Sleep disturbances predict prospective declines in resident physicians’ psychological well-being

Abstract

BackgroundMedical residency can be a time of increased psychological stress and sleep disturbance. We examine the prospective associations between self-reported sleep quality and resident wellness across a single training year.MethodsSixty-nine (N=69) resident physicians completed the Brief Resident Wellness Profile (M=17.66, standard deviation [SD]=3.45, range: 0–17) and the Pittsburgh Sleep Quality Index (M=6.22, SD=2.86, range: 12–25) at multiple occasions in a single training year. We examined the 1-month lagged effect of sleep disturbances on residents’ self-reported wellness.ResultsAccounting for residents’ overall level of sleep disturbance across the entire study period, both the concurrent (within-person) within-occasion effect of sleep disturbance (B=−0.20, standard error [SE]=0.06, p=0.003, 95% confidence interval [CI]: −0.33, −0.07) and the lagged within-person effect of resident sleep disturbance (B=−0.15, SE=0.07, p=0.037, 95% CI: −0.29, −0.009) were significant predictors of decreased resident wellness. Increases in sleep disturbances are a leading indicator of resident wellness, predicting decreased well-being 1 month later.ConclusionsSleep quality exerts a significant effect on self-reported resident wellness. Periodic evaluation of sleep quality may alert program leadership and the residents themselves to impending decreases in psychological well-being.

Perceived utility and relevance of intern well‐being sessions

“…As in other studies, our results indicate that a majority of interns (Figs ,) experience stress from a variety of workplace causes, and feel unable to lead healthy lives due to long work hours, poor work–life balance and challenging conditions . It may be that the level of stress imposed on some interns is so great that a state of well‐being is not possible, rendering well‐being practices, and theoretical knowledge insufficient.…”

“…As in other studies, our results indicate that a majority of interns (Figs 3,4) experience stress from a variety of workplace causes, and feel unable to lead healthy lives due to long work hours, poor work-life balance and challenging conditions. 12,13,[15][16][17][18][19][20]35 It may be that the level of stress imposed on some interns is so great that a state of well-being is not possible, rendering well-being practices, and theoretical knowledge insufficient. Furthermore, our qualitative data implied that well-being sessions may even offend some interns who interpret them as the hospital placing sole responsibility on them to cope rather than addressing systemic factors.…”

“…An intern must quickly adapt to working in unfamiliar, erratic, time‐pressured, disruptive and complex healthcare system, while clinically learning, achieving training requirements and meeting the high standards placed upon them by supervisors, colleagues, patients and their families . High workload, shift work, limited leave, sleep debt and overtime are commonly accepted as a normal part of the life of an intern . Interns have little spare time to engage in self‐care activities that support their health and well‐being and prior years of study may mean that they missed the opportunity to experiment with extra‐curricular activities that serve as constructive coping mechanism, thus entering internship without adaptive resilience skills in place .…”

“…10,[14][15][16][17] High workload, shift work, limited leave, sleep debt and overtime are commonly accepted as a normal part of the life of an intern. 18,19 Interns have little spare time to engage in self-care activities that support their health and well-being and prior years of study may mean that they missed the opportunity to experiment with extra-curricular activities that serve as constructive coping mechanism, thus entering internship without adaptive resilience skills in place. 10,14,20 Intrinsic traits, such as perfectionism, may further contribute to the vulnerability of doctors to ill-health if not skillfully managed.…”

Night duty and decreased brain activity of medical residents: a wearable optical topography study

“…Numerous studies have linked fatigue and sleep deprivation of resident physicians to poor performance in neurobehavioral testing, lack of motivation, and attentional failure [2,3]. Disturbed sleep not only reduces the quality of life, but also deteriorates the psychological well-being of resident physicians [4]. Alarmingly, these distressing conditions are associated with an increased risk of self-perceived major medical errors, including tacit incidents of critical medical accidents.…”