Peer-to-peer support after adverse outcomes in neurosurgery: a model in an academic department

Severe adverse events and complications are an unfortunate but inevitable part of practicing neurosurgery. Complications, unexpected deaths, and outcomes that fall short of what patients and surgeons hoped for are often attributed to causes on a personal level, and may contribute to guilt, shame, moral injury, emotional blunting, and burnout. Despite these effects, many neurosurgeons and trainees are reluctant to seek formal mental health care after difficult cases, instead preferring confidential support from trusted colleagues. The authors describe a peer-to-peer wellness model in the Department of Neurosurgery at Columbia University in which faculty and residents can access confidential sessions with a senior neurosurgeon to process complications and patient outcomes, and they situate this work within the evidence base for clinician peer support.

This is a narrative description of a departmental support structure informed by literature on peer support in surgery.

In this model, faculty and residents are offered confidential one-on-one sessions with a senior colleague trained by experience to listen, normalize reactions, and facilitate adaptive processing after high-impact events. Sessions focus on helping surgeons make sense of the case, separate responsibility from what was unavoidable, reduce isolation and shame, plan for disclosure and return to the operating room, and recognize when additional professional support is needed. Existing surgical literature supports the idea that adverse outcomes commonly provoke second-victim symptoms and that surgeons often prefer peer support. Structured peer programs have demonstrated feasibility and uptake in surgical departments.

Department-embedded, confidential peer support can provide timely emotional first aid for neurosurgeons at moments when feelings of guilt, shame, or incompetence are most acute. A simple, trusted, senior-facilitated model may complement formal institutional resources, strengthen professional connection, and reduce the downstream harms. Future work should evaluate utilization patterns, perceived impact, and pathways to escalation of care.