Tip of the week: Educate residents and faculty about fatigue

Residency Program Insider, December 14, 2010

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Teach residents and faculty to recognize the signs of fatigue and sleep deprivation and to mitigate the effects of fatigue on themselves personally, as well as professionally.

Most people need more sleep than they get. A relatively easy way to assess how sleep-deprived a person is (at least in people under 40) is to determine what he or she does on a day off. For example, if the person doesn’t get up at the time their alarm clock customarily rings and sleeps past the usual wake up time, he or she is probably carrying some level of “sleep debt.”

Program administrators should keep the following tips in mind when educating residents and faculty members about fatigue:

  • If someone falls asleep during rounds or conferences, he or she is probably too tired—it isn’t that the conference is boring (in which case they are awake and annoyed).
  • People underestimate how tired they are. It can be similar to the effects of drinking too much alcohol—sometimes, by the time someone realizes he’s had too much to drink, he’s drunk. By the time someone is tired, he’s exhausted.
  • Studies have shown that being up for 18 or more hours have equivalent effects on performance as being legally drunk.
  • Napping strategically helps. Short naps are useful. Residents should nap early in the period of time in which fatigue is anticipated rather than waiting until they’re tired.
  • In general, most residents (younger than 40 years) can “recovery sleep” by sleeping longer in off periods to erase their sleep debt; this means they need protected sleep time on off days and can’t spend all their free time doing laundry, running errands, helping with housework, caring for children, or socializing, despite great temptation to do so.
  • Protected sleep time is important. Residents and their families and friends should help protect their sleep time allowing them to recovery sleep and nap before prolonged duty periods.
  • Strategic use of caffeine can help with fatigue. Residents who want to use caffeine for its alerting effects during call should dispense with daily coffee or multiple caffeinated sodas.
  • Post-call, residents should consider a nap before driving home.
  • Residents are human beings too, and sometimes they may have a primary sleep disorder, such as obstructive sleep apnea, narcolepsy, or another medical condition. If residents are fatigued, and the fatigue is not related to duty hours, they should seek medical attention, as true for any patient.

This week’s tip is from Insider’s Guide to the ACGME Site Visit, Second Edition, by Kathryn Andolsek, MD, MPH and Shepard Cohen.

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