The impact of adverse patient events among German anesthesiologists

Abstract

Background

Adverse patient events are an inevitable part of an anesthesiologist’s work. When such incidents occur, they may lead to significant emotional and psychological distress in healthcare providers—a phenomenon known as the Second Victim Phenomenon (SVP). While international evidence of SVP exists, data from German anesthesiologists remain scarce.

Objective

This study aimed to determine the prevalence, symptom severity, recovery time, and available support structures for second victims among German anesthesiologists and to identify individual and workplace-related risk and protective factors.

Methods

A cross-sectional survey was conducted using the validated SeViD questionnaire. The survey assessed five domains: demographics, SVP experience and symptoms, support structures, and personality traits (Big Five Inventory-10). Data were collected both online and on paper at three national anesthesiology symposia in Germany.

Results

Of the 408 respondents (mean age: 50.8 years), 76.9% identified as second victims, with 27% having experienced a related incident in the previous 12 months. Common triggers included patient harm or death, near misses, and critical events. The most frequently reported symptoms were self-doubt (69%), feelings of guilt (66%), reliving the event (59%), and sleep disturbances (59%). 16% of the respondents had not recovered at the time of the survey, and 14% had not recovered even after more than a year. Legal consultation, debriefing, and preventive feedback mechanisms were rated as the most helpful support strategies. A lack of support was significantly associated with increased symptom burden and prolonged recovery. A higher level of neuroticism and a lower level of openness were associated with increased symptom load.

Conclusions

SVP is highly prevalent among German anesthesiologists, with a significant psychological burden in many cases. These findings highlight the urgent need for systematic interventions, including peer support and organizational frameworks, to address and mitigate the effects of SVP in clinical practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-025-03328-z.

Introduction

The purpose of anesthesiologic work is to provide care for patients in critical situations in the operating room, emergency department, intensive care unit, and beginning and end of life. In these settings, adverse events are unavoidable and may result in patient harm, requiring our full attention. In the aftermath of such events, we may experience guilt or grief, even when the incident is unforeseeable. In these cases, we may become a Second Victim.

The American internist Albert Wu coined the term “Second Victim Phenomenon” (SVP) in the early 2000s, initially focusing on physicians traumatized by medical mistakes identifying them as Second Vicitms (SVs) and patients and families as first victims [1]. The term Second Victim was later expanded by Scott et al., who included all healthcare workers affected by other unforeseen adverse patient events [2]. In 2022, the European Researchers’ Network Working on Second Victims (ERNST) defined the term “Second Victim” as “any health care worker directly or indirectly involved in an unanticipated adverse patient event, unintentional healthcare error, or patient injury, who becomes victimized in the sense that they are also negatively impacted” [3].

The SVP describes the psychological and emotional response that healthcare professionals (HCPs) may experience in the aftermath of an adverse event. SVP can lead to significant distress, manifesting as psychological, cognitive, and physical symptoms, including intense anxiety, overwhelming guilt, grief, depression, professional dissatisfaction, and even burnout [1, 2]. In addition to affecting mental well-being, SVP can also contribute to maladaptive coping behaviors such as practicing defensive medicine, experiencing posttraumatic stress disorder (PTSD), increasing turnover intention, and, in severe cases, suicidal ideation [3, 4]. Several studies have suggested that up to 89% of healthcare providers experience symptoms consistent with SVP at some point in their careers [5–7]. A deeper insight was obtained through the studies of Susan Scott, who conducted quantitative analyses on the burden of the SVP and qualitative explorations of the experiences and recovery trajectory of past second victims. In these studies, she described stereotypic phases of the SVP that ultimately might lead to growth, maladaptive coping, or dropping out [4, 8, 9].

Second victims have existed in anesthesiology long before the term was coined. One of the earliest known cases may be that of dentist Horace Wells (1815–1848), a pioneer in anesthesia. Wells was heavily impacted by the failed demonstration of tooth extraction using nitrous oxide in 1845 in Boston. He was scorned by colleagues, suffered from severe dejection, and quit his job for approximately one year. Later, and after William Morton’s success with ether anaesthesia, he recovered but became addicted to chloroform. Twelve days after being honored by the Academie Royale de Medicines as the first man practicing painless surgery, he committed suicide without knowing about his honor [10].

