Sleep deprivation is a health risk for both physicians and patients.
It’s no surprise that medical students and resident physicians alike are subjected to varied degrees of sleep deprivation. The combination of up to 80-hour work weeks, a consistent series of exams to prep for, and attempts to maintain a life outside of medicine can really put physicians at a sleep deficit.
Not only does physician and resident sleep deprivation pose a risk for the practitioners themselves, but it also affects the quality of patient care they provide. In 1984, Libby Zion, an 18-year-old patient in New York whose death was thought to be related in part to resident physician sleep deprivation.
Action taken on sleep deprivation
In response, New York State enacted laws in 1989 that prohibit resident physicians from working more than 80 hours per week. The Accreditation Council for Graduate Medical Education (ACGME) came out with rules in 2003 and updated them again in 2011. Not surprisingly, these changes have sparked great controversy surrounding the balance of patient care, resident education, and depth and breadth of experiences during graduate medical training.
Research has identified four major physiologic factors that contribute to resident sleep deprivation:
- Acute total sleep loss
This is sustained wakefulness. Performance of cognitive tasks after 24 hours of wakefulness has been equated to a blood alcohol concentration of 100mg/dl—a level at which it is illegal to drive.
- Chronic partial sleep deprivation
This is when we sleep, but consistently have our alarm clock go off before we would normally wake up. If we sleep <6 hours for 2 weeks, the effects are is similar to one night of complete lack of sleep.
- Sleep inertia
The body takes 10-15 minutes to become fully functional after waking. This is of concern for physicians who are suddenly woken to provide emergent care.
- Our internal time clock
The hypothalamus tells us to be awake (the “Circadian rhythm”), and this system is quietest between 3 and 5 a.m. This is why night shifts can hurt so much.
I find these factors fascinating, and am motivated to address my own sleep deprivation based on each of these physiologic factors—something I encourage others to do as well. I am also led to consider how the Accreditation Council for Graduate Medical Education (ACGME) work hour restrictions have been aimed at addressing these factors in one way or another.
Not there yet …
Significant controversy remains over the work hour restrictions impact on patient care, resident education, and a resident’s well-being. As the debate unfolds, there are likely to be heavy impacts on future residents, and the implications bring up very important questions such as:
- Will there need to be longer residency training periods in order to gain the experience needed?
- Will we start to see more of a transition to shift workers?
- Will we need to become even more sub-specialized in the medical field, training professionals with narrower skill sets and focuses, which could have implications, for example, for the already struggling specialization of primary care?
In the meantime, we can take charge of our own destiny as health care professionals and professionals-in-training by being mindful of our sleep habits and guarding as much as possible against harmful deprivation—one night at a time.
To help you balance your busy work schedule and exams, we offer live online USMLE prep courses through Kaplan—the world leader in test prep.
The post Dangers of Sleep Deprivation in Medical Training appeared first on Residency Secrets.