Psychology, 2024, 15, 145-154
https://www.scirp.org/journal/psych
ISSN Online: 2152-7199
ISSN Print: 2152-7180
Association between Personality Traits and
the Effectiveness of Balint Training among
Medical Students
Odelia Ben Harush1, Ohad Avny2, Meni Koslowsky3,4, Ariela Giladi5
1
Department of Health Administration, Ariel University, Ariel, Israel
Department of Medicine, Hebrew University, Jerusalem, Israel
3
Department of Psychology, Ariel University, Ariel, Israel
4
Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
5
Department of Education, Ariel University, Ariel, Israel
2
How to cite this paper: Harush, O. B.,
Avny, O., Koslowsky, M., & Giladi, A.
(2024). Association between Personality Traits
and the Effectiveness of Balint Training
among Medical Students. Psychology, 15,
145-154.
https://doi.org/10.4236/psych.2024.151010
Received: December 18, 2023
Accepted: January 23, 2024
Published: January 26, 2024
Copyright © 2024 by author(s) and
Scientific Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution International
License (CC BY 4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
Abstract
Introduction: Promoting communication and empathy skills is an important
component of medical students’ education. Recently, a technique called Balint training has been introduced in several medical schools to foster the nonclinical aspects of physician-patient interaction. Aim: We aim to explore
whether personality traits help explain the medical students who were more
satisfied with Balint training. In particular, whether students who are more
open to experience and more agreeable are more likely to be satisfied with
Balint training. Method: Balint groups have been introduced as part of the
medical school curriculum in the 4th year as part of their clinical training.
Students participated in five monthly Balint meetings in groups of 8 - 10 students led by two medical staff facilitators. At the end of the program, questionnaires were delivered to all students. Results: A total of 65 participants
(36% of the population) who completed all sessions, answered the questionnaires. Findings showed a positive correlation between the personality traits
openness to experience and agreeableness to the level of satisfaction in participating in Balint group sessions. Discussion: Our findings contribute to
the advancement of more effective planning and design of Balint groups in
medical education. To maximize the educational benefit of students’ participation in Balint training, their personality traits should be taken into consideration.
Keywords
Balint, Medical Students, Personality, Empathy, Communication Skills
DOI: 10.4236/psych.2024.151010
Jan. 26, 2024
145
Psychology
O. B. Harush et al.
1. Introduction
Balint groups are guided peer group discussions of health care providers (physicians, nurses, and health caregivers) who meet periodically to discuss their interaction with their patients. This model of group discussions was introduced by
Dr. Michael Balint to primary care physicians in England in 1950 with the intent
to share, learn, and support primary care physicians struggling with the burden
of care for their patients (Horder, 2001). These group sessions were designed to
help general practitioners achieve a more meaningful understanding of their patients and improve doctor-patient relationships (Ryding & Birr, 2022).
Balint training comprises a small group of clinicians who meet regularly to
discuss cases from their practices, focusing on psychological aspects and doctor-patient relationships (Yang & Wang, 2022). In Balint training, general practitioners and/or other medical professionals narrate complex cases under the
guidance of psychoanalysts, who play a leading role. Then, the described cases
are processed (Van Roy, Vanheule, & Inslegers, 2015). Samuel (1987) suggested
three primary goals of Balint’s work: to encourage doctors to evaluate their interpersonal skills and understand their limits; improve doctors’ perception and
understand their patients’ communication; and allow doctors to become aware
of blind spots in their patient interactions. Balint training has been shown to increase empathy, decrease fatigue, and reduce burnout, thus enhancing continued
alignment with the meaning of one’s career in healthcare (The American Balint
Society, 2016).
As the worldwide burden of care is growing, promoting the self-care of physicians is becoming a necessity to prevent burnout. In this context, Balint peer
group discussions are beginning to spread to all subspecialties in medicine to
support clinicians by cultivating their humanistic qualities as healthcare providers (Colthorpe et al., 2021).
