From the Guidelines
Residents appear slow because fatigue and sleep deprivation significantly impair their cognitive and psychomotor skills, leading to decreased reaction time, accuracy, and decision-making ability. This is a critical concern in the medical field, as fatigue can increase the risk of medical errors 1. According to a study published in Pediatrics, sleep-deprived residents attribute their medical errors to fatigue in 41% of cases 1. The same study highlights that prolonged wakefulness of 18 hours can have a negative effect on human performance equivalent to a blood alcohol concentration of 0.1% 1.
Factors Contributing to Fatigue
- Shift work and schedule rotation can disrupt circadian rhythms, leading to sleep deprivation and fatigue 1
- The length of shifts, particularly 12-hour shifts, can increase fatigue and safety concerns 1
- Inadequate time for rest and recovery between shifts can exacerbate fatigue 1
Strategies to Mitigate Fatigue
- Strategic napping, such as taking a nap in a call room after an overnight shift, can help reduce fatigue 1
- Scheduling single overnight shifts, rather than consecutive overnight shifts, can help minimize sleep deprivation 1
- Encouraging residents to prioritize self-care and stress management can also help mitigate the effects of fatigue 1
Implications for Resident Training
- The medical education system should prioritize resident well-being and safety, recognizing that fatigue can compromise patient care 1
- Residents should be encouraged to speak up when they are feeling fatigued or overwhelmed, and supervisors should be supportive of their needs 1
- By addressing fatigue and promoting a healthy work-life balance, residents can develop the skills and confidence they need to provide high-quality patient care while maintaining their own well-being 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Possible Reasons for Slowness
- Residents may be slow due to sleep deprivation, as studies have shown that interventions to reduce resident work hours can improve their quality of life, including the amount of sleep they get 2.
- Sleep disorders can also have serious consequences on patients' health and quality of life, and it is possible that residents may be experiencing similar issues 3.
- Certain medications, such as sedating antihistamines, can cause drowsiness and impair cognitive function, which may contribute to slowness 4, 5.
- The effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety can vary, with some classic antihistamines increasing daytime sleepiness and decreasing sleep quality, while new-generation antihistamines may reduce sleep latency and dream anxiety 6.
Factors Affecting Resident Performance
- Resident work hours and fatigue can impact their education and quality of life, with interventions to reduce work hours resulting in mixed effects on operative experience and perceived educational quality 2.
- The use of certain medications, such as diphenhydramine, can impair cognitive performance, including divided attention, working memory, speed, and vigilance 5.
- Sleep quality and daytime sleepiness can also affect resident performance, with some antihistamines increasing daytime sleepiness and improving sleep quality 6.