Capsule Commentary on Zebrowski et al., So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents

Journal of General Internal Medicine, Feb 2018

Lisa C. Martinez

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Capsule Commentary on Zebrowski et al., So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents

Capsule Commentary on Zebrowski et al., So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents Lisa C. Martinez 0 0 Schmidt College of Medicine, Florida Atlantic University , Boca Raton, FL , USA - T and how it is impacted by intern year1 comes at a time his study exploring incoming interns’ sleep dysfunction when there is considerable focus on outcomes in residency education, specifically, resident wellness and patient safety. The investigators had previously reported sleep dysfunction in incoming interns2 and with this study investigated whether these baseline characteristics evolve during internship. Fiftyfour percent of the 281 residents enrolled at study initiation completed the year-long follow-up. The incoming residents completed the Pittsburg Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), along with demographic information. This study was performed when interns’ schedule was working under the 2011 work-hour restrictions. While the ACGME has expanded the duty hours to now include 24 h shifts, many programs have not incorporated this schedule, so this may still be valid for many programs throughout the country. The results of this investigation showed that interns generally have worsening scores in their ESS and PSQI, specifically in daytime dysfunction, sleep disturbance, and change in bedtime and wake time leading to decreased sleep duration, regardless of their specialty. This offers insight into the possible effect internship has on sleep quality. This study, however, did not address the effect that sleep dysfunction has on patient outcomes or resident wellness. Previous studies have looked at the effect of the 2011 duty-hour restrictions on medical errors and depressive symptoms,3 showing that despite no effect on sleep duration, residents still reported concern of making a serious medical error. In another study, the ESS did not show any statistically significant effect on patient outcomes.4 As we focus on ways to assess contributors to intern and resident performance, it is important to assess whether these markers have real and measurable effects on either patient or resident outcomes. For educators, this study promotes consideration of sleep dysfunction in interns as they progress through their first year; however, it does not address the real world implications of this dysfunction. Continued research into the specific markers that play a role in resident performance and outcomes needs to be continued. Compliance with ethical standards: Conflict of interest: The author declares that he/she does not have a conflict of interest. 1. Zebrowski JP , Pulliam SJ , Denninger JW , Berkowitz LR . So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents . J Gen Intern Med . https:// doi.org/10.1007/s11606-018-4348-3. 2. Pulliam SJ , Weinstein DF , Malhotra A , Macklin EA , Berkowitz LR . Baseline sleep dysfunction among matriculating interns . J Grad Med Educ . 2012 ; 4 ( 2 ): 202 - 8 . 3. Sen S , Kranzler HR , Didwania AK , et al. Effects of the 2011 Duty Hour Reforms on Interns and Their Patients: A Prospective longitudinal Cohort Study . JAMA Intern Med . 2013 ; 173 ( 8 ): 658 - 662 . 4. West CP , Tan AD , Habermann TM , Sloan JA , Shanafelt TD . Association of resident fatigue and distress with perceived medical errors . JAMA . 2009 ; 302 ( 12 ): 1294 - 300 .


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Lisa C. Martinez. Capsule Commentary on Zebrowski et al., So Tired: Predictive Utility of Baseline Sleep Screening in a Longitudinal Observational Survey Cohort of First-Year Residents, Journal of General Internal Medicine, 2018, 1-1, DOI: 10.1007/s11606-018-4369-y