Effectiveness of Balint group interventions for physician burnout: a systematic review and meta-analysis protocol

Physician burnout is a global crisis compromising healthcare sustainability and patient safety. Balint groups, a structured case-based discussion intervention focusing on the doctor-patient relationship, are increasingly used to mitigate this distress. However, existing evidence regarding their efficacy remains fragmented. This systematic review and meta-analysis aims to evaluate the effectiveness of Balint groups in reducing physician burnout and improving secondary psychological outcomes, while also assessing implementation characteristics.

We will search MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, PsycINFO and major Chinese databases (China National Knowledge Infrastructure, Wanfang Data and SinoMed) from inception to 31 May 2026, supplemented by grey literature and trial registries. The formal search has not yet commenced and is planned to begin on protocol publication. We will include both randomised controlled trials (RCTs) and non-randomised studies of interventions (non-randomised trials (NRTs), including non-controlled before-after studies) that evaluate Balint groups for practising physicians. The primary outcome is the change in burnout severity, with priority given to the emotional exhaustion subscale of the Maslach Burnout Inventory; however, data from other validated tools, such as the Oldenburg Burnout Inventory, will also be extracted and synthesised if reported. Secondary outcomes include stress and anxiety as psychological comorbidities closely associated with burnout, and job satisfaction, adherence and medical errors as its downstream occupational consequences. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane RoB 2.0 tool for RCTs and the Effective Public Health Practice Project tool for NRTs. Data synthesis will be conducted separately for RCTs (between-group effects) and NRTs (within-group effects) using random-effects models. Heterogeneity will be explored via subgroup analyses (eg, career stage) and, where data permit, meta-regression. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Ethical approval is not required as this study synthesises primary data from published research. Findings will be disseminated through a peer-reviewed journal publication and conference presentations to inform interventions for physician well-being.

CRD420251142526.