What We Talk About When We Talk About Coping: A Qualitative Study of Surgery Residents’ Coping following Complications and Deaths

Abstract

Objective:

To explore how surgery residents cope with unwanted patient outcomes including post-operative complications and death.

Summary Background Data:

Surgery residents face a variety of work-related stressors that require them to engage coping strategies. Post-operative complications and deaths are a common source of such stressors. While few studies examine the response to these events and their impacts on subsequent decision-making, there has been little scholarly work exploring coping strategies among surgery residents specifically.

Methods:

This study investigated the ways in which general surgery residents cope with unwanted patient outcomes, including complications and deaths. Mid-level and senior residents (n=28) from 14 academic, community, and hybrid training programs across the United States participated in exploratory semi-structured interviews conducted by an experienced anthropologist. Interview transcripts were analyzed iteratively, informed by thematic analysis.

Results:

When discussing how they cope with complications and deaths, residents described both internal and external strategies. Internal strategies included a sense of inevitability, compartmentalization of emotions or experiences, thoughts of forgiveness, and beliefs surrounding resilience. External strategies included support from colleagues and mentors, commitment to change, and personal practices or rituals, such as exercise or psychotherapy.

Conclusions:

In this novel qualitative study, general surgery residents described the coping strategies that they organically employed following post-operative complications and deaths. In order to improve resident well-being, it is critical to first understand the natural coping processes. Such efforts will facilitate structuring future support systems to aid residents during these difficult periods.

MINI-ABSTRACT

There is little data on how surgical residents cope during times of need such as following a complication or death. This qualitative study found that residents shared similar beliefs (e.g., compartmentalization, resilience) and employed a number of strategies (e.g., support from colleagues and mentors, personal practices and rituals) that facilitated coping. These findings may inform future initiatives aimed at resident well-being.

INTRODUCTION

There is no doubt that surgery residency is difficult. From long work hours to challenging learning environments¹, surgery residents face a multitude of stressors². One salient source of emotional strain may be their proximity to serious illness and death. This is likely compounded when a patient suffers a serious complication as a result of an operation in which they participated, as unwanted outcomes can have profound and lasting impacts on surgeon well-being³. Workplace events impact surgery residents and can lead to physical symptoms, such as stress-related tachycardia⁴, and psychological consequences, including emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, together termed “burnout”^5,6.

Despite recurrent exposure to challenging events, there has been limited scholarly work exploring the ways that surgery residents cope, defined as the use of cognitive and behavioral strategies to manage stress⁷ in a nuanced fashion^8–10. Although there has been some focus on the impacts of postoperative complications among practicing surgeons^3,9,10 and in how residents cope in intra-operative settings^11,12, there is a relative paucity of data on how residents cope from complications and death after surgery through the lens of behavior and beliefs^8,13,14. This is in contrast to a vast body of work exploring the effects of stressor events in other groups who routinely experience death and other traumatic incidents as a part of their occupation, specifically first responders such as firefighters^15,16, paramedics^15,17, police officers^15,18,19, and child protective service workers^15,20,21. Not only have the impacts of acute work-related stressors been characterized in these groups, but they have also been involved in interventional studies focused on improving coping skills following critical incidents^18,19,22. Prior work demonstrates that among both resident and faculty surgeons, adverse patient outcomes are a significant source of distress, and there are inadequate support structures in place to address these issues^23–27.

In this context, we designed a qualitative study to explore how surgery residents cope with a type of stressor that is unique to surgeons and proceduralists — unwanted patient outcomes, such as post-operative complications and deaths. Considering the high rates of surgery resident distress⁶ and potential impacts on attrition²⁸, a thorough understanding of coping strategies employed by residents is needed in order to direct future efforts aimed at resident well-being.

METHODS

Study Design

This study sought to explore how resident surgeons cope with unwanted outcomes, including postoperative complications and death. This study underwent expedited review and was deemed exempt from further review by the University of Michigan Institutional Review Board (HUM00157651).

Interview Participants

Participants were recruited by email from 14 general surgical residency programs across the United States, using convenience and snowball sampling. Residents were required to have completed at least two years of clinical training because of their increased experience and exposure directly managing and operating on patients. Participants received $50 in exchange for their participation.

Interview Procedures

An interview topic guide was developed by three members of the research team (MCB, CAV, PAS), exploring experiences with complications and deaths, including questions about coping strategies following these events (Appendix 1). Individual interviews were conducted in person or over the phone between December 2019 and April 2020 by an anthropologist (CAV) with extensive experience in qualitative interviewing. The interviewer was acquainted with a small number of study participants (n = 5) from our home institution. All individuals volunteered for participation and were not approached directly and provided verbal consent.

