Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

Abstract

ObjectiveTo explore the effects of the UK Working Time Regulations (WTR) on trainee doctors’ experience of fatigue.DesignQualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors purposively selected from Foundation and specialty training. Final compliance with a 48 h/week limit had been required for trainee doctors since August 2009. Framework analysis of data.Setting9 deaneries in all four UK nations; secondary care.Participants82 doctors: 53 Foundation trainees and 29 specialty trainees. 36 participants were male and 46 female. Specialty trainees were from a wide range of medical and surgical specialties, and psychiatry.ResultsImplementation of the WTR, while acknowledged as an improvement to the earlier situation of prolonged excessive hours, has not wholly overcome experience of long working hours and fatigue. Fatigue did not only arise from the hours that were scheduled, but also from an unpredictable mixture of shifts, work intensity (which often resulted in educational tasks being taken home) and inadequate rest. Fatigue was also caused by trainees working beyond their scheduled hours, for reasons such as task completion, accessing additional educational opportunities beyond scheduled hours and staffing shortages. There were also organisational, professional and cultural drivers, such as a sense of responsibility to patients and colleagues and the expectations of seniors. Fatigue was perceived to affect efficiency of skills and judgement, mood and learning capacity.ConclusionsLong-term risks of continued stress and fatigue, for doctors and for the effective delivery of a healthcare service, should not be ignored. Current monitoring processes do not reflect doctors’ true working patterns. The effectiveness of the WTR cannot be considered in isolation from the culture and context of the workplace. On-going attention needs to be paid to broader cultural issues, including the relationship between trainees and seniors.

Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review

“…Many causes of burnout derive from organizational-and system-level factors, including electronic health records (EHRs (5), 33,47,52,54,57 Canada (2), 42,48 Egypt (1), 53 and multinational (2). 24,35 Study designs included randomized controlled trials (10), 23,28,29,37,39,40,42,45,48,51 prospective studies (5), 43,44,50,56,60 cross-sectional studies (7), 19,38,47,52,53,66,68 and other designs (4). 24,27,35,59 The included studies evaluated interventions among primary care physicians and residents (12) 31,63,66 and groups of physicians with specialty unspecified (7).…”

“…56 Two studies 34,64 provided qualitative findings, and 10 studies did not report the instrument used to measure burnout. 31,35,36,41,43,46,47,59,60,67…”

“…39,41e46,52 The effect on burnout of restricting the number of hours physicians are allowed to work, primarily residents or interns, was examined in 6 studies. 40,43,44,47,49,50 Only 2 of these studies found that limiting work hours alleviated burnout. 43,44 Both studies evaluated outcomes of the 2003 Accreditation Council for Graduate Medical Education duty hour restrictions.…”

Prevalence of fatigue among postgraduate trainees in the United States and Japan

“…Extended work hours are known to result in fatigue and fatigue‐related medical errors . Fatigue has been shown to affect postgraduate trainees’ performance, learning, and patient safety . Desai et al (2013) have demonstrated increased sleep duration when compliance with duty hour regulations implemented by American Council for Graduate Medical Education in 2011 is achieved, but the impact on patient care or trainee well‐being remains controversial .…”

“…1 Fatigue has been shown to affect postgraduate trainees' performance, learning, and patient safety. 2 for Graduate Medical Education in 2011 is achieved, 4 but the impact on patient care or trainee well-being remains controversial. 5 On the contrary, Japanese postgraduate training programs are not mandated to report trainees' work hours although Japanese government issued a guideline for work hours and standard labor act in 2005.…”