 |
|
Neurobehavioral Performance of Residents After Heavy Night Call vs After Alcohol Ingestion
J. Todd Arnedt, PhD;
Judith Owens, MD, MPH;
Megan Crouch, BA;
Jessica Stahl, BA;
Mary A. Carskadon, PhD
JAMA. 2005;294:1025-1033.
Context Concern exists about the effect of extended resident work hours; however, no study has evaluated training-related performance impairments against an accepted standard of functional impairment.
Objectives To compare post-call performance during a heavy call rotation (every fourth or fifth night) to performance with a blood alcohol concentration of 0.04 to 0.05 g% (per 100 mL of blood) during a light call rotation, and to evaluate the association between self-assessed and actual performance.
Design, Setting, and Participants A prospective 2-session within-subject study of 34 pediatric residents (18 women and 16 men; mean age, 28.7 years) in an academic medical center conducted between October 2001 and August 2003, who were tested under 4 conditions: light call, light call with alcohol, heavy call, and heavy call with placebo.
Interventions Residents attended a test session during the final week of a light call rotation (non–post-call) and during the final week of a heavy call rotation (post-call). At each session, they underwent a 60-minute test battery (light and heavy call conditions), ingested either alcohol (light call with alcohol condition) or placebo (heavy call with placebo condition), and repeated the test battery. Performance self-evaluations followed each test.
Main Outcome Measures Sustained attention, vigilance, and simulated driving performance measures; and self-report sleepiness, performance, and effort measures.
Results Participants achieved the target blood alcohol concentration. Compared with light call, heavy call reaction times were 7% slower (242.5 vs 225.9 milliseconds, P<.001); commission errors were 40% higher (38.2% vs 27.2%, P<.001); and lane variability (7.0 vs 5.5 ft, P<.001) and speed variability (4.1 vs 2.4 mph, P<.001) on the driving simulator were 27% and 71% greater, respectively. Speed variability was 29% greater in heavy call with placebo than light call with alcohol (4.2 vs 3.2 mph, P = .01), and reaction time, lapses, omission errors, and off-roads were not different. Correlation between self-assessed and actual performance under heavy call was significant for commission errors (r = –0.45, P = .01), lane variability (r = –0.76, P<.001), and speed variability (r = –0.71, P<.001), but not for reaction time.
Conclusions Post-call performance impairment during a heavy call rotation is comparable with impairment associated with a 0.04 to 0.05 g% blood alcohol concentration during a light call rotation, as measured by sustained attention, vigilance, and simulated driving tasks. Residents’ ability to judge this impairment may be limited and task-specific.
Author Affiliations: Department of Psychiatry and Human Behavior, Brown Medical School (Drs Arnedt, Owens, and Carskadon); Division of Ambulatory Pediatrics, Rhode Island Hospital (Dr Owens and Mss Crouch and Stahl); and Sleep and Chronobiology Research Laboratory, E. P. Bradley Hospital (Dr Carskadon), Providence, RI. Dr Arnedt is now with the Sleep and Chronophysiology Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
RELATED LETTERS
Heavy Night Call vs Alcohol Ingestion in Residents
Daniel Merenstein
JAMA. 2006;295(2):162.
EXTRACT
| FULL TEXT
Heavy Night Call vs Alcohol Ingestion in Residents—Reply
J. Todd Arnedt, Judith A. Owens, and Mary A. Carskadon
JAMA. 2006;295(2):162-163.
EXTRACT
| FULL TEXT
RELATED ARTICLE
Work Hours and Reducing Fatigue-Related Risk: Good Research vs Good Policy
Drew Dawson and Phyllis Zee
JAMA. 2005;294(9):1104-1106.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
How long does it take to train a surgeon?
Purcell Jackson and Tarpley
BMJ 2009;339:b4260-b4260.
FULL TEXT
Sleep Deprivation, Physician Performance, and Patient Safety
Olson et al.
Chest 2009;136:1389-1396.
ABSTRACT
| FULL TEXT
Fatigue, Countermeasures, and Performance Enhancement in Resident Physicians
Rose and Curry
Mayo Clin Proc. 2009;84:955-957.
FULL TEXT
Doit-on continuer de priver les residents de sommeil?
Kelsall
CMAJ 2009;180:E59-E59.
FULL TEXT
Must we keep depriving residents of sleep?
Kelsall
CMAJ 2009;180:1087-1087.
FULL TEXT
Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison
Cappuccio et al.
