Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians

Area of Science:

• Medical Education and Training
• Sleep Medicine
• Patient Safety Research

Background:

• Extended-duration work rosters (EDWRs) with shifts exceeding 24 hours are common in medical training but are known to impair cognitive performance.
• Previous research indicated performance deficits in postgraduate year 1 (PGY-1) residents on EDWRs compared to rapid cycling work rosters (RCWRs).

Purpose of the Study:

• To evaluate the impact of a RCWR on neurobehavioral performance and patient safety in PGY-2 and PGY-3 resident physicians.
• To compare performance metrics between EDWRs and RCWRs in more senior residents.

Main Methods:

• A multicenter clinical trial involving 294 resident physicians in 6 US pediatric intensive care units (PICUs).
• Residents worked either 4-week EDWRs (shifts ≥24 hours) or RCWRs (most shifts ≤16 hours).
• Data collected included daily sleep logs, Psychomotor Vigilance Task (PVT) performance, and Karolinska Sleepiness Scale (KSS) ratings.

Main Results:

• Attentional failures on the PVT were significantly higher (P=.01) in EDWRs (6.8 ± 1.0) versus RCWRs (2.9 ± 0.7).
• Reaction time increased by ~18% and subjective alertness decreased by ~9% (both P<.0001) with EDWRs, persisting throughout the rotation.
• Attentional failures correlated with resident-physician-related serious medical errors (SMEs) (P=.04); RCWRs showed a protective effect against SMEs (rate ratio 0.48).

Conclusions:

• Limiting shift duration to ≤16 hours via RCWRs effectively improves neurobehavioral performance in resident physicians.
• The findings underscore the detrimental effects of extended-duration shifts on cognitive function and highlight their critical implications for patient safety.
• Implementing RCWRs is crucial for mitigating performance deficits and reducing medical errors in resident physicians.