Duty Hours Research Articles

Post-Vaccination COVID-19 Transmission among Healthcare Workers in a Tertiary Level Hospital in Nepal

Background and Aims: Frontline healthcare workers have faced an increased risk of contracting COVID-19 since the beginning of the pandemic. Nurses, in particular, faced a substantial risk compared to doctors, possibly due to their prolonged exposure to patients. Despite the vaccine coverage to healthcare workers before the second wave of the pandemic, breakthrough infection was unavoidable. Methods: This observational study was conducted at Shahid Gangalal National Heart Center, Kathmandu, Nepal, during the second wave of the COVID-19 pandemic. The study aimed to investigate COVID-19 infections among nursing staff, focusing on the number of infections, severity, the relationship between infections and time spent in the COVID ward, the comparison of infections among vaccinated and unvaccinated staff, and the effectiveness of infection control measures. Results: Among the 132 nursing staff, the overall positive rate after vaccination was 15.15%, with a breakthrough infection rate of 4.34%. Significant differences were observed in age and prior infection. However, no significant differences were observed among the type of family, education level, work experience, wards, total duty hours, level of PPE used, mask type, or mask reuse. Conclusion: Vaccines reduce the severity of infections but do not eliminate the risk, especially in high-exposure settings like healthcare facilities.

Knowledge and Awareness on Swine Origin Influenza A(H1N1) Among Health Care Providers and Civil Employees in a Tertiary Level Hospital, Dhaka Bangladesh

Background: Swine Origin Influenza A(H1N1) viruses create yearly epidemics and rarely pandemics that cost millions of lives worldwide. Health care providers and civil employees at hospital can help in prevention of transmission of influenza by acquiring knowledge and awareness. Methods: A descriptive cross-sectional study was conducted at Combined Military Hospital Dhaka from July to December 2023. Total 213 participants were interviewed that comprises doctors, nurses, medical assistants and civil employees. Purposive sampling technique was used to collect data. Face to face interview was done through a pre-tested semi-structured questionnaire. Data were analysed by using Statistical Package for the Social Sciences (SPSS) version 25.0. Informed consent were obtained from the respondents addressing proper ethical issues. Results: In this study out of total participants 70.4% had previously heard about H1N1 influenza A. Total 38% participants said that internet was found as major source of information. Among the participants 64.3% told fever was common symptom and use of facemask at duty hour was consented by 33.8% as an important means for prevention. Maximum (66.3%) civil employees do not know about washing hand after contact as a preventive procedure leading to spread of infection. Maintaining distance as preventive measures observed by 13.6% participants. Moreover, all participants were aware of transmission through droplet infection except civil employees. In the present study, 50% doctors and 38.1% nurses had knowledge that drug Oseltamivir is very effective against swine Influenza A(H1N1). Remarkable differences were identified among doctors, nurses, medical assistants and civil employees regarding knowledge of quarantine and availability of vaccine. RT-PCR laboratory test is the confirmatory method to defect swine influenza A(H1N1) were exactly known by 9.9% participants, while 70.9% participants don't know the confirm diagnostic method. Conclusion: Knowledge and awareness regarding swine influenza A(H1N1) was low among study participants. For controlling epidemic or even pandemic, awareness by mass media is important. Remarkable gap observed regarding knowledge and awareness about swine influenza A(H1N1) among the health care providers and civil employees, needs to be addressed by proper training and motivation. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 1-7

417 Despite Their Concerns, Residents Have a Poor Understanding of ACGME Duty Hours Rules

417 Despite Their Concerns, Residents Have a Poor Understanding of ACGME Duty Hours Rules

Identifying Suicide-Related Predictors Using Overseas Airborne Infantry Brigade Serious Incident Reports.

