Physicians with experience of family members who were injured reported errors or patient safety practices more frequently offering insights to the challenges of medical reporting.

The dominating culture in the profession makes it difficult to disclose medical errors to peers.

Doctors prefer to be informed of their errors and require education and guidance about how to handle peers' medical errors.

Adopting a non-judgemental approach towards a peer affected by medical error is important.

Residents prefer to speak about medical error events with medical colleagues.

Supervisors (leaders) were perceived to have the knowledge, authority and experience to support and relieve the anxiety and stress experienced by the resident.

Interactions between physicians and supervisors (leaders) are critical to the coping process and leaders need to pay attention to blame responses within teams and encourage constructive and open discussion.

Second victims require support from colleagues and leaders/managers. When not received victim experiences rejection.

Promotion of safety culture by leaders is required.

Colleagues react towards the adverse event with surprise ‘acting as if nothing has happened’ to avoid involvement resulting in stigmatisation for the second victim.

Support from peers was recognised as helpful but fears over confidentiality may prohibit some staff from accessing peer support.

Greater responsibility be placed on Healthcare organisations, commissioners, policy makers, regulators and professional bodies to develop systems to support affected clinicians in order to foster the necessary open, transparent culture and to ensure that incident reporting becomes a learning activity.

Non-punitive environment can be achieved by combining well-integrated support systems with a well-developed Just Culture.

A Just Culture is contributory to greater patient safety overall and possible healing for second victims.

In implementing a Just Culture, managers (Leaders) need to hold their direct reports to account without being unduly punitive.

Supervising physicians to provide feedback and act as role models for trainees to observe.

Recommends the vertical integration of error disclosure training into medical education recommended.

Quality improvement opportunities exist within error disclosure practices and make these as well as professional guidelines and standards well known.

A ‘hidden curriculum’ exists in which a punitive response to errors is modelled by senior doctors in the healthcare team. These values and attitudes about error disclosure are ‘transmitted’ to trainees that observe them.

Cultures of safety within surgical and non-surgical learning environments to be promoted.

Institutional leaders should seek to identify poor cultural behaviours and thoughtfully confront physicians who model negative behaviours in response to errors.

Educational and hospital leaders should provide confidential means for all members to report physicians who exhibit a dysfunctional response to medical error and other disruptive behaviours.

Restriction of hospital privileges to those physicians who persistently exhibit disruptive behaviours.

Interdisciplinary and multilevel training in error disclosure to ensure shared understanding and normalise the discussion of medical error.

Negative role-modelling is more influential than positive role-modelling for trainees.

Institutional leaders to ensure all physicians receive sufficient training in patient safety and error disclosure to allow them to function as effective and positive role models for responding to errors.

Helpful conversations for physicians coping with medical error promote learning and healing.

Barriers that healing conversations have on due to legal practices and institutional culture should be examined.

The ‘hidden curriculum’ in medicine encourages doctors to be silent about error. This should be overcome by developing skills in physicians to seek out (and provide) appropriate support for one another.

Role of colleagues and leaders post adverse event is crucial, particularly in the early stages and health professionals are not equipped with the necessary training to cope with the aftermath.

Addressing the number of potential numbers of second victims in primary and secondary care suggests that managers and leaders have ‘hardly begun to address this issue’.

Raising awareness and reinforcing a safety culture is recommended.

A cultural shift is required, through supportive acknowledgement of medical error and second victim and open discussion to help curb the effects on unspoken expectation of perfection.

Emphasising that most errors are not personal blemishes stemming from unacceptable fallibility but a natural consequence of being human.

Provide Doctors a trained 'peer and an ear' to ‘hold’ the feelings for the second victim and help physicians cope with an adverse events.

Enrich the curricula on ethics, humanism and spirituality in medicine to enhance Doctors own moral context.

Provide Doctors with experience of error teaching opportunities allowing them to pass on wisdom.

Institutional awareness campaigns promoting open dialogue about second victims that ask direct questions about safety experiences that result in psychological distress and whether institutional support was received.

Training frontline supervisors and peers to provide immediate and targeted support in early stages of recovery.

Impact on the healthcare professional was related to the organisation’s response to the adverse event.

Attention should be paid to organisational climate where these issues should be addressed and discussed in a non-judgemental manner.

Well-established support structures can meet the needs of involved individuals that include timely and transparent procedures for the investigation and analysis are necessary.

Provide a culture where staff can share their emotions and receive personal and professional reassurance.

Organisational cultures of support and respect reduce psychological impact of patient safety incidents. However, only when full support rather than partial support is given.

Organisational cultures that blame create a ‘devastating’ psychological impact on second victim.

When patients experience ‘severe harm’ doctors report higher retrospective psychological impact compared with nurses who report higher retrospective psychological impact when patient dies.

Leaders have a role in teaching others to investigate and debrief without blame and instead create performance improvement

Junior clinicians to be made aware of the topics by senior clinician coaches.

Regular non-confrontational peer review meetings should replace incident based meetings, providing clear information and acknowledging learning opportunities.

Theoretically, involvement in PSI constitutes a resource loss (Conservation of Resources Theory). Resource loss invokes stress (eg, burnout) leading to further resource loss (eg, confidence loss, work-home interference).

Alcohol consumption, problematic medication use are coping strategies to counteract loss.

High quality of work and positive organisational commitment support the reduction in turnover intentions.

Critical Stress Incident Management (CSIM), psychological debriefing following PSI and support systems help second victims cope more effectively.

‘No blame, No shame’ culture coupled with recognition of the role that system errors play in learning are helpful for second victims and prevent future errors.