             Vol. II, London: Karnac, 2005.Series.
     

  6. Frugé, E., Mahoney, D.H., Poplack, D.G. & Horowitz, M.E. Leadership: "They Never Taught Me This in Medical School". Journal of Pediatric Hematology/Oncology, 2010, 32, No. 4, 304-308.
     

  7. Patel, V.L., Arocha, J.F.& Kaufman, D.R.  Expertise and tacit knowledge in medicine. In R. J. Sternberg & J. A. Horvath (Eds.), Tacit knowledge in professional practice: Researcher and practitioner perspectives.Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers. 1999