Balint groups in medical education: facilitator communication practices and interactional dynamics of empathy-related engagement

Balint groups are structured, facilitator-led discussions in which clinicians and trainees explore the relational and emotional dimensions of patient care. Although widely used in medical education to support empathy and reflection, less is known about the communication practices that facilitate these outcomes. This qualitative study examined interviews with 13 facilitators who led mandatory Balint sessions for fourth-year medical students at a Northeastern U.S. medical school. Using in vivo and pattern coding, we analyzed facilitator accounts of session management and student engagement. Facilitators described creating communicatively distinct environments by reducing evaluative pressures, encouraging reflective dialogue, and supporting emotional exploration through practices such as reframing, validation, and strategic silence. Within these conditions, students were perceived as engaging in perspective-taking, questioning assumptions, and collaboratively constructing empathic understandings of patients and peers. Findings suggest that empathy-related communication emerged when facilitators established interactional conditions that reduced evaluative pressure and encouraged reflective engagement.