For Residents

Sleep Deprivation

While you may be aware that you are indeed fatigued or feeling tired, your ability to accurately assess or predict the impact on increasingly complex tasks diminishes with greater levels of extreme tiredness. Further, as fatigue becomes a chronic pattern during your residency training, your ability to assess the degree of sleep-related impairment diminishes, and many incorrectly come to the conclusion that they have acclimated or ‘adapted’ to a deprived sleep state.

Fatigue Mitigation Strategies

Sample Individual Fatigue Mitigation Strategies

Ensure adequate recovery time prior to each shift
Attend and be engaged during fatigue risk management education and training sessions
Judicious use of caffeine
Work break/work break with no pager/phone
Quiet rest
Napping/sleep
Increased physical activity/light exercise
Ensure adequate hydration and nutrition
Task rotation
Double-checking calculations and instructions
Defer non-urgent cases
Limit overtime hours
Avoid mundane tasks during periods of higher fatigue risk
When possible avoid highly complex tasks during periods of higher fatigue risk
Work in pairs or teams
Declaration of fatigue risk to team
Employ self-assessment checklists for signs and symptoms of fatigue
When necessary, stand down

Sample Team-based Fatigue Mitigation Strategies

Communicate fatigue risk declaration to team
Communicate/document fatigue status in ‘fatigue diary’ or logbook
Communicate fatigue status on daily team notice board
Work in pairs or teams
Reallocate tasks
Increase team cross-checking
Increase supervision
Use of video conferencing/telemedicine
Base shift schedules on sleep science
Seek second opinion on critical clinical decisions
Ensure fatigued individual avoids acting as primary operator in procedural work
Scheduling less complex or less safety-critical tasks at times of highest fatigue risk, when possible
Ensure fatigued individual has priority access to on-call room/napping facility where available
Access to taxi vouchers or transportation for safe commute
All clinicians, educators, and learners take responsibility for identifying and reporting unsafe conditions, in accordance with professional standards and hospital policy, without fear of reprisal
All clinicians, educators, and learners take responsibility for maintaining optimal personal health and well-being outside of work, including maintaining physical fitness, nutrition, and sleep

To download the Fatigue Mitigation Strategies, click here

Who Should Conduct the Fatigue Risk Assessment?

To identify the unique risks for each local context, a Fatigue Risk Assessment should be conducted by a group of people who are most familiar with the local working environment, including, but not limited to:

Clinical educators and supervisors
Learners
Faculty physicians and supervisors
Hospital employees
Program Directors

Decanal team, including PGME
The FRM Local Working Group or Officer (LWG)
Risk management experts
Other key stakeholders

For more information on the group involved in conducting a Fatigue Risk Assessment, please see Governance, Responsibility & Accountability

Sleep Deprivation

Fatigue Mitigation Strategies

Sample Individual Fatigue Mitigation Strategies

Sample Team-based Fatigue Mitigation Strategies

Who Should Conduct the Fatigue Risk Assessment?

If you believe you are at risk of suffering from excess fatigue in the workplace, talk to your immediate supervisor.

Have Questions?