Interviews were digitally recorded and lasted 30 to 60 minutes. They were deidentified and transcribed to facilitate analysis. Field notes were documented after each interview to assist in thematic identification. Recruitment and interviewing continued until data saturation was reached, determined when new themes emerged infrequently and the code definitions remained stable²⁹. Transcripts were not returned to participants.

Analysis

Analyses of transcripts were performed iteratively and informed by an inductive approach to thematic analysis³⁰. Two members of the research team (MCB, CAV) read the first half of the transcripts independently to identify an initial set of codes. The team (MCB, CAV, PAS) then met to discuss codes and define a codebook, which was organized into five overarching domains. This specific report focuses on themes within the domain, “Coping Mechanisms.” Other reports focused on “responses to and impacts of” unwanted outcomes and “well-being resources”^31,32. All transcripts were independently coded (MCB, CAV) using MAXQDA (version 18.2.3, VERBI Software, Berlin, Germany). Meetings were held to discuss discrepancies. The codebook was modified or expanded as needed during these consensus meetings. A thematic schema was then created by three members of the research team (MCB, CAV, PAS) and subsequently discussed with all authors in a group meeting, where it was revised based on comments.

RESULTS

A total of 28 midlevel and senior residents were included in this report. Participant demographics are presented in Table 1.

Table 1:

Participant Demographics

	N	%
Gender
Male	15	54%
Female	13	46%
Self-Identified Race and Ethnicity
White / Non-Latinx	22	79%
Asian	5	18%
Indo-Caribbean	1	4%
Age
30–34	23	82%
35–39	4	14%
40–44	1	4%
Training Setting
Academic	16	57%
Community	8	29%
Hybrid	4	14%

When describing how they cope with complications and deaths, residents described several internal coping strategies, which included beliefs about why and how complications occur, as well as how residents should respond to them. These included:

1. Inevitability: the unwanted outcome was unavoidable, regardless of the surgeon’s actions.

2. Compartmentalization: difficult feelings related to unwanted outcomes can be isolated and prevented from affecting other areas of one’s life.

3. Forgiveness: feelings of guilt can be absolved through forgiveness, the sources of which varied.

4. Emotional Resilience: resident surgeons should respond to challenges with resilience, although what this means in practice varied.

In addition, residents described external coping strategies, which included actions and activities that provided relief. These included:

1. Support from Colleagues and Mentors: discussions with co-residents or faculty, often centered on the common experience of unwanted outcomes.

2. Commitment to Change: patient care-related changes that resulted from and are part of the coping process, often with the goal of global changes in practice.

3. Personal Practices and Rituals: activities and actions performed by the individual, including exercise, spending time with family, seeing a therapist, or religious observance.

Things We Tell Ourselves: Internal Strategies that Facilitated Coping

Exemplary quotes are displayed in Table 2.

Table 2:

