Young hospital doctors after night duty: their task-specific cognitive status and emotional condition

Abstract

Sleep deprivation is an unpleasant burden of young hospital doctors during their medical training. It may disrupt the balance between coping strategies available to them and the professional demands encountered. Impaired medical care offered by sleep-deprived juniors may be a consequence. Valid research work on this subject is rare and surprisingly contradictory. Therefore, we evaluated the task-specific cognitive status and emotional condition of 40 young hospital doctors (27 men and 13 women, 29.9 +/- 2.9 years of age) at the University of Tuebingen, all of whom were in the beginning of their academic career. Subjects were tested twice acting as their own control, once at 8.00 am after a night off duty (OD) (at least 6 hours of uninterrupted sleep), and once at a similar time after a night on call (OC) being in the hospital for 24 hours. Standardized and reliable psychometric tests thought to represent daily routine medical function were performed. On-call activities were recorded by means of a sleep diary, whereas a questionnaire interrogated aspects of private and professional life. Neuropsychological function deteriorated significantly: number connection test (per cent of norms +/- SD, 103.2 +/- 9.8 OC vs 107.8 +/- 10.5 OD, F = 27.7, P < 0.001), things-to-do list (correct items +/- SD, 6.7 +/- 1.2 OC vs 7.4 +/- 1.5 OD, F = 12.7, P < 0.01), Vienna reaction timer (per cent of norms +/- SD, 95.6 +/- 9.0 OC vs 97.7 +/- 10.4 OD, F = 4.8, P < 0.05), Stroop test (T-values +/- SD, 59.7 +/- 6.3 OC vs 64.6 +/- 7.1 OD, F = 37.1, P < 0.001), ECG test (correct responses +/- SD, 38.3 +/- 7.3 OC vs 43.4 +/- 6.5 OD, F = 45.2, P < 0.001) and status of mood (T-value +/- SD, 60.3 +/- 9.0 OC vs 54.0 +/- 6.6 OD, F = 19.6, P < 0.001). Cognitive function and mood status of young hospital doctors after a night on call decrease considerably. In view of the special vulnerability of medical trainees to occupational stress all efforts are warranted to reduce sleep deprivation in the medical profession.

Work Environment and Mental Health Status Assessed by the General Health Questionnaire in Female Japanese Doctors

“…Hodiamont et al 25) showed a higher mean GHQ score among divorced people than for any other marital status. The reason for this association has not been fully understood; however, several hypotheses have been proposed.…”

“…This study showed night duty to be a significant factor associated with psychological distress, even when adjusting for other factors, including working time. Other studies have shown that night work is a critical occupational stressor 24) , and that night duty for doctors has more impact on physical and mental health because of sleep deprivation and psychological pressure 25) . Furthermore, for female doctors, night duty may be an obstacle to their household duties.…”

Summary of the Performance Effects of Sustained Operations

“…The task was completion of a complex numeric pattern. Lingenfelser et al (1994) compared the performance of 40 young doctors after a night off (at least 6 hours sleep) and after a night on call (in the hospital for 24 hours). Tasks were connecting numbers, recall of a list of items, choice reaction time, Stroop test, and electrocardiogram simulation.…”

Inclusion of fatigue effects in human reliability analysis

“…Older subjects have been shown to be more affected by sleep deprivation in comparison to younger subjects (Lingenfelser et al, 1994;. Most studies seem to have more male than female participants (Thomas et al, 2000).…”