New Peer Support Program Helps Surgeons Process Adverse Events and Improve
By Elisabeth Geier
When things go wrong in the operating room, it can have lasting effects on everyone involved. Of course, the patient and their loved ones are most directly impacted. For patients facing a challenging recovery, or families negotiating the grief of an unexpected loss, psychological services and emotional support groups offer the opportunity for healing.
For surgeons involved in adverse outcomes, the aftermath can be overwhelmed by feelings of grief and guilt. Steven Stylianos, MD, Chief of Pediatric Surgery at NewYork-Presbyterian/Columbia, says it’s all part of the reality of being a surgeon. “The circumstances of taking care of really sick people every day, where so many things can go wrong, is that if they do go wrong, the first thing a surgeon will do is internalize it,” he says.
As research and understanding of mental health have grown, the medical community has recognized the importance of processing difficult emotions that come with the job. Both to help the surgeon, and to ensure patients continue receiving top-notch care.
Dr. Stylianos is the champion behind a new peer support program at Columbia that lets surgeons process adverse events in a supportive, stigma-free setting.
It started earlier this year with a surgery debriefing in which a young attending had a bad complication. Dr. Stylianos was troubled by the way some people on the call reacted. “They were a touch less sympathetic than they could have been,” he recalls. “It was nothing like the old days when people would say obnoxious, horrible things. None of us do that anymore.” But he could tell the young surgeon was suffering and needed greater support to process what happened.
Dr. Stylianos reached out to Craig Smith, MD, Chair of the Department of Surgery, with a question: “What do we do for our young surgeons when they’ve had an adverse outcome?” Dr. Smith explained that somebody would usually talk to them and offer an empathetic ear. But Dr. Stylianos worried that without a formal support program in place, some practitioners were inevitably falling through the cracks.
“When a clinician is really suffering over a bad outcome, over possible litigation, it’s a devastating blow,” he says. Clinicians needed space to vent some of the negative feelings that come up and receive effective support to move forward. “Over the last 20 years, there’s been a more scientific approach to peer support,” he says. “And I asked, ‘Shouldn’t we do that?’”
Dr. Smith agreed. That’s when Dr. Stylianos reached out to a national expert on peer support in medicine, Jo Shapiro, MD. An ENT surgeon at Harvard, Dr. Shapiro has devoted her career to fostering peer support programs around the country. Peer support programs function with the understanding that while clinicians must be strong and responsive in supporting families, it is not sustainable for them to deny the challenges and emotional impact of their work in the long run. Peer support programs increase the capacity to give compassionate and wise care to patients.
After meeting with Dr. Shapiro, Dr. Stylianos began planning a peer support program across surgical departments at Columbia. “I spoke to the chairs in otolaryngology, in urology, neurosurgery, and orthopedics,” he says. “They all said, ‘Let’s do it!’”
He also consulted experts in psychiatry to act as advisors for the project but pointedly they do not offer treatment directly to surgeons. “If a surgeon makes a mistake and speaks to a psychiatrist, that sounds like psychiatric treatment,” Dr. Stylianos explains. Peer support is different, facilitators are trained to listen without offering advice or counseling. The goal is to provide an empathetic ear and respond with compassion: “it’s a platform in which to share their grief.”
With those guidelines in mind, they set out to find facilitators for the peer support program. “It has to be an individual with certain personal qualities that are admired by their peers,” Dr. Stylianos explains. “Someone who's trustworthy, someone who's empathetic. We purposefully did not do self-volunteering but sought nominees so that others recommended who they thought would be great in their department.”
Eventually, they identified 18 peer support trainees—13 attendings and five residents, including participants from each department—and invited them to a 2.5 hour training session with Dr. Shapiro.
The logistics are fairly simple: after an adverse event, as the relevant department analyzes what happened and how to prevent it from happening again, the clinicians involved are identified and referred for peer support.
“The toughest part is to initiate,” Dr. Stylianos explains. “It's not based on someone asking for help. It's based on, as soon as an event occurs, that person being identified as a candidate for peer support and contacted.”
Once a clinician has been identified as a candidate, a peer support facilitator schedules a meeting with them, “allowing the person suffering to speak, to just get it out.” At the end of that session, the facilitator offers to reach out again and provides institutional resources that may be useful.
It might sound basic, but just the intentional act of reaching out and offering support has a huge impact on clinicians in the aftermath of an adverse event. And the sooner they receive support, the more likely they are to avoid long term issues.
So far, the peer support program at Columbia is flourishing in its “initiation phase.” The next challenge is to keep it going so that it becomes part of the institutional culture.
Dr. Stylianos has high hopes for the program’s success, in part because of how far the science of wellbeing and peer support have come over the course of his own career.
“It’s really heartwarming, in a way, to see that this is now being incorporated into all of medical education,” he says.
Dr. Stylianos even admits that his generation of surgeons might be a little jealous of the new class. “No one ever used the term ‘wellbeing’ in the past,” he says. “We cared deeply for one another, but especially in the surgical game, there's a certain toughness and grit that is supposed to be inherent.” In the past, if you had a less than optimal outcome, “you’d just suck it up and move on to your next challenge.” Nowadays, more weight is given to the impact of adverse outcomes on the practitioners involved.
Of course, it can be difficult to talk about adverse outcomes in surgery. Nobody wants to consider the possibility of complications or clinician error. Patients want to know they’re in capable hands, and surgeons have to be confident in what they do. The goal of the peer support program (and other initiatives supporting practitioners’ mental and emotional health) is to provide space for surgeons to navigate the complexities of their work while maintaining its excellent quality.
We’re all human after all. “And ultimately,” says Dr. Stylianos, “It’s about being the best surgeons we can be.”