Lack of sleep for the junior doctors can affect their neurobehavioral performance as much as having alcohol and working.
During heavy call rotation and long hours, effects on residents' neurobehavioral performance are comparable to the impairment associated with a 0.04 to 0.05 grams percent blood alcohol concentration. The article was published in the September issue of JAMA .
AdvertisementWork-related sleep loss and fatigue in medical training has become a source of increasing concern, according to background information in the article. One study found that interns got 5.8 hours less sleep, had 50 percent more mistakes from being inattentive, and made 22 percent more serious errors on critical care units while working a traditional schedule compared with a schedule with less hours. Also, self-reported lifetime rates of motor vehicle crashes and near-miss crashes among residents are 3 and 2.5 times those of nonresident drivers, respectively.
Researchers from the University of Michigan had compared post-call neurobehavioral performance of 34 medical residents (18 women, 16 men) after their rotations to examine the effect of extended work hours. The residents were tested after light call rotation (four-week rotations averaging 44 hours per week), light call with alcohol, heavy call (an average of 90 hours per week, every fourth or fifth night, 80 hours after July 2003), and heavy call with placebo. In the light call with alcohol condition, participants' blood alcohol concentrations were raised to 0.05 grams percent. Average age of residents was 28.7 years.
The researchers found that performance impairment during a heavy call rotation was comparable to impairment associated with a .04 to .05 grams percent blood alcohol concentration during a light call rotation. Compared with light call, heavy call reaction times were 7 percent slower and lane variability and speed variability during the simulated driving test were 27 percent and 71 percent greater, respectively. Speed variability was 29 percent greater in heavy call with placebo than light call with alcohol, and there were similar errors and reaction times.
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