While significant progress has been made in addressing burnout and emotional distress in medicine, and in incorporating these topics into medical education, many clinicians remain hesitant and uncertain about how to address grief and distress from patient care in day-to-day clinical practice. This uncertainty exists both in terms of their own experiences and, even more so, in supporting trainees. A lack of emotional processing in these difficult situations can accelerate burnout and further disconnect clinicians from the humanism and vulnerability that are intrinsic to the privilege of practicing medicine.
Time is often a limiting factor in addressing emotional distress. Physicians may be required to quickly pivot from a distressing patient case to the next, leaving little opportunity to process their emotions or reflect on the situation. Additionally, grief is highly individualized—shaped by each person’s lived experiences, cultural beliefs, and values, and cognitive processing—making it even more challenging to develop standardized approaches that resonate with trainees from diverse backgrounds.
The recently published Hospital Pediatrics article by Bloomhardt et al, “Good Grief? Introducing the TEARS Framework for Educator to Support Learners Experiencing Grief,” (10.1542/hpeds.2024-008096) addresses the hesitancy many clinicians experience when assessing learners’ emotional processing during or after distressing patient cases by introducing the TEARS framework. This framework was developed through a combination of literature review, a needs assessment of pediatric residents at the authors' institution, and input from health educators and palliative care specialists. It thoughtfully incorporates strategies for initiating conversations about grief, acknowledging its presence, and providing support through various coping strategies, external resources, and time-based follow-up with the trainee.
The TEARS framework outlines clear steps and goals to support learners experiencing grief. It begins with T—Turning inward—which encourages clinicians to first recognize and process their own emotional responses before engaging with learners. The next step, E—Exploring—involves asking open-ended questions, seeking permission to discuss the learner’s experience, and finding an appropriate time and setting for the conversation. A—Acknowledging—emphasizes validating the learner’s grief in whatever form it presents, normalizing it, and, when appropriate, modeling vulnerability by sharing one's own emotional responses. R—Resources—highlights the importance of offering appropriate support mechanisms, such as bereavement rituals (e.g., condolence cards or follow-up calls), team debriefs to share collective experiences, mentorship, access to psychosocial therapy, time for reflection and silence, or other creative outlets tailored to the individual’s needs. Finally, S—Support—underscores the need to recognize that grief is not linear, and that learners may require varying levels and timing of support, from immediate intervention to long-term follow-up, depending on the situation’s severity.
The TEARS framework appears feasible for use in clinical settings but would require some training and practice to implement effectively. Incorporating it into medical education—from medical school through fellowship—would be highly valuable in normalizing the processing of grief and restoring humanity within medicine. With clear, actionable steps, it equips clinicians to support learners in processing grief while also encouraging self-reflection and emotional awareness among more experienced providers. Tools like this can help mitigate burnout and foster a more emotionally resilient generation of healthcare professionals.
