Residency training is demanding, leading busy residents to forfeit sleep

Federal mandates last year capped the resident’s work week at 80 hours, reducing the amount of time spent in the operating room and in the hospital treating patients.

To insure that residents still gain the necessary skills, medical educators have had to adapt teaching methods and are increasingly turning to virtual training techniques and laboratories.

A lingering concern, however, is that even with the reduced workload, residency training is demanding, leading busy residents to forfeit sleep. To find out whether sleep deficits would affect the acquisition of surgical skills in the lab, Temple University researchers evaluated learning in residents who had had varying amounts of sleep the previous evening. Their findings were recently published in Surgical Endoscopy.

“We tested the efficacy of our laboratory model for teaching the technically challenging surgical skills of minimally invasive surgery,” said Harsh Grewal, M.D., associate professor of surgery at Temple University School of Medicine and a pediatric surgeon at Temple University Children’s Medical Center. “We found that the amount of sleep the night before had no significant effect on their learning or performance.”

Because medical errors can be associated with fatigue and sleep deprivation, the Accreditation Council for Graduate Medical Education mandated changes last year in the education of surgical and medical residents. In addition to the 80-hour work week cap, continuous on-call duty is now limited to a 24-hour maximum.

“The overnight call remains a key component of a residency. Thus the lab setting can offer several benefits. First, it permits flexibility in scheduling residents for training sessions. Second, this type of teaching model allows us to evaluate the effects of all working conditions on skill acquisition,” explained Grewal.

“Our challenge is to provide training that fits in with the residents’ already intense workload, under the new guidelines. There are many new options that can be performed virtually in a laboratory setting, but we need to make sure that the skills gained in a lab are comparable to those skills gained in a real-life setting.”

Grewal emphasizes that further study of the effect of sleep deficits on learning more complex surgical skills is necessary before conclusions can be made about transferring these skills to real-life.

Temple’s School of Medicine is expanding its current surgical skills laboratory and building a new clinical simulation lab. Such facilities will allow medical students, residents and practicing physicians to hone both their clinical judgment and technical skills, by practicing on sophisticated clinical simulators.