277 - Factors Impacting Pediatric Physician Experiences of Second Victim Phenomenon

Publication Number: 1263.277

Anneliese Grewing, University of Colorado School of Medicine, Aurora, CO, United States; MIchelle Kiger, MD, PhD, University of Colorado School of Medicine, Aurora, CO, United States; Jennifer Reese, University of Colorado School of Medicine, Aurora, CO, United States; Meredith Bone, University of Colorado School of Medicine, Aurora, CO, United States

Background: Second victim phenomenon (SVP), the emotional and psychological distress healthcare workers experience following adverse patient events, has been described to entail six stages: chaos/accident response, intrusive reflections, restoring personal integrity, enduring the inquisition, obtaining emotional first aid, and moving on. However, little is known about what influences the progression through these stages, which limits our ability to tailor interventions to help physicians experiencing SVP. Therefore, we investigated which factors, both internal and external to the physician, impact how physicians experience and move through the stages of SVP.

Objective: To characterize internal and external factors that influence physicians’ progression through SVP.

Design/Methods: Under a constructivist framework, we conducted a single-center qualitative study individually interviewing attending physicians from six pediatric subspecialties: critical care, neonatology, cardiology, hematology/oncology, hospital medicine, emergency medicine. We ask about participants’ experiences with SVP, including specific attention to coping mechanisms they used, which people they turned to for support and why, and what institutional factors affected their progression through the stages of SVP. We analyzed data through an inductive thematic analysis.

Results: We conducted twenty-nine interviews, through which we identified three themes capturing key influencers on the progression of participants through SVP: 1) Helpful internal mindsets and self-thoughts included self-compassion, growth mindset, self-awareness, acceptance of ambiguity, and vulnerability. Individuals also described personal rituals to process events, and both positive and negative coping strategies; 2) Interpersonal influences involved formal and informal peer support, mentorship from seniors as well as mitigating trainees’ experiences of SVP, and support from family and friends outside work; and 3) System-level and cultural factors such as morbidity and mortality conferences, safety event reviews, debriefings, and scheduling also shaped responses to adverse events.

Conclusion(s): Experiences of SVP among pediatric subspecialty attendings are shaped by a complex interplay of internal dispositions, social relationships, and institutional culture. Tailoring interventions to address these multifaceted influences may promote resilience and psychological safety in high-acuity pediatric environments.