A national survey of the effects of fatigue on trainees in anaesthesia in the UK

Abstract

Long daytime and overnight shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. The Working Time Regulations (1998) implemented the European Working Time Directive into UK law, and in August 2009 it was applied to junior doctors, reducing the maximum hours worked from an average of 56 per week to 48. Despite this, there is evidence that problems with inadequate rest and fatigue persist. There is no official guidance regarding provision of a minimum standard of rest facilities for doctors in the National Health Service, and the way in which rest is achieved by trainee anaesthetists during their on-call shift depends on rota staffing and workload. We conducted a national survey to assess the incidence and effects of fatigue among the 3772 anaesthetists in training within the UK. We achieved a response rate of 59% (2231/3772 responses), with data from 100% of NHS trusts. Fatigue remains prevalent among junior anaesthetists, with reports that it has effects on physical health (73.6% [95%CI 71.8-75.5]), psychological wellbeing (71.2% [69.2-73.1]) and personal relationships (67.9% [65.9-70.0]). The most problematic factor remains night shift work, with many respondents commenting on the absence of breaks, inadequate rest facilities and 57.0% (55.0-59.1) stating they had experienced an accident or near-miss when travelling home from night shifts. We discuss potential explanations for the results, and present a plan to address the issues raised by this survey, aiming to change the culture around fatigue for the better.

Stress, burnout, depression and work satisfaction among UK anaesthetic trainees: a qualitative analysis of in‐depth participant interviews in the Satisfaction and Wellbeing in Anaesthetic Training study

“…Published literature suggests that anaesthetists can find work demanding ; two recent surveys of UK anaesthetic trainees reported high risk of burnout . Our findings confirm this and add detailed examples of this emotional and physical exhaustion.…”

EWTD implementation in anaesthesia: effects on training and quality of life

“…P values have no value in reference to non-random samples [5] and truncating variance to increase statistical significance, or lack thereof, should not be allowed to worm its way into acceptability. We note the recent publication of a large study examining fatigue amongst anaesthetic trainees [1]. This has some similarities with a prospective audit undertaken in Cork University Hospital, Ireland looking at the implementation of the European Working Time Directive (EWTD) and its effects on both training and quality of life.…”

“…Should a dispensation on the maximum shift duration (currently 13 h) be granted for doctors to protect both training and quality of life post-EWTD implementation? McClelland et al highlight the issue of fatigue and its consequences in anaesthetic trainees [1]. This risk can relate to the doctor themselves, to their colleagues and to their patients or the public at large if an impaired doctor takes to the road.…”

“…Assessing the likelihood that purportedly random samples are indeed random [1] is a powerful tool for diminishing the problem realised by Ioannidis, that 'false findings may be the majority or even the vast majority of published research claims' [2]. Concern over results that are too good to be true was emphasised when Ronald Fisher calculated the probability that Gregor Mendel tidied up his data to an extreme degree: 'The data of most, if not all, of the experiments have been falsified so as to agree closely with Mendel's expectations' [3].…”

“…Contrary to Wilson's surmise [4], Carlisle did not overstate his case [1]. P values have no value in reference to non-random samples [5] and truncating variance to increase statistical significance, or lack thereof, should not be allowed to worm its way into acceptability.…”