Fatigue Management for Residents

Medical residents are constantly faced with work-place pressure and long stressful hours of work. Many of them are suffering from fatigue. Fatigue is the feeling of constant tiredness or weakness that can be physical, mental, or a combination of both. It can cause sleepiness, impaired vigilance, and sustained attention. Signs of clinical fatigue include moodiness, irritability, poor speech, nodding off, five to ten-second lapses in attention, diminished problem-solving ability, and difficulty in focusing on tasks. All of these signs can result in medical errors.

Fatigue may be seen as something of less importance by those who are looking from the outside. This condition is actually so grave that it can affect a person physically, mentally, emotionally, and socially. Fatigue also increases the chance of medical residents to experience burn-out at an early stage of their lives which may damage their careers in the future. They may lose their drive to serve their patients which will decrease the value of healthcare they offer.

With this, hospital administrators, faculty physicians, and medical residents must be educated to recognize the signs of fatigue and come up with measures to counteract or prevent its possible unfavorable effects. One of the primary factors that cause fatigue is lack of sleep. Notwithstanding the 80-hour work limitation, residents still have difficulty in getting enough sleep. Residents work long hours, night shifts, and rotating shifts which cause havoc in their sleep patterns. Contributory to this is the mandatory or voluntary overtime, all of which contribute to fatigue. Fatigue can result in accidents, mistakes, and errors. Apart from the safety and ethical consequences, fatigue can also lead to legal repercussions which may include loss of license. Evidently, this is not just a US experience it was also noted in Japan and in other parts of the world. Therefore, there is a need to come up with immediate solutions to the problem.

A vast majority of studies have shown that naps and longer sleeping periods can help lessen some of the effects of fatigue experienced during night shifts and long duty periods. A two to eight hours of sleep before 24 hours of sleep loss can improve vigilance and lessen sleepiness for 24 hours. Even naps as short as fifteen minutes at two to three-hour intervals during a 24-hour loss can increase performance. These studies suggest that naps and longer sleep periods may be an important countermeasure to fatigue suffered by residents. There is no effective sleep mitigation process to restore full cognitive ability other than restoring lost sleep.

The Resident Physician Fatigue Policy has set measures to solve the fatigue problem of residents. In accordance with Accreditation Council for Graduate Medical Education (ACGME) requirements programs must educate all faculty members and residents to recognize the signs of fatigue and sleep deprivation, in alertness management, and mitigation process and encourage residents to use fatigue mitigation processes to manage the potential negative effects on patient care and learning. It directs the Program Director to present a lecture from the American Academy of Sleep Medicine to all residents and hospital-based faculty. Moreover, the resident is tasked to monitor himself or herself for signs of fatigue. He or she must stop and acquire rest when fatigued but if he is fatigued to the point of potentially impairing his or her ability to perform duties, then the resident must transfer his or her responsibilities. A call room is provided as a sleeping quarter for residents in the hospital.

​​​​​​​​​​​​​​​​​There must be a balance between the training and sleeping or resting time of residents in order for them to have effective learning and minimize or altogether avoid any mistakes in their health care delivery. It must be impressed on the residents as well as the faculty the importance of sleep as it is still the most effective solution for sleep loss. Every resident should never underestimate the importance of being rested before starting work. It is understandable that doctors have to work long hours in some situations, but steps must be taken to ensure a healthy workplace.

The high expectations of patients for their care and the demands of the hospital for excellent performance should not pose a risk to the well-being of the medical resident. It is common knowledge that doctors not only see their profession as a job but as a vocation. Finishing medical school entails so much hard work and dedication. In order to become a successful health provider, you must help yourself first before you help others and that help is to take care of oneself to be at the best state of health. The reality is working as a resident is highly stressful. The harmful stress you suffer increases the fatigue you feel every day. Learn and do some techniques to help you manage stress before fatigue will take over your life.

There are many courses offered online that are designed to solve the self-care needs of residents. Your hospital most likely offers guidance to any resident who is in need of help, but the most effective recourse would be to do some self-care activities. This allows you to have full control of your time. Self-care activities that help alleviate stress also offer additional benefits aside from reducing fatigue. Some of these are weight control, better working relationships, an increase in energy, and clearer thinking. Stress-relief breathing is one of the easiest techniques, try to do Yoga breathing exercises since this will aid in your relaxation and clear thinking. Always eat healthy food and do it on time. Erratic eating can give you stomach ulcers. It pays to consume a lot of fruits and vegetables and do not forget to hydrate yourself. The last but not the least possible self-care activity to reduce fatigue is exercise. Start with walking, then proceed to other active exercises. This will help both your mind and body. Take note that stress can cause fatigue so as you do these de-stressing activities, you are doing a great favor for yourself.

Residency is a collaborative experience in the field of medicine. You are not alone in suffering from fatigue. This is where peer support comes into play. It is a shared condition, so take it as experience and recount these incidents to other residents and learn from each other. These highlight the power of empathy. Empathy includes learning to listen coupled with understanding in such a manner that it is neither egocentric nor judgmental. This will help you to understand and share your feelings with one another. Practice empathy and support and encourage any colleague to ask for help as soon as possible. Camaraderie will be developed with your peers resulting in a happy and healthy working environment. Thus, do not feel that you are alone in your pain. Many doctors even those who have finished their residency and fellowship also experienced fatigue but were able to manage it well and maintained a work-life balance. If they were able to do it, why can’t you do it too? Do not let fatigue squeeze the life out of you. For sure, with the right attitude and self-management techniques, you will be able to be more energetic and feel better.

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