The empathic behavior of doctors has been shown to not only increase patients’ subjective satisfaction but also improve diagnosis and treatment outcomes
(Haque, 2019). For example, a study showed that patients with diabetes mellitus
had fewer metabolic complications when treated by physicians with high empathy levels (Del Canale et al., 2012). The advantages of better-quality empathetic
communication are significant for both clinician and patient as empathy considers patients’ values, ideas, and feelings beyond deductive logic, physical examinations, and treatment (Decety & Fotopoulou, 2015). Subsequently, this
highly effective and influential communication tool improves patient belief in
the physician, reduces anxiety, improves patient satisfaction, improves treatment
adherence, improves health outcomes, and reduces malpractice complaints while
increasing physician health, well-being, and professional satisfaction (Stone,
2018).
Participation of medical students in Balint groups has been investigated in
both qualitative and quantitative methods and showed improvement in communication skills, the conceptualization of the patient-doctor relationship, and empathy (McCarron et al., 2023; Ng, Seu, & Cullum, 2022). Research demonstrated
DOI: 10.4236/psych.2024.151010
146
Psychology
O. B. Harush et al.
that Balint’s effect on students’ empathy arriving from different nationalities and
cultures such as France, Australia, Israel, and China improved when they participated in Balint groups as part of their training (Yazdankhahfard, Haghani, &
Omid, 2019). Yet, in these studies, Balint’s effect was only of moderate magnitude. Thus, it is of great importance to further investigate the barriers to the
success of medical students’ Balint training.
Personality is defined as the pattern of thoughts, feelings, attitudes, habits, and
behavior of everyone that persists over time in different situations distinguishing
one individual from others (Allport, 1961). Traits as factors can impact life outcomes by generating thoughts, feelings, and behaviors, especially in ambiguous
or novel situations (Roberts & Jackson, 2008).
Personality traits imply consistency and stability such that those who score
high on a specific trait, for instance, extroversion individuals are expected to be
sociable in different situations and over time. Hence, people differ from one
another in terms of where they stand on a set of basic trait dimensions that persist over time and across situations (Diener & Lucas, 2019). The Big Five personality model is the most influential and widely accepted personality theory in
recent years. It classifies personality traits and differentiates among emotions,
values, temperament, and character (John & Srivastava, 1999). The Big Five
personality model has some predictive value in almost all personality-related
behaviors and includes five dimensions: neuroticism, extroversion, openness,
agreeableness, and conscientiousness (Diener & Lucas, 2019).
Research demonstrated a relationship between personality traits and levels of
empathy (Bętkowska-Korpała et al., 2022). Greater empathy is an important
element in the development of a trustful doctor-patient relationship and has
been positively correlated with optimal doctor-patient communication, more
accurate diagnosis, and better treatment adherence (Wu, Jin, & Wang, 2022). In
medical students, self-reported empathy was positively associated with increased
communication skills scores in an objective clinical skills examination (OSCE)
(Casas et al., 2017). Interestingly, Cowell et al. (2023) reported that trainees rated
“work-life balance” as the thing they valued most in training (64%).
A cross-sectional study conducted at a medical university in China demonstrated that five personality traits were important predictors of cognitive and affective empathy among medical students (Song & Shi, 2017). Nevertheless, the
associations between empathy and Big Five personality traits in medical education are still underrepresented in the existing literature (Bętkowska-Korpała et
al., 2022). Two studies used the Jefferson Scale for Physician Empathy (JSPE)
among medical students (Costa et al., 2014; Magalhães, Costa, & Costa, 2012)
and concluded that empathy is positively associated with Agreeableness and
Openness to Experience traits. In another study that used the Big Five scale,
empathy among medical students was found to be positively associated with
Agreeableness and Openness to Experience (Magalhães, Costa, & Costa, 2012).
In contrast, in a recent study with Japanese medical students, findings showed
that the JSPE was not associated with openness and only weakly related to the
DOI: 10.4236/psych.2024.151010
147
Psychology
O. B. Harush et al.
trait of Agreeableness (Abe et al., 2018). However, the authors argued that personality measures are subject to cultural influences and may not have the same
association with empathy across different groups.
