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Updated: Jun 29, 2025
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Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments
Published on: August 8, 2019
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Exploring sleep duration and clinical reasoning process in resident physicians: a thematic analysis
Jacob Collen1, Steven Durning1, Joshua Berk1
1Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Summary
Resident physicians experienced more sleep during outpatient rotations. Less sleep, especially with distracting clinical cases, led to poorer diagnostic reasoning, highlighting the need for adequate rest and supervision.
Area of Science:
- Medical Education
- Cognitive Science
- Sleep Medicine
Background:
- Connecting resident physician work hours and sleep deprivation to adverse outcomes is challenging.
- Diagnostic errors, a leading cause of medical errors, may stem from impaired clinical reasoning.
- This study investigates the relationship between sleep duration and diagnostic reasoning in resident physicians using simulated cases.
Purpose of the Study:
- To explore the impact of sleep duration on the clinical reasoning process of resident physicians.
- To identify specific themes in diagnostic reasoning that are affected by sleep deprivation and contextual factors.
- To provide evidence supporting the importance of adequate sleep for resident physicians' diagnostic accuracy.
Main Methods:
- A 2-month study involving resident physicians (n=17) tracking sleep via diaries and actigraphy.
- Residents completed simulated clinical encounters with "think aloud" protocols after inpatient and outpatient months.
- Thematic analysis was used to interpret "think aloud" transcripts, comparing reasoning themes based on sleep duration and case complexity (distractors).
Main Results:
- Residents slept significantly more during outpatient months (450.5 hours) compared to inpatient months (425.6 hours).
- Suboptimal clinical reasoning themes (disorganized knowledge, error, semantic incompetence, uncertainty) were more prevalent in cases with contextual distractors.
- Sleep restriction combined with distracting cases resulted in a greater number of problematic diagnostic reasoning themes.
Conclusions:
- Resident physicians achieve more sleep during outpatient rotations than inpatient rotations.
- Inadequate sleep, particularly when combined with complex or distracting clinical scenarios, negatively impacts diagnostic reasoning.
- Findings underscore the critical need for sufficient sleep and adequate supervision for resident physicians, especially in challenging clinical situations.
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