Suicidal ideation and attempts are considered to be graduated risks for suicide, yet they remain under studied. Suicide is among the leading causes of death in the U.S. for all individuals between the ages of 10 and 64 years. Suicide is a critical problem in the U.S. Military. The U.S. Army suicide rates surpassed civilian rates in 2008 and continue to climb steadily; with U.S. Army soldiers at more than twice the risk than U.S. civilians, and enlisted personnel at more than twice the risk of officers. Suicidal ideation and attempts are routinely reported within U.S. Army brigades using suicide-related serious incident reports (SR-SIRs). These reports could form a useful source of information for prevention planning, but to date there have been no efforts to summary these reports. This paper analyzes SR-SIRs among enlisted personnel for a 4-year period for 1 Army brigade, to test the usefulness of this information and to explore whether risk factors for attempts compared to ideation can be identified. This report analyzes 130 de-identified reports of suicidal ideation (n = 102) and suicide attempts (n = 28) reported as SR-SIRs from August 2018 to June 2022 among enlisted personnel in an airborne infantry brigade combat team (BCT) outside the continental U.S. Analysis of de-identified data was not considered research by brigade and university human subject/IRB authorities. Fourteen soldier characteristics and context factors were examined to determine if they differentiate the two types of incidents, suicidal ideations and suicide attempts. Unit location and alcohol use at the time of the incident were strongly associated with suicide attempts compared to ideation. Attempts occurred disproportionately during off duty hours, and attempters were more likely to have had prior contact with behavioral health services than ideators; however, these differences did not attain conventional statistical significance. The study can help inform unit-specific suicide prevention and intervention strategies. Off duty hours and alcohol use are risk factors for attempts, particularly among soldiers who have sought behavioral health care. Plans to engage and support soldiers who have sought behavioral health care during off duty hours, and information regarding the risks of alcohol use, could meaningfully reduce their risk. This is the first known attempt to examine active duty U.S. Army brigade combat team SR-SIRs, and they are a potentially valuable source of health and mental health-related information.

Looking beyond duty hours: Offering a balanced quantitative-qualitative approach to resident burnout.

Burnout, stress and overwork are highly prevalent amongst junior training physicians worldwide, which explains the widespread phenomenon of physicians leaving the field and organised protests/strikes for better working conditions. Back in 2003, the mandatory duty hour restriction was a landmark intervention rolled out by the Accreditation Council for Graduate Medical Education that formally mandated limiting working hours of trainee residents to no more than 80 h per week, and not exceeding 24-h shifts with 6 added hours for education and handover. Nonetheless, 20 years later, this measure continues to be subject to multiple debates on its purported efficacy in achieving its intended objectives and fails to adequately prevent physician burnout and exodus. In our view, the current duty hour restriction model is, in and of itself, inadequate for combating burnout amongst medical residents for several reasons, including insignificant reduction in duty hours with suboptimal adherence/reporting, failure to account for off-site clinical and non-clinical duties, as well as nature of clinical work which typically involves high work intensity in less-than-optimal/unconducive work environments and significant psychoemotional stress. In this article, we offer our perspectives on pursuing a balanced approach towards both meaningful quantitative reduction in working hours as well as practical qualitative improvement in nature of clinical and non-clinical work that could collectively address resident burnout and improve work and training outcomes.

Knowledge and Prevalence of Plantar Fasciitis among Nurses of Selected Hospital of Kathmandu, Nepal

An uncomfortable foot ailment called plantar fasciitis is brought on by an inflammation of the plantar fascia. When this band of tissue is overworked or overextended, plantar fasciitis develops. This results in tiny rips in the fascia's fibers, particularly where it connects to the heel bone. This study set out to determine how much the nurses at the Civil Service Hospital in Kathmandu knew about plantar fasciitis and how common it was. At the Civil Service Hospital in Kathmandu, 58 nurses participated in a descriptive cross-sectional research. Data were gathered using a self-administered questionnaire and the windlass test. SPSS version 20 was used to analyze the data, which included frequency and percentage using a descriptive statistical approach. The results showed that majority of respondents (53.4%) of nurses were age group of 18 to 25 years. Maximum respondents (93.1%) had normal BMI, maximum (46.6%) had 1 to 4 years work experience and majority of respondents (74.1%) worn flats during duty hours. Out of 58 respondents (56.9%) had poor knowledge, (29.3%) satisfactory and (13.8%) had good knowledge regarding plantar fasciitis with positive prevalence of windlass test (63.80%) and (36.2%) had negative windlass test. In the present study, it is concluded that majority of the respondents had (56.9%) poor knowledge, (29.3%) satisfactory and (13.8%) had good knowledge regarding plantar fasciitis with positive prevalence of windlass test (63.80%) and (36.2%) had negative windlass test, which means majority have plantar fasciitis.