Individuals who exhibit elevated levels of openness to experience manifest
qualities such as creativity, innovation, and a tendency to deviate from established norms. They display heightened curiosity and are more open to receiving
feedback (Pathak, 2015). Agreeableness is linked to traits such as politeness,
adaptability, trustworthiness, cooperativeness, tolerance, and the fair and considerate treatment of others (Trapmann et al., 2007). Thus, we suggest that individuals with higher levels of either openness to experience or agreeableness will
be more cooperative during Balint sessions and thus will have greater satisfaction in participating in the group.
Given the influence that personality may have on empathy and the patient-doctor relationship, the current research aims to explore the relationship
between personality traits and satisfaction with Balint sessions. Concerning the
above literature, we chose to concentrate on two personality traits—Openness to
Experience and Agreeableness. Hence, we hypothesized the following:
2. Hypotheses
H 1: Students with a trait of Openness to Experience at a high level will report
greater satisfaction with the Balint sessions compared to students with Openness
to Experience at a low level.
H 2: Students with a high level of Agreeableness will report greater satisfaction
with the Balint sessions compared to students with a low level of Agreeableness.
3. Material and Methods
1) Sample
Participants included 65 fourth-year medical students at the Hebrew University faculty of medicine who participated in five monthly Balint meetings in
2022. A total of 32 men (49%) and 33 women (51%) with an average age of 26.06
responded.
2) Setting
Balint Groups included 8 to 10 students supervised by 2 facilitators-physicians, nurses, social workers, and clinical psychologists working in hospitals and
primary care medical facilities. At the end of the training, a measure of satisfaction was distributed. At least one of each co-leader had prior experience as a
participant or leading Balint groups.
4. Measures
A very brief measure of the Big Five personality domains: Participants
completed the shortened measure of the Big Five personality domains (Gosling,
Rentfrow, & Swan, 2003). This scale consists of 10 items asking participants to
rate their level of agreement for each item on a 1 (strongly disagree) to 7
DOI: 10.4236/psych.2024.151010
148
Psychology
O. B. Harush et al.
(strongly agree). In this study, we referred to the two main personality traits related to satisfaction with training at Balint—openness to experience—the items:
1) Open to new experiences, complex and 2) denotes reverse-scored item: Conventional, uncreative. The other trait examined is agreeableness. The items for
these traits are: 1) Sympathetic, warm, and 2) denotes reverse-scored item: Critical, quarrelsome.
Satisfaction with the Balint sessions: A three-item scale was developed to
measure whether the students perceived the Balint training as beneficial. The
items are scored on a 10-point Likert scale ranging from 1 “not relevant” to 10
“very relevant”: 1) How much do you feel Balint training benefited you? 2) How
much did you feel the discussion in the training was beneficial in general? 3)
How suitable is Balint training for the 4th year of medical studies? Cronbach alpha was .88.
5. Procedure
IRB approval was conducted, and all ethical procedures were observed. Participants completed the above questionnaires voluntarily and anonymously after
they completed the Balint sessions. Data were analyzed using SPSS 2006. Descriptive statistics including Means and Standard Deviations were used for analyzing the data. The descriptive statistics for the measures are reported in Table
1.
6. Results
Three measures were evaluated in the present study: Balint satisfaction, Openness to experience, and Agreeableness.
For testing hypothesis 1, Pearson correlations were examined (see Table 2).
Results showed a positive correlation between openness to experience to the level of satisfaction with the Balint session (r = .371, p < .01) and a negative correlation between conventional and uncreative traits which is the reverse-scored item
of openness to experience (r = −.392, p < .01). Thus, Hypothesis 1 was confirmed.
For testing hypothesis 2, Pearson correlations were examined (see Table 3).
Results showed a positive correlation between Agreeableness (the understanding, warm item) to the level of satisfaction with the Balint session (r = .374, p
< .01) and a negative correlation between critical and quarrelsome traits which is
the reverse-scored item of Agreeableness (r = −.338, p < .01). Thus, Hypothesis 2
was confirmed.
Table 1. Descriptive statistics for study variables.
N
DOI: 10.4236/psych.2024.151010
Minimum Maximum Mean Std. Deviation
Satisfaction from Balint sessions
68
1
10
7.10
2.420
Openness to experience
65
1
7
4.97
2.42
Agreeableness
65
1
7
4.53
1.56
149
Psychology
O. B. Harush et al.
Table 2. Intercorrelations: satisfaction with openness to experience.
