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Restoration of resident sleep and wellness with block scheduling
Author(s) -
Bordley James,
Agustin Algene G,
Ahmed Mohamed A,
Khalid Raeesa,
Paluso Anthony M,
Kobza Bethany S,
Spaugy Aaron W,
Emens Jonathan,
Desai Sima S,
Khan Akram
Publication year - 2017
Publication title -
medical education
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.776
H-Index - 138
eISSN - 1365-2923
pISSN - 0308-0110
DOI - 10.1111/medu.13392
Subject(s) - medicine , actigraphy , ambulatory , context (archaeology) , physical therapy , epworth sleepiness scale , emergency medicine , polysomnography , circadian rhythm , paleontology , apnea , biology
Context Block scheduling during residency is an innovative model in which in‐patient and ambulatory rotations are separated. We hypothesised that this format may have a positive impact on resident sleep and wellness in comparison with a traditional format. Methods We performed a single‐centre, cross‐sectional, observational study of residents rotating in the medical intensive care unit (MICU). Residents were observed for 4 weeks at a time: internal medicine (IM) residents were observed for 3 weeks in the MICU followed by 1 week in an ambulatory context, and non‐IM residents were observed for 4 weeks in the MICU. We monitored daily total sleep time (TST) utilising actigraphy, and wellness measures with weekly Epworth Sleepiness Scale (ESS) and Perceived Stress Scale (PSS) questionnaires. Results A total of 64 of 110 (58%) eligible residents participated; data for 49 of 110 (45%) were included in the final analysis. Mean ± standard deviation (SD) daily TST in the entire cohort was 6.53 ± 0.78 hours. Residents slept significantly longer during the ambulatory block than during the MICU block (mean ± SD TST 6.97 ± 1.00 hours and 6.43 ± 0.78 hours, respectively; p < 0.0005). Sleep duration during night call was significantly shorter than during day shift (mean ± SD TST 6.07 ± 1.16 hours and 6.50 ± 0.73 hours, respectively; p < 0.0005). A total of 390 of 490 (80%) ESS and PSS questionnaires were completed; scores significantly declined during rotations in the MICU. Internal medicine residents showed significant improvements in TST, and in ESS and PSS scores (p < 0.05) at the end of the ambulatory week. Non‐IM residents, who remained in the MICU for a fourth week, continued a trend that showed a decline in perceived wellness. Conclusions Despite duty hour restrictions, residents obtain inadequate sleep. As MICU days accumulate, measures of resident wellness decline. Residents in a block schedule experienced improvements in all measured parameters during the ambulatory week, whereas residents in a traditional schedule continued a downward trend. Block scheduling may have the previously unrecognised benefits of repaying sleep debt, correcting circadian misalignment and improving wellness.