Internal Strategies that Facilitated Coping

Inevitability	“You can do the best that you can every single day, and you’re still going to have people that don’t do well, whether it’s the system or their disease process, or something that you did, not maliciously, but you know, because you’re a human being and you’re fallible.” (ID16)
	“I better recognize now that there’s only so much that you can control and that there’s a certain component of all surgeries that, regardless of how much you try, just can’t control all the variables, necessarily always have that good outcome…maybe now I’m a little bit more accepting that it’s not always a personal mistake or not always a true technical problem that led to the complication, that there’s a whole host of things that you can’t necessarily make perfect, and that complications are a normal part of doing big surgeries on people, especially people who aren’t healthy to begin with.” (ID7)
	“As a senior resident, I’ve kind of come to terms with the fact that like bad things happen. You can do your best and be a good surgeon, and bad things will still happen. You can do your best and be a good surgeon and still make mistakes sometimes.” (ID6)
Compartmentalization	“I’m pretty good at compartmentalizing, and so I think, you know, that has helped me personally just be able to continue with other things in my life without letting it affect me too much.” (ID25)
	“I don’t really know why or how, but I think I try and compartmentalize what’s going on at work and what’s going on at home in some way.” (ID7)
	“I think in, it could make you really sad over time and really kind of burned-out. And it can also make you stop caring, just become desensitized to it, which also isn’t good.” (ID2)
Forgiveness	“You’ve got to be able to forgive yourself in these kinds of situations…So that kind of helps me move forward in these situations and allows me to forgive myself and not have crippling guilt or remorse or things like that that would preclude me from continuing to take care of people.” (ID1)
	“So I, the thing that I think makes me feel the best is when I actually just talk with the patient and their family about these things.” (ID4)
Emotional Resilience	“I think in general people who go into medicine, we’re thought of and we think of ourselves as these strong people who are hard workers and can get through things, and that’s why we’ve, we’re in the profession that we are. And the thing is, is that, you know, we’re not superheroes, and there’s only so much that one person can take in and deal with. So I think that’s just, it’s part of the pride of, you know, doctors in general.” (ID14)
	“It was really kind of hard to come back from that, although I, you know, essentially did the next day and did the same procedure multiple times again. And I think that’s kind of what you have to do as surgeons, but also I think it was hard for me to kind of, you know, maintain your sense of self-confidence when you have an outcome like that. “ (ID26)
	“I think the idea of resilience is, you know, exceptionally important within surgeon culture, because it’s just open to the nature of the profession. You know what I mean? It’s a pretty grueling residency, you know. You go to high school. You go to college, have to do what you take in college, go to medical school, go to medical school, and then after that, oh, wait, you’re going to get basically, you know, worked to the bone for a period of five to seven years. You know, some of us are doing academic things. So that’s, you know, resilience is, just by nature of the training paradigm, it sort of helps a lot for those who are resilient as people. Because if you have kind of a woe-is-me kind of give-up-ism attitude, you’re just not going to make it. You know, so I think it’s a profession that’s very demanding, that kind of self-selects for those who are able to handle these things because they’ve gone through, what, 13 minimum years of schooling after high school to be able to have the privilege of operating on somebody to help save their life.” (ID1)

Inevitability

Residents discussed a belief in the inevitability of unwanted outcomes. One resident explained that some unwanted outcomes “just aren’t possible to avoid” (ID14), and another summarized, “bad outcomes are things that are going to happen” (ID18).

Some residents described complications and deaths as inherent components of surgery because it is a human act and subject to human fallibility. By contrast, others explained that surgeon skill is unrelated to the development of bad outcomes, as even flawless operations can result in complications or deaths, as one resident stated, “even the best anastomosis can leak, right?…so you’re trying to do as good as you can, but there’s always a possibility of complication” (ID27).

Other residents independently quoted the well-known adage that the only surgeon who doesn’t have complications is a surgeon who doesn’t operate, summarizing the ubiquity of unwanted outcomes.

Compartmentalization

In discussing coping and personal impacts of unwanted outcomes, some residents described compartmentalization as a strategy that aimed to minimize the effects of these events. Some residents clearly identified their tendency to “compartmentalize” (ID7, ID20, ID25), while others described their efforts to “keep work at work and keep home at home” (ID22).

Some residents described intentionally creating emotional distance between themselves and their unwanted outcomes, as one resident explained their approach “not to engage with it emotionally too much” (ID2). As an extension of this sentiment, some residents described themselves as feeling “numb” (ID15, ID18), and others described the feeling that unwanted outcomes “harden you” (ID9) leading to the perception that surgeons are “cold, and…emotionally detached” (ID9).

Forgiveness

Some residents discussed forgiveness as a critical element of the coping process. One resident described the source of forgiveness as religious in nature, “I’m a Christian, so I believe that I am forgiven” (ID1), whereas another explained that the source of forgiveness was the patient and family, “they can forgive you or at least make you feel like you’re still a good doctor at the end of it” (ID4).

Emotional Resilience

While residents often discussed resilience and its effect on coping, there were different concepts of what it means to be resilient. There was consensus, however, that resilience is an important attribute for surgeons, as one resident described, “a surgeon is expected to be resilient, vigilant, and emotionally strong and stoic” (ID8).

Some residents described resilience as the ability to continue your work regardless of unwanted outcomes or emotional challenges. One resident compared their concept of resilience with lessons learned from a lifelong chronic disease,

“Resiliency for me can just be related to being comfortable with always having to fight the battle, never having it be won, and each day still trying to figure out how to fight it a little bit better than the day before”

(ID4).

For other residents, the discussion surrounding resilience was in terms of personal strength or weakness. In describing expectations of resident surgeons coping with unwanted outcomes, interviewees described “strong people” (ID14) with a “tough front” (ID21) who “don’t need the help of others” (ID29). By contrast, if someone were struggling after such an event, they would be viewed as “mentally weak” (ID17) and “less strong of a resident, or lazy even” (ID24).

