Comment on: Second victim syndrome in surgeons: systematic review and meta-analysis of the impact of adverse events on surgeons

Correspondence to: Vincent Sier (email: v.q.sier@lumc.nl)

Department of Surgery

Leiden University Medical Center

Leiden

Netherlands

BJS, https://doi.org/10.1093/bjs/znaf258, published 07 January 2026

It is with great interest that we read this timely and unique meta-analysis by our British colleagues. By reporting double-digit prevalence for anxiety, guilt, rumination, and sleep disturbance following adverse events, Bryan et al.1 demonstrate that second victim syndrome is a relevant occupational challenge among surgeons that warrants serious attention.

In their Discussion, personality is mentioned as a potential factor influencing surgeon’s responses to adverse events. We would like to expand upon this point and propose a structured, hypothesis-driven direction for future research in this area.

The authors identify sex, years of experience, and environmental or institutional context as factors associated with variability in response.1 We suggest that these variables themselves may entail differences in underlying Big Five personality (sub)traits and should therefore be explicitly considered in models of second victim syndrome in surgery. It is well established that surgeon personality distribution differs by sex, generation, culture, and even subspecialty.2,3 Therefore, we propose that future research tests whether personality is directly associated with three core components of the second victim syndrome response: how an adverse event is appraised, which coping strategies are selected, and how recovery unfolds over time. Speculatively and as an example only, in this framework, specific traits might be associated with sustained rumination, could intensify self-blame following perceived error, or may rather facilitate disclosure and peer support.

Finally, we hypothesize that diversity in personality characteristics within surgical teams may be protective. Teams combining varying levels of emotional stability, conscientiousness, extraversion, agreeableness, and openness may offer complementary coping perspectives and peer support following adverse events. However, such diversity can only function protectively within an environment that is aware of these differences, supported by a shared commitment to psychological safety and a safe surgical culture.4