Introduction: The impact of extended-duration work shifts (EDWS) on trainee education and patient care is a controversial topic in graduate medical education. Given the high rate of burnout in critical care medicine, we examined the impact of EDWS on the well-being and clinical performance of pediatric critical care (PCC) fellows in the US. Given the high rate of burnout in critical care medicine, we hypothesized that EDWS negatively impacts the well-being and clinical performance of PCC fellows in the US. Methods: A cross-sectional, online survey was sent to PCC fellows nationwide, based on validated tools that assessed all 3 domains of burnout (personal accomplishment PA, emotional exhaustion EE, and depersonalization DP), attention, sleepiness, self-efficacy, perceived patient and personal safety, and perceived stress. EDWS was defined as in-house fellow call system with shift durations of ≥24 hours. Results: A total of 120 completed surveys were analyzed - 73 (61%) in the EDWS group and 47 (39%) in the non-EDWS group. Comparing burnout domains for EDWS vs. non-EDWS groups, we found a median PA score of 38 IQR 31-42 vs. 35 IQR 32-42 (p=0. 63), median DP score of 14 IQR 8-20 vs. 11 IQR 7-17 (p=0. 15), and median EE score of 17 IQR 7-25 vs. 14 IQR 9-22 (p=0. 23). EDWS vs. non- EDWS fellows had mean attention scores of 12. 8 vs. 11. 8 (p=0. 10). Mean sleepiness scores were 11. 9 vs. 10. 4 in EDWS vs. non-EDWS fellows (p=0. 09). 26% of EDWS fellows reported occupational exposures vs. 10. 6% of non-EDWS (p=0. 06), while 5. 4% vs. 2. 1% (p=0. 65) EDWS vs. non-EDWS were reported percentages for physical injuries. Compared to the non-EDWS group, the EDWS group reported higher patient care errors due to fatigue (19. 18% vs. 0%, p< 0. 0008) and higher rates of motor vehicle near misses (38. 36% vs. 19. 15%, p=0. 03). Self-efficacy was similar in both groups. Conclusions: In this national survey of PCC fellows, higher perceptions of patient care fatigue errors and motor vehicle near misses were observed amongst EDWS fellows. Generalizability is limited since our cohort represents less than 20% of the PCC fellows in the U. S. Further research with a larger fellow cohort is necessary to investigate how work shift duration impacts the well-being of PCC fellows during training.
Noor et al. (Sun,) studied this question.