Editor: Deborah Sesok-Pizzini, MD, MBA, adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Causes of death among U.S. medical residents
August 2025—The Accreditation Council for Graduate Medical Education (ACGME) oversees graduate medical education and closely monitors resident wellness. In 2017, the ACGME published findings from a national study outlining the causes of death among residents and fellows from 2000 through 2014. The most common overall cause of death was malignant neoplasm, and it was the leading cause of death among female residents and fellows. Suicide was the leading cause of death for male residents and the second leading cause for females. Twenty-three percent of deaths by suicide occurred in the first academic quarter of trainees’ first year in their medical programs. Other medical and surgical diseases and accidents accounted for 31 percent of trainee deaths. The authors of the initial study called for the graduate medical education community to take preventive action, including increasing access to mental and physical health care to initiate better self-care for trainees and faculty and better educating stakeholders on signs of burnout, depression, and social isolation. Since that study, stakeholders in the realm of graduate medical education have made efforts to support trainee well-being by increasing primary care and counseling services and implementing ACGME Common Program requirements. The authors conducted a study to provide an update on assessing causes of death, focusing on trainees who died between 2015 and 2021, and they compared the findings to the 2017 published research. The study also compared rates of death across cause categories with those of age- and gender-matched peers in the general population using the 22 years of death-related data, as well as rates of death across multiple specialties. The authors performed a cross-sectional study of residents and fellows who were enrolled in an ACGME-accredited training program and who died between January 2015 and December 2021. The deaths were submitted to the National Death Index to obtain causes of death. These were then compared with causes of death for residents and fellows who died between January 2000 and December 2014. The authors analyzed the study results between July 2024 and March 2025. The primary study outcome was the difference in rates of death for U.S. residents and fellows between the two time periods. Poisson regression modeling was used to calculate incidence rate ratios (IRRs) and 95 percent confidence intervals (CIs), as well as differences in causes of death. The results showed that between 2015 and 2021, 370,778 residents and fellows participated in 961,755 person-years of training. A total of 161 residents died during training—47 (29.2 percent) by suicide, 28 (17.4 percent) from neoplastic diseases, 22 (13.7 percent) from other medical and surgical diseases, 22 (13.7 percent) from accidents, 21 (13 percent) from accidental poisoning, and 21 (13 percent) from other causes. Consistent with previous results, the highest number of resident suicides occurred during the first quarter of the first year of residency. While rates of other causes of death remained unchanged from the previous study, the death rates from neoplastic diseases decreased since the 2000 to 2014 measurement (IRR, 0.59; 95 percent CI, 0.38–0.90). In comparison to age- and gender-matched peer controls, the resident death rates from 2000 to 2021, including rates by suicide, were lower. Of interest, pathology had the highest suicide rate of the specialties assessed (19.76 deaths per 100,000 person-years). Psychiatry had the highest death rate from neoplastic diseases (9.67 deaths per 100,000 person-years), and anesthesiology had the highest death rate from accidental poisoning (15.46 deaths per 100,000 person-years). The authors showed that suicide rates for residents and trainees did not differ significantly from the first to the second study. They concluded that this calls attention to the need for deeper understanding of the cause of resident suicide and mitigation strategies. It also highlights the need to address well-being research and interventions during the transition phase from medical school to residency. Additional qualitative research is needed to explore underlying factors that drive trainee suicide, accidental overdose, and the distress observed during program transitions.
Yaghmour NA, Bynum WE, Hafferty FW, et al. Causes of death among US medical residents. JAMA Netw Open. 2025. doi.org/10.1001/jamanetworkopen.2025.9238
Correspondence: Nicholas A. Yaghmour at [email protected]
Platelet transfusion: review of AABB and ICTMG international clinical practice guidelines
Platelet transfusion is a common treatment for patients with thrombocytopenia or platelet dysfunction. Platelets are also often transfused to reduce bleeding from hemorrhage in thrombocytopenic patients. However, they have a shelf life of only five to seven days, which can result in demand exceeding supply. Furthermore, adverse events happen more frequently after transfusion of platelets than after transfusion of other blood products, so it is important that transfusion services understand clinical practice guidelines and audit platelet use. The authors, as members of the joint Association for the Advancement of Blood and Biotherapies (AABB) and International Collaboration for Transfusion Medicine Guidelines (ICTMG) international platelet transfusion guidelines panel, reviewed international guidelines from the AABB and ICTMG, which they used to update recommendations for health care providers on the appropriate use of platelets for transfusion in adult and pediatric patients. They applied the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology to findings from 21 randomized trials and 13 observational studies in the context of limited randomized platelet clinical trial data. The authors also compared transfusion strategies for using restrictive versus liberal amounts of platelets for transfusion. Their findings showed that the restrictive strategy did not increase mortality or bleeding in relation to a more liberal strategy for certain clinical populations. The authors also developed strong recommendations with high to moderate certainty of evidence for nonbleeding patients with hypoproliferative thrombocytopenia receiving chemotherapy or undergoing allogenic stem cell transplant, for whom they recommend platelet transfusion when the platelet count is less than 10 × 103/μL; preterm neonates without major bleeding, for whom they recommend platelet transfusion when the platelet count is less than 25 × 103/μL; patients undergoing lumbar puncture, for whom they recommend platelet transfusion when the platelet count is less than 20 × 103/μL; and patients with Dengue-related consumptive thrombocytopenia without major bleeding, for whom they do not recommend platelet transfusion. They too made conditional recommendations based on a low or very low certainty of evidence for, among others, adults with consumptive thrombocytopenia due to critical illness (non-Dengue) and without major bleeding, for whom they recommend platelet transfusion when the platelet count is less than 10 × 103/μL, and adults undergoing venous catheter placement in anatomic sites amenable to manual compression, for whom they recommend platelet transfusion when the platelet count is less than 10 × 103/μL. Of interest, they do not recommend platelet transfusion for patients without thrombocytopenia who are undergoing cardiovascular surgery in the absence of major hemorrhage. In conclusion, some of the authors’ recommendations were similar to previous guidelines pertaining to hypoproliferative thrombocytopenia, interventional radiology, major nonneuraxial surgery, and cardiovascular surgery, but the authors updated recommendations for certain groups, including neonates and those with Dengue-related consumptive thrombocytopenia. The authors noted that randomized control trials conducted in clinical settings and that involve different age groups for which there are currently limited data could provide additional evidence that will warrant further updating the recommendations. Therefore, they will consider adjusting their guidelines accordingly as relevant clinical trial data become available.
Metcalf RA, Nahirniak S, Guyatt G, et al. Platelet transfusion: 2025 AABB and ICTMG international clinical practice guidelines. JAMA. 2025. doi.org/10.1001/jama.2025.7529
Correspondence: Dr. Ryan A. Metcalf at [email protected]