Professional traumatic grief in neurosurgery: domains, red flags, and first-line support for trainees and surgeons,...

Complications and deaths are unavoidable in neurosurgery, and although their emotional impact on surgeons and trainees is increasingly recognized, distress, burnout, and silent attrition remain substantial. In parallel, fields such as nursing and psychology have developed rich frameworks for understanding and supporting professional grief, suggesting opportunities for collaboration. Herein, the authors aimed to 1) use a nursing-derived professional traumatic grief (PTG) framework to describe how this construct might manifest in neurosurgeons and neurosurgical trainees after major adverse events, 2) derive clinically recognizable symptom domains for these reactions and distinguish expected short-term responses from more concerning red-flag patterns, and 3) outline simple, realistic coping options mapped to these symptom domains.

The authors convened a multidisciplinary expert working group within a specialized neurorehabilitation hospital consisting of 3 senior neurosurgeons, 2 senior clinical psychologists, 1 senior operating room/ward nurse coordinator, 1 senior physician, and 1 senior neuroscience researcher. After preparing a narrative synthesis of the nursing literature on PTG and the Inventory of Symptoms of Professional Traumatic Grief (ISDUTYP) and neurosurgical research on complications, distress, and "second victim" experiences, the group used structured consensus meetings to 1) derive clinically recognizable symptom domains for neurosurgeons and trainees that were conceptually informed by the 25-item nursing ISDUTYP, 2) differentiate expected short-term reactions from more persistent or intensified red-flag patterns, and 3) identify example coping strategies mapped to each domain. No patients, scale administration, or quantitative analyses were involved.

Five descriptive domains were identified: emotional burden; intrusions and re-experiencing; physiological arousal and sleep problems; maladaptive coping behaviors; and avoidance, detachment, and impaired adaptation. Each domain was linked to composite neurosurgical examples grounded in the neurosurgical literature. Within each domain, short-term reactions that are intense but usually expected in the first days to weeks after a major complication or death were distinguished from more persistent or impairing red-flag patterns. Simple adaptive strategies that neurosurgeons, trainees, and programs can consider to support healthy coping were summarized, and trainee-specific nuances were briefly noted.

Informed by the ISDUTYP scale, the authors offer neurosurgery-specific domains, expected short-term reactions versus red-flag patterns, and domain-based coping examples as clinical heuristics rather than diagnostic tools. They borrowed this PTG lens from nursing and used it within multidisciplinary teams (including neurosurgeons, psychologists, and nurses) to further develop, adapt, and test future frameworks specifically meaningful for neurosurgeons and trainees.