15 After a Suicide | A Toolkit for Physician Residency/Fellowship Programs 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. It’s best to provide several options for individuals to speak with, including one to two individuals outside the program or even home institution, since privacy is very important to some trainees and faculty. A second meeting with the residents 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/or doing something kind for another person. Other reflective activities such as writing, poetry reading, 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 residents 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 attendings and staff assigned to the services with affected residents/fellows (e.g., Emergency Dept. staff, Hospitalist Services, etc.) and nursing leadership (so that they can let the nurses on the floor know) about the death and the fact that the residents have just been informed. These individuals may have known the resident and may also be affected by this news. It is also important that these individuals understand that some residents may be distraught when they return to the floor. Fellow residents in the same program as the deceased resident who did not attend the in-person meeting should be informed as soon as possible, preferably by telephone and not email. Written Communication with Others Next, an email announcement should be sent to members of the surrounding graduate medical education community (e.g., PDs, PCs, and residents of other programs, core faculty of the deceased resident’s program), Chairs of other departments, ACGME representative, DIOs in the local community, and Dean of Students at deceased resident’s medical school. 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 and if applicable, funeral/memorial service information. Sample email scripts can be found in Appendix D. A similar approach should be used for cases of death by any cause. For PDs and GME leaders at other institutions/hospitals in the surrounding geographical area, particularly where residents from different programs have rotations together, a thoughtful approach to whether an announcement should be made must be considered. On the one hand, if residents at other programs have learned about the death, it can be helpful for leaders to gather them together to provide factual information and similar messages about the importance of wellbeing, support being available, and help seeking being a sign of strength. However, if most residents have not become aware, this type of messaging can create unnecessary anxiety. It is recommended to start by meeting with the CRs to determine the level of knowledge among the residents, as well as to gauge the tone and level of concern the community is experiencing.