Psychomotor testing of on-call anaesthetists

Moving beyond response times with accessible measures of manual dynamics

Button-press measures of response time (RT) and accuracy have long served a central role in psychological research. However, RT and accuracy provide limited insight into how cognitive processes unfold over time. To address this limitation, researchers have used hand-tracking techniques to investigate how cognitive processes unfold over the course of a response, are modulated by recent experience, and function across the lifespan. Despite the efficacy of these techniques for investigating a wide range of psychological phenomena, widespread adoption of hand-tracking techniques within the field is hindered by a range of factors, including equipment costs and the use of specialized software. Here, we demonstrate that the behavioral dynamics previously observed with specialized motion-tracking equipment in an Eriksen flanker task can be captured with an affordable, portable, and easy-to-assemble response box. Six-to-eight-year-olds and adults (N = 90) completed a computerized version of the flanker task by pressing and holding a central button until a stimulus array appeared. Participants then responded by releasing the central button and reaching to press one of two response buttons. This method allowed RT to be separated into initiation time (when the central button was released) and movement time (time elapsed between initiation and completion of the response). Consistent with previous research using motion-tracking techniques, initiation times and movement times revealed distinct patterns of effects across trials and between age groups, indicating that the method used in the current study presents a simple solution for researchers from across the psychological and brain sciences looking to move beyond RTs.

Impact of extended duty hours on medical trainees

Many studies on resident physicians have demonstrated that extended work hours are associated with a negative impact on well-being, education, and patient care. However, the relationship between the work schedule and the degree of impairment remains unclear. In recent years, because of concerns for patient safety, national minimum standards for duty hours have been instituted (2003) and revised (2011). These changes were based on studies of the effects of sleep deprivation on human performance and specifically on the effect of extended shifts on resident performance. These requirements necessitated significant restructuring of resident schedules. Concerns were raised that these changes have impaired continuity of care, resident education and supervision, and patient safety. We review the studies on the effect of extended work hours on resident well-being, education, and patient care as well as those assessing the effect of work hour restrictions. Although many studies support the adverse effects of extended shifts, there are some conflicting results due to factors such as heterogeneity of protocols, schedules, subjects, and environments. Assessment of the effect of work hour restrictions has been even more difficult. Recent data demonstrating that work hour limitations have not been associated with improvement in patient outcomes or resident education and well-being have been interpreted as support for lifting restrictions in some specialties. However, these studies have significant limitations and should be interpreted with caution. Until future research clarifies duty hours that optimize patient outcomes, resident education, and well-being, it is recommended that current regulations be followed.

Attention and working memory in resident anaesthetists after night duty: group and individual effects

AIMS

To investigate the effects of a single period of night duty on measures of attention and working memory in a group of residents (registrars) in anaesthesiology. Emphasis was placed on individual deficits using a reference point of the equivalent effect of a blood alcohol concentration (BAC) >0.05% determined by other researchers.

METHODS

There were 33 subjects aged 26-42 years. Night duty was performed on a weekly basis. Baseline assessments were conducted at either 08 15 or 08 55 preceding night duty and repeated 24-25 hours later, just after the completion of duty. Questionnaires included items regarding duration of sleep and the Stanford Sleepiness Scale. A battery of four reaction time (RT) tasks of increasing difficulty, lasting approximately 35 minutes, was administered on a personal computer. These ranged from simple RT to progressively more complex RT tasks incorporating working memory. A significant change was regarded as >15% deterioration in respect of speed or accuracy.

RESULTS

The mean duration of sleep preceding night duty was 7.04 hours and 1.66 hours during the period of night duty. Intergroup comparisons revealed significant prolongation in mean response speed in the first three tests. Mean accuracy was significantly reduced only in respect of the two more complex tests. A >15% deterioration in response speed occurred in up to 30% of subjects on a single task, rising to 52% (17/33) overall. Deterioration occurred in a patchy distribution in most subjects, involving no more than one or two of the four tasks. As regards accuracy, the prevalence of deterioration increased with task complexity.

CONCLUSIONS

Results are in general agreement with previous group analyses. A new dimension was added by the analysis of a broad spectrum of individual response to sleep deprivation. The effects of sleep loss in residents cannot be overlooked, even in a relatively benign work schedule.

Occupational stress in anaesthesia

Anaesthetists, like most in the medical profession, often deny that they may be suffering from work-related stress. This article explores the sources and effects of occupational stress with suggestions for dealing with the stresses of our specialty.

The effects of fatigue on physician performance--an underestimated cause of physician impairment and increased patient risk

Evidence is reviewed demonstrating the high level of drug and alcohol abuse and marital disharmony among physicians and the particularly high rate among anaesthetists. The relationship between these factors and the effects of fatigue is explored. The current evidence for reduction in physician performance and vigilance resulting from fatigue and sleep loss is reviewed. Supplementary indirect evidence is surveyed which suggests that increased experience may not compensate adequately for this reduced performance. Since hours of work can be controlled, it is essential that anaesthetists, their professional organizations and regulatory agencies ensure that pressure for efficiency does not result in fatigue and the consequent compromise of both patient and physician health and safety.