Minimally invasive training in surgical oncology: Current status and needs assessment

Utilization of minimally invasive surgery (MIS) has grown significantly over the past three decades, changing the face of surgical oncology practice. Changes to educational programming have been more scattered. Surgical training has undergone a major transformation with duty hour restrictions, decreased autonomy, and increased technology in the workplace. Despite increasing exposure to laparoscopic and robotic approaches, there is a lack of standardized training in residency, fellowship and beyond. As a result, surgeons report feeling ill-equipped for independent MIS oncology practice. While long term data is limited, several models of MIS curriculum implementation exist in gastrointestinal, hepato-pancreatico-biliary, and colorectal surgery. The aim of this review is to describe the current state of robotic training in surgical oncology and offer directions for future research and practice.

Analysis Of Increasing Lubricating Oil Temperature In Ship Diesel Generators

Abstract Auxiliary aircraft is a vital part of a ship that is needed as a power plant or generator. In order to avoid more heat, lubricating oil is needed in the form of a chemical substance, in the form of a liquid given between two moving objects to reduce friction, as a protective layer separating the two surfaces in contact. This is due to the operation of the diesel generator which occurs continuously and can cause friction and erosion of the moving parts. So that friction causes changes in material structure which over time can cause heat. However, this condition makes the lubricating oil temperature increase every hour. This qualitative research uses Primary and secondary data collection methods, with observation (field survey), interviews and library research. Based on the results of the analysis, the cause of the increase in lubricating oil temperature is due to the condition of the electromotor of the seawater cooling pump through the bypass faucet not according to the desired pressure, pump bearings have wear and pump gears, then the heat absorption of the L.O Cooler shelf is not optimal due to blockages in the capillary pipes. That the increase in the temperature of the diesel generator lubricating oil above 700 C and the pressure of 2 kg/cm2 during the machinist’s duty hours 00.00-04.00 LT is caused by the diesel generator auxiliary motor having an ineffective Lo Cooler heat absorption capacity, sea water cooling pressure that is less than normal and the presence of pipe connections that leak cooling pipes

A qualitative study on the adoption of the new duty hour regulations among medical residents and faculty in Korea.

Duty hour regulations (DHRs) were enforced in 2017 in Korea to prevent the detrimental effects of excessively prolonged working hours among medical residents. We investigated the adoption of and implications of the new DHRs among medical residents and faculty members. Semi-structured interviews were conducted with 15 medical residents and 9 faculty members across general surgery, internal medicine, obstetrics-gynecology, and pediatrics departments at Chonnam National University Hospital. Based on the constructivist grounded theory, we developed themes from the data by concurrent coding and analysis with theoretical sampling until data saturation. In addition, respondent validation was used to ensure accuracy, and all authors remained reflexive throughout the study to improve validity. The methods of DHRs adoption among residents and faculty members included the following 4 themes: DHRs improved work schedule, residents have more time to learn on their own, clinical departments have come to distribute work, organization members have strived to improve patient safety. Residents have undertaken initial steps towards creating a balance between personal life and work. Teamwork and shift within the same team are the transitions that minimize discontinuity of patient care considering patient safety. Teaching hospitals, including faculty members, should ensure that residents' work and education are balanced with appropriate clinical experience and competency-based training.