The significant impact of SVP on the anaesthesia workforce is well established. Studies have shown that perioperative adverse events can have profound psychological consequences for healthcare providers, affecting their ability to deliver high-quality patient care. For example, Gazoni et al. [11] reported that at least 84% of anesthesiologists had experienced unanticipated patient death or serious injury during their careers, resulting in a profound and lasting psychological burden. Similarly, a survey conducted in Belgium revealed that 73.7% of anesthesiologists had experienced a patient safety incident within the past year, often with limited departmental support. The authors emphasized that implementing supportive structures, such as open discussions about critical incidents and peer support systems, is essential for addressing this issue [12].

Despite its known impact, more awareness and research on SVP in anesthesiology are still needed. In Germany, Wulf (2013) was the first to highlight the phenomenon among anesthesiologists [13]. A description as well as a useful toolbox to address or prevent such phenomena was published [14]. However, the current prevalence and concrete burden of SVP among anesthesiologists in Germany have not been studied [15]. To address this gap, we conducted a survey — the Second Victim in German-speaking Countries (SeViD) study [16, 17]. Our aims were to investigate: (1) the prevalence of Second Victims among anesthesiologists in Germany, (2) symptom severity, and (3) the availability of supportive structures. We also analyzed risk factors for (a) identifying as a Second Victim, (b) symptom severity, and (c) symptom duration.

Methods

Study design

This study was designed as a cross-sectional survey.

Setting

The survey was conducted under the patronage of the Professional Association of German Anaesthesiologists (Berufsverband Deutscher Anästhesistinnen und Anästhesisten, BDA) at three different German anaesthesiological symposia: Sylter Woche der Anästhesie (“Sylt Anaesthesia Week”, 08/31/2024–09/05/2024), Bayrische Anästhesietage (“Bavarian Anaesthesia Days”, 10/18/2024–10/19/2024), and Südwestdeutsche Anästhesietage (“Southwest German Anaesthesia Days”, 11/29/2024–11/30/2024). All participants were invited to complete the survey via a data-secure, web-based tool (SurveyMonkey, San Mateo, CA, USA) or a paper-based questionnaire.

Participants and ethics

All participants were informed in advance about the purpose of the study and provided explicit informed consent prior to participation. Participation was voluntary, and data were collected anonymously, without tracking tokens, cookies, or IP addresses. All the data were used exclusively in aggregated form for scientific purposes. Because participation was voluntary and anonymous, ethical approval was waived by the Chair of the Ethics Committee of the Medical Faculty at Goethe University Frankfurt/Main, Germany. This decision was made in accordance with the principles outlined in the Declaration of Helsinki.

Instruments

The survey instrument used was the validated SeViD questionnaire. It includes five domains:

1. General information on baseline and work experience

2. General experiences with the second victim phenomenonand time to recover

3. Burden of second victim symptoms

4. Frequency of Second Victim Support and Rating of Second Victim Support Strategies

5. The five-factor model of personality (the Big Five Inventory (BFI)-10) [18]

The construction and validation of the German SeViD questionnaire was published in 2022 [19]; its full translation, as used for this study, is provided in the appendix (SEVID_X_Survey).

Preparation of the data

First, all paper-based questionnaires (n = 39) were transferred to the web-based tool (SurveyMonkey) following the two-person rule. The continuous variables of age and work experience were divided into terciles. The work setting variable was simplified into hospital-based work, comparing those in emergency-related environments (ICU/pre- and intrahospital emergency services) with those in nonemergency-related environments. Further dichotomizations included second victim status, distinguishing between participants who had experienced one or more second victim incidents and those who had never experienced such incidents.

General information on baseline and work experience

Baseline characteristics, including sex, age, years of experience, current professional status, work setting, and country of medical practice, were collected.

General experiences with the second victim phenomenon and time to recover

After a short explanation of what a second victim is, we asked the participants if they were familiar with the term SV and if they had experienced the SVP already during their professional work.

Burden of second victim symptoms

The burden of symptoms was derived from the third domain of the SeViD questionnaire. For this purpose, we calculated a Symptom Severity Score (SSS) as a sum score. The responses were scored as follows: “strongly pronounced” = 1; “weakly pronounced” = 0.5; “not at all” = 0; “don’t know” = not scored. The sum score was calculated individually for each participant, and the median of all participants was used as a cut-off value to categorize symptom load as low (≤ 8) or high (≥ 8.5).

