The Pediatric Neurology Residency Program abides by the NYS Department of Health requirements for resident work hours (section 405, the “Bell Commission” requirements) see page. The Chairman and Residency Program Director recognize the importance of observing the limitations on resident working hours imposed by the New York Health Care Reform Act of 2000. As Pediatric Neurology residents take call from home these policies apply mostly to rotating residents on our service (Pediatric and Neurology).
The Department has established the following policies regarding resident work hours:
- During rotations in which residents take call in house overnight, the resident cannot be on call for more than a 24-hour period. There is an additional 3 hours in morning following call to allow rounds and transmission of information and patient handoff to the accepting team.
- Post-call residents are required to leave the Hospital by 11 AM. They may not participate in any clinical or educational activities after 11 AM.
- Every resident has at least a 24-hour period off per week averaged over a month.
- Every resident will work no more than 80 hours in a given week averaged over a month period
- Pediatric Neurology Clinic schedules are adjusted so that residents do not have clinic on their post-call days.
Our procedures to monitor compliance with resident working hour rules include:
- Ongoing education of residents and faculty about these work hour requirements.
- Mandatory resident reporting on-line of work hours reporting using the E*value system
- Direct observation of compliance by the Attending on Service, on the inpatient service, in the context of morning rounds.
- Identification of residents having difficulty meeting work-hour requirements with direct intervention to quickly address issues to their non-compliance with work-hours requirements.
- Discussion of work hour issues at monthly resident meetings.
- Data will be reviewed at regular intervals by the Program Director, and issues addressed as they arise.
Resident Fatigue
The Accreditation Council on Graduate Medical Education requires all training programs to “…educate faculty and residents …to recognize the signs of fatigue…and adopt and apply policies to prevent and counteract the potential negative effects.” The implementation of policies limiting duty hours (see above resident work hours) helps limit fatigue. Residents nevertheless are susceptible to fatigue; both residents and attending faculty need to be educated in identifying signs of fatigue.
The pediatric neurology residency program is committed to assisting residents avoid excessive fatigue which may be the result of 1) too little sleep 2) fragmented sleep, 3) disruption of circadian rhythm or 4) a primary sleep disorder. Occasionally other disorders may mimic fatigue such as depression.
Sleep Deprivation
Sleep disruption, as occurs on call, may result in a sleep debt that may hinder performance with as little as two hours less than “normal”. Allowed to accumulate over several nights, sleep debt may require in order to recover several nights of full night’s sleep. Sleep deprivation of 24 hours causes impaired psychomotor function comparable to a blood alcohol level of .08%, which is considered legally drunk in the State of New York. The ability to recognize the level of psychomotor impairment when someone is sleep-deprived is usually poor and declines the more sleepy the resident becomes.
The characteristic symptoms of sleepiness should be recognized, and include:
Frequent yawning; nodding off nodding during conferences; mini sleeps (dozing off momentarily); increased risk taking, dulling of cognitive abilities, irritability, inattentiveness to detail; increased errors and slowing speed of task.
Resident should be made aware of sleep inertia, a phenomenon of confusion that occurs upon awakening from NREM sleep and that has the potential of causing more impairment than sleep loss. The resident may thus be more error-prone shortly upon awakening; the period of vulnerability usually lasts about 10 minutes from arousal, but rarely can extend to 2 hours. The disorientation of sleep inertia may be abated by exercise.
The methods of resident education include:
- A mandatory noon conference sponsored by Drs. Blair and Bazil, a sleep specialist that focuses on sleep deprivation, it effects and ways to recognize it.
- The residents have access through the GME office to the SAFER program a power pint presentation that residents and faculty may review to identify signs and symptoms of resident fatigue.
- Pediatric neurology attendings on service ensure that duty hours are maintained and are vigilant for any evidence of fatigue on the part of CN residents on call.
- The float resident will be called to replace post call residents on service who experience or attending feel are experiencing fatigue (see float below).