A Prospective Observational Study Comparing Effects of Call Schedules on Surgical Resident Sleep and Physical Activity Using the Fitbit

Abstract

Background Surgical residency training has an extended tradition of long hours. Residency programs use a variety of call schedules to combat resident fatigue and sleep deprivation while maintaining adherence to duty hour restrictions. Nonetheless, there is a paucity of data regarding objective measurements of sleep during the different call schedules included in general surgery training. Objective The primary objective of this study was to compare the quantity of sleep in 24-hour time frames across all types of shifts worked by general surgery residents at our institution. The secondary objective was to measure activity level in total steps during various time frames. Methods This prospective observational study was performed between April 4 and August 26, 2018, with general surgery residents. Each resident was assigned a Fitbit Charge 2 to wear during all rotations, including general surgery and subspecialty services. Results Twenty-six out of 31 residents voluntarily participated in the study (84%). In-house call (IHC) had significantly less sleep in a 24-hour time frame than home call and night float (144 vs 283 vs 246 minutes, P < .001 and P < .028). IHC had significantly more steps than home call (11 245 vs 8756 steps, P = .039). The smallest number of steps was obtained when residents were not working (7904 steps). Conclusions Our data demonstrate that surgical residents on IHC have significantly less sleep compared to all other types of on-call time frames. Residents on IHC have the most steps across all time frames.

A prospective observational study of sleep patterns and work-related communications during home call for a pediatric surgery fellow

“…While prior studies have investigated the sleep duration of surgical residents, there is a notable gap in the literature regarding surgical fellows. A 2021 study of 26 general surgery residents reported an average of 4 h 44 min of sleep on home call nights, compared to 6 h 22 min on post-call nights [ 15 ]. Meanwhile, a 2017 study tracked ten urology residents and demonstrated an average of 2 h 45 min of sleep on home call nights, compared to 4 h on post-call nights [ 16 ].…”

Pilot study comparing sleep logs to a commercial wearable device in describing the sleep patterns of physicians-in-training

“…In the studies investigating multiple dimensions of sleep health in physicians, few directly compare sleep log data to that from commercial wearable devices. Existing studies found in this area either rely on sleep logs alone, such as study of sleep banking in internal medicine residents by Cushman et al [ 32 ], or on Fitbit data alone, such as the study of 26 surgical residents wearing Fitbit devices on night float and home call [ 33 ]. To our knowledge, no study in physicians-in-training has directly compared sleep logs to commercial actigraphy device, which would allow for an evaluation of the external validity of our findings.…”

“…On the other hand, there are affordable and user-centric commercial wearable devices that offer a modest amount of sleep data that can be transmitted through cloud systems, eliminating the requirement for proprietary software. For this reason, there is a growing volume of studies employing such commercial devices, for example, in research involving surgery residents [ 15 ], and internal medicine residents [ 16 ]. Nevertheless, in these investigations, there is still a lack of comparisons with manual sleep logs to ascertain the variance between self-report and sleep data derived from commercial wearable devices.…”

What Educators Can Learn from the Biopsychosocial-Spiritual Model of Patient Care: Time for Holistic Medical Education

“…28,31,32 Surgical residents on rotations with in-house 24-h calls sleep significantly less than those on rotations with home call and night float. 33 Taken together, these findings suggest that residency training programs ought to prioritize the restructuring of rotations and teams to promote healthy sleep rhythms and allow time for exercise. Trainees should be granted time to attend to their own personal healthcare, including preventive care and chronic disease management, without fear of penalization or stigma.…”