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Note: Program Directors of the deceased trainee will need to notify trainees, faculty, and staff in their program. The Crisis Response Team will support this effort. Written communication should be handled by the Crisis Response Team, in partnership with Medical School Communications. This will allow program directors to focus on the needs of the trainees and leave the coordination to the Crisis Response Team.
In-Person Communication with Trainees and Faculty
Following notification of key personnel and the emergency contact person, a plan must be developed and implemented for how to notify fellow trainees of the deceased trainee and relevant faculty. What to say and how to say it varies by the group being informed and the cause of death.
Notification should occur as soon as possible, ideally the same day of the death or before work starts in the morning. If there are trainees who were very close to the deceased who are known to the institution (significant others, close friends), they should be notified first and separate from the others. Members of the Crisis Response team should connect regularly with these individuals over the next few weeks. The Crisis Response team through the GME office can partner with you to provide crisis counselors/psychologists to be available for when you break the news. Someone from the team can be present to make sure that all key messages are communicated. When you contact the DIO/Associate DIO, just ask for this assistance.
Although it is permissible to disclose that a trainee has died, the cause of death should not be disclosed unless approved by the emergency contact person. In situations where the family does not want the cause of death shared with other trainees, it is still important to acknowledge the death and follow that immediately by saying or writing about the supportive mental health resources that are available to the trainees. If the cause of death has not been confirmed, and there is an ongoing investigation, individuals on the Crisis Response Team should state that the cause of death is still to be determined and additional information will be forthcoming.
Notifying trainees in the same program as the deceased trainee:
Should occur in-person the same day of the death or before work starting in the morning.
If possible to divide the trainees into groups to deliver the news, this is recommended in order to encourage honest dialogue and to avoid group escalation in anxiety, which is more likely in a large group setting. If not possible, the office staff should secure a room large enough to hold all trainees in the same program as the deceased trainee.
The office staff should page/call every trainee telling them of an emergency mandatory meeting. Trainees who cannot be reached by phone can be emailed with instructions to call in as soon as possible regarding a work emergency.
Program Leadership including APD and PC should attend this meeting.
It can be helpful to have mental health counselors/psychologist, available at the meeting if possible.
During the meeting, any Crisis Response team members should introduce themselves and any other guests. Share accurate information about the death of the trainee, as permitted by the emergency contact person. If disclosure is not allowed at this time, the team can state: "The family/emergency contact person has requested that information about the cause of death not be shared at this time."
If the death was from suicide, members of the Crisis Response Team can take the opportunity to talk with trainees about suicide in general terms: "We know there has been a lot of talk about whether this was a suicide death. Since the subject of suicide has been raised, we want to take this opportunity to give you accurate information about suicide in general, ways to prevent it, and how to get help if you or someone you know is feeling depressed, struggling, or may be suicidal.”
Allow trainees to express their grief, and identify those who may need additional support and resources. Explain that everyone’s grief response is different - some trainees will need time off and others may find solace in working. Commit to providing coverage or changing schedules as needed. Remind all trainees of the importance of seeking help if they are experiencing difficulty, and how to do so.
Remind the trainees of the processes in place for accessing care.
Provide a list of individuals, such as attendings well known to be particularly excellent advisors to trainees, who the trainees can reach out to talk about the loss and to debrief.
They can seek out help from our EAPs (Physician Wellness Collaborative or Vital WorkLife)
Clinical treatment may be indicated ( for sleep, anxiety, mood and prevention of a depressive episode, for example in a trainee with a history of recurrent depressive episodes). They can reach out to their PCP, online through Blue Cross Doctor on Demand, or utilize the Physician Wellness Collaborative.
Address barriers to help self care.
Explain the process for taking time off and how CRs or PDs will help arrange coverage. Emphasize that over the course of training everything evens out and colleagues are happy to cover for them.
Remind trainees that the PDs will not know who is receiving mental health care. Consider having people in the audience speak about their own experience about seeking mental health care, or stating that many people who have never sought mental health services find speaking with a trained mental health professional at times like these very helpful.
Some trainees may have heard that seeking mental health services may have a negative ramifications on licensure. In fact, unaddressed mental health problems are much more likely to negatively impact safe practice or medical licensure than appropriate help seeking behaviors.
Remind trainees if they have struggled with depression themselves or are actively getting mental health care to check in with their therapist.
Other Key Points to Cover
Inform them of a clear mechanism to help identify anyone they are concerned about (e.g. who should they bring that information to if concerned).
