{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:48:58Z","timestamp":1785890938564,"version":"3.56.0"},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Neurosurgical residents encounter patient death during their training, yet the literature lacks understanding of their experiences and responses. The aim of this study was to explore how residents navigate patient death, communicate with families, and engage with coping and support mechanisms during their neurosurgical training in Germany.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors conducted a qualitative-dominant mixed-methods study among neurosurgical residents in Germany. The qualitative component included semistructured in-depth interviews and focus group discussions with neurosurgical residents. The quantitative component consisted of a cross-sectional survey administered across university, community, and private training hospitals. Emotional burden related to patient death was assessed using a 0\u201310 numeric rating scale, with 0 indicating no burden and 10 indicating the maximum perceived emotional impact. Data collection occurred between January and February 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Among 44 in-depth interviews, 2 focus group discussions, and a cross-sectional survey, 112 neurosurgical residents (70% male and 30% female; 57% in their 5th year or beyond, and 56% training in university hospitals) reported a range of experiences following patient deaths and serious clinical events. Junior residents, particularly those caring for pediatric patients or rapidly deteriorating adults, described heightened emotional engagement, self-reflection, and occasional self-doubt. In the 6 months preceding the survey, 41% (n = 46) of participants reported exposure to 1\u20132 patient deaths. The mean emotional burden increased with greater exposure to patient death; residents who reported 1\u20132 deaths scored 5.8 and those who reported \u2265 3 deaths scored 7.2. Residents reported relying primarily on informal coping strategies, including peer discussion (80%, n = 90), personal reflection, and self-directed activities such as exercise or mindfulness. Formal support mechanisms, including structured debriefings, mentorship, or psychological counseling, were less consistently available: 35% reported regular debriefings (n = 39), 28% had access to a mentor in cases of grief (n = 31), and fewer than 9% used institutional support services (n = 10).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study captured neurosurgical residents\u2019 experiences of grief, their communication with families, the emotional burden of patient deaths, as well as coping mechanisms that include both formal and informal strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.5.focus26160","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:01:49Z","timestamp":1785283309000},"page":"E7","source":"Crossref","is-referenced-by-count":0,"title":["Navigating patient death and grief in German neurosurgical residency: a mixed-methods study"],"prefix":"10.3171","volume":"61","author":[{"given":"Mazin","family":"Omer","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamoun","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sana Kliniken Duisburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon-Shanun","family":"Schroth","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Bissolo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Doria-Medina","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oday","family":"Atallah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nordwest Hospital Sanderbusch, Carl von Osseitzky University, Oldenburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Al-Tarawni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Rheinfelden Hospital, Health Center Fricktal, Reinfeld, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mosab","family":"Adam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, General Hospital Bamberg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Cifaldi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Klinikum Dessau;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Alnaggar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Klinikum Kassel;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeyhun","family":"Farzullayev","sequence":"additional","affiliation":[{"name":"Department of Neurotraumatology and Spine Surgery, Klinikum Wolfsburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana Rivera","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Center for Medicine and Society, University of Freiburg, Germany;"},{"name":"Research Group GIGA, University Francisco de Paula Santander, Cucuta, Colombia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hind","family":"Chaib","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University Lausitz, Carl Thiem, Cottbus;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron Lawson","family":"McLean","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Germany; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Volz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Beck","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jussi P.","family":"Posti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Neurosurg","first-page":"1055","article-title":"Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. 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