Satisfaction
Pearson Correlation
Sig. (2-tailed)
1) Satisfaction
2) Open to
experience
Complex
1
Open to
Conventional
experience
.371**
.091
.002
.469
N
68
65
65
Pearson Correlation
.371**
1
−.392**
Sig. (2-tailed)
.002
N
65
65
65
Pearson Correlation
.091
−.392**
1
Sig. (2-tailed)
.469
.001
N
65
65
3) Conventional
Uncreative
.001
65
**p < .01.
Table 3. Intercorrelations-satisfaction with agreeableness.
Pearson Correlation
1) Satisfaction
1
2
3
1
−.191
.374**
.128
.002
Sig. (2-tailed)
N
68
65
65
Pearson Correlation
−.191
1
−.338**
Sig. (2-tailed)
.128
N
65
65
65
Pearson Correlation
.374**
−.338**
1
Sig. (2-tailed)
.002
.006
N
65
65
2) Critical
Quarrelsome
3) Understanding
Warm
.006
65
**p < .01.
7. Discussion
In addressing the challenges inherent in medical education, it is prudent to find
educational programs that promote communication skills, enhance the understanding of patient-doctor relationships, and cultivate empathy among medical
students. There is a scarcity of studies exploring the correlation between these
educational targets, and medical students’ psychological variables, in particular
their personality traits. Hence, the purpose of the present study was to investigate the correlation between medical students’ personality traits and their satisfaction with Balint group sessions.
As hypothesized, the findings showed a positive correlation between the personality traits openness to experience and agreeableness to the level of satisfaction with Balint sessions, such that those with higher levels of openness and
DOI: 10.4236/psych.2024.151010
150
Psychology
O. B. Harush et al.
agreeableness were more satisfied with Balint sessions compared to students
with lower levels of openness and agreeableness.
Prior studies demonstrated that openness and agreeableness were correlated
with empathy (Suciu, Melit, & Mărginean, 2021) and that participation in Balint
groups improves communication skills and empathy (Yang & Wang, 2022).
Thus, our results showing the association between personality traits (openness
and agreeableness) and students’ subjective impression of Balint group effectiveness may have considerable importance in improving medical education.
Although our study is the first to examine the relationship between personality traits and satisfaction with Balint training, validating our findings will lead to
several conclusions. One possible contribution may be in the process of interviewing medical students, as knowing the student’s personality traits may influence empathetic behavior towards patients, and therefore advice concerning the
suitability of the student. In addition, as personality-targeted interventions have
gained increasing popularity in health promotion research and practice (Suciu,
Melit, & Mărginean, 2021), it might be feasible to enhance the empathy of medical students by raising medical students’ awareness of the unique constellation
of personality traits they possess, which can either bolster or hinder their empathy and interactions with patients (Song & Shi, 2017).
Medical students’ participation in Balint groups was mostly studied in
small-scale studies (Salter et al., 2020). Usually, the group leaders were all experienced Balint leaders who were well trained (psychiatrists, psychologists, social
workers co-leading with an experienced M. D clinician). In this context, our
study is unique since it evaluated short-term Balint training of medical students,
with less experienced team leaders (at least one of each co-leader had prior experience) and a relatively large number of participants. As Balint training has been
shown to be beneficial in several studies, it may be useful to consider it as a major component in training all medical students in the future. Medical schools
may want to extend Balint training to a major educational challenge. However,
in the face of limited resources perhaps it might be more feasible to investigate
the effectiveness of shorter interventions for more students with less experienced
team leaders, to spread the Balint method in the medical profession, instead of
leaving it as part of an exclusive group of students and professionals.
8. Limitations
This study has several limitations that we want to address. The first limitation is
the “self-report” nature of the measure. Such data are generally considered to be
susceptible to common method bias effects. Yet, when little personal gain is involved, it appears to have only a limited effect on response bias. The second limitation is its generalizability, due to the highly limited nature of the subject
sample in a single university setting. The inferences from such a sample may not
be fully generalizable to students from other academic institutions or other
countries with different national cultures.
