Evaluating the Workload of On-Call Psychiatry Residents: Which Activities Are Associated With Sleep Loss?

Cooke, Brian K.; Cooke, Erinn O; Sharfstein, Steven S.

doi:10.1176/appi.ap.10060086

Cited by 12 publications

(19 citation statements)

References 5 publications

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“…No commonly agreed-upon definition exists for the term standard of care, 2 in part because it is determined de novo each time a new diagnostic tool or therapy is introduced and/or is relative to the perspective of who is discussing it (eg, the courts, physicians, industry). 3 Interestingly, a formal definition for the term cannot be found in medical dictionaries yet can be found in a legal one. Legally, it is defined as "the degree of care or competence that one is expected to exercise in a particular circumstance or role."…”

Section: What Is a Standard Of Care?mentioning

confidence: 99%

“…These gray areas are a direct result of standards of care being determined by tort law, which examines the integrity of processes, instead of contract law, which is outcome focused. 3,15 When medical care is operationalized as a tort law construct, clinical outcomes as objective end points become irrelevant, and the focus instead becomes about execution of processes. 3,15 To further complicate this issue, courts are also inconsistent in the sources used to define a common standard.…”

Section: The Glaucoma Case That Changed Standard Of Care Lawmentioning

confidence: 99%

“…3,15 When medical care is operationalized as a tort law construct, clinical outcomes as objective end points become irrelevant, and the focus instead becomes about execution of processes. 3,15 To further complicate this issue, courts are also inconsistent in the sources used to define a common standard. Initially, standards were determined by the American Medical Association.…”

Section: The Glaucoma Case That Changed Standard Of Care Lawmentioning

confidence: 99%

“…This geographic dimension of standard of care varies by statute and jurisdiction 10 and calls on physicians to provide the same degree of skill and care that is required of other physicians practicing in the same community. 3,16 On a national level, this creates tremendous inequality and further exacerbates disparities locally. Indeed, despite similarities in training, licensing, and certification, demanding that doctors mimic the behavior of their nearest neighbors could place unreasonable demands on some practitioners while limiting others by putting them at risk of litigation for personalizing treatment or practicing more advanced medicine.…”

Section: The Glaucoma Case That Changed Standard Of Care Lawmentioning

confidence: 99%

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Challenges in Elucidating Ophthalmology’s Standards of Care

Hellem

VanderBeek

2022

JAMA Ophthalmol

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IMPORTANCE Defining a standard of care is difficult, and physicians don't always agree on what it means in specific contexts. This is, in part, owing to constantly changing treatment patterns; but at the same time, the underlying framework that determines standards of care is continuously evolving. This situation presents clear challenges for all practicing physicians, including ophthalmologists.OBSERVATIONS Complicating the issue of defining a standard of care are the confusing origins and lexicon used to describe 3 related yet distinct ideas: standard of care, practice guidelines, and gold standards. Indeed, each of these terms is defined and influenced by many stakeholders both inside and outside the health care system. The term standard of care is one example that, although used frequently as a medical term, is often decided by courts and industry. Ophthalmology itself has provided one of the most influential cases in standard-of-care law history (Helling v Carey), which standardized the routine use of tonometry after the plaintiff lost vision because of a delayed glaucoma diagnosis. But even the courts' current view of standard of care is far different than it was at that defining moment in eye care history.CONCLUSIONS AND RELEVANCE Today, health care professionals typically equate standard of care with best clinical practices, and yet the law specifies a standard of minimal competence when determining standard of care. These competing definitions are, at best, misleading and, at worst, counterproductive. This narrative review examines how medical guidelines are developed, formalized, communicated, and adopted in the United States. It seeks to clarify ophthalmologists' understanding of the related but distinct ideas of standard of care, practice guidelines, and gold standards. Last, this review argues that quality of care must be distinguished from standard of care and outlines how legal definitions of standards of care can set exceedingly low benchmarks, discouraging innovation without reducing frivolous litigation.

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Section: What Is a Standard Of Care?mentioning

confidence: 99%

Section: The Glaucoma Case That Changed Standard Of Care Lawmentioning

confidence: 99%

Section: The Glaucoma Case That Changed Standard Of Care Lawmentioning

confidence: 99%

Section: The Glaucoma Case That Changed Standard Of Care Lawmentioning

confidence: 99%

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Challenges in Elucidating Ophthalmology’s Standards of Care

Hellem

VanderBeek

2022

JAMA Ophthalmol

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“…To the best of our knowledge, only one study has investigated sleep duration in on-call psychiatry residents, demonstrating that the total number of pages received and the number of admissions best explain the variance in the hours of sleep. 9 Thus, sleep quality and daytime sleepiness (EDS), and their association with caffeinated beverage intake in psychiatry trainees still need to be addressed.…”

Section: Introductionmentioning

confidence: 99%

Sleep Quality, Perceived Stress, and Caffeinated Drinks Intake in Psychiatry Residents: A Cross-Sectional Study

Concerto

Conti

Muscatello

et al. 2017

Journal of Caffeine Research

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Background: Medical residencies are highly demanding and stressful and have been associated with mental and emotional problems. Studies that evaluated this relationship in Italian psychiatry residents are scarce. In this study, we examined sleep quality and its association with perceived stress and caffeinated beverages consumption in Italian psychiatry residents.Methods: Seventy-two PGY1–5 psychiatry residents at two University Hospitals in Italy were asked to complete an anonymous questionnaire. The Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used to determine the sleep quality and the level of daytime sleepiness (EDS). In addition, we investigated perceived stress and caffeinated drinks consumption (coffee, tea, soda, energy drinks).Results: Seventy psychiatry residents responded to the survey (97.2% response rate) (M = 34.3%, F = 65.7%; mean age = 30.5 ± 4.2 SD years). 44.3% had poor sleep quality and 15.7% had abnormal EDS. 64.3% reported significant perceived stress. Perceived stress score and coffee consumption were associated with greater likelihood of poor sleep quality.Conclusions: Psychiatry residents have high prevalence of poor sleep quality. Future longitudinal studies are needed to investigate causality and identify appropriate coping strategies and lifestyle changes aimed to improve mental health in psychiatry trainees.

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