Frequency of second victim support and rating of second victim support strategies

Initially, we asked whether the second victim had requested support, whether it was provided, and who provided it. Furthermore, all the participants were asked to rate support strategies. Support ratings were scored as follows: “Very helpful” = 3; “Rather helpful” = 2; “Rather not helpful” = 1; and “Not helpful at all” = 0. An additional sum score was calculated.

BFI-10

For the BFI-10, mean scores were computed from a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Negatively phrased items were reverse-coded. The participants were then dichotomized into high/low trait values using the median.

Impact of support on symptom severity and time to recovery

Statistical analysis

Noncompletion was defined as failure to answer whether a second victim event had been experienced. Metric variables are presented as the mean (SD) or median (IQR), depending on their distribution. In the bar charts, the standard error of the mean (SEM) indicates the reliability of the estimate. Categorical variables were analysed via chi-square tests, with effect sizes reported as Cramér’s V or Kendall’s tau-b. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Statistical significance was set at α < 0.05.

"For better visualization, bar graphs are presented as means with standard error of the mean (SEM). All analyses were performed via JASP 0.18.2 and Julius.ai (Caesar Labs, Inc., 2024) for graph generation.

Results

Participation

In total, 408 anesthesiologists participated in the survey. Seven noncompleters were excluded from further calculation. Eight self-perceived SVs did not complete the Big Five Inventory, and 25 did not complete the Big Five Inventory or the symptom load. All data regarding the event, support wishes, and baseline were given. Seven of those who did not perceive themselves as SV did not fill out the Big Five Inventory; these participants provided all the data regarding the nonevent and baseline.

General information on baseline and work experience

The average age was 50.8 years (10.4), with a mean working experience of 21.5 years (11.2). All baseline characteristics are given in Table 1.

Table 1.

Demographic and professional characteristics

Baseline	n (%)
Gender (female/male/diverse)	238 (59.4)/162 (40.4)/1 (0.2)
Age	50.8 (SD10.457)
Age groups (years) in Tercile
27–46	136 (33.9)
47–58	141 (35.2)
59–67	125 (30.9)
Work Experience (years) in Tercile
≤15	144 (35.9)
16–29	126(31.4)
30–50	131(32.7)
Professional Status (abbreviation of the german term)
Postgraduate training (AIW)	44 (11)
Specialist physician (FA)	149 (37.2)
Senior physician (OA)	126 (31.9)
Managing Senior Physician (ltd OA)	36 (9.0)
Head physician (CA)	40 (10.0)
Other	4 (1.0)
Work Setting
Hospital	318 (82.8)
Settled	66 (17.2)
Emergency-related	287 (71.6)
Country
Germany	343 (85.8)
Switzerland	41 (10.3)
Austria	13 (3.3)
Other	3 (0.8)

Demographic and professional characteristics of the respondents, including survey count, gender, age, work experience, professional status, work setting, and country of origin. Concerning professional status, the German equivalents are as follows: postgraduate training = “Arzt in Weiterbildung”; specialist physician = Facharzt”; senior physician = “Oberarzt”; managing senior physician = “Leitender Oberarzt”; and head physician “Chefarzt”

 General experiences with the second victim phenomenon and time to recover

48% stated that they had never heard of it before, and 52% had heard about the SVP before. A total of 76.9% of the participants reported having experienced an SV themselves, and 47.5% reported having experienced it more than once. There were no differences in the baseline characteristics (gender, age, work experience, professional status, or work setting) with respect to having experienced one or more SV incidents.

Patient-related incidents (harm, death, near misses) made up the majority (82.9%). The events leading to experiencing an SVP are listed in Table 2.

Table 2.

Key events

Event leading to becoming an SV	n (%)
Aggressive behavior of a patient, relative, or caregiver	17 (5.6)
Unexpected death/suicide of a colleague	22 (7.2)
Unexpected death/suicide of a patient	75 (24.7)
Incident with patient harm	114 (37.5)
Incident without patient harm/near miss	63 (20.7)
Other	13 (4.3)
Prevalence in Total	304 (100.0)
Other specified
Aggressive behavior of a surgeon
Rampage involving a mass casualty incident (MCI)
Rear-end collision caused by a fleeing vehicle at a railway barrier, leading to the victim’s death
Stabbing attack on a toddler with fatal outcome
Multiorgan donation from a kindergarten child
Emergency involving a deceased child
Emergency response with fatal outcome
Pandemic
Unfounded accusations, verbal aggressive behavior, intimidation attempts by patients/relatives
Death of a teenage accident victim in the ICU due to severe traumatic brain injury
Sexual assault by a patient

Overview of events leading to becoming an SV, categorized by type of incident or self-reported

Time to recover

16% (46) of the SVs reported that they had not yet fully recovered. Of these, 59% [20] reported that the incident occurred over one year ago.