DOI: 10.4236/psych.2024.151010
151
Psychology
O. B. Harush et al.
9. Conclusion
Our findings contribute to the advancement of more effective planning and design of Balint groups in medical education. The results demonstrating the association between personality traits and satisfaction with Balint sessions empower
policymakers to make more informed decisions regarding the subject. We suggest that tailored individualized intervention strategies based on the personality
traits of medical students be integrated into educational programs to enhance
empathy and improve doctor-patient relationships as part of their medical training. Furthermore, the outcomes obtained in this study can serve as a foundation
for subsequent research and the broadening of knowledge in the field.
Conflicts of Interest
The authors declare that the research was conducted in the absence of any
commercial or financial relationships that could be construed as a potential conflict of interest.
References
Abe, K. et al. (2018). Associations between Emotional Intelligence, Empathy, and Personality in Japanese Medical Students. BMC Medical Education, 18, Article No. 47.
https://doi.org/10.1186/s12909-018-1165-7
Allport, G. W. (1961). Pattern and Growth in Personality. Holt, Reinhart & Winston.
https://psycnet.apa.org/record/1962-04728-000
Bętkowska-Korpała, B. et al. (2022). Personality Characteristics of Empathy Profiles—Practical
Implications for Education of Medicine Students. BMC Medical Education, 22, Article
No. 376. https://doi.org/10.1186/s12909-022-03432-5
Casas, R. S., Xuan, Z., Jackson, A. H., Stanfield, L. E., Harvey, N. C., & Chen, D. C. (2017).
Associations of Medical Student Empathy with Clinical Competence. Patient Education
and Counseling, 100, 742-747. https://doi.org/10.1016/j.pec.2016.11.006
Colthorpe, A., Sakhinia, F., & Shackley, E. (2021). Use of Multidisciplinary Balint Groups
in Paediatrics and Neonates to Enhance Well-Being. Archives of Disease in Childhood-Education and Practice, 106, 310-311.
https://doi.org/10.1136/archdischild-2019-318672
Costa, P., Alves, R. D. C., Neto, I., Marvão, P., Portela, M., & Costa, M. J. (2014). Associations between Medical Student Empathy and Personality: A Multi-Institutional Study.
PLOS ONE, 9, e89254. https://doi.org/10.1371/journal.pone.0089254
Cowell, V., Ayalogu, C., Ros, A., Brown, H., Shittu, B., Akella, A., Lasisi, A., Bancroft, J.,
Whitcroft, H., Surendran, I., & Bu, C., (2023). Balint Group Sessions for Medical Students: A Pilot Study. BJPsych Open, 9, S16-S17.
Decety, J., & Fotopoulou, A. (2015). Why Empathy Has a Beneficial Impact on Others in
Medicine: Unifying Theories. Frontiers in Behavioral Neuroscience, 8, Article 457.
https://doi.org/10.3389/fnbeh.2014.00457
Del Canale, S., Louis, D. Z., Maio, V., Wang, X., Rossi, G., Hojat, M., & Gonnella, J. S.
(2012). The Relationship between Physician Empathy and Disease Complications.
Academic Medicine, 87, 1243-1249. https://doi.org/10.1097/acm.0b013e3182628fbf
Diener, E., & Lucas, R. E. (2019). Personality Traits. General Psychology. In R. B. Diener,
& E. Diener (Eds.), Noba Textbook Series: Psychology (pp. 278-296).
DOI: 10.4236/psych.2024.151010
152
Psychology
O. B. Harush et al.
Gosling, S. D., Rentfrow, P. J., & Swann, W. B. (2003). A Very Brief Measure of the Big-Five
Personality Domains. Journal of Research in Personality, 37, 504-528.
https://doi.org/10.1016/s0092-6566(03)00046-1
Haque, M. (2019). Importance of Empathy among Medical Doctors to Ensure High-Quality
Healthcare Level. Advances in Human Biology, 9, 104-107.
https://doi.org/10.4103/aihb.aihb_44_18
Horder, J. (2001) The First Balint Group. British Journal of General Practice, 51,
1038-1039. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314185/
John, O. P., & Srivastava, S. (1999). The Big Five Trait Taxonomy: History, Measurement,
and Theoretical Perspectives. In L. A. Pervin, & O. P. John (Eds.), Handbook of Personality: Theory and Research (2nd ed., pp. 102-138). Guilford.
