Fatigued medical residents' performance on attention tests and on a driving simulator is comparable – or worse – than their performance after drinking three to four cocktails, according to research from Brown Medical School and University of Michigan.
The negative effects of fatigue on doctors-in-training are well documented and increasingly a matter of concern. In July 2003, the Accreditation Council for Graduate Medical Education instituted a landmark 80-hour-per-week limit on the nation's roughly 98,000 residents.
But the latest study, published in the current issue of JAMA, is the first to compare residents' sleep deprivation with alcohol ingestion – a standard of impairment long studied by researchers and easily recognized by the public.
"The take-home message here is that the repercussions of fatigue on residents are considerable," said Judith Owens, director of the Pediatric Sleep Disorders Clinic at Hasbro Children's Hospital and associate professor of pediatrics at Brown Medical School. "This is a national problem, and we shouldn't consider it solved by an 80-hour cap on hours."
Owens, a pediatrician who was involved in a serious car accident after an overnight shift as a resident, helped create the Sleep, Alertness, and Fatigue Education in Residency (SAFER) Program used in residency programs across the nation. She said regulators, hospitals and medical schools must keep pushing to protect residents – and the public – from work-related fatigue.
"We have to continue to educate doctors-in-training," Owens said, "and we should help them develop sleep risk-management strategies. This is particularly important since our study shows that many sleep-starved residents don't recognize that they're impaired."
Mary A. Carskadon, director of the Bradley Hospital Sleep and Chronobiology Research Lab and professor of psychiatry and human behavior at Brown Medical School, said further reducing residents' hours need not be the only solution to the problem.
"We could improve on-call sleeping quarters, provide rides to and from work, reinforce the importance of catching up on sleep after heavy call," Carskadon said. "Because there is a risk to residents and to other drivers – and that risk needs to be managed."
Led by former Brown Medical School researcher J. Todd Arnedt, now at the University of Michigan Health System, the team compared the post-call performance of 34 medical residents to examine the effects of extended work hours.
Each resident was tested under four conditions – light call, light call with alcohol, heavy call and heavy call with placebo.