For some, these concepts affected their willingness to seek counseling services. When discussing their decision to see a therapist, these residents described feeling like they should not need help in addressing their own problems. As one resident described,

“We’re like …the people that everybody else goes to when they can’t solve the problem… And, you know, you kind of—it’s a matter of accepting that you might need some help, too, and that’s ok”

(ID14).

Things We Do: External Coping Strategies

Exemplary quotes are displayed in Table 3.

Table 3:

External Strategies that Facilitated Coping

Support from Colleagues and Mentors	“It’s probably finding a sounding board, finding colleagues who you can reflect with, talk to about this. And I think that’s one of the most powerful ways to deal with it. Talk to people who can relate to what you’re going through and say I’ve, that’s happened to me too, right. So then you don’t feel alone that you’re the only person that messed up. And I think that’s one of the ways I handle it.” (ID8)
	“My colleagues, my co-residents are the most helpful. They are, I think, can best understand.” (ID7)
	“At least my experience was there’s nothing formal about it, but the support came from the relationships that I had with residents and faculty. You know, I work with these people every day, and we’re close with each other. So definitely the faculty, in that case, you know, sat down and we talked about it quite a bit afterwards.” (ID3)
Commitment to Change	“Every major complication I’ve had in residency has in some way changed my practice, and maybe that’s not a good thing. Maybe that’s kind of reactionary. Some of them are way bigger changes than others. Some just slightly move the needle and some like are huge adjustments. I think that like kind of the process they go through to like deal with complications.” (ID16)
	“It’s made me more open to talking with patients, certainly about risks but also if something happens just talking to them with, about that at bedside. So like, and not standing over them but pulling up a chair and saying, here’s what either happened or I think is going on. Here’s what we’re going to do to get you through this, and, you know, again, here’s our action plan and then listening. So I feel like those are the skills that have really kind of blossomed from dealing with these problems. These I know that certainly will help them, but it also helps me there as well.” (ID4)
	“I would say that each one of these experiences impacts my future care of patients…When I’m trying to talk about bad outcomes or the potential for bad outcomes with patients and families, I spend a lot more time with the patient and their family than I used to. I used to kind of just rush through these kinds of talks because I had a lot of other things that I had to deal with. But now I realize the gravity of the situation a little bit more, and I take that extra time to spend with the patient and their family to explain things and make sure that we’re all on the, try to make sure that we’re all on the same page or understanding of what’s going to happen next. And I think that’s the main way I’ve changed, is just my desire to spend more time with the patients and their family to try to explain what’s going on or what the outcomes could potentially be.” (ID24)
Personal Practices and Rituals	“And so honestly, over the last year I’ve started seeing a counselor. And I go in, I talk about all the crap that’s happened at work, and I feel lots better.” (ID14)
	“The other way is really on my weekends off, I just love to be quiet and just have some time to internally process. And I guess the other thing I would say is, I mean, you know, just a hobby like, in my case, I guess, either picking up my guitar or going out for a really nice meal, having just one drink and sitting down and enjoying that meal. You know, just something to kind of divert energy or quiet time to think through that situation. Those are probably the things I do.” (ID8)
	“When I have a really shitty day, I’ll look, I scroll through my phone, and I look at that picture, and I remember exactly how I felt on that best day, and exactly like how happy I was and how amazing it was. And I try to have perspective that like for every like shitty day I have, I’m going to have like another day that makes it all worthwhile, because it’s just the absolute best experience. So that’s what I do when I’m feeling down… I just look at the picture and like I can’t not smile. You remember everything about that day… it was certainly the best day of my residency, and it was in the top ten best days in my life. It was just perfect. Everything just fit, like fell into place. So I try to have a little perspective and remember that when I have days where everything doesn’t fall into place.” (ID16)

Support from Colleagues and Mentors

Participants cited support from colleagues and mentors as a factor that aided the coping process following unwanted outcomes. Often, residents found comfort in the sense of shared experience, as one described, “there’s some solace that comes in the universality of the experience” (ID16).

There was a consistent message that residents reached out to colleagues and mentors for support because they wanted to talk to someone who understood their experiences first-hand. One resident summarized this succinctly, “it’s sort of hard to explain to people, when unless you’ve gone through it, you can’t understand” (ID26). Residents also described coping as a skill that is taught informally through modeling of behavior. One resident described turning to “peers and those higher up on the hierarchy… looking for guidance on how we should feel” (ID30). In this way, it’s not just the coping strategies that are learned, but one’s emotional response, as well.