We also tested whether repetitive SV incidence may be associated with recovery time, as suggested in previous studies [18]. In our cohort, however, no statistically significant difference was observed in self-perceived recovery time between those who experienced SVP once and those who experienced it multiple times (p = 0.717, Chi² = 2.891, df = 5, tau-b = −0.023).

Additionally, we did not find any protective factors or groups at risk for prolonged recovery. The details are given in the Appendix (Tables A8.1–3).

The distribution of the time to recover is given in Table 3.

Table 3.

Time to recover

Recovery Duration	Single Events n (%)	Multiple Events n (%)	Total n (%)
Not fully recovered yet	17 (6.0)	29 (10.2)	46 (16.3)
More than a year	13 (4.6)	27 (9.5)	40 (14.1)
Within a year	27 (9.5)	43 (15.1)	70 (24.6)
Within a month	33 (11.6)	41 (14.4)	74 (26.1)
Within a week	15 (5.3)	33 (11.6)	48 (16.9)
Less than a day	2 (0.7)	4 (1.4)	6 (2.1)
Total	107 (37.7)	177 (62.3)	284 (100.0)

Recovery durations after an event are categorized into different time spans. The number of events groups the data into three groups: single event (%), multiple event (%), and total (%)

Burden of second victim symptoms

For those who experienced SVP, the median Symptom Severity Score (SSS) was 8 (IQR = 5.25), with 48.41% above the median. When each symptom was calculated separately, rates higher than 0.5 were considered relevant (between weakly present (0.5) and strongly present [1]). This was the case for reliving situations in similar professional contexts (SSS = 0.59 (IQR = 0.36)), defensive behavior, overly cautious behavior (SSS = 0.54 (IQR = 0.38)), sleep disturbances, or excessive need for sleep (SSS = 0.59 (IQR = 0.39)), feelings of guilt (SSS = 0.66 (IQR = 0.36)), self-doubt (SSS = 0.69 (IQR = 0.33)), the desire for support from others (SSS = 0.62 (IQR = 0.36)), and the desire to process the event to understand it better (SSS = 0.75 (IQR = 0.34)). Details about the distribution of the symptom load for each symptom are given in Fig. 1.

Fig. 1.

Horizontal bar graph displaying the mean scores of the symptom load, with error bars representing the standard error of the mean (SEM). Higher scores indicate greater symptom severity

Frequency of second victim support and rating of second victim support strategies

46% of the SVs received support after the incident. 41% of the SV reported that they had not asked for help, and 12% reported that, despite having asked, they had not received support. The details are given in Table 4.

Table 4.

Support request

Did you receive support from other people during this key event?
No. I have not asked anyone for help. n (%)	126 (41.4)
No, although I have asked for help. n (%)	37 (12.2)
Yes	141 (46.4)
From who did you recieve support?
Collegues n (%)	116 (28.4)
Superiors n (%)	62 (15.2)
Administration n (%)	4 (1)
Family n (%)	79 (19.4)
Pastoral care/psychological counselling/psychotherapy n (%)	22 (5.4)

This table presents data on whether respondents asked for support or received support during key events associated with the second victim phenomenon

95% of the participants rated the options to seek legal advice, prompt debriefing, and contribute information to help prevent similar events in the future as very helpful or rather helpful. Details about the support ratings are provided in Fig. 2.

Fig. 2.

Horizontal bar graph showing the mean score rating of support, with error bars representing the standard error of the mean (SEM). Higher scores indicate a greater rating for the specific support measure. Very helpful = 3, Rather helpful = 2, Rather not helpful = 1, Not helpful at all = 0

Impact of support on symptom severity and time to recovery

Among participants who reported having asked for support but not having received it, we observed a statistically significant association with a greater symptom burden (Chi² (1) = 23.237, p < 0.001, OR = 2.197 [95% CI: 1.190–3.205], tau-b = 0.370), as well as with a longer symptom duration exceeding one month (Chi² (1) = 13.146, p < 0.001, OR = 5.523 [95% CI: 2.049–14.886], tau-b = 0.303). The odds of symptom persistence beyond one year were also markedly elevated in this group (Chi² (1) = 14.518, p < 0.001, OR = 14.786 [95% CI: 2.854–76.592], tau-b = 0.452).

