| Does simulator-based clinical performance correlate with actual hospital behavior? The effect of extended work hours on patient care provided by medical interns. | |
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MedLine Citation:
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PMID: 20881679 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The correlation between simulator-based medical performance and real-world behavior remains unclear. This study explored whether the effects of extended work hours on clinical performance, as reported in prior hospital-based studies, could be observed in a simulator-based testing environment. METHOD: Intern volunteers reported to the simulator laboratory in a rested state and again in a sleep-deprived state (after a traditional 24- to 30-hour overnight shift [n=17]). A subset also presented after a shortened overnight shift (16 scheduled hours [n=8]). During each laboratory visit, participants managed two critically ill patients. An on-site physician scored each case, as did a blinded rater later watching videotapes of the performances (score=1 [worst] to 8 [best]; average of both cases=session score). RESULTS: Among all participants, the average simulator session score was 6.0 (95% CI: 5.6-6.4) in the rested state and declined to 5.0 (95% CI: 4.6-5.4) after the traditional overnight shift (P<.001). Among those who completed the shortened overnight shift, the average postshift simulator session score was 5.8 (95% CI: 5.0-6.6) compared with 4.3 (95% CI: 3.8-4.9) after a traditional extended shift (P<.001). CONCLUSIONS: In a clinical simulation test, medical interns performed significantly better after working a shortened overnight shift compared with a traditional extended shift. These findings are consistent with real-time hospital studies using the same shift schedule. Such an independent correlation not only confirms the detrimental impact of extended work hours on medical performance but also supports the validity of simulation as a clinical performance assessment tool. |
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Authors:
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James A Gordon; Erik K Alexander; Steven W Lockley; Erin Flynn-Evans; Suresh K Venkatan; Christopher P Landrigan; Charles A Czeisler; |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Academic medicine : journal of the Association of American Medical Colleges Volume: 85 ISSN: 1938-808X ISO Abbreviation: Acad Med Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-30 Completed Date: 2010-10-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8904605 Medline TA: Acad Med Country: United States |
Other Details:
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Languages: eng Pagination: 1583-8 Citation Subset: AIM; IM |
Affiliation:
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Gilbert Program in Medical Simulation, Harvard Medical School, Boston, Massachusetts, USA. jgordon3@partners.org |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Clinical Competence* Critical Care / standards* Education, Medical, Graduate / methods* Humans Internal Medicine / education* Internship and Residency* Manikins* Prospective Studies Sleep Deprivation* Videotape Recording Work Schedule Tolerance* |
| Grant Support | |
ID/Acronym/Agency:
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1 UL1 RR025758/RR/NCRR NIH HHS; M01 RR02635/RR/NCRR NIH HHS; R01 HS12032/HS/AHRQ HHS; R01 OH07567/OH/NIOSH CDC HHS; T32 HL079010/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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