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Fellowship training, workload, fatigue and physical stress: a prospective observational study
Christopher S Parshuram1, Sonny Dhanani, Joel A Kirsh
1Department of Critical Care Medicine, Hospital for Sick Children, Tornto, ON. chris@sickkids.ca
Summary
Physician trainees experience significant on-call workload and physical stress, leading to sleep deprivation. This impacts trainee well-being and potentially patient safety, despite current duty-hour regulations.
Area of Science:
- Medical Education
- Physician Trainee Well-being
- Critical Care Medicine
Background:
- Physician trainee fatigue can negatively impact patient safety and trainee well-being.
- Despite regulations, anecdotal evidence points to high on-call workloads and physical demands for trainees.
Purpose of the Study:
- To objectively measure the workload, fatigue, and physical stress experienced by senior fellows in a critical care unit.
- To assess the impact of on-call duties on trainee well-being and identify potential risks.
Main Methods:
- Assessed workload through rostered hours, admissions, procedures, and nurse:patient ratios.
- Measured trainee fatigue and stress via self-reported sleep, pages, distance walked (pedometer), electrocardiographic monitoring, and urine analysis.
Main Results:
- Fellows worked an average of 69 hours/week, with shifts averaging 25.5 hours.
- During shifts, fellows slept only 1.9 hours, received 41 pages, and walked 6.3 km.
- Physiological stress indicators like ketonuria and arrhythmias were observed in participants.
Conclusions:
- Current Canadian and proposed US guidelines do not adequately mitigate significant on-call workload and sleep deprivation for trainees.
- The study highlights substantial physical stress and sleep debt among senior fellows, indicating a need for revised regulations.