Psychiatry resident physician duty hours, resting times and European Working Time Directive compliance in Spain

Introduction There is a growing interest in understanding the impact of duty hours and resting times on training outcomes and the well-being of resident physicians. Psychiatry resident’s duty hours in Spain comprise a regular working schedule of 37.5h per week and a minimum of 4 mandatory on-call shifts. The most recent duty hours regulations in Spain were transposed from the European Working Time Directive (EWTD). According to Spanish Law, doctors cannot work for more than 48h per week and need to have resting times per day (at least 12h), per week (at least 36h) as well as annual leave (at least a month). However, there is practically no data on this situation in psychiatry resident physicians.Objectives Our aim is firstly, to describe the number of shifts performed by psychiatry resident physicians in Spain. Secondly, to describe compliance with the daily and weekly rests compared to those set in national and European law. Finally, to analyse the difference by demographic variables (gender and year of residency), in both the number of on-call duty shifts and compliance with rests.MethodsA descriptive cross-sectional study was designed through an online survey adapted from the existing literature. The target population were Spanish psychiatry resident physicians undergoing PGT who started their specialist training during the years 2018–2021. The survey was disseminated through the Spanish regional medical councils to all active psychiatry resident physicians by mail as well as through informal communication channels. The study was authorised by the Spanish Medical Organization’s General Assembly which is the highest ethical and deontological body of physicians in Spain.Results 55 responses were obtained, of which 61.82% identified as females. The mean number of on-call shifts in the last 3 months was 14.05. This mean was highest in women 14,32 and in the cohort of 2020 15.46 (first year of residency). Among the resident physicians surveyed, 66.07% exceeded the 48h per week limit set by the EWTD and 7% of them did not rest after a 24-h on-call shift. Furthermore, 22% of respondents did not have a day-off after a Saturday on-call shift. The mean working hours when not resting after an on-call-shift were 7 hours. The comparison by gender and year of residency of the main variables can be seen in figures 1 and 2 respectively.Image:Image 2:ConclusionsPsychiatry resident physicians in Spain greatly exceed the established 48 h/week EWTD limit. Likewise, non-compliance with labour regulations regarding mandatory rest after on-call duty and minimum weekly rest periods are observed. Differences can be seen by gender and year of residency. The situation described could potentially create a high-risk situation for the health and psychosocial well-being of resident physicians, hinder learning outcomes and could lead to suboptimal patient care.Disclosure of InterestNone Declared

Effects of Use of Personal Protective Equipment on Physical and Mental Health of Health Care Workers: A Mixed-Method Study

Abstract Background: Due to the high transmissibility of the SARS-CoV-2 virus, the use of personal protective equipment (PPE) was recommended worldwide during the COVID-19 pandemic for health care workers (HCWs). Objectives: The study aims to understand the effects of the use of PPE on the health of HCWs. Materials and Methods: The study was a mixed-method study consisting of two parts, conducted in the year 2019. Initially, 200 HCWs were asked to fill out an online questionnaire enquiring about the effects of PPE on their health. To assess the distress caused by PPE, Kessler Distress Scale was used. In the second part, 20 random participants were interviewed for a subjective understanding of their experience with PPE. Results: Excessive sweating, fatigue, increased thirst, dyspnea, and headache were the most reported symptoms, along with several dermatological symptoms. About 10% of the participants suffered from severe distress. The interviews showed themes involving donning and doffing, physical, psychological, and social well-being, work efficacy, security, and stigma. Conclusion: The scarcity of PPE, prolonged duty hours, and lack of prior training led to various mental and physical ailments among HCWs. These could be tackled by simple preventive strategies, which, if implemented at a broad scale, would help the health care community during similar situations in the future.

Replacing the Scalpel With a Computer Mouse: An Evaluation of Time Spent on Electronic Health Record for Plastic Surgery Residents and Its Impact on Resident Training.

