Post-Code PTSD Symptoms in Internal Medicine Residents Who Participate in Cardiopulmonary Resuscitation Events: A Mixed Methods Study

Internal medicine (IM) residents participate in cardiopulmonary resuscitation events (or "codes"), stressful events that involve the death or near death of patients. Experiencing traumatic stress can lead to posttraumatic stress disorder (PTSD). We examined whether IM residents who participate in codes developed PTSD symptoms. We conducted this research as a 2-phase, mixed methods study. In the first phase, we analyzed interview transcripts from 25 IM residents at 9 institutions for content relevant to PTSD. In the second phase, we surveyed 82 IM residents at 1 midwestern institution for symptoms reported post-code that are associated with PTSD (post-code PTSD symptoms). A total of 7 of 25 residents (28%) interviewed characterized codes as traumatic or described experiencing PTSD symptoms, including intrusive thoughts about the code, avoidance and emotional numbing, and hyperarousal, irritability, or hypervigilance. Of the 82 residents, 51 (62%) responded to the questionnaire. Of the 42 respondents who had participated in a code, 6 (14%) reported at least 1 PTSD symptom, and 3 (7%) women screened positive for potential PTSD with 2 or more PTSD symptoms. Endorsing any PTSD symptom was associated with residents' perception that code participation negatively affected their work performance. Our study found that some IM residents reported symptoms of PTSD after being involved in a code.