Abstract
Aim
Emergency medicine (EM) trainees often work nightshifts. We sought to measure how
this circadian disruption affects EM resident performance during simulated resuscitations.
Methods
This retrospective cohort study enrolled EM residents at a single Canadian academic
centre over a six-year period. Residents completed twice-annual simulation-based resuscitation-focused
objective structured clinical examinations (OSCEs) with assessment in four domains
(primary assessment, diagnostic actions, therapeutic actions and communication), and
a global assessment score (GAS). Primary and secondary exposures of interest were
the presence of a nightshift (late-evening shifts ending between midnight and 03h00
or overnight shifts ending after 06h00) the day before or within three days before
an OSCE. A random effects linear regression model was used to quantify the association
between nightshifts and OSCE scores.
Results
From 57 residents, 136 OSCE scores were collected. Working a nightshift the day before
an OSCE did not affect male trainee scores but was associated with a significant absolute
decrease in mean total scores (−6% [95% CI −12% to 0%]), GAS (−7% [−13% to 0%]), and
communication (−9% [−16% to −2%]) scores among women. Working any nightshift within
three days before an OSCE lowered absolute mean total scores by 4% [−7% to 0%] and
communication scores by 5% [−5% to 0%] irrespective of gender.
Conclusion
Our results suggest that shift work may impact EM resident resuscitation performance,
particularly in the communication domain. This impact may be more significant in women
than men, suggesting a need for further investigation.
Keywords
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Article info
Publication history
Published online: March 12, 2018
Accepted:
March 10,
2018
Received in revised form:
February 15,
2018
Received:
August 28,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.03.019.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
