Lack of Sleep Not Impairing, Study Finds
Hospital interns and residents who are on call for long periods of time, sometimes even caring for patients around the clock, are not, in any significant way, mentally or physically impaired by the lack of sleep. At least that is the conclusion of what is sure to be a controversial study published today in the Journal of the American Medical Assn.
The study, conducted last year on 26 surgical residents at a private medical school in Wisconsin, contradicts a growing body of complaints that young physicians undergoing the rigors and stresses of residency programs are unable to give quality care to patients.
After two highly publicized cases in which New York medical residents were said to have caused, or at least contributed to, the deaths of pop artist Andy Warhol and Libby Zion, the daughter of Sidney Zion, a prominent New York journalist and lawyer, several states, including California, have begun to consider redesigning hospital residency training programs. The proposed changes would increase the supervision of young doctors and reduce the number of consecutive hours that physicians in training can be on duty.
So far, however, these reform efforts have been based largely on anecdotal reports and not on objective data, said one of the author’s of the new study, Dr. Timothy F. Deaconson, chief resident of surgery at the Medical College of Wisconsin. Other authors of the study include the college’s chief of surgery, two resident surgeons, a statistician and a neuropsychologist from Loyola University Medical Center in Illinois.
According to their report in the medical journal, the team administered a variety of psycho-motor tests to three separate groups of residents working on trauma, open heart or vascular surgery rotations at a county hospital in Milwaukee. The tests, given between 6 a.m. and 8 a.m. over a monthlong period to each group, included grammar exams, addition exercises and drawing assignments--all measures that were thought by the team to have a high correlation with actual performance in the operating room.
In an effort to motivate the residents to do well on the tests, the researchers offered a reward of $200 worth of books to the person in the study who earned the highest score. And to keep the residents from intentionally performing badly in an effort to bolster arguments that resident hours should be reduced, the team warned the subjects that their scores would be made public.
The researchers then compared scores made after nights of less than four hours of uninterrupted sleep to scores made after nights when the residents reported in diaries that they had had more sleep. Although each of the three groups averaged slightly worse on the tests when they were sleep-deprived, a statistical check led the research team to conclude, “Effects of sleep deprivation were essentially nil.”
Some Take a Dim View
A few physicians and other medical experts who reviewed the study in advance of its publication took a dim view of its findings, largely on the grounds that the tests that were chosen for the study were unrealistic and not a reliable gauge of actual clinical performance.
Dr. Neil H. Parker, assistant chairman of the Department of Medicine at UCLA, expressed the view of many critics when he said: “The tests were not given in a realistic setting . . . nor were they a realistic measure of how physicians at work actually perform.”
“The quality issue (that teaching hospitals are grappling with today) is not that residents can’t learn when they are deprived of sleep or that they make gross mistakes. They don’t. What we’re dealing with is a much more subtle issue. How much are (residents) able to pay attention to the subtleties of what patients tell them or the subtleties of a patient’s condition?” said Parker who has been an outspoken advocate of reform in residents’ training programs.
Currently, in UC medical schools, as in most medical schools in the United States, there is no uniform set of work hours for residents. However, in an attempt to ward off passage of a variety of restrictive legislative proposals, the university is now considering, along with USC, Loma Linda University and Stanford, drafting the state’s first guidelines on resident training programs.
A study released in May by the California Assembly Office of Research found that most residents at California medical school were working a minimum of 75 hours per week. Moreover, the study found that two-thirds of the residents surveyed had either experienced or observed situations in which stress and fatigue due to long working hours resulted in inadequate patient care.
