Resident physicians completing rotations in intensive care units (ICU) overestimate their sleep duration and experience increased sleepiness and burnout, according to a study by West Virginia University researchers investigating the level of fatigue medical school graduates experience. 

The study, which took place during the COVID-19 pandemic, was published in Sleep and Breathing.

The American Medical Association outlines that physician burnout is an epidemic affecting healthcare systems across the United States, resulting from a variety of system-level factors such as balancing patient care and administrative tasks. The COVID-19 pandemic also caused increased stress on physicians and residents due to increases in admitted patients and higher patient volumes in the ICU.

“Physician burnout affects all levels but may be uniquely devastating at the training level,” says Sunil Sharma, MD, chief and professor in the Division of Pulmonary Critical Care and Sleep Medicine, in a release. “These are not only the formative years, but patient contact is high at this level. And the consequences of a tired brain may have real-time consequences.

“While there are many ways to combat burnout, we chose to focus on the adequate sleep. Even at the professional level, there are still myths and prejudices about sleep. Understanding these myths and developing situational awareness of your own sleep needs can be transformational. The purpose of the study was to highlight sleep deprivation as a potential cause for burnout and improve sleep awareness among residents.”

Researchers and physicians from West Virginia University School of Medicine and School of Public Health studied 40 residents from August 2021 through May 2022. Participants wore a sleep tracking device, a Fitbit Inspire 2, which collected data about their sleep habits for four consecutive weeks—two weeks prior to the rotation and two weeks during the rotation—and participants also completed daily diaries, surveys, and tests related to sleepiness and fatigue-related changes in alertness.

Results from the study found residents experienced higher rates of sleep deprivation and burnout during the ICU rotation compared to other rotations. Reaction time also reduced for residents during the rotation according to a test that measured participants’ reaction time to seeing a red number randomly appear on a screen.  

Residents also overestimated the amount of sleep they were getting according to their validated daily log by a mean of 62 minutes, with 464 minutes before ICU and 442 during ICU, which reflected a decrease in sleep of 22 minutes in their estimates pre- and during ICU. This overestimation of sleep duration was significant—both at baseline and during ICU, according to the study.

“The findings of sleep deprivation experienced by the residents during ICU weeks compared to other elective rotations was interesting but not surprising,” says Sharma in the release. “However, it was quite revealing that despite the deep medical background of the residents, there was significant overestimation of their sleep. This is an important area of future intervention as it suggests that objective tracking of sleep may help. While the data on the clinical utility of psychomotor vigilance test score is controversial, it is concerning that residents had reduced reaction time, suggesting slower response, which may have implication in a critical care environment.”

While residents overestimating their sleep duration is consistent with previous studies, the researchers note that it suggests residents are unaware of their own sleep habits.

“Self-reported sleep duration is subject to memory recall, and difference in perception by individuals in distinguishing between time in bed versus sleep,” says Sharma in the release.

Preventing Burnout Among Residents

Efforts across West Virginia University Health Sciences and the School of Medicine are implemented to promote wellness and prevent burnout within residency programs.

The university’s Faculty and Staff Assistance Program offers mental health assessments, short-term counseling services, and referrals to community providers. Monthly social events, humanism meetings, group activities, and support from senior residents, faculty, and attending physicians also promote wellness among residents across departments, according to a release from West Virginia University.

“While there are many aspects to wellness which are being addressed at the departmental level, including a dedicated wellness clinic, we also educate our residents on the importance of proper sleep and rest,” says Sharma in the release. “Residents are not allowed to stay past their shift, and proper breaks are provided on a weekly basis. Our study’s new findings add another layer of objective monitoring of sleep which we will encourage our residents to do.”

Across the United States, promoting physician wellness is an emphasis for many organizations and institutions. The American Medical Association is addressing physician burnout with several resources and strategies and has identified well-being as a core element of its Recovery Plan for America’s Physicians.

“A well-rested and alert resident is the best protection a patient can have,” Sharma says in the release. “Many of the hospital errors in hospitalized patients can be linked to lapse of judgment due to a sleep-deprived provider. By continuing to advocate for the residents’ well-being, we are investing in the future of healthcare.”

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