A Sorry State: Managing Guilt and the Second-Victim Phenomenon in Interventional Radiology – A Guide for Trainees and Early-Career Interventional Radiologists

Learning Objectives: • Understand the Second-Victim Phenomenon (SVP) and its impact on mental health and clinical performance in interventional radiology (IR).
• Identify factors contributing to SVP among trainees and early-career interventional radiologists.
• Learn evidence-based strategies to manage and mitigate SVP.

Background: Second-victim phenomenon (SVP) describes a psychological reaction healthcare providers experience after adverse patient events and outcomes. SVP, which was coined by Albert Wu in 2000, describes the emotional burden placed on providers related to medical errors or complications. Due to the high-risk procedures and evolving technology in IR, trainees and early-career radiologists are more vulnerable to SVP. When guilt and inadequacy are compounded with the fear of malpractice and peer judgment, they negatively impact well-being and care quality. The management of this phenomenon plays an important for providers and to ensure the safety of patients.

Clinical Findings/Procedure Details: IR trainees and early-career interventional radiologists face a steep learning curve, increasing their risk of SVP.Complications such as periprocedural morbidity and/or mortality often trigger feelings of inadequacy and "imposter syndrome" phenomena, resulting in poor outcomes and self-doubt. Those affected report anxiety, sleeplessness, a lack of confidence, and concerns about their reputation. Unless appropriately addressed, these emotions can have a long-term negative impact on both the provider's psychological health and subsequent patient outcomes. 
 

• Recognition and Awareness: Early identification of SVP symptoms can lead to timely intervention and prevent long-term psychological distress.


• Support Systems: Peer mentoring, debriefing sessions, and counseling services are vital components of an effective support system for those experiencing SVP.


• Institutional Responsibility: Healthcare institutions must foster a non-punitive culture that encourages reporting of errors and provides robust support to second victims.


• Ongoing Education: Education on managing the emotional impact of adverse events should be integrated into IR training programs.

Conclusion and/or Teaching Points: Managing SVP and guilt is vital to the well-being of early career IRs and IR trainees as well as the quality of care they provide. As a result, institutions should recognize the prevalence of SVP and provide support through the provision of psychological services, mentoring, and communication. The establishment of a supportive environment for clinicians can help them detect and recover from SVP and improve patient safety.