For deaths by suicide, share information about suicide bereavement groups in the community (afsp.org has > 500 nation-wide support group listing).
Ask if trainees know if there are others (outside of the institution) who may need to be notified or sent resources. For example, the trainee may have a partner/significant other from the local area that is not known to the family but those friends of the deceased all know.
As applicable, inform the trainees about the funeral and process for requesting time-off to attend the funeral.
Share that there will be plans for a memorial service in the coming weeks.
Considerations
There are likely to be individuals in the group who are more deeply affected by the death. It may be difficult to meet their needs during the initial meeting. It might be helpful to allow for a separate time for those who wish to discuss in more detail, particularly if the reporting is to a larger group. For example, Crisis Response Team members could offer to spend an additional 30 minutes with anyone who wants to talk further about the death.
A second meeting for the trainees may also be wise to encourage them to think about how they would like to remember their comrade. Ideas include writing a personal note to the family, participating in or attending the memorial service, and doing something kind for another person. Other reflective activities such as writing, poetry readings, or an art project can also be very helpful. These can be done individually or as a group. It is important to acknowledge the need to express their feelings while helping them identify appropriate ways to do so.
At the end of the meeting the Crisis Response Team should gather to review the day’s challenges, debrief and share experiences and concerns, consider strategies for individuals who may need additional support, remind each other of the importance of self-care, and plan for next steps and follow up. This might also be a good time to write an email to the trainees and key faculty about resources that were verbally shared during the meeting and any next steps.
Immediately after this meeting, it is critical to inform Emergency room staff, Hospitalist Services, attendings assigned to the services with affected residents/fellows, and nursing leadership (so that they can let the nurses on the floor know) about the death and the fact that the trainees have just been informed. These individuals may have known their trainee and may also be affected by this news. Also it is important that these individuals understand that some trainees may be distraught when they return to the floor.
Fellow trainees in the same program as the deceased trainee who did not attend the in-person meeting should be informed as soon as possible, preferably by telephone and not email.
Specific Scripting When Delivering the News Face to Face
The circumstances of the death have a critical impact on the framing of the communication. See the sample scripts below for examples of the best practices in communicating a death:
Death from illness or an accident
Cause of death may not be disclosed
For Deaths from Suicide or Domestic Violence
It is critically important for steps to be taken to ensure that suicide contagion risk is minimized to every extent possible (See link below). Contagion risk is heightened with 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 risk of suicide contagion is mitigated by including support and mental health resources in several communications and ensuring that every communication following the death is vetted with the don'ts and do's included in a section below in mind. Do's and Don't When Breaking the News About a Suicide
Trainees may also experience guilt about not recognizing the signs of distress in co-trainees. As physicians, trainees tend to be people who are sensitive to others, and not having “noticed” the signs of distress can induce guilt. It is important to remind everyone that trainees have enormous personal strength, and as such they often can “compensate” for and mask the presence of psychiatric symptoms. This both makes it difficult to identify those in distress so they can receive assistance and ends up making individuals feel more isolated as no one knows how they really feel.
For suicides in particular, this is really a great opportunity to highlight the importance of reaching out and the complexity of suicide - that it has multiple “causes” and that often, we do not know all of the things that the person was contending with, physically, emotionally or in terms of their life stressors/ past experiences.
Written Communication with the Broader Community
Written communication will be led by the Crisis Response Team, in concert with the Office of Medical School Communications. An email announcement should be sent to members of the surrounding GME community. Chairs of other departments, the ACGME representative, DIO’s in the local community, and the Dean of Students at deceased trainee’s Medical School should also receive communication. Such communication should be sent within 24-48 hours. A follow up email can be sent later with details regarding the obituary, address of emergency contact person (if released) and if applicable, funeral/memorial service information. In addition, PDs and PAs may benefit from a separate communication from the Crisis Response Team the next day on messaging to trainees.
Sample communication is included in these documents:
Same day communication to the Medical School after a suicide
Same day communication from Clinic Manager to staff after a suicide
Mental health resources may be highlighted in any of these communications: Support Resources for the GME Community
Social Media and the Press
A member of the Crisis Response Team should be assigned to media relations and social media. A media statement should be prepared (sample media statement ) and a designated media spokesperson identified. Identifying key messages can be helpful ( Key messages for media relations spokesperson ). Typically only authorized staff or institutional communication personnel should speak with the media. It may be best to advise trainees to avoid interviews with the media. If the death is by suicide, the media can also be provided guidance on how best to report on suicide to minimize risk of suicide contagion (afsp.org/SafeReporting).
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