James Bordley1, Algene G Agustin1, Mohamed A Ahmed1, Raeesa Khalid1, Anthony M Paluso1, Bethany S Kobza1, Aaron W Spaugy1, Jonathan Emens2, Sima S Desai3, Akram Khan1. 1. Division of Pulmonary and Critical Care, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA. 2. Department of Psychiatry, Oregon Health and Science University and Portland Veterans Affairs Medical Center (VAMC), Portland, Oregon, USA. 3. Division of Hospital Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Abstract
CONTEXT: Block scheduling during residency is an innovative model in which in-patient and ambulatory rotations are separated. We hypothesised that this format may have a positive impact on resident sleep and wellness in comparison with a traditional format. METHODS: We performed a single-centre, cross-sectional, observational study of residents rotating in the medical intensive care unit (MICU). Residents were observed for 4 weeks at a time: internal medicine (IM) residents were observed for 3 weeks in the MICU followed by 1 week in an ambulatory context, and non-IM residents were observed for 4 weeks in the MICU. We monitored daily total sleep time (TST) utilising actigraphy, and wellness measures with weekly Epworth Sleepiness Scale (ESS) and Perceived Stress Scale (PSS) questionnaires. RESULTS: A total of 64 of 110 (58%) eligible residents participated; data for 49 of 110 (45%) were included in the final analysis. Mean ± standard deviation (SD) daily TST in the entire cohort was 6.53 ± 0.78 hours. Residents slept significantly longer during the ambulatory block than during the MICU block (mean ± SD TST 6.97 ± 1.00 hours and 6.43 ± 0.78 hours, respectively; p < 0.0005). Sleep duration during night call was significantly shorter than during day shift (mean ± SD TST 6.07 ± 1.16 hours and 6.50 ± 0.73 hours, respectively; p < 0.0005). A total of 390 of 490 (80%) ESS and PSS questionnaires were completed; scores significantly declined during rotations in the MICU. Internal medicine residents showed significant improvements in TST, and in ESS and PSS scores (p < 0.05) at the end of the ambulatory week. Non-IM residents, who remained in the MICU for a fourth week, continued a trend that showed a decline in perceived wellness. CONCLUSIONS: Despite duty hour restrictions, residents obtain inadequate sleep. As MICU days accumulate, measures of resident wellness decline. Residents in a block schedule experienced improvements in all measured parameters during the ambulatory week, whereas residents in a traditional schedule continued a downward trend. Block scheduling may have the previously unrecognised benefits of repaying sleep debt, correcting circadian misalignment and improving wellness.
CONTEXT: Block scheduling during residency is an innovative model in which in-patient and ambulatory rotations are separated. We hypothesised that this format may have a positive impact on resident sleep and wellness in comparison with a traditional format. METHODS: We performed a single-centre, cross-sectional, observational study of residents rotating in the medical intensive care unit (MICU). Residents were observed for 4 weeks at a time: internal medicine (IM) residents were observed for 3 weeks in the MICU followed by 1 week in an ambulatory context, and non-IM residents were observed for 4 weeks in the MICU. We monitored daily total sleep time (TST) utilising actigraphy, and wellness measures with weekly Epworth Sleepiness Scale (ESS) and Perceived Stress Scale (PSS) questionnaires. RESULTS: A total of 64 of 110 (58%) eligible residents participated; data for 49 of 110 (45%) were included in the final analysis. Mean ± standard deviation (SD) daily TST in the entire cohort was 6.53 ± 0.78 hours. Residents slept significantly longer during the ambulatory block than during the MICU block (mean ± SD TST 6.97 ± 1.00 hours and 6.43 ± 0.78 hours, respectively; p < 0.0005). Sleep duration during night call was significantly shorter than during day shift (mean ± SD TST 6.07 ± 1.16 hours and 6.50 ± 0.73 hours, respectively; p < 0.0005). A total of 390 of 490 (80%) ESS and PSS questionnaires were completed; scores significantly declined during rotations in the MICU. Internal medicine residents showed significant improvements in TST, and in ESS and PSS scores (p < 0.05) at the end of the ambulatory week. Non-IM residents, who remained in the MICU for a fourth week, continued a trend that showed a decline in perceived wellness. CONCLUSIONS: Despite duty hour restrictions, residents obtain inadequate sleep. As MICU days accumulate, measures of resident wellness decline. Residents in a block schedule experienced improvements in all measured parameters during the ambulatory week, whereas residents in a traditional schedule continued a downward trend. Block scheduling may have the previously unrecognised benefits of repaying sleep debt, correcting circadian misalignment and improving wellness.
Authors: Laura K Barger; Brian E Cade; Najib T Ayas; John W Cronin; Bernard Rosner; Frank E Speizer; Charles A Czeisler Journal: N Engl J Med Date: 2005-01-13 Impact factor: 91.245
Authors: Robert L Barrack; Linda S Miller; Wayne M Sotile; Mary O Sotile; Harry E Rubash Journal: Clin Orthop Relat Res Date: 2006-08 Impact factor: 4.176
Authors: Srijan Sen; Henry R Kranzler; Aashish K Didwania; Ann C Schwartz; Sudha Amarnath; Joseph C Kolars; Gregory W Dalack; Breck Nichols; Constance Guille Journal: JAMA Intern Med Date: 2013-04-22 Impact factor: 21.873
Authors: Klara K Papp; Eleanor P Stoller; Paulette Sage; James E Aikens; Judith Owens; Alon Avidan; Barbara Phillips; Raymond Rosen; Kingman P Strohl Journal: Acad Med Date: 2004-05 Impact factor: 6.893
Authors: Saima I Chaudhry; Sandy Balwan; Karen A Friedman; Suzanne Sunday; Basit Chaudhry; Deborah Dimisa; Alice Fornari Journal: J Gen Intern Med Date: 2013-08 Impact factor: 5.128
Authors: Jayaram Thimmapuram; Robert Pargament; Sonya Del Tredici; Theodore Bell; Deborah Yommer; Dana Daoud; Frankie Powell; Divya K Madhusudhan Journal: Ann Neurosci Date: 2021-09-23