Effects of night-float and 24-h call on resident psychomotor performance

Night-float work schedules were designed to address growing concerns of the affect of fatigue on resident psychomotor and cognitive skills after traditional 24-h call work schedules. Whether this transition has achieved these results is debatable. This study was designed to compare the psychomotor performance of general surgery residents on both work schedule types. We hypothesized that when measured with novel laparoscopic simulator tasks, residents on a 24-h call schedule would exhibit worse psychomotor performance compared with those on a night-float work schedule.

Nine general surgery residents at the post-graduate year (PGY) 2, 3, and 5 levels were recruited and trained on the Simbionix LAP Mentor Simulator (Simbionix, Cleveland, OH). Performance on two tasks was tested before and after a 24-h call work shift and a night-float shift. A survey assessing levels of work shift activity and fatigue were administered after all work shifts.

There was no statistically significant difference in resident accuracy, speed of movement, economy of movement, and time to completion of the two simulation tasks. The only measures of work shift activity achieving statistically significant difference were number of patients seen and numbers of steps walked on call. There was no statistically significant difference in subjective evaluation of fatigue.

In this study of general surgery residents, a statistically significant difference in psychomotor performance between residents working 24-h call shift versus a 12-h night-float shift could not be found. Psychomotor performance does not appear to suffer after a work shift. Additionally, post-shift subjective evaluations of fatigue are comparable regardless of shift type.