Following the integration of the electronic health record (EHR) into the healthcare system, concern has grown regarding EHR use on physician well-being. For surgical residents, time spent on the EHR increases the burden of a demanding, hourly restricted schedule and detracts from time spent honing surgical skills. To better characterize these burdens, we sought to describe EHR utilization patterns for plastic surgery residents. Integrated plastic surgery resident EHR utilization from March 2019 to March 2020 was extracted via Cerner Analytics at a tertiary academic medical center. Time spent in the EHR on-duty (0600-1759) and off-duty (1800-0559) in the form of chart review, orders, documentation, and patient discovery was analyzed. Statistical analysis was performed in the form of independent t tests and Analysis of Variance (ANOVA). Twelve plastic surgery residents spent a daily average of 94 ± 84 minutes on the EHR, one-third of which was spent off-duty. Juniors (postgraduate years 1-3) spent 123 ± 99 minutes versus seniors (postgraduate years 4-6) who spent 61 ± 49 minutes (P < 0.01). Seniors spent 19% of time on the EHR off-duty, compared with 37% for juniors (P < 0.01). Chart review comprised the majority (42%) of EHR usage, followed by patient discovery (22%), orders (14%), documentation (12%), other (6%), and messaging (1%). Seniors spent more time on patient discovery (25% vs 21%, P < 0.001), while juniors spent more time performing chart review (48% vs 36%, P = 0.19). Integrated plastic surgery residents average 1.5 hours on the EHR daily. Junior residents spend 1 hour more per day on the EHR, including more time off-duty and more time performing chart review. These added hours may play a role in duty hour violations and detract from obtaining operative skill sets.

The Relationship Between Resilience and the Intention to Leave Among Staff Nurses at Governmental Hospitals in the Al-Baha Region of Saudi Arabia.

Background Nurses with high intent to leave can cause substantial problems for healthcare organizations, such as staffing shortages and higher expenses due to hiring and onboarding new nurses. In light of the increasing demands placed on nurses in understaffed and overloaded healthcare systems, nurses frequently face various pressures and difficulties in their field of work, including high workloads, irregular hours, complicated patients, and infectious disease exposure; resilience is critical for handling stress and hardship at work. Nurses will thus retain their jobs for longer. This study aimed to determine the relationship between resilience and the intention to leave among staff nurses. Methods This study utilized a quantitative, cross-sectional correlation design. It comprised three Saudi Ministry of Health-affiliated facilities in the Al-Baha region(King Fahad Hospital, Prince Mashari Hospital, and Mikhwah General Hospital). The study sample comprised nurses employed in critical areas and inpatientand outpatient hospital departments using convenience sampling and inclusion and exclusion criteria. An online questionnaire involving three sections was given out.The first part collected sociodemographic data, the second part included the Connor-Davidson Resilience Scale 25 (CD-RISC-25), and the third included the Anticipated Turnover Scale (ATS). Results This study found a moderate degree of intention to leave and resilience. Most participants in the survey held a bachelor's degree (75.8%), and around 87.1% of the sample consisted of women. About half of the sample (57.2%) were married; 67.6% of the participants were not Saudi nationals; and regarding the number of children, the majority (53.8%) were childless. Overall, 318 nurses working in acute and outpatient departments and critical regions participated. According to the study, 73.3% of the participants reported a moderate intention to quit, whereas 50.9% had moderate resilience. Similarly, a significant negative relationship was found between nurses' intention to leave and resilience. Conclusions In the current study, resilience has a statistically significant negative relationship with the nurses' intention to leave. Hospital management must consider the amount of work and the excessive work schedule to reduce nurses' intentions to leave. One way to do this is by assigning tasks to employees, minimizing their workload through flexible work schedules and shorter duty hours, and fostering teamwork among coworkers by ensuring clear communication and cooperation. Interventions like orientation programs for new nurses, regular meetings, seminars, and training sessions can improve nurse resilience.

