Tired resident takes a break - Credit: iStock

Tired resident takes a break - Credit: iStock

Managing Resident Fatigue

The ideal formula for regulating the number of consecutive or weekly hours that a resident is able to work for optimal well-being, learning and safe, quality patient care has been an important and contentious debate internationally for a very long time. In 2013, the National Steering Committee on Resident Duty Hours of the Royal College of Physician and Surgeons of Canada released their report, Fatigue, Risk and Excellence: Towards a Pan-Canadian Consensus on Resident Duty Hours, making a statement on duty hour issues, and recommending best practices and a way forward for Canadian postgraduate medical education. Dr. Susan Edwards, Director of Resident Wellness, was Co-Chair of the Subcommittee on Resident and Faculty Well-Being as well as a National Steering Committee Member. The report identified that improving patient safety and resident fatigue needs to involve more than the regulation of resident duty hours alone and recommended a more comprehensive strategy focused on minimizing fatigue related risk. This strategic shift aligned well with the Fatigue Management workshops that Chris Hurst, the Education Lead of the Office of Resident Wellness (ORW), had been delivering to residents and faculty. Together, this led the ORW to identify Fatigue Risk Management as a priority topic for education, research and leadership in 2015-16.

In addition to the Fatigue Management workshops presented to residency programs in their academic half days, the ORW responded to requests for fatigue management education at faculty development events, at both departmental levels and the Centre for Faculty Development. Dr. Susan Edwards and Chris Hurst’s workshop, “Fatigue Risk Management Plans: the what, why, when and how,” at the 2015 International Conference on Residency Education, was not only one of the most highly attended workshops of the conference, but was highlighted in an ICRE blog interview with Chris Hurst.

Susan and Chris were also invited to join research colleagues at St. Michael’s Hospital to investigate organizational contributions to resident fatigue, a project funded by the Academic Health Sciences Centre’s Alternate Funding Plan Innovation Fund. With research assistants presently following residents from three programs (surgery, internal medicine and psychiatry) through their regular day and night call experiences at St. Mike’s, the hope is to better understand factors in the work environment that drive and mitigate resident fatigue, and then to share this understanding across our hospital networks.

As an ongoing member of the Royal College’s Fatigue Risk Management National Advisory Committee and Expert Working Group, Dr. Susan Edwards continues to be engaged in national discussions on both how to ensure adequate training and competency acquisition for medical trainees as duty hours are being increasingly restricted, as well as on the development of best practices, including tool kits, for fatigue risk management programs in residency education.