The five-factor model of personality (BFI-10): The five-factor model of personality (the Big Five Inventory [BFI]−10) is presented in Table 5, including the cut-offs (median) used for dichotomization. With respect to becoming a second victim, having low values for the item extraversion seems to be protective for reporting a second victim, although with a small effect size (p = 0.020, Chi² = 5.385, df = 1, tau-b = −0.121), as well as low values for neuroticism (p < 0.001, Chi² = 19.283, df = 1, tau-b = −0.232]). With respect to symptom load, high levels of openness seem protective, but neuroticism seems to have a greater effect, with a weak to moderate association concerning the effect size. Details are provided in the Appendix (Tables A6.1–3 and A7.1–3).

Table 5.

Big five inventory [BFI]−10

Trait	Median [IQR]	High Values (%)
Extraversion	2.5 [1.5]	44.9
Agreeableness	3.0 [1.0]	33.1
Conscientiousness	4.0 [1.5]	30.2
Neuroticism	3.0 [1.0]	38.0
Openness to Experience	3.0 [1.0]	41.4

The table displays the five major personality traits along with their median values, interquartile ranges (IQRs) and percentages (%) of individuals with high values

Discussion

The findings of our exploratory study provide critical insights into the actual prevalence and impact of the second victim phenomenon (SVP) among anesthesiologists in Germany. To our knowledge, this was the first explorative systematic evaluation performed among German anesthesiologists focusing on the SVP.

Experiences with the second victim phenomenon: The majority (76.9%) of the anesthesiologists who completed the questionnaire reported at least one adverse event that led them to perceive themselves as second victims. This prevalence aligns with the findings of previous SeViD studies, including those studies that described perioperative catastrophes and their psychological consequences, without naming the HCP who experienced this a second victim [11]. In the SeViD III study, the prevalence of SVP was 53.1% among prehospital Emergency Medical Services (EMS) physicians, whereas it was 60% and 59% among German residents in internal medicine and nurses, respectively [5, 7, 16, 19]. In our cohort, the prevalence of SVP was much higher at 76.9%. Three reasons might explain the higher level of SVP. First, anesthesiologists perform different types of work. This may expose them more often to threatening incidents. On the other hand, the majority of the EMS physicians in the SeViD III study also worked in environments similar to those of an anaesthesiologist [5]. Second, SVP is better recognized as such; therefore, participants may be more likely to identify with effects that are better known and part of educational material. This hypothesis is supported by the fact that 52% of the participants were aware of the term SV, whereas in former studies, this knowledge about the term SV was much lower (10–25%) [7, 18]. Third, our study participants had a mean work experience of 21.5 years, which was greater than that in previous studies. Consequently, the probability of being involved in an incident associated with SVP might have been greater among these participants.

Time to recovery and burden of second victim symptoms: The burden of SVP was found to be substantial. For 46% of the participants, the recovery time was more than one month. 16% reported that they had not fully recovered, with the majority having experienced adverse events more than one year prior, indicating the long-term nature of the psychological impact. Common symptoms included reliving the situation in similar professional contexts, defensive or overly cautious behavior, sleep disturbances, feelings of guilt, self-doubt, and a strong desire for support and to understand the incident better. These symptoms are consistent with those described in other studies [8, 9, 21], underscoring that they directly affect the quality of the anesthesologists’ work and responsibility to their patients. In particular, sleep disturbances and defensive, overly cautious medicine might profoundly impact patient safety. These findings are reflected in the study by Gazoni et al., where 67% of the respondents stated that their ability to provide high-quality care was compromised for at least 24 h and 16% for more than one week [11]. In a recent small study by Ginzberg et al., surgical trainees were asked for their perceptions of the SVP. The majority, 85% of the affected trainees, reported experiencing embarrassment, 82% rumination and 65.4% fear of attempting future procedures. Additionally, 35.9% considered quitting [22]. These findings highlight the necessity of structured interventions to address the emotional and psychological needs of second victims [23, 24].

