Those left behind: the impact of resident suicide on trainees, faculty, departments, and institutions

Suicide is a leading cause of death for residents and can have a profound impact on those left behind, increasing their risk of suicide. Suicide survivorship has not previously been explored in residency programs. This study sought to understand and describe the impact of resident suicide on trainees, faculty, and programs via a hermeneutic phenomenological approach.

Semistructured interviews and focus groups were conducted during site visits to 15 U.S. Accreditation Council for Graduate Medical Education-accredited general surgery residency programs (March 2019-March 2020) with purposive sampling to identify key stakeholders in resident wellness. If suicide was disclosed, interviewees were asked to share perspectives on their relationship to the resident, perceived risk, responses, and subsequent changes. Transcripts were analyzed with both deductive and inductive coding by multidisciplinary dyads.

Of 393 transcripts, 34 had content focused on suicide, representing residents (postgraduate years 1-5), faculty, program directors or associate program directors, program coordinators, department chairs, and designated institutional officials or deans from 10 programs. Themes were aligned with the stages of processing suicide-sense-making, postvention, and transition to prevention. Across all phases, programs differed in their recovery trajectories. Respondents reported convergent and divergent reactions, perceptions, and pathways through sense-making and described both effective and ineffective postvention efforts. Some programs successfully transformed loss into prevention efforts, while others confronted the limits of understanding a suicide. Lack of faculty support after a suicide was noted to have far-reaching implications for resident education. Programs that successfully transitioned reduced barriers to accessing mental health resources: ensuring confidentiality, easing financial and scheduling challenges, decreasing stigma, and implemented risk mitigation strategies.

Resident suicide is a profound loss, affecting everyone left behind. Providing support to those affected during the aftermath of suicide is critical to facilitate sense-making, provide effective postvention, and spur a meaningful transition to prevention.