Navigating patient death and grief in German neurosurgical residency: a mixed-methods study

Neurosurgical residents encounter patient death during their training, yet the literature lacks understanding of their experiences and responses. The aim of this study was to explore how residents navigate patient death, communicate with families, and engage with coping and support mechanisms during their neurosurgical training in Germany.

The authors conducted a qualitative-dominant mixed-methods study among neurosurgical residents in Germany. The qualitative component included semistructured in-depth interviews and focus group discussions with neurosurgical residents. The quantitative component consisted of a cross-sectional survey administered across university, community, and private training hospitals. Emotional burden related to patient death was assessed using a 0-10 numeric rating scale, with 0 indicating no burden and 10 indicating the maximum perceived emotional impact. Data collection occurred between January and February 2026.

Among 44 in-depth interviews, 2 focus group discussions, and a cross-sectional survey, 112 neurosurgical residents (70% male and 30% female; 57% in their 5th year or beyond, and 56% training in university hospitals) reported a range of experiences following patient deaths and serious clinical events. Junior residents, particularly those caring for pediatric patients or rapidly deteriorating adults, described heightened emotional engagement, self-reflection, and occasional self-doubt. In the 6 months preceding the survey, 41% (n = 46) of participants reported exposure to 1-2 patient deaths. The mean emotional burden increased with greater exposure to patient death; residents who reported 1-2 deaths scored 5.8 and those who reported ≥ 3 deaths scored 7.2. Residents reported relying primarily on informal coping strategies, including peer discussion (80%, n = 90), personal reflection, and self-directed activities such as exercise or mindfulness. Formal support mechanisms, including structured debriefings, mentorship, or psychological counseling, were less consistently available: 35% reported regular debriefings (n = 39), 28% had access to a mentor in cases of grief (n = 31), and fewer than 9% used institutional support services (n = 10).

This study captured neurosurgical residents' experiences of grief, their communication with families, the emotional burden of patient deaths, as well as coping mechanisms that include both formal and informal strategies.