“…nobody ever talked about it again” - Residents perceptions on failure to rescue

INTRODUCTION: Failure to Rescue (FTR) refers to patient death following a complication despite opportunities for timely recognition and intervention. Residents are particularly vulnerable during FTR events because they provide frontline care while training within hierarchical systems. Although FTR is widely used as a quality indicator, its impact on residents remains underexplored. This study examined residents' emotional responses, coping strategies, and the influence of supervisory behavior and institutional culture on recovery and learning. METHODS: We conducted a qualitative interview study following constructivist grounded theory (CGT). Semi-structured interviews were performed with residents from multiple Swiss hospitals between October 2022 and May 2023. Interviews explored emotional experiences related to FTR events, coping mechanisms, supervisory interactions, and perceptions of institutional culture. Data was analyzed iteratively using constant comparison, memo writing, and reflexive team discussions. RESULTS: Fifteen residents (4 males, 11 females), primarily from surgery and internal medicine, participated. Mean age was 30.6 years, with an average of 2.6 years of residency experience. Four interrelated themes emerged: (1) temporal layering of emotional responses, from shock to insecurity and rumination; (2) problem- and emotion-focused coping strategies, including vigilance, peer support, and counseling; (3) supervisory responses, where guidance, debrief, or silence shaped emotional outcomes; and (4) institutional error culture, which influenced expectations around coping and responsibility. Participants described self-doubt, avoidance, and hypervigilance that evolved into either constructive learning or prolonged distress depending on team and organizational support. DISCUSSION: FTR events can leave emotional and professional effects on residents. Supportive leadership, structured debriefings, and accessible psychological support facilitated recovery and learning, whereas silence and blame intensified distress and avoidance. These findings informed a model of contextually mediated recovery in which supervisors serve as key interpreters of failure, while institutional culture facilitates or constrains this role. Coping with FTR is a collective responsibility embedded within team and institutional culture.