One concerning finding was the prolonged recovery time reported by many participants. More than half (56.9%) of those affected reported taking over a month to recover, and a significant proportion (16.2%) had not recovered at the time of their participation. However, no significant demographic or personality traits were found to influence recovery time, indicating that external factors, such as institutional support and workplace culture, may play a crucial role [25].

Compared with their younger colleagues, older anesthesiologists reported a greater symptom load, which could suggest an accumulative effect on the incidence rate over the years.

Risk and protective factors: The analysis of risk factors suggests that personality traits may influence an individual’s susceptibility to SVP. Extraversion and neuroticism were associated with a greater likelihood of becoming a second victim. Interventions targeting emotional regulation and stress management could therefore be beneficial in mitigating the psychological impact of adverse events.

Interestingly, neither age nor work experience significantly influenced the likelihood of becoming a second victim, suggesting that the phenomenon affects anesthesiologists across all career stages.

Second Victim Support Strategies: We asked all the participants to rate their support strategies. Interestingly, legal counselling was the highest-rated request, followed by contributing information to prevent further events, including prompt debriefing. These findings were in line with those of the former SeViD III study on EMS physicians [5]. In this case, in Germany, an excellent institution, the PSU-helpline© offers support via phone and email for all healthcare employees, managers, and peers who are experiencing SVP and stressful situations (www.psu-helpline.de). However, addressing only the top-rated support strategies is not sufficient and might lead us, in disastrous situations, to not observe the whole process. If our aim is to mitigate the duration of symptoms and reduce the burden of symptom load, with all its impacts on HCPs’ and patients´ safety, addressing all support measures, not only the top-ranked measures, might be highly important.

We also observed that if help is not provided, even when it is requested, we demonstrated markedly elevated odds for symptom persistence and burden of symptoms. However, these results should be interpreted with caution, as unmeasured confounding factors may influence group comparisons. The limitation of these findings is the rather wide CI interval, suggesting a rather lower precision of the odds ratio. However, the risk of greater symptom load in the case of poor colleague support is in line with findings from the SeViD IX pilot study, which revealed that colleague support decreases symptom load, as long as physical distress is low. In high distress, colleague support of any kind did not [26]. Therefore, our findings reinforce the need for second victim support programs, especially those asking for help, and those who are being asked first—these are colleagues and peers better available to a second victim. Conclusively, these persons have to be educated regularly in “first aid skills” to act appropriately on second victims (and themselves). With respect to anaesthesia, this applies to all professionals.

Implications for Policy and Practice: Given the high prevalence and profound impact of SVP, healthcare institutions must take proactive steps to address the needs of second victims. For this purpose, the European Researchers’ Network Working on Second Victims (ERNST) has proposed a five-level model of support that includes (1) Prevention (individuals/organizations), (2) Self-care (individual/team), (3) Peer support, (4) Professional support and (5) Structured clinical support [27].

Currently, empirical data on the effectiveness of second-victim (SV) programs are limited. A meta-analysis by Anger et al. demonstrated that intervention programs positively influence the mental health of healthcare professionals [20]. Common features of these programs include raising awareness about the second victim phenomenon, establishing professional peer support systems, and incorporating higher levels of care [28, 29].

Limitations and Future Research: While our study provides initial valuable insights, it has certain limitations. The use of self-report surveys and the recruitment of participants in a conference setting may introduce self-selection bias. Participation was voluntary and may have particularly attracted anesthesiologists already engaged with the topic or who were more willing to share their experiences. This limits the representativeness of the sample and may affect the generalizability of the results. Conversely, the survey could not reach those who had already left practice due to the effects of being a second victim.

Another limitation is that the sample appears to overrepresent experienced clinicians (mean age 50.8 years, mean of 21.5 years of experience). A cumulative effect on the development of the Second Victim Phenomenon with increasing professional experience is plausible because of greater exposure to critical incidents over time. However, resilience and adaptive coping may also increase with experience. In support of these effects, a previous study revealed that even among young physicians with an average of 4 years of experience, 59% had already experienced one or more SV incidents [18].

Furthermore, social desirability and self-awareness may have influenced responses to the item regarding second victim status. On the other hand, when asked whether they had ever heard of the second victim phenomenon, 48% reported that they had never heard of it.

