Introduction: There continues much debate about optimal work hours for the neurosurgical resident in training. Multiple entities have asserted that cognitive and manual performance deteriorate with prolonged work shifts. We sought to study the effects of 24 hours of neurosurgical duty on manual dexterity, cognition, and mood.
Methods: Subjects underwent multiple batteries of validated dexterity, cognitive, and mood evaluations before and after a 24 hour stint of neurosurgical duty. This included a night of neurosurgical call. All subjects were required to stay awake throughout their 24 hour stint.
Results: 27 subjects underwent the full battery of testing before and after their 24 hours of neurosurgical activities. 13 were "seasoned"neurosurgical residents and P.A..'s- that is they had extensive experience with neurosurgical call. 14 were "non-seasoned" medical students who had no previous experience with 24 straight hours of medical activities.
Overall performance of the group showed no significant decrement in performance in dexterity, cognition, or overall mood.
When divided into a seasoned group and a non-seasoned group however, the non-seasoned group demonstrated statistically significant decrements in multiple functions in dexterity, cognitive, and mood testing. The seasoned group demonstrated no decrements in dexterity or cognition, and only limited change in isolated mood functions (no changes in overall mood).
Conclusions: We believe that this study raises interesting questions about neurosurgical training with respect to the alleged detrimental effects of prolonged work hours. The results suggest that fatigue-induced decrements in professional function can be ameliorated by experience. If this is the case, an argument can be made that we are turning the training paradigm upside down with the current ACGME restrictions.
Since long and arduous hours are a fact of life in a neurosurgical career, learning how to recognize and manage fatigue during training will improve physician resilience and therefore patient care.
Patient Care: we feel that this study may help optimize neurosurgeon training to better withstand the challenges of fatigue
Learning Objectives: To better understand the effects of prolonged work hours and loss of sleep on physician performance in cognitive tasks and manual dexterity, as well as on physician mood and resilience.