Fatigued Residents “Experience Significant Performance Decrements”

Philibert I. “Sleep loss and performance in residents and nonphysicians: a meta-analytic examination.” SLEEP Nov 2005;28(11). (Download in PDF)

Landrigan, C. “Editorial: Sliding Down the Bell Curve: Effects of 24-hour Work Shifts on Physicians’ Cognition and Performance.” SLEEP Nov 2005;28(11). (Download in PDF)

A study and accompanying editorial published in the November 2005 issue of the medical journal SLEEP raise alarming questions about the sensibility of current regulations governing resident work hours permitting extended work shifts of up to 30 consecutive hours. In a meta-analysis of 60 previous studies of the effects of sleep deprivation, researcher Ingrid Philibert found that sleep deprivation greatly impairs both the clinical performance and vigilance of resident physicians.

Philibert is the Director of Field Activities for the American Council on Graduate Medical Education (ACGME), the body charged with creating and enforcing work hour standards for physicians-in-training in the US. In the journal article, Philibert acknowledged the likelihood that “residents may experience significant performance decrements under the current minimum [work hour] standards,” identifying the continuing need “to find the limit on weekly and continuous hours and the organization of call … that will optimally foster the dual goals of resident learning and safe and effective patient care.”
 
The long shifts permitted by ACGME regulations were also the focus of a critical editorial in the same issue by sleep researcher Christopher Landrigan, MD. “Few passengers would be comfortable flying with an exhausted pilot who had been working in the cockpit for 24 consecutive hours, never mind one who had done so every third or fourth night for the past several years,” wrote Landrigan. “Yet this is the norm in medicine.” He also noted the role of sleep loss in the “astonishingly high incidence of serious error” committed by doctors, arguing that, “to protect our trainees and patients, the dangerous tradition of 24-hour shifts must at last be put to rest.”