Workload, fatigue and physical stress on physician residents in training

Physicians in training are required to work long hours even though there are labour agreements that limit these to a maximum of 7 shifts of up to 24 hours per 4 week period. Christopher Parshuram and colleagues show that even working within the labour guidelines, the physical demands faced by senior research fellows while on call in a pediatric critical care unit result in significant fatigue and physical stress. He says "this style of health care delivery is almost certainly associated with the production of error and adverse patient outcomes."

On average, fellows worked 69 hours a week (mean shift duration 25.5 hours), received 41 pages seeking their services, walked 6.9 km and slept 1.9 hours. The authors also found that ketonuria (a marker for dehydration) affected residents in 21% of the 33 shifts during which it was measured.

In a related commentary, Drs. Steven Howard and David Gaba discuss whether the current limitations on residents' hours of work are sufficient to ensure physician and patient safety.

p. 965 Fellowship training, workload, fatigue and physical stress: a prospective observational study -- C.S. Parshuram et al
p. 975 Trainee fatigue: are new limits on work hours enough? -- S.K. Howard, D.M. Gaba

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