Vulnerability of Inexperience: A Qualitative Exploration of Physician Grief and Coping after Impactful Pediatric Patient Deaths.

Abstract

<b><i>Background:</i></b> Caring for dying patients can result in burnout, stress, and emotional trauma for some physicians,^1,2 particularly among trainees. Research is lacking that focuses on the emotional impact and coping techniques utilized by novice and experienced pediatricians after impactful pediatric patient deaths. <b><i>Objectives:</i></b> To define the salient features of an impactful pediatric patient death and physicians' grief and coping responses. As a secondary aim, we explored the cognitive and emotional training physicians described as helpful or would be helpful when coping after impactful patient deaths. <b><i>Design:</i></b> We conducted a prospective qualitative study using semistructured interviews and applied descriptive thematic content analysis to the transcribed interviews. <b><i>Setting/Subjects:</i></b> We enrolled pediatric intensive care unit trainees and attendings in a single United States institution over a six-month period from January 2021 to June 2021. <b><i>Results:</i></b> Both trainee and attending physicians were most impacted by acute or unexpected patient deaths. Trainees were particularly impacted by their first or early career patient deaths. Both groups found talking about the death of a patient the most helpful coping mechanism. Attending physicians coped with positive reframing, whereas novices more frequently utilized avoidance, numbing, and rumination. The importance of experienced physician's role modeling vulnerability and supporting trainee growth rather than "getting it right" were highlighted as trainee coping gaps. <b><i>Conclusions:</i></b> Novice physicians are particularly vulnerable to acute stress after the death of a patient and require additional coping resources and supports. Future projects should explore the impact of teaching emotion-focused coping techniques on trainee resiliency and coping after early career patient deaths.