Residents are trained to handle clinical crises, yet many culture shaping moments are not medical at all. Support U is a resident peer support program that equips trainees to notice distress, open a brief supportive conversation, validate without fixing, set boundaries, and make a warm handoff to resources.

The program evolved in three stages. We began as a referral based model that trained a small group of designated supporters. We then shifted to a program centered didactic to reach as many trainees as possible across specialties. We now deliver a two-hour simulation based session that mirrors real peer to peer conversations while protecting psychological safety. The session opens with a 45-minute interactive mini lecture to teach core skills, followed by a fishbowl simulation where residents practice support skills with a simulated resident. Peer observers provide feedback while all of the residents rotate into the peer support role and debrief.

Cases come directly from resident experiences, including experiences of embarrassment from the attending, feeling helpless in the healthcare system, and continued rumination about poor patient outcomes. In early surveys, residents reported an increase in their confidence initiating support, more frequent use of skills on service, and a shared language that reduces the reflex to fix peers. This lightning talk will share the simulation blueprint, sample cases, debrief prompts, and a practical adoption checklist, along with straightforward ideas to track uptake and impact.