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)