Regarding the source of support, some preferred to reach out to co-residents, as one interviewee asserted, “talking it out with my fellow residents or my fellow seniors would probably be the best coping mechanism” (ID17), while others preferred discussion with attending surgeons, “I think our faculty are the primary kind of support network because they’ve had these experiences before” (ID10). Residents described the importance of a supportive environment, with some even describing their training program as “a family” (ID16, ID27).

Commitment to Change

Following an unwanted outcome, some residents described a commitment to change, characterized by alterations in their future practice to reflect lessons learned from the event.

Residents discussed changes in the way they counseled patients preoperatively, especially when obtaining informed consent. For some, this was described as sitting with the patient and their family to explain what surgery would entail, both likely and unlikely complications, and how this aligned with the patient’s personal goals. Others described the way that prior experience helped them to set expectations with both team members and patients and their families.

Residents also described having an increased attention to detail when they found themselves in situations that had previously led to unwanted outcomes. For some residents, this included checking their work after a technical error, as one resident described, “definitely during closures, double, triple checking my work” (ID17), and for others, this involved intentional analysis of potential consequences after judgment errors, as another resident described, “it definitely plays a role in future decision making, because you’re always going to have that in the back of your head” (ID22).

Personal Practices and Rituals

Residents described different personal practices and rituals that helped them cope with unwanted outcomes. These were often activities that occurred outside of the hospital. Several residents stated that they engaged in physical activity in order to relieve stress following unwanted outcomes, while others preferred to sleep. Faith and religion were also mentioned by some residents.

Some residents cited family relationships as critical to their coping. Some explained that they preferred to talk through their struggles with their spouses; this occurred across genders, and with spouses that were or were not in medicine.

Other residents described crying as a crucial act in coping with an unwanted outcome. As one resident described, “keeping it bottled up inside, I would probably, I’d probably have a nervous breakdown” (ID9).

Few residents said that they saw a therapist or counselor to help them cope with unwanted outcomes. Most of the residents who saw a therapist or counselor felt that it contributed positively to their well-being.

DISCUSSION

This study provides a detailed report of the coping strategies employed by surgery residents following unwanted outcomes. Residents described internal and external strategies that contributed to their coping processes. Internal strategies included the sense of inevitability, compartmentalization of emotions or experiences, thoughts of forgiveness, and beliefs surrounding resilience. External strategies included seeking support from colleagues and mentors, a commitment to change, and personal practices and rituals.

This study illuminates a frequently overlooked part of every surgeon’s training. As residents learn to operate and to care for patients, they also experience emotionally challenging events that require the engagement of coping strategies in order to return to psychological homeostasis. There have been limited studies investigating this topic in a qualitative fashion, and the existing survey studies lack detail, as they describe broad trait-based approaches to coping^23,33. While there have been several initiatives to improve surgeon well-being overall, these demonstrate minimal effectiveness^34–36, suggesting a need for better understanding of the processes underlying surgeon psychological well-being prior to further investment in interventions.

Emotional resilience was widely discussed by participants and merits further comment, especially given its increased attention as an actionable target for improving resident well-being^2,37. Participants often discussed a surgeon’s resilience as a personal trait that is either present or absent and that precludes emotional distress or perturbation. This conceptualization is in stark contrast to that of many experts. While there are many definitions of resilience, it is often understood as a process or trajectory, characterized by “a relatively brief period of disequilibrium but otherwise continued health”³⁸. Within the culture of surgery, “resilience” often fails to acknowledge the initial transient period of struggle; rather, it is discussed as a steady state, with minimal response to stressors. The absence of emotional perturbation following an event does not imply resilience as it is understood within the psychological literature; rather, it suggests avoidance coping strategies. Thus, within surgical culture, avoidance and compartmentalization have been conflated with emotional resilience. This problematic association carries potentially harmful side effects, as it may stigmatize individuals who experience strong emotional responses and fail to support them as they engage coping resources to process these events³⁸. In other words, the implicit pressure to immediately return to one’s baseline may disrupt the normal and accepted sequence of resiliency: stressor, disequilibrium, return to baseline.

Additionally, when discussing surgical resilience, some residents defaulted to a discussion of “strong” and “weak” personalities, which likely perpetuates stigma around mental health, as some residents reported delaying mental healthcare or counseling because they felt that it implied personal inadequacy. The belief that one was “weak” or lacked resilience was closely tied to seeking mental health care when needed. In contrast, “strong” resident behaviors were characterized by self-sufficiency and self-control. If resilience is to remain an actionable target for improving resident well-being, then there must be an effort to accept that resilience is a process, transient struggles are normal, and requiring support does not imply weakness.

