Impact of extended duty hours on medical trainees

Abstract

Many studies on resident physicians have demonstrated that extended work hours are associated with a negative impact on well-being, education, and patient care. However, the relationship between the work schedule and the degree of impairment remains unclear. In recent years, because of concerns for patient safety, national minimum standards for duty hours have been instituted (2003) and revised (2011). These changes were based on studies of the effects of sleep deprivation on human performance and specifically on the effect of extended shifts on resident performance. These requirements necessitated significant restructuring of resident schedules. Concerns were raised that these changes have impaired continuity of care, resident education and supervision, and patient safety. We review the studies on the effect of extended work hours on resident well-being, education, and patient care as well as those assessing the effect of work hour restrictions. Although many studies support the adverse effects of extended shifts, there are some conflicting results due to factors such as heterogeneity of protocols, schedules, subjects, and environments. Assessment of the effect of work hour restrictions has been even more difficult. Recent data demonstrating that work hour limitations have not been associated with improvement in patient outcomes or resident education and well-being have been interpreted as support for lifting restrictions in some specialties. However, these studies have significant limitations and should be interpreted with caution. Until future research clarifies duty hours that optimize patient outcomes, resident education, and well-being, it is recommended that current regulations be followed.

Perseverance, faith and stoicism: a qualitative study of medical student perspectives on managing fatigue

“…Our students’ perception of fatigue as a threat to their personal health reflects existing literature that links fatigue, sleep deprivation and burnout in the medical profession at large . Our participants questioned the relevance of espoused wellness strategies intended to protect them from these negative outcomes.…”

“…Workplace fatigue is ubiquitous amongst medical trainees and physicians . There is good reason to be concerned about its impact on patient safety and provider well‐being . Across many international jurisdictions, working hour regulations remain the primary solution to the problem of fatigued physicians .…”

“…First, FRM focuses exclusively on ensuring workplace safety and overlooks the potential holistic impact of fatigue on employee well‐being beyond the workplace. However, it is well established that long working hours, overnight shifts and emotional fatigue during medical training and practice put providers at risk of exhaustion, depression and burnout, as well as impairing learning . Second, FRM assumes a shared understanding of fatigue as hazardous .…”

“…[1][2][3][4][5][6] There is good reason to be concerned about its impact on patient safety and provider well-being. 7,8 Across many international jurisdictions, working hour regulations remain the primary solution to the problem of fatigued physicians. [9][10][11] However, these restrictions have largely fallen short of expectations as a result of unintended consequences 12,13 and inconsistent evidence of benefit.…”

“…However, it is well established that long working hours, overnight shifts and emotional fatigue during medical training and practice put providers at risk of exhaustion, depression and burnout, as well as impairing learning. 3,8 Second, FRM assumes a shared understanding of fatigue as hazardous. 22 For example, experts within aviation have shed previously held assumptions that 'fatigue was a state of mind and that the effects of selfinduced sleep deprivation could be overcome with professionalism, training or motivation'.…”