Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study

Abstract

Long duty hours (DH) impair sleep and negatively affect residents’ health and medical safety. This cross-sectional study investigated the association among residents’ DH, sleep duration, insomnia, sleep impairment, depressive symptoms, and self-reported medical errors among 5579 residents in Japan who completed the General Medicine In-Training Examination (2021) and participated in the training-environment survey. Weekly DH was classified under seven categories. Sleep duration and insomnia symptoms, from the Athens Insomnia Scale, were analysed to determine sleep impairment; depressive symptoms and medical errors were self-reported. Among 5095 residents, 15.5% slept < 5 h/day, and 26.7% had insomnia. In multivariable analysis, compared with ≥ 60 and < 70, DH ≥ 90 h/week associated with shorter sleep duration and worsen insomnia symptoms. Shorter durations of sleep and more intense symptoms of insomnia were associated with increased depressive symptoms. Medical errors increased only among residents with insomnia, but were not associated with sleep duration. DH > 90 h/week could lead to shorter sleep duration, worsen insomnia symptoms, and negatively impact well-being and medical safety. There was no significant association between sleep duration and medical errors; however, insomnia conferred an increased risk of medical errors. Limiting DH for residents to avoid excessive workload can help improve resident sleep, enhance resident well-being, and potentially reduce insomnia-associated medical errors.

Program Directors’ Perspectives on Duty Hours Following the Physicians’ Work Style Reforms in Japan

“…Despite previous studies suggesting optimal overtime duty hours as 80–100 per month (C5) for resident physicians, 3,4,5 our survey revealed that residency program directors now lean towards a much lower limit of 40 hours per month (C3), highlighting a significant evidence-practice gap. This conservative shift, likely influenced by the impending reforms and anticipation of stricter overtime enforcement, suggests a preemptive adjustment for compliance, and also raises concerns regarding the quality of clinical training.…”

“…Approximately half of all resident physicians took the GM-ITE in Japan. 5,6 The survey was conducted from October 18 to December 15, 2023, and included items like the level planned at their own facility, items that fall under working hours rather than self-improvement, and the residency program directors’ perceptions on the optimal working hours for resident physicians. Overtime duty hours per month was divided into eight categories (C1 to C8) (Supplementary file 1).…”

“…2 Previous research indicates that 60–65 duty hours per week (80–100 overtime duty hours per month) may provide the optimal balance for residents’ education, well-being, and patient safety. 3,4,5 This study assessed the impact of physician’s work style reforms on clinical resident physicians’ environments, in Japan by examining residency program directors’ perceptions of optimal overtime duty hours toward training efficacy and trainee well-being.…”

Sleep quality and related factors among healthcare workers in designated quarantine hospital site in post-pandemic based on the health ecological model: a cross-sectional study in Nanjing, China

“…Previous studies have shown that sleep quality has a significant impact on health ( 15 , 16 ), especially among HCWs ( 17 , 18 ). Poorer sleep quality may lead to lower work productivity ( 19 ), more medical errors ( 20 ) and burnout ( 21 ) for HCWs. Research has identified that both personal (such as education and socio-economic status) ( 22 , 23 ) and work-related factors (like job type and workload) ( 24 ) influence HCWs’ sleep quality.…”