Magalhães, E., Costa, P., & Costa, M. J. (2012). Empathy of Medical Students and Personality: Evidence from the Five-Factor Model. Medical Teacher, 34, 807-812.
https://doi.org/10.3109/0142159X.2012.702248
McCarron, R., FitzGerald, J. M., Swann, P., Yang, S., Wraight, S., & Arends, F. (2023). A
Mixed-Methods SWOT Analysis of a Medical Student Balint Group Programme. Medical Teacher. https://doi.org/10.1080/0142159X.2023.2239999
Ng, L., Seu, C., & Cullum, S. (2022). Modelling Vulnerability: Qualitative Study of the Balint Process for Medical Students. BMC Medical Education, 22, Article No. 436.
https://doi.org/10.1186/s12909-022-03508-2
Pathak, D. (2015). Big-Five and Personal Effectiveness: An Empirical Study on B-School
Students. Abhigyan, 33, 40-52.
Roberts, B. W., & Jackson, J. J. (2008). Sociogenomic Personality Psychology. Journal of
Personality, 76, 1523-1544. https://doi.org/10.1111/j.1467-6494.2008.00530.x
Ryding, E. L., & Birr, A. (2022). Becoming the Kind of Doctor That You Want to Be. A
Qualitative Study about Participation in Balint Group Work. The International Journal
of Psychiatry in Medicine, 57, 283-292. https://doi.org/10.1177/00912174211042972
Salter, E., Hayes, A., Hart, R., Orrell, R. A., Jameson, J., Knight, C. et al. (2020). Balint
Groups with Junior Doctors: A Systematic Review. Psychoanalytic Psychotherapy, 34,
184-204.
Samuel, O. W. (1987). Aims and Objectives of Balint Training. Journal of the Balint Society, 15, 23-25.
Song, Y., & Shi, M. (2017). Associations between Empathy and Big Five Personality Traits
among Chinese Undergraduate Medical Students. PLOS ONE, 12, e0171665.
https://doi.org/10.1371/journal.pone.0171665
Stone, J. (2018). The Importance of Empathy in Healthcare.
http://blog.medicalgps.com/the-importance-of-empathy-in-healthcare/
Suciu, N., Meliț, L. E., & Mărginean, C. O. (2021). A Holistic Approach of Personality
Traits in Medical Students: An Integrative Review. International Journal of Environmental Research and Public Health, 18, Article 12822.
https://doi.org/10.3390/ijerph182312822
The American Balint Society (2016).
http://americanbalintsociety.org/content.aspx?page_id=22%26club_id=445043module
_id=229705
Trapmann, S., Hell, B., Hirn, J. O. W., & Schuler, H. (2007). Meta-Analysis of the Relationship between the Big Five and Academic Success at University. Zeitschrift für Psychologie/Journal of Psychology, 215, 132-151.
Van Roy, K., Vanheule, S., & Inslegers, R. (2015). Research on Balint Groups: A LiteraDOI: 10.4236/psych.2024.151010
153
Psychology
O. B. Harush et al.
ture Review. Patient Education and Counseling, 98, 685-694.
https://doi.org/10.1016/j.pec.2015.01.014
Wu, Q., Jin, Z., & Wang, P. (2022). The Relationship between the Physician-Patient Relationship, Physician Empathy, and Patient Trust. Journal of General Internal Medicine,
37, 1388-1393. https://doi.org/10.1007/s11606-021-07008-9
Yang, Y., & Wang, Q. (2022). The Effect of Balint-Style Group on Empathy Ability and
Interpersonal Communication Skills of Rehabilitation Students. In Proceedings of the
2022 3rd International Conference on Mental Health, Education and Human Development (pp. 24-29). Atlantis Press. https://doi.org/10.2991/assehr.k.220704.006
Yazdankhahfard, M., Haghani, F., & Omid, A. (2019). The Balint Group and Its Application in Medical Education: A Systematic Review. Journal of Education and Health
Promotion, 8, 124.
DOI: 10.4236/psych.2024.151010
154
Psychology