BACKGROUND The prevalence and detrimental effect of physician burnout requires new strategies for supporting physicians. In this project, we describe the development, and assessment, of a "Balint-like" physician support group that provided social cohesion and delivered novel didactic curricula for building resilience. METHODS The project began with a nine-month facilitated peer-support group for physicians that met every other week. Based on input from the first group, tailored content was developed to address physician wellness needs. These curricula were delivered to participants in the second nine-month Balint-like group. We then conducted semi-structured interviews with 7 hospitalists and 2 outpatient primary care physicians who participated in the Balint-like groups to explore the intervention's value and to identify remaining unmet physician wellness needs. Using an inductive thematic analysis approach, we identified a set of institutional-, community- and individual-level factors affecting physician wellness and corresponding intervention opportunities. RESULTS Physicians spoke of systems-level factors that contributed to distress, and proposed infrastructure, both physical and procedural, that they felt could better support physician wellness. They highlighted the emotional challenges of daily work, and the need for a forum by which to process these interactions in order to maintain their own wellness. Participants reported that participation in Balint-like groups provided this forum and served to help the physicians normalize struggles, reduce isolation and provide new strategies for navigating challenging interactions. CONCLUSIONS Institutional infrastructure, in the form of regular, psychologically-safe forums for processing with peers and learning relational strategies for preserving wellness, may mitigate physician distress. This project provides a model for how to develop and deliver a low-cost physician wellness program that can be tailored to the needs of individual clinical units.

中文翻译：

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开发用于医师健康的机构基础设施：来自VA医师的定性见解。

背景技术医师倦怠的流行和有害影响需要用于支持医师的新策略。在这个项目中，我们描述了一个“类似于Balint的”医师支持小组的发展和评估，该小组提供了社会凝聚力并提供了新的教学课程来增强适应能力。方法该项目开始于一个为期9个月的促进同伴支持小组，每隔一周举行一次会议。根据第一组的意见，开发了量身定制的内容来满足医生的健康需求。这些课程已交付给第二个为期9个月的Balint式小组。然后，我们对参与Balint式小组的7位住院医生和2位门诊初级保健医生进行了半结构化访谈，以探讨干预措施' 的价值，并确定尚未满足的医生健康需求。使用归纳主题分析方法，我们确定了一系列影响医师健康和相应干预机会的机构，社区和个人层面的因素。结果医师谈到了导致困扰的系统级因素，并提出了他们认为可以更好地支持医师健康的拟议基础设施，包括物理和程序方面。他们强调了日常工作中的情感挑战，以及需要一个论坛来处理这些互动以保持自己的健康。参加者报告说，参加类似Balint的小组的参加者提供了这个论坛，并帮助医师规范了斗争，减少了孤立感，并提供了应对挑战性互动的新策略。结论机构基础设施的形式是定期的，在心理上安全的论坛以与同龄人进行处理以及学习相关策略以保持健康，这可以减轻医生的困扰。该项目为如何开发和提供低成本的医生保健计划提供了模型，该计划可根据各个临床部门的需求量身定制。