Fatigue Strategies Recommended for Canadian Physicians

Lengthy shifts for physicians in training have been a cultural norm in North America for decades. Viewed as almost a rite of passage, the caffeine-fueled marathons of the past have largely given way to strict limits on hours.

Just north of the border in Canada, however, The Globe and Mail reports that “sleepless shifts of up to 26 hours are routine for many of Canada’s 12,000 resident doctors.” A panel of medical experts calls the practice “unacceptable,” and plans to implement fatigue risk management strategies throughout the country.

According to The Globe, the report by the National Steering Committee on Resident Duty Hours, does not recommend limiting continuous shifts or the workweek to a specific number of hours—conditions that are in place in American and most European hospitals. Instead, the committee envisions implementing “fatigue risk-management” strategies in residency programs nationwide that would introduce measures, such as mandatory sleep breaks, to ensure residents are getting restorative shuteye.

“What we’re saying is that the status quo of residents working as much as 26 hours without sleep needs to change,” said Kevin Imrie, MD, physician-in-chief at Sunnybrook Health Sciences Centre in Toronto, and a co-chair of the committee. “There is a consensus that a one-size-fits-all, hard number [on work hours] is not the solution.”

Imrie expects the report to have a near-immediate impact on the grueling schedules of residents because its authors include representatives of the bodies that accredit residency programs, including the Royal College of Physicians, Surgeons of Canada, and the College of Family Physicians of Canada.

The Globe reports that the ruling followed proposals by the Institute of Medicine in the United States in 2008 to require naps and more structured shift changes to reduce the risk of fatigue-induced medical errors. Now, American residents are limited to 80-hour work weeks.

Source: The Globe and Mail

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