As a clinical clerk and even now as an intern, I have been assigned to 36-hour duty every 3 days. Will this affect my intellectual capacity, and what would be the most detrimental long-term effect?
Response from Anne Vinsel, MS, MFA
Project Administrator, University of Utah School of Medicine, Salt Lake City, Utah
Sleep deprivation to that level is the cognitive equivalent of being legally intoxicated. The most detrimental effect would be involvement in a fatal accident while driving home post call. To learn more about the current state of evidence with respect to resident fatigue and effects on residents and patients, see the American Medical Student Association (AMSA)'s good collection of research on the topic.
Another informative Website is Hours Watch, which is cosponsored by AMSA and the Committee of Interns & Residents of SEIU Healthcare. This site provides information from key scientific studies on the impact of fatigue and long hours on resident physicians.
But it doesn't really matter what the short- or long-term effects are; if your program is accredited by the Accreditation Council for Graduate Medical Education (ACGME) and you are truly doing a 36-hour shift every 3 days, the program is out of compliance and should be reported.
Here is the relevant rule from the ACGME Website:
Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care. No new patients may be accepted after 24 hours of continuous duty.
You may be understandably reluctant to report your own program, but you can do so confidentially on the ACGME's work hours reporting site. Do it for your own health and safety and for your patients' as well.
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Cite this: Anne Vinsel. Will Long Work Hours Diminish My Mental Abilities? - Medscape - Mar 23, 2009.