Mayo Clinic’s Dr. Colin West: Stressed-out medical residents at risk of car crashes
It’s no secret that doctors in training work brutally long and arduous hours. But new research from the esteemed Mayo Clinic suggests that the effects of these grueling schedules — as well as the distress that accompanies them — could lead to more auto accidents.
According to Dr. Colin West, an internal medical physician at the Mayo Clinic and lead author of the study, nearly half of the 300 Mayo residents polled during the course of their residencies reported nearly getting into a car crash during their training, and about 11 percent actually were involved in auto accidents.
The study, recently published in Mayo Clinic Proceedings, found that residents attributed the traffic mishaps to fatigue and distress — including feelings of burnout and depression. InsuranceQuotes.com talked with West about his findings and their possible consequences.
What originally prompted you to look into this phenomenon?
Prior studies connected resident fatigue with both patient and resident safety. We had previously extended this work to looking at links to patient safety by showing that not just fatigue, but also distress and burnout, led to patient safety concerns. Possible links between distress and resident safety had not been explored, however, so we wanted to address that gap in knowledge.
How did you go about conducting the research for this study?
We have been conducting an ongoing study of resident well-being and distress at the Mayo Clinic since 2003. This study involves quarterly surveys of internal medicine residents, and in 2007 we added questions about motor vehicle incidents. Because of the repeated nature of this study with data collection on the same residents over the course of their training, we are able to link concerns such as fatigue and burnout with outcomes occurring after distress first appears.
Apparently there are several factors contributing to this phenomenon. Did you find that there was any one factor in particular that rose to the top, such as work stress or physical fatigue?
Our main point is that although fatigue contributes to motor vehicle incidents — as would be expected — resident distress and burnout also contribute strongly to those same safety concerns. Future work will be needed to further tease out the most important contributors to resident safety from these larger topics.
Nearly half of the 300 residents polled reported nearly getting into an accident, and about 11 percent have actually been involved in an accident. Those are pretty sobering statistics. Were you surprised by these findings?[JE1]
These figures were not unlike the results from the very few prior reports on residents from other training environments. We were not overly surprised by the frequency we found, although these rates are clearly higher than anyone would consider acceptable.
What, in your opinion, does this study tell us about the hours residents are being asked to work?
We know that fatigue has improved since hour regulations were first put into place nationally in 2003. Residents are confined to an 80-hour weekly limit, averaged over four weeks, and must be granted a 10-hour rest between duty periods and after in-house calls. But this study tells us that even with hour regulations, fatigue remains an issue. Our study also suggests that we need to consider more than just fatigue in order to improve medical training environments, since distress and burnout have harmful consequences as well.
In what ways do you hope this study helps shape the future of residents’ working hours?
Our hope is that the ongoing attention to fatigue management in medical training will be supplemented with additional efforts to reduce distress and promote well-being during training. In this way, we can meet the ideal of training excellent physicians without compromising their patients’ or their own safety.