Suicidal ideation in Residency: Recommendations for building a Supportive Learning Environment

Although overall suicide risk for physicians may be decreasing from historical estimates, each physician suicide is a tragic loss of life for the affected individual and their family and has a profound impact on their colleagues, their team, and their organization. Work-related problems appear to be more common prior to instances of physician suicide relative to suicide occurring in other workers, and Nasca and colleagues' study, "One Is Too Many: Suicidality Among General Surgery Residents," elucidates several factors that were associated with increased risk for suicidal ideation in the previous 12 months among surgical residents. While all of the causal mechanisms and inter-relationships among burnout, depression, suicidal ideation, and work environment are incompletely understood, it seems clear that there are factors in the training and practice environment that influence the risk of burnout, depression, and possibly suicidality, beyond individual risk factors. Programs and institutions can work to improve the training environment by fostering belonging and social connection at work; striving for a culture that fosters psychological safety and reduces shame after adverse events or suboptimal performances; ensuring a manageable workload that allows adequate time for sleep, self-care, and personal relationships; and providing opportunities for developing progressive autonomy and maintaining meaning in work. For example, institutions can ensure that mental health services have a low barrier to access and are free or low cost. In addition, they can prioritize providing adequate time for faculty to engage in teaching and mentoring to support trainees' progressive development of autonomy and connection to meaningful work. In the post-COVID landscape, policy and advocacy efforts locally and nationally that protect health care workers from bullying, harassment, and workplace violence are additional important components of creating a sustainable and thriving clinical environment.