Sleep and stress before and after duty across residency years under 2017 ACGME hours

Veterinarian burnout demographics and organizational impacts: a narrative review

Burnout is a work-related syndrome of physical and emotional exhaustion secondary to prolonged, unresolvable occupational stress. Individuals of different demographic cohorts may have disparate experiences of workplace stressors and burnout impacts. Healthcare organizations are adversely affected by burnt out workers through decreased productivity, low morale, suboptimal teamwork, and potential impacts on the quality of patient care. In this second of two companion reviews, the demographics of veterinary burnout and the impacts of burnout on affected individuals and work environments are summarized, before discussing mitigation concepts and their extrapolation for targeted strategies within the veterinary workplace and profession.

Methylphenidate use and misuse among medical residents in Israel: a cross-sectional study

BACKGROUND

Methylphenidate (MPH) and other stimulants may be misused, mainly as cognitive enhancers and recreational drugs. Data regarding misuse among medical residents are scarce. This study aimed to evaluate the prevalence of and main reasons for methylphenidate (MPH) use and misuse among Israeli medical residents.

METHODS

In this cross-sectional study, we sent an online questionnaire to medical residents who had completed their first residency exam and specialists with up to 2 years of experience. We asked about the use of MPH before and during residency and attitudes toward the use of MPH as a cognitive enhancer. We also added the Adult ADHD Self-Report Scale (ASRS) questionnaire, a validated tool used to screen for the presence of attention deficit hyperactivity disorder (ADHD). Users and misusers were classified based on self-report of use and formal ADHD diagnosis. Logistic regression analysis was used to evaluate factors associated with MPH misuse.

RESULTS

From March 2021 to August 2021, 370 physicians responded to our questionnaire (response rate 26.4%). Twenty-eight met the exclusion criteria and were not included. The respondents' average age was 36.5 years. Women comprised 63.5% of the respondents. Of the participants, 16.4% were classified as users and 35.1% as misusers. The prevalence of misusers was 45.6% among surgery and OB/GYN physicians, 39.4% among pediatricians and internists, and 24% among family physicians (P < 0.001). Misusers had a more liberal approach than others to MPH use as a cognitive enhancer. Factors associated with misuse of MPH included not being a native-born Israeli (OR-1.99, 95% CI 1.08, 3.67) and type of residency (OR-2.33, 95% CI 1.22, 4.44 and OR-4.08, 95% CI 2.06, 8.07 for pediatrics and internal medicine and surgery, respectively).

CONCLUSION

Very high levels of MPH misuse during residency may be related to stress, long working hours, night shifts, and the academic burden of the residency period. We believe that our findings should be considered by healthcare policymakers as they make decisions regarding the conditions of medical residencies. The use of MPH as a cognitive enhancer should be further studied and discussed.

The effect of prior night sleep on simulated driving performance in medical residents

OBJECTIVE

Indications of driving performance negatively affected by poor sleep often occur early in simulated driving experiments and are measured to progress over relatively large epochs of time. How driving performance changes over smaller increments of time as a function of not only sleep quantity but also sleep quality is largely unknown. The overall objective of this work in progress is to examine the trajectory of driving performance in medical residents as a function of the prior night's sleep quality using a high-fidelity driving simulator.

METHOD

Thirty-two medical residents were enrolled and wore sleep tracking devices for up to 2 weeks. The residents drove a 16-min scenario in a high-fidelity driving simulator. A mixed effects model was used to estimate baseline intercept and slope of simulated driving performance over the course of the drive. The slope of driving performance over the drive and actigraphy-estimated sleep variables from the prior 24 h served as predictors.

RESULTS

Preliminary descriptive findings indicate a wide range of sleep quality metrics in the sample.

CONCLUSIONS

This study is among the first to focus on the trajectory of driving performance over small continuous epochs of time when simulated driving performance may first begin to degrade. Further, objective estimates of sleep using actigraphy as predictors of the next day's driving will enhance our understanding of the potential "dose-response" between low sleep quality and crash risk in the following 24 hours.