Figuring in fatigue: A commentary on Schwartz et al., “Fatigue in surgical residents: An analysis of duty-hours and the effect of hypothetical naps on predicted performance”

• Published in: The American journal of surgery 2021-05, Vol.221 (5), p.864-865
• Main Authors: Barnard, Melanie, Mellinger, John D.
• Format: Article
• Language: English
• Subjects: Alertness; Constrictions; Culture; Fatigue; Medical education; Restrictions; Sleep; Surgery; Training
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.09.022

Surgery residents have experienced significant changes in lifestyle, including an up to 20 hour decrease in the average reported weekly work hours subsequent to these restrictions.1 A systematic review of the effect of duty hour restrictions on surgical residents showed an increase in hours of sleep and levels of alertness, with little to no effect on operative volumes.2 Despite these changes, concerns regarding resident fatigue and wellness remain, and have fostered ongoing discussions around flexible educational strategies that promote healthy sleep patterns and related effective personal and clinical function. [...]it is not clear that a 90-min mid-shift nap and 30-min recovery period represents a feasible and scalable construct for addressing resident fatigue issues in a fashion comparable to what might prove practical and effective for a transportation worker. Experience thus far with duty hour reform has suggested that seniorization of work, inaccurate reporting of hours, and infrequent efforts to go home early or hand off care due to cultural commitments to continuity and patient ownership are more common than not.5 There is a prevalent and persistent viewpoint within surgical training programs that the “old school” method of teaching is superior, and duty hour restrictions inhibit appropriate surgical training and preparation for autonomous practice.