# Balint groups for improving the ability of doctors and medical students to manage the doctor–patient relationship: a systematic review, quantitative meta-analysis and qualitative meta-synthesis of intervention studies

## TL;DR

Balint groups help doctors and medical students improve communication and empathy with patients, based on a review of 56 studies.

## Contribution

First systematic review combining quantitative and qualitative evidence on Balint groups' impact on doctor-patient relationships.

## Key findings

- Balint group participants showed higher communication and empathy scores and lower anxiety compared to controls.
- Balint groups significantly reduced emotional exhaustion and increased personal accomplishment among healthcare workers.
- Qualitative analysis confirmed improved doctor-patient communication and team cooperation through Balint groups.

## Abstract

Balint groups are a crucial method for improving the relationship between medical students/doctors and patients. Nevertheless, no review has examined the effects of Balint groups in this regard. This study aimed to conduct quantitative meta-analyses and qualitative meta-syntheses based on a systematic review to provide references for improving doctor‒patient relationships.

We searched six databases from inception through October 2024. Two reviewers independently conducted screening and quality assessment. Quantitative data were analyzed using meta-analysis methods with standard mean differences (SMDs) and 95% confidence intervals (CI) in RevMan 5.4.1, while qualitative results were summarized using meta-synthesis methods.

A total of 56 studies were included, including 45 quantitative studies and 11 qualitative studies. Two, fifty-one, and three studies were rated as having a low risk of bias, unclear risk or some concerns, and high risk of bias, respectively. Thirteen quantitative studies were included in the meta-analyses. Compared with those in the control group, participants in the Balint group had higher communication scores and empathy scores and lower anxiety scores (SMD = 1.26, 95% CI 0.97 to 1.56, I2 = 0%, five studies; SMD = 2.40, 95% CI 1.31 to 3.49, I2 = 96%, six studies; SMD = -0.79, 95% CI -1.39 to -0.19, I2 = 71%, three studies). Participants who received the Balint intervention had significantly lower burnout scores in emotional exhaustion and reduced personal accomplishment among healthcare workers post-intervention compared with pre-intervention (SMD = -1.62, 95% CI -3.21 to -0.03, I2 = 88%, three studies; SMD = -1.22, 95% CI -2.26 to -0.17, I2 = 74%, three studies), while no significant change was saw in cynicism (SMD = -0.90, 95%, CI -1.91 to 0.10, I2 = 75%, three studies). The meta-synthesis results of 11 qualitative studies show that Balint groups have a positive effect on doctors’ doctor–patient communication, empathy, psychological adjustment, and team cooperation abilities.

Balint groups may contribute to improving doctor‒patient relationships. We suggest caution and advocate for multicenter large-sample randomized controlled trials with low risk-of-bias design to avoid evidence bias.

The online version contains supplementary material available at 10.1186/s12909-025-08072-z.