In contrast to other European countries, German anesthesiologists working in different medical fields (e.g., operating theatres, intensive care medicine, in-hospital and out-of-hospital emergency medicine, pain therapy, and palliative care) should be compared with anesthesiologists in other nations with caution and remain to be explored in more detail. Although we adjusted for the workplace, interactions that do not exist in other countries may be prevalent. Additionally, and as intended, our work is explorative without adjusting for multiplicity and with subtests with partially low sample sizes. Consequently, confirmatory research in larger populations is needed for the specification of risk factors and dependency in different working fields. Future research should explore the longitudinal outcomes of second victims, investigate the efficacy of institutional interventions, and examine the role of workplace culture in modulating SVP experiences.

Conclusion

The second victim phenomenon is prevalent among German anesthesiologists and has potentially severe implications for physicians’ mental health and, consequently, the quality of patient care. Our study highlights the burden of the second victim phenomenon, the symptom load, and the recovery time. This underscores the need for institutional interventions and support structures to mitigate the psychological burden of adverse events. Addressing this issue through education, peer support, and systemic changes in leadership and work culture will be essential to provide better support for second victims, promote a healthier work environment, and ensure the best patient care.

Participants received the following information prior to participation:

The study was submitted in advance to the Chair of the responsible ethics committee. Owing to the voluntary and anonymous nature of the survey, the need for professional advice (ethics vote) was waived. The results of the survey will be used in aggregated form for scientific purposes and specialist publications. By participating, you kindly give your consent for these data to be used for this purpose.

Abbreviations

Abbreviation

Full Term/Meaning

SVP

Second Victim Phenomenon

SV

Second Victim

HCP

Healthcare Professional

PTSD

Posttraumatic Stress Disorder

ERNST

European Researchers’ Network Working on Second Victims

ICU

Intensive Care Unit

BFI-10

Big Five Inventory − 10 Item Version

BDA

Berufsverband Deutscher Anästhesistinnen und Anästhesisten (Professional Association of German Anaesthesiologists)

OR

Odds Ratio

CI

Confidence Interval

SD

Standard Deviation

SEM

Standard Error of the Mean

IQR

Interquartile Range

SSS

Symptom Severity Score

AIW

Arzt in Weiterbildung (Postgraduate training physician)

FA

Facharzt (Specialist Physician)

OA

Oberarzt (Senior Physician)

ltd OA

Leitender Oberarzt (Managing Senior Physician)

CA

Chefarzt (Head Physician)

MCI

Mass Casualty Incident

EMS

Emergency Medical Services

PSU

Psychosoziale Unterstützung (Psychosocial Support) – as in PSU-Helpline©

JASP

Statistical software

SeViD

Second Victim in German-speaking Countries (Survey series)

SVEST-R

Second Victim Experience and Support Tool – Revised

Authors’ contributions

As the first and corresponding author, Tobias Bexten (TB) contributed substantialy in conceptualizing the study, drafted the original manuscript, coordinated the author group, and performed/supervised data analysis and interpretation.Hannah Roesner (HR) contributed substantially to the study design, data acquisition, project administration, and critically revised the manuscript.Stefan Bushuven (SB) supported the conceptual framework, supervised the project, validated findings, and contributed to the critical revision of the draft, especially on the statistical aspects.Victoria Klemm (VK) was involved in data interpretation, formal analysis, and reviewed the manuscript critically for important intellectual content.Anne Kamphausen (AK) supervised the project, validated findings, and participated in reviewing and editing the manuscript.Reinhard Strametz (RS), as senior investigator, supervised the study design, data acquisition, project administration, and critically revised the manuscript.Grietje Beck (GB) as senior investigator, initiated the study, coordinated the data collection unter the patronage of the Professional Association of German Aneesthesiologists, contributed to data interpretation, methodological refinement, and provided significant input during the review and revision phases of the manuscript.All authors meet the criteria for authorship in accordance with the recommendations of the International Committee of Medical Journal Editors (ICMJE).Each author has approved the final version of the manuscript and agrees to be accountable for all aspects of the work.

Funding

This research received no funding from any public, commercial, or not-for-profit agency.

Data availability

The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Owing to the voluntary and anonymous nature of the study, formal ethical approval was requested but waived by the Chair of the Ethics Committee of the Medical Faculty at Goethe University Frankfurt/Main, Germany. This decision was made in accordance with the Declaration of Helsinki. Informed consent to participate was obtained from all participants prior to their inclusion in the study. Participation was entirely voluntary, and data were collected anonymously, without the use of tracking tokens, cookies, or IP addresses.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.