Neurosurgical Focus. 2026;61(2):E2
Objective
To examine grief, moral injury and coping among neurosurgical trainees and compare their experience with other specialties regularly exposed to death and devastating outcomes.
Methods
Anonymous cross-sectional survey of trainees in neurosurgery, general surgery, emergency medicine, oncology and critical care at one academic center. Forty-five of 97 eligible trainees responded.
Main results
Neurosurgical trainees reported a median of 1.5 patient deaths and 1.5 devastating outcomes each week. After adjustment, surgical trainees had greater grief and moral injury than medical trainees (p=0.043 and p=0.032). Perceived program support correlated inversely with moral injury (Spearman ρ=−0.58; p<0.001).
Interpretation
Repeated exposure to severe disability and death may create a substantial emotional burden during neurosurgical training. Program-level support appears relevant and potentially modifiable.
Limitations
Small, single-center, cross-sectional survey with a 46.4% response rate. Self-selection and adapted measurement scales limit generalizability and prevent causal conclusions.
Clinical takeaway
Structured debriefing, mentoring and confidential psychological support should be considered core components of neurosurgical training rather than optional wellness initiatives.