Resident Duty Hours Enhancing Sleep, Supervision, and Safety (2009) / Chapter Skim
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5 Impact of Duty Hours on Resident Well-Being
5 Impact of Duty Hours on Resident Well-Being
Pages 159-178
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From page 159... ...
worker population revealed that working 50 hours or more a week can have detrimental effects on workers, placing them at risk for sleep deprivation or fatigue, declines in alertness or concentration, depression, poorer general health (including weight gain, cardiovascular decline, and muscular pain) , and injuries (Caruso, 2006)
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From page 160... ...
A prospective cohort study surveyed 2,737 interns (first-year residents) nationwide in a number of medical specialties in 2002-2003 before Accreditation Council for Graduate Medical Education (ACGME)
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From page 161... ...
. Injury among trainees was associated with less sleep before an injury and longer work hours per week.
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From page 162... ...
11 percent) than did faculty and were involved in more motor vehicle crashes (20 vs.
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From page 163... ...
In one case, the hospital at which a resident worked was found not liable for impaired driving incidents caused by their residents, as a court ruling in Illinois established: "There is no liability imputed to health care providers for injuries to third is considered a crime to drive with a blood alcohol level of 0.08 g per 100 mL of blood It throughout the United States (Insurance Institute for Highway Safety, 2008) and with a level of 0.04 g for commercial drivers (FMCSA, 2008)
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From page 164... ...
Recommendations for duty hours and work schedules that incorporate ways to protect residents against acute and chronic sleep loss and fatigue can be found in Chapter 7. Regarding driving incidents, the committee found only one study that measured incidents involving residents after the 2003 rules were adopted, and it showed no significant change in motor vehicle accidents or near-miss motor vehicle incidents compared to before implementation for pediatric residents at 3 institutions (Landrigan et al., 2008)
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From page 165... ...
This section discusses aspects of mental health such as levels of resident burnout and depression, concerns regarding their physical fitness, satisfaction with their personal and professional lives, and how these aspects have been impacted by ACGME's duty hour regulations or fatigue. Before discussing burnout and depression, definitions may clarify the differences between these two similar symptoms experienced by residents.
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From page 166... ...
Studies focused on the impact of duty hour regulations tended to be of small numbers of residents, single institutions, and specialty-specific. As discussed below, the data are mixed -- residents do experience high levels of burnout, but burnout is not necessarily associated with the numbers of hours worked or slept.
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From page 167... ...
Impact of Duty Hour Regulations on Burnout Evidence of whether the 2003 ACGME duty hour limits reduced burnout is mixed, but no studies have shown that duty hour reductions or limits have increased its prevalence. Duty hour regulations did not decrease symptoms of burnout in a study of 33 surgical residents in six institutions (Gelfand et al., 2004)
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From page 168... ...
. It is important to note here that the committee's proposed changes in duty hours without appropriate adjustments of workload could possibly have an unintended consequence of leading to more stress or burnout.
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From page 169... ...
. In addition to finding that the prevalence of chronic sleep deprivation increased from 9 percent at the beginning of the year to 43 percent at the end of the year, Rosen and colleagues reported that the prevalence of moderate depression (as measured by the Beck Depression Inventory-Short Form)
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From page 170... ...
Although the exact mechanisms linking sleep deprivation to weight gain are unknown, a number of wellcontrolled laboratory experiments suggest that sleep restriction alters the levels of leptin and other hormones involved in the regulation of appetite (Guilleminault et al., 2003; Spiegel et al., 2004a, 2005)
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From page 171... ...
For example, 128 residents from four training programs adhering to ACGME duty hour regulations were surveyed for their impressions of how the rules would continue to affect future residents. The results indicated a strong agreement (by a Likert-type fixed response scale from "strongly agree" to "strongly disagree")
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From page 172... ...
. A different study that gathered 554 surveys from orthopedic surgical residents across the country showed that PGY-3 and more junior residents, who worked in excess of 80 hours per week more frequently than their senior peers, still had more positive attitudes toward duty hour regulations than the senior residents.
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From page 173... ...
. Impact of Reduced Duty Hours on Professionalism Although professionalism is difficult to measure, a few methods exist that attempt to capture a physician's level of professionalism, including surveys of peer assessment, faculty assessments, and self-reflection, as well as objective clinical exams (Cohen, 2006; Swick, 2000)
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From page 174... ...
In a study of 169 internal medicine, neurology, and family practice residents in three hospitals, 45 percent of the residents studied believed that professionalism decreased after duty hours were reduced because of having less time to talk with patients and families, leading to fewer opportunities to participate in shared decision making. However, 32 percent of residents perceived no change and 19 percent believed professionalism improved due to reduced fatigue, allowing for increased reserves of empathy, compassion, and sensitivity to patients and colleagues (Ratanawongsa et al., 2006)
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From page 175... ...
2004. The effect of the Ac creditation Council for Graduate Medical Education duty hours policy on plastic surgery resident education and patient care: An outcomes study.
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From page 176... ...
2008. Work hour rules and contributors to patient care mistakes: A focus group study with internal medicine residents.
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From page 177... ...
2008. Effects of the Ac creditation Council for Graduate Medical Education duty hour limits on sleep, work hours, and safety.
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From page 178... ...
2003. The cumula tive cost of additional wakefulness: Dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation.
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