QJM 2009;102:271-282.
ABSTRACT
| FULL TEXT
Napping on the Night Shift: Slacker or Savior?
Alspach
Crit Care Nurse 2008;28:12-19.
FULL TEXT
Physicians ... Wake Up!
Shah and French
J Am Coll Cardiol Intv 2008;1:689-691.
FULL TEXT
An Endogenous Circadian Rhythm in Sleep Inertia Results in Greatest Cognitive Impairment upon Awakening during the Biological Night
Scheer et al.
J Biol Rhythms 2008;23:353-361.
ABSTRACT
Effects of the Accreditation Council for Graduate Medical Education Duty Hour Limits on Sleep, Work Hours, and Safety
Landrigan et al.
Pediatrics 2008;122:250-258.
ABSTRACT
| FULL TEXT
Crossroads: Two Points of View: RESIDENT WORK HOURS: DISTINGUISHING RESIDENT SERVICE ISSUES FROM EDUCATION AND SAFETY
Watson
Neurology 2008;71:375-376.
FULL TEXT
The Urgency of Surgical Debridement in the Management of Open Fractures
Werner et al.
J Am Acad Orthop Surg 2008;16:369-375.
ABSTRACT
| FULL TEXT
Prevalence of Sleep Disturbances in a Cohort of Older Drivers
Fragoso et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2008;63:715-723.
ABSTRACT
| FULL TEXT
The Effects of Resident Work-Hour Regulation on Psychiatry
Rabjohn and Yager
Am. J. Psychiatry 2008;165:308-311.
FULL TEXT
Work Hours Regulations for House Staff in Psychiatry: Bad or Good for Residency Training?
Rasminsky et al.
Acad. Psychiatry 2008;32:54-60.
ABSTRACT
| FULL TEXT
Work patterns and fatigue-related risk among junior doctors
Gander et al.
Occup. Environ. Med. 2007;64:733-738.
ABSTRACT
| FULL TEXT
Trucks, Planes, and Scalpels: Is There an Evidence-Based Approach to Surgeons' Working Hours?
Leff et al.
Arch Surg 2007;142:817-820.
FULL TEXT
Effect of Residency Duty-Hour Limits: Views of Key Clinical Faculty
Reed et al.
Arch Intern Med 2007;167:1487-1492.
ABSTRACT
| FULL TEXT
Sleep and Well-Being of ICU Housestaff
Parthasarathy et al.
Chest 2007;131:1685-1693.
ABSTRACT
| FULL TEXT
Burnout Syndrome in Critical Care Nursing Staff
Poncet et al.
Am. J. Respir. Crit. Care Med. 2007;175:698-704.
ABSTRACT
| FULL TEXT
Identification of a biomarker for sleep drive in flies and humans
Seugnet et al.
Proc. Natl. Acad. Sci. USA 2006;103:19913-19918.
ABSTRACT
| FULL TEXT
Association of extended work shifts, vascular function, and inflammatory markers in internal medicine residents: a randomized crossover trial.
Zheng et al.
JAMA 2006;296:1049-1050.
FULL TEXT
Extended work duration and the risk of self-reported percutaneous injuries in interns.
Ayas et al.
JAMA 2006;296:1055-1062.
ABSTRACT
| FULL TEXT
Interns' compliance with accreditation council for graduate medical education work-hour limits.
Landrigan et al.
JAMA 2006;296:1063-1070.
ABSTRACT
| FULL TEXT
Timing of Debridement of Open Fractures
Pollak
J Am Acad Orthop Surg 2006;14:S48-S51.
ABSTRACT
| FULL TEXT
The effects of on-duty napping on intern sleep time and fatigue.
Arora et al.
ANN INTERN MED 2006;144:792-798.
ABSTRACT
| FULL TEXT
Heavy Night Call vs Alcohol Ingestion in Residents
Merenstein
JAMA 2006;295:162-162.
FULL TEXT
A Shift for the Better
Lilly and Landrigan
Chest 2005;128:3787-3788.
FULL TEXT
Heavy Call Schedule Has Alcohol-Like Effect
Lamberg
Psychiatr. News 2005;40:17-17.
FULL TEXT
Work Hours and Reducing Fatigue-Related Risk: Good Research vs Good Policy
Dawson and Zee
JAMA 2005;294:1104-1106.
FULL TEXT
Medical Education 2005: From Allegory to Bull Moose
Golub
JAMA 2005;294:1108-1110.
FULL TEXT
|
