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Suicidal Ideation Among Vascular Surgery Trainees
Christina L. Cui, MD, MAS1, Margaret A. Reilly, MD, MS
2, Eric B. Pillado, MD, MBA, MS
2, Ruojia D. Li, MD, MS
3, Joshua S. Eng, PhD
4, Leanne E. Grafmuller, MD
5, Kathryn L. DiLosa, MD, MPH
6, Allan M. Conway, MD
7, Guillermo A. Escobar, MD
8, Palma M. Shaw, MD, MBA
9, Yue-yung Hu, MD, MPH
2, Karl Y. Bilimoria, MD, MS
4, Malachi G. Sheahan, III, MD
10, Dawn M. Coleman, MD
1.
1Duke University, Durham, NC, USA,
2Northwestern University, Chicago, IL, USA,
3Loyola University, Chicago, IL, USA,
4Indiana University, Indianapolis, IN, USA,
5University of Rochester, Rochester, NY, USA,
6University of California, Davis, Sacramento, CA, USA,
7University of California, San Francisco, San Francisco, CA, USA,
8Emory University, Atlanta, GA, USA,
9Upstate Medical University, Syracuse, NY, USA,
10Louisiana State University, New Orleans, LA, USA.
OBJECTIVES: Suicidal ideation (SI) during surgical training remains poorly understood, as existing studies are often limited by sample size or scope. The purpose of this study is a comprehensive evaluation of the incidence, implications, and environmental associations with SI among vascular surgery trainees.
METHODS: Data was collected from a confidential, voluntary survey administered after the 2020-2024 VSITE as part of the SECOND trial. Trainee demographics and their perceptions of their learning environment were collected. SI was assessed with the following question: “In the past twelve months, have you had thoughts of taking your own life?”. Positive screens prompted presentation of the National Suicide Hotline. Descriptive statistics were utilized to evaluate demographic and learning environment factors associated with suicidality.
RESULTS: A total of 3,272 survey results were collected from 2020-2024, with 74 (2.2%) responses screening positive for SI. This rate did not change over the course of the study (p=0.103). (
Table 1) The survey responses from 2021 had the lowest rate of missing responses (5%) and, therefore, 2021 responses were used for further descriptive statistics. Demographic variables were comparable between trainees who did and did not screen positive for suicidal ideation. However, trainees who screened positive were more likely to report weekly symptoms of burnout (78% among positive SI responses versus 45% among negative SI responses, p=0.012), driven by higher rates of emotional exhaustion (78% versus 42%, p=0.006). These trainees also reported higher rates of sexual harassment (44% versus 12%, p<0.001). Suicidal ideation was not associated with thoughts of attrition or personal satisfaction. Positive learning environment factors were also less frequently reported among trainees who screened positive for SI, including a sense of belongingness among trainees (83% versus 97%, p=0.022), a culture of learning from rather than blaming mistakes (82% versus 97%, p=0.018), and trainee perceptions of a responsive program (76% versus 97%, p<0.001).
CONCLUSIONS: This is one of the most comprehensive studies on SI among vascular surgery trainees. Although rates remain low, it can be associated with burnout. Modifiable learning environment factors, such as harassment, program responsiveness, and trainee camaraderie, may be potential areas for intervention.
Table 1: Number of Trainees Reporting Suicidal Ideation (2020-2024, p=0.103)| Year | Total Number of Trainees | Clinically Active Trainees who Responded (n (%)) | Clinically Active Trainees Reporting Suicidal Ideation (n (%)) |
| 2020 | 638 | 532(84%) | 22(4%) |
| 2021 | 610 | 510(84%) | 19(4%) |
| 2022 | 656 | 527(82%) | 6(1%) |
| 2023 | 674 | 521(82%) | 14(3%) |
| 2024 | 694 | 532(78%) | 13(2%) |
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