The occupational stress and lifestyle of anesthesiologists living in the southern district of Tamil Nadu- A pilot questionnaire-based survey

A pilot questionnaire-based method was used to assess the qualitative data on work-related stress, family spending time and to evaluate the usefulness of this survey in managing their stress in their own feasible way among the anesthesiologists living in Tamil Nadu, Southern India.It was a cross-sectional, confidential survey conducted using a questionnaire method. It consisted of 15 questions under four headings prepared and handed over personally to 100 anesthesiologists who attended the State-level Anesthesiology Continuing medical education (CMEs), conducted in two districts of the southernmost part of Tamil Nadu. All the questions had a minimum of three multiple-choice options. They were subdivided into four sections: a) Questions on Demographic profile, b) Questions on assessment of time spent with family members: travel time, c) Questions on the assessment of personal time spent: hobbies, recreational activities, exercise, and habits of addiction d) Questions to assess the work pressure.Seventy anaesthesiologists (70%) responded to the survey. The mean age of the participants was 39.5(12.2) years. Among them, 14.3% (10) had diabetes, and 11.4% (8) had hypertension young. 24.3% (17) had&amp;#62;12 duty hours. Most of them spend (34.3%; 24) only 1-2 hours per day with family. Only 15.6% (5) exercise &amp;#62; 5 hours a week. Fifty percent of the participants were stressed during the first case of death on the table (DOT), only 17% handled with confidence and were not stressed, but 33% were stressed and did not sleep well for a few days. The overall stress levels were 61.4%. Forty-two percent (42.8%; 30) have addictive habits such as smoking and drinking alcohol. Our questionnaire-based study helped the responded Anaesthesiologists realize the amount of work-related stress, personal time, and family time is inadequate. At the end of the survey, most wanted to change their lifestyle and spend valuable family and me time for the rest of their life.

Suicide among psychiatrists: From healers to seekers of mental health care

Addressing suicide and mental health issues among psychiatrists, particularly during a crisis such as the COVID-19 pandemic is important. several factors contribute to this risk, such as long duty hours, burnout, emotional exhaustion, exposure to secondary trauma, and the impact of the pandemic on the mental health of healthcare workers. This paper emphasizes the urgent need for interventions at individual and organizational levels to address burnout and mental health issues among psychiatrists. Supporting the mental resilience of mental health professionals will improve the mental health of the community.

Physician-assisted interhospital transfer-an analysis from Schleswig-Holstein

The need for interhospital transport (IHT) of intensive care patients is increasing due to changes in the hospital environment. Interhospital transports are challenging and require careful operational planning of personnel and rescue vehicles. To investigate the need for IHT, an analysis was conducted in the service area of the emergency medical service central dispatch center (IRLS) in Schleswig-Holstein. Emergency physician-assisted IHT were analyzed in the period from 01.10.2021 to 30.09.2022. Of atotal of 158,823 documented IRLS missions, 2264 (1.4%) records could be identified and included as IHT: 1389IHT (61.4%) were managed by specialized ambulances, 875(38.6%) by primary care ambulances. Primary care ambulances were mainly used for time-critical transfers and outside the duty hours of the intensive care ambulances, 21.2 % were by air. Of all IHT, 43.1% were required to hospitals with ahigher level of medical care. Emergency physician-assisted IHT are arelevant part of the emergency service's operational spectrum and concern both primary care and specialized rescue vehicles. Arelevant number of urgent IHT were recorded outside the duty hours of the intensive care ambulances. For emergency transports during nighttime, an expansion of air-based transfer capacities should be considered due to the time advantage. For less urgent IHT, an adjustment of the capacities of specialized ground-based vehicles in Schleswig-Holstein seems reasonable.

