Trajectory of Distress: A Qualitative Study of the Evolution of Second Victim Phenomenon Over Time

Introduction: Second victim phenomenon (SVP) describes the emotional and psychological distress healthcare workers experience following adverse patient events. Whether due to a medical error, treatment complication, or even an expected patient outcome, medical providers can feel guilt, shame, anxiety, and self-doubt. While stages of SVP have been described, how physicians experience SVP over time and how this evolves over the course of their career is unknown. Therefore, we explored how attending physicians in high-acuity pediatric subspecialties experienced SVP and how their coping mechanisms and responses to SVP evolved from training to their current practice.


Methods: We conducted a single-center, qualitative study of attending physicians from six pediatric subspecialties: critical care, neonatology, cardiology, hematology/oncology, hospital medicine, emergency medicine. Within a constructivist paradigm, we performed individual, semi-structured interviews to explore participants’ lived experiences with SVP and how such experiences changed over time. We conducted a thematic analysis to identify patterns and insights into the progression of SVP experiences and responses.


Results: We interviewed twenty-nine physicians and constructed five themes that captured their responses. 1) The increased responsibility as an attending compared to as a trainee led to an increase in SVP intensity. 2) Participants gained perspective over time, recognizing the inevitability of some adverse events and more acceptance of ambiguity within medicine. 3) While self-doubt persists, increased acceptance of vulnerability resulted in more comfort participating in debriefs and seeking feedback from peers. 4) Some stages of SVP were shortened by use of effective coping strategies. 5) Integrating these experiences into a broader understanding of their roles, limits, and purpose within medicine helped make sense of continuing to work in spite of adverse events.


Conclusions: Attendings experienced evolving responses to adverse events characterized by increased acceptance, humility, and refined coping mechanisms despite ongoing self-doubt. Understanding these longitudinal changes may inform tailored support strategies to enhance resilience and well-being throughout physicians’ careers.