Fatigue Management

Module Summary

Fatigue is a common problem among residents due to a combination of long work hours, high work load, interrupted sleep, and the expectation that patients’ needs take precedence above one’s own. Unmitigated fatigue can lead to concentration difficulties, irritability, and burn-out, causing adverse outcomes for both patients and residents themselves. Furthermore, within surgical specialties, the culture often implies that trainees who admit to being fatigued are “less dedicated” than their peers. To maintain resident well-being, it is critical that residents recognize fatigue in themselves and others, be able to use strategies to mitigate fatigue during their training, and provide support to fellow trainees.

Module Learning Objectives 
  1. Describe the impact of fatigue on resident well-being and patient care.
  2. Identify factors that contribute to resident fatigue.
  3. Detect signs of fatigue in yourself and in colleagues.
  4. Describe strategies to manage and mitigate fatigue in pre-call, on-call, and post-call states.
  5. Use fatigue management strategies to diminish personal fatigue.

Case Studies

  1. You are the chief on the busiest otolaryngology clinical service. The PGY-2 resident on your team fell asleep in didactic conference yesterday, yelled at a nurse this morning on rounds, and just documented on the wrong patient in the electronic medical record system. How do you address this situation with the resident and the rest of the team?
  2. You are scheduled to be on call tonight. Unfortunately, you got food poisoning yesterday, and were up all night vomiting. What strategies could you use to mitigate fatigue before, during, and after your call?

Review

Review Questions 
  1. What factors during residency training contribute to increased fatigue?
  2. What are the consequences of resident fatigue for patients and residents?
  3. What warning signs can indicate dangerous levels of resident fatigue?
  4. Describe strategies for mitigating fatigue in the pre-call, on-call, and post-call time frames.
  5. What strategies do you employ to decrease fatigue during your residency training?
References