Physician Impairment: Fatigue

INTERNAL MEDICINE RESIDENCY PROGRAM

Faculty: Robert Healy, MD, Janet Jokela, MD, Mehtab Mizan, MD, Andrew Robbins, MD

Sites: Provena Covenant Medical Center (PCMC), Carle Foundation Hospital, Danville Veterans Administration Illiana Health Care System (DVAIHS)

Duration: Continuing 18 Month Curriculum

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Description:

Core Conference curriculum to educate residents on physician impairment and fatigue.

I. GOALS

Demonstrate comprehensive knowledge of the effects of fatigue on physician performance.

II. OBJECTIVES

A. PATIENT CARE:

Objective 1: Describe the effects of fatigue on physician performance in caring for patients including, but not limited to, physician impairment, e.g., medical errors.

Objective 2: Describe the effects of fatigue on patient and physician safety including, but not limited to, motor vehicle accidents, pregnancy complications, psychiatric illness.

Objective 3: Describe medical evidence supporting ACGME guidelines for work hour restrictions.

B. MEDICAL KNOWLEDGE

Objective 1: Describe the physiological effects of fatigue and sleep deprivation on the human body including, but not limited to, physical impairment, i.e. physical health; cognitive impairment, e.g. memory, task completion, analytical thinking; and psychological impairment, e.g., motivation, demeanor, mood, psychiatric illness.

C. PRACTICE-BASED LEARNING AND IMPROVEMENT

Objective 1: Recognize the signs and symptoms of fatigue to initiate measures to cope with fatigue and the subsequent impairment of physician performance.

Objective 2: Describe ways to measure and to cope with fatigue.

D. INTERPERSONAL AND COMMUNICATION SKILLS

Objective 1: Describe the effects of fatigue on interpersonal skills.

Objective 2: Describe ways to measure and to cope with fatigue.

E. PROFESSIONALISM

Objective 1: Describe effects of fatigue on demeanor, morale, mood, etc. and the subsequent effect upon professionalism.

Objective 2: Discuss techniques to intervene when a colleague believes another physician is impaired due to fatigue.

F. SYSTEM-BASED PRACTICE

Objective 1: Discuss the effects of fatigue on physician performance, efficiency, and errors, and the influence on interactions with other health care providers.

III. METHODS

Residents attend weekly core lectures. As part of the 18 month curriculum, there are 2 scheduled physician impairment conferences of one to two hours. The SAFER Education module includes slides, syllabus and pre-post testing. The second conference involves lecture, and role play.

IV. EVALUATION

Evaluation of resident knowledge of physician impairment related to fatigue will be assessed by pre-post testing. Additional evaluation includes role play, e.g. measures a resident can take to cope with his or her fatigue; a resident approaches another resident with concerns of fatigue and impairment. Residents will be surveyed on the second conference regarding effectiveness. Residents evalute the second conference by survey.

V. REFERENCES

American Academy of Sleep Medicine, " S.A.F.E.R. Educational Module: Sleep Alertness, and Fatigue Education in Residency."

Brown BJ, et al. Influence of sleep deprivation on learning among surgical house staff and medical students. Surgery. 1994;115:604-610.

Engel W, et al. Clinical performance of interns after being on call. Southern Medical Journal. 1098;80:761-763.

Friedman RC, et al. The intern and sleep loss. New England Journal of Medicine. 1971;285:201-203.

Nasmyth DG, et al. Reducing hour of work of pre-registration house officers: reports of a shift system. British Medical Journal. 1991;302:93-94.

9/29/2005