Many physicians have experience dealing with patient deaths, but the death of a resident or a fellow by suicide can initiate a different set of emotions and responsibilities. A toolkit with consensus recommendations endorsed by the American Foundation for Suicide Prevention offers practical tips and tools to help training programs respond in the aftermath of a suicide. These include strategies to minimize the risk of suicide contagion.
The toolkit, “After a Suicide: A Toolkit for Physician Residency/Fellowship Programs,” advocates having a plan in place prior to a suicide occurring and specifies 14 crucial procedures, which include:
- Creating a checklist. This will break out essential activities, from making notifications to planning a memorial service, in both the immediate aftermath and the following weeks. The toolkit offers a detailed suggestion.
- Forming a crisis response team. This team will carry out the critical functions of crisis management. It should include several key individuals, such as a designated institutional officer, associate deans, mental health staff and members of the communications, human resources and legal teams. The team leader will make sure the checklist is carried out.
- Getting the facts first. Communicating accurate information helps prevent speculation and rumors that can fuel emotional turmoil. Depending on the situation, the right information may be obtained by contacting the coroner, the medical examiner’s office or local law enforcement.
- Do’s and don’ts of sharing the news. These are critically important to ensuring that suicide contagion risk is minimized. “Contagion risk is heightened when a vulnerable individual is exposed to sensationalized communication about the suicide or when the deceased’s manner of death or life is portrayed in an idealized manner,” the toolkit notes. This risk can be mitigated by highlighting available mental health resources and ensuring that every communication is vetted.
- Helping residents cope. The suicide of a peer can make residents and fellows feel overwhelmed and disrupt patient care. Some may experience it as psychological trauma and have related symptoms, such as hypervigilance and sleep disruption. Consider giving trainees explicit permission to seek wellness activities and mental health services.
- Supporting faculty and staff. Those who worked with the trainee should be reminded that caring for oneself is a professional obligation and that they can play important roles in looking out for each other. Also, take time to build relationships with trainees and acknowledge their hard work. And if you are worried about a trainee, call the program director.
- Memorializing the trainee who has died. The approach for responding to the death of a trainee by suicide should be the same as for a trainee who dies from an accident or illness. This will minimize stigma and reduce the risk of suicide contagion. The toolkit includes advice for choosing a location, time and format for a memorial service, as well as tips for responding to requests for a permanent memorial.
- Dealing with the news media. A member of the crisis response team should lead media relations efforts, and trainees might be advised to avoid media interviews. In addition, guidance should be given to news media on how to report on the death to minimize the risk of suicide contagion.
- Moving forward. Trainee wellness must be supported well beyond the acute phase. The toolkit provides seven tips for navigating the months following the suicide.
The appendix provides a variety of crisis-response tools, such as sample scripts for face-to-face and email communications, key messages for media spokespeople and a memorial service-planning checklist.
Companion video and webinar
The toolkit is part of a library of educational resources compiled by AFSP, the Accreditation Council for Graduate Medical Education and Mayo Clinic as part of an initiative to prevent suicides among physicians and medical trainees. The resources include a video, “Make the Difference: Preventing Medical Trainee Suicide,” which urges residents and fellows talk to each other about the stressors of medical training and encourages help-seeking behavior.
The library also features a webinar, “Combating Burnout, Promoting Physician Well-being: Building Blocks for a Healthy Learning Environment in GME,” detailing a hands-on approach for conducting a needs assessment for developing a resident well-being plan. The free webinar requires registration.
In addition to Mayo Clinic’s work on preventing and responding to trainee suicide, Mayo Medical School received a grant through the AMA’s Accelerating Change in Medical Education Consortium to pilot an educational model to prepare students to practice within collaborative care teams. To help ensure students are wellequipped for a career in medicine, Mayo Medical School is developing curricula and tools to enhance student well-being and resiliency. One of these is the Medical Student Well-Being Index, which allows self-assessment of distress and immediate access to local and national resources.
To reach out for help for yourself or someone else, call the National Suicide Prevention Lifeline at (800) 273-TALK.