"You Really Never Forget It": Psychiatry Trainee Supervision Needs and Supervisor Experiences Following the Suicide of a Patient

Abstract

Background: Suicide has become the second leading cause of death in adolescents and young adults ages 15-34 and the third leading cause of death in individuals between the ages of 10-14. About 30-60% of Psychiatry Residents experience patient suicide during their training, however the supervision and guidance around managing the emotional burden is highly variable. Timely oversight and support from supervisors can provide a safe place to explore and process the difficult experience of patient loss due to suicide. Currently, there are no formal guidelines for either the supervisor or supervisee in educational practice. Methods: This study was designed as a qualitative research project and utilized individual semi-structured interviews of trainees and supervisors identified by criterion sampling. Participants were recruited from General Psychiatry residency, Consultation Liaison fellowship, and Child & Adolescent Psychiatry fellowship training programs in New England. A second coder reviewed the first level and second level codes, as well as the main categories and sub-categories. Mentors reviewed the interim themes and also the final results. An inductive thematic analysis was conducted to reach final interpretations. Results: 13 Trainees and 14 supervisors were interviewed. There was lack of preparedness at an individual and programmatic level with the need for formal protocols to direct trainees about the trajectory of events that unfold when a patient dies by suicide. Credibility of both the process and supervisor was deemed to be important by trainees who appreciated supervision where they could hear from a supervisor about their experience of dealing with a patient suicide, so as to have a framework in which to process their own experience. Participants considered the suicide of a patient a life changing event that impacted them emotionally and also their sense of self-efficacy. A hidden curriculum of stoicism often created barriers to seeking additional support for trainees and supervisors and this was further perpetuated by a disconnect with an administrative system that was more analytically focused than being emotionally supportive. Conclusions: There is a significant lack of preparedness on how to deal with the aftermath of a patient suicide for both the psychiatry trainee and supervisor, and at a programmatic level. This study will address this gap by helping inform the development of formal supervision guidelines that can be used by Psychiatry training programs.