Assessing needs of children for childcare at Allama Iqbal Open University

The present study aimed to assess the children needs for childcare at daycare centre of Allama Iqbal Open University Islamabad. Childcare is an important area for research as it directly affects the life of working women in an organization. The University has a daycare centre to facilitate those female employees having kids. It is situated in the main campus of the university. The mothers usually place their offspring in the daycare due to the need to work. The mothers visit daycare centre during duty hours and during break. The present study assessed the working conditions of the daycare centre and suggest some possible interventions for quality provisions and facilities at the daycare centre. It was a need assessment survey. The population of the study included mothers, daycare workers, ayas and members of the management committee of the daycare centre of AIOU. Data was collected through interview, checklists and observations of the care workers with children. It was a need assessment study. A checklist was used to record existing facilities at daycare. While, an interview was conducted regarding awareness, opinion and vision of the mothers and caregivers. Results indicated that the day care centre was equipped with necessary facilities. However, some of the facilities need to provided/upgraded. The study recommended active role of the parents in affairs of the daycare centre.

Associations of sleep with psychological health and alertness: a national survey of Japanese physician duty hours

Associations of sleep with psychological health and alertness: a national survey of Japanese physician duty hours

Optimum Working Hours for College of Physicians and Surgeons Pakistan Fellowship Residents of General Medicine and General Surgery Disciplines.

To determine the optimum working hours per week for CPSP trainees of Fellowship Programmes in the disciplines of General Surgery and General Medicine. Mixed-methods, explanatory study. Place and Duration of the Study: Department of General Medicine and Department of General Surgery, Abbasi Shaheed Hospital, Karachi, from February to August 2023. The total number of subjects included were 33 residents, 7 supervisors (4 from General Medicine and 3 from Geneneral Surgery), and 3 hospital managers (from private sector), constituting a representative sample. Postgraduate trainees (PGTs) of third-and fourth-year FCPS training programme who showed willingness to participate were included as were all supervisors and hospital managers involved in the training programme. FCPS residents, who were not willing, on leave, and on rotation to other departments were excluded, as were PGTs enrolled in university and other programmes. For quantitative analysis, survey forms were distributed to the selected participants. For qualitative analysis, one-to-one interviews were conducted in-person and through video-link. Data collection procedure included distribution by hand and via email. SPSS was used for the data analysis. All residents recorded that duty stress, fatigue, and burnout resulted in poor quality of family and social life. All the stakeholders were convinced that acquisition of skills, learning outcomes, and patient safety with optimum care is compromised. The duration of emergency calls varied from 30 to 36 hours. There were 19 out of 33 residents (57.5%) who recommended 24 hours of rest after each emergency call. All the supervisors recommended six to eight daily duty hours and 66 to 90 weekly working hours. Four out of seven supervisors (57.1%) suggested emergency duty of 30 hours with post-call rest of 24 hours at every 3rd day. There is a need for a comprehensive approach that caters to the patient care as well as learning outcomes and residents' well-being when devising the duty schedules. Training hours, Fellowship programme, Fatigue, Learning outcomes.

Association of sleep quality with duty hours, mental health, and medical errors among Japanese postgraduate residents: a cross-sectional study

Long duty hours (DH) impair sleep and negatively affect residents’ health and medical safety. This cross-sectional study investigated the association among residents’ DH, sleep duration, insomnia, sleep impairment, depressive symptoms, and self-reported medical errors among 5579 residents in Japan who completed the General Medicine In-Training Examination (2021) and participated in the training-environment survey. Weekly DH was classified under seven categories. Sleep duration and insomnia symptoms, from the Athens Insomnia Scale, were analysed to determine sleep impairment; depressive symptoms and medical errors were self-reported. Among 5095 residents, 15.5% slept < 5 h/day, and 26.7% had insomnia. In multivariable analysis, compared with ≥ 60 and < 70, DH ≥ 90 h/week associated with shorter sleep duration and worsen insomnia symptoms. Shorter durations of sleep and more intense symptoms of insomnia were associated with increased depressive symptoms. Medical errors increased only among residents with insomnia, but were not associated with sleep duration. DH > 90 h/week could lead to shorter sleep duration, worsen insomnia symptoms, and negatively impact well-being and medical safety. There was no significant association between sleep duration and medical errors; however, insomnia conferred an increased risk of medical errors. Limiting DH for residents to avoid excessive workload can help improve resident sleep, enhance resident well-being, and potentially reduce insomnia-associated medical errors.