Medical residency training, like many occupations with demanding work hours, poses a safety risk to trainees; fatigue is one of these risks. In the past, and in some current situations, residents have been scheduled for duty periods of 24 or more consecutive hours without restorative sleep. At the centre of debate regarding resident duty hours have been concerns regarding the negative implications of such hours worked by residents on their physical, mental, and occupational health (NSC 2013).
Evidence from multiple studies evaluating the effects of fatigue on healthcare worker performance indicate that fatigue increases the risk of medical error, compromising patient safety while increasing the risk to the personal safety and wellbeing (The Joint Commission, 2011). Whether it is a motor vehicle accident post-call or a treatment error made while on duty, evidence shows that chronic sleep deprivation leads to errors; residents and physicians are just as vulnerable to the effects of fatigue as the rest of the population (Asch et al, 2017). Efforts to minimize this risk cannot be undertaken by
addressing resident duty hours alone, and in their 2013 report the National Steering Committee on Resident Duty Hours recommended that a one-size-fits-all approach to resident duty hours will not be effective or appropriate in Canada (NSC, 2013). Therefore, the shift to managing fatigue related risk during residency training is essential to supporting the dual role of learner and care provider.
Resident wellness matters
Fatigue Risk affects us all
Within a shared responsibility framework, trainees have a key role in managing and reporting their own fatigue to their supervisors, peers and to the healthcare team. To support this, leaders within medical education are accountable for ensuring practices are in place that enable and protect every trainee’s ability to fulfill their role in the management of fatigue risk.
- FRM Principles
- Governance + Policy
Tools are available to foster change
Fatigue Risk is actionable on all levels
The strategies employed to prevent and manage the hazard of fatigue during residency training must be comprehensive and reflective of each local context and recognize the impacts and consequences of fatigue on the physical, professional, occupational and psychological/sociological aspects of medical education.
- Auditing the FRM system: Audit of Policy, Education, Risk
- Assessment Methods & Strategies
- Facilitating FRM Infrastructure: Knowledge Sharing and Best Practices
- Additional Resources
- Appendix and References
It’s our responsibility to make a just culture
Make a culture in which Fatigue Risk Management is the norm
Any successful risk management approach necessitates the development of a culture that actively discusses and recognizes fatigue as a risk in training and practice. This includes ongoing incorporation of meaningful, actionable steps that improve the safety of the clinical learning environment.
- System Recommendations: Risk Assessment
- Risk Mitigation Tools and Strategies
- Recommendations for Training and Education + Case Studies
Managing fatigue signals a turning point for Canadian medical training as we move to join leading countries and best practices in the management of fatigue risk. If we are successful, we will promote the establishment of training environments where fatigue risk is acknowledged, individuals and teams are enabled to recognize the risks and empowered to take action to apply adaptive strategies suited to local contexts. Focusing on fatigue risk management does not imply that long work hours are acceptable; rather, this approach recognizes the risk associated with extended work hours and aims to identify practical approaches to managing the risk.