Sleep Deprivation in Resident Physicians, Work Hour Limitations, and Related Outcomes:

A Systematic Review of the Literature

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Meghna P. Mansukhani, MBBS; Bhanu Prakash Kolla, MBBS, MRCPsych; Salim Surani, MD, MPH, FAASM, FCCP; Joseph Varon, MD, FACP, FCCP, FCCM; Kannan Ramar, MD

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Postgraduate Medicine:

Volume 124 No. 4


Clinical Features

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DOI: 10.3810/pgm.2012.07.2583
Abstract: Extended work hours, interrupted sleep, and shift work are integral parts of medical training among all specialties. The need for 24-hour patient care coverage and economic factors have resulted in prolonged work hours for resident physicians. This has traditionally been thought to enhance medical educational experience. These long and erratic work hours lead to acute and chronic sleep deprivation and poor sleep quality, resulting in numerous adverse consequences. Impairments may occur in several domains, including attention, cognition, motor skills, and mood. Resident performance, professionalism, safety, and well-being are affected by sleep deprivation, causing potentially adverse implications for patient care. Studies have shown adverse health consequences, motor vehicle accidents, increased alcohol and medication use, and serious medical errors to occur in association with both sleep deprivation and shift work. Resident work hour limitations have been mandated by the Accreditation Council for Graduate Medical Education in response to patient safety concerns. Studies evaluating the impact of these regulations on resident physicians have generated conflicting reports on patient outcomes, demonstrating only a modest increase in sleep duration for resident physicians, along with negative perceptions regarding their education. This literature review summarizes research on the effects of sleep deprivation and shift work, and examines current literature on the impact of recent work hour limitations on resident physicians and patient-related outcomes.

Keywords: internship; medical training; residency; hours; stress; psychological; clinical competence; quality of life; well-being; burnout; medical errors; safety; fatigue; sleep loss; sleep deprivation