Notably, when interpreting our findings, we found that residents often described engaging emotion-focused coping, which attempts to reframe thoughts and feelings rather than to change the stressor itself³⁹. For example, believing that complications are inevitable may help to assuage feelings of guilt or inadequacy, and pursuing discussion with colleagues focused on the universality of the experiences may help residents to feel less alone in their grief. Many residents described compartmentalizing their emotions to the point of feeling “numb,” which is another emotion-focused strategy called avoidance coping. This can be an extremely effective short-term coping mechanism to deal with highly stressful, uncontrollable events⁴³, but when used as a primary strategy for long periods of time, it is associated with worse mental health outcomes^44,45. In general, emotion-focused coping strategies are associated with increased levels of emotional exhaustion, anxiety and dissatisfaction²⁷, as well as increased emotional avoidance, higher cortisol levels, and higher rates of post-traumatic stress disorder^{28 29}. This is in contrast to problem-focused coping strategies, which seek to manage or alter the stressor itself²⁶ and are associated with decreased levels of emotional exhaustion²⁷. Finally, recognizing that perceived control dictates if and how an individual manages stressors (i.e., those with high control demonstrate more problem-focused coping and act preemptively to prevent stressful episodes), the notion that poor outcomes in surgery are inevitable may impact how a surgeon copes and whether they chose to employ proactive coping mechanisms in an effort to mitigate expected stress are both worth future investigation^40–42.

Although coping theory has established that problem-based coping is more consistently associated with lower stress levels and improved mental health, we did not identify a great deal of problem-based coping among surgical residents.⁴⁶ While we acknowledge that the appropriateness of a particular coping strategy is directly connected to the stressor itself, we believe that there may be value in developing interventions that incorporate opportunities for problem-focused coping. Further, developing such interventions may not only improve overall resident well-being, but may also test the contextual and disciplinary boundaries of extant coping theories. For example, although not a prominent finding, residents in this study described meaningful changes in the way they practice as surgeons following a complication or death. While some of these changes focused on surgical skill to avoid repeating a technical error, many of the changes globally addressed their delivery of care, including assessing patient goals, setting appropriate expectations, and providing support for patients and their families. These strategies cannot change an outcome that already happened, but they are problem-focused in that they aim to improve the quality of surgical care. Similarly, engagement in quality improvement (QI) initiatives may provide residents with a creative opportunity for problem-focused coping. For example, if a patient outcome was impacted by a systems-based problem, then the resident can be encouraged and empowered to be directly involved in root cause analyses and finding systems-based solutions.

We acknowledge limitations to this study. While an individual may engage different coping strategies in response to different types of stressors, characterization of this variation was beyond the scope of the study. Additionally, the focus of this study was to better understand postoperative coping thoughts and behaviors. However, future studies should focus on a systematic evaluation of their effects. From a methodological standpoint, we employed convenience sampling because our study population is not readily available or accessible, and we did not want to place an undue burden on study participants. As a potential consequence of sampling, our study population mirrors current surgical trainees across the US⁴⁷ but lacks racial and ethnic diversity. We fully appreciate that experiences may be different for individuals who are under-represented in medicine, and that available coping strategies may differ when dealing with unwanted outcomes. Future efforts should focus on racial and ethnic minorities however to ensure that any potential interventions are effective in supporting their wellbeing. Convenience sampling may have also introduced selection bias, as the residents who volunteered for participation may be more comfortable talking about unwanted outcomes and may therefore engage different coping strategies than residents who chose to refrain from a study on this topic. Future research should explore institutional policies and practices that promote or prevent engagement of effective coping strategies. Finally, we acknowledge that participants who were acquainted with the interviewer may feel less comfortable expressing their true experience and opinions due to anonymity concerns. However, in this instance, we feel that the preexisting relationship helped to establish rapport and as the interviewer was a non-surgeon, presented no issues in regard to power dynamics. Despite these limitations, we provide the first detailed description of the coping processes that surgery residents employ following unwanted patient outcomes, which is critical to developing effective interventions to support resident well-being.

CONCLUSIONS

This exploratory qualitative study provides a detailed examination of resident surgeons’ coping processes following postoperative complications and deaths. A clearer understanding of existing coping strategies can serve as a framework for developing meaningful and effective initiatives to improve resident surgeon well-being.

Data:

All data presented in this manuscript is original to the authors.