Use of a PDA to Monitor Surgery Student Work and Sleep Hours Susan Steinemann, MD, FACS Jill Omori, MD University of Hawaii School of Medicine.

Use of a PDA to Monitor Surgery Student Work and Sleep Hours

Susan Steinemann, MD, FACS

Jill Omori, MD

University of Hawaii School of Medicine

TOP 10 SIGNS YOU’VE BEEN IN SURGICAL EDUCATION TOO

LONG….

10. You never argue…..you exchange summative and formative comments

9. Your girlfriend gets a Needs Assessment instead of foreplay

8. Your toddler was potty trained by cognitive task analysis

7. Your statistics may be rusty, but you know dozens of ways to achieve a sum of “80”

Medical Student Work Hours

LCME Guidelines, Feb 2004Duty hours should be setNot longer than residents

26% of medical schools had written work hours policy in 2003-4

LCME Part II survey

Monitored? Enforced?

U Hawaii Work Hours Policy

Developed Fall 2003

Guidelines specifyAverage <80 hours/wkLeave early post-callEliminate non-

educational activities1 day/week off

Faculty and residents were advised of the work hours policy

Students were encouraged to report transgressions

Students rarely reported noncompliance (….. to US)

Pilot study using PDA to record work hours data

September 2004 – March 20057 consecutive days in mid-point of clerkshipHanDBase softwareStudents logged real-time work and sleep hours

Work hours log

Activities performed during work hours categorized and logged in 15-minute increments

Noted if they “would have left” if their presence was not expected or required

All sleep hours (home & work) logged

Logs reviewed

Identify transgressions from work hours policy

Correlate logged work hours withEstimated work hoursSleep hoursNBME subject exam scoreClinical evaluation by faculty

All students successfully collected work hours data

Better compliance than with patient logs3 of 35 students

failed to log sleep hours at home

Only positive comments about PDA log system

Transgressions from Work Hour Policy

24 students (69%) deviated from the written work hour policy12 students worked >80 hours17 students worked late post-call

49% of students reported non-educational activitiesNo two students reported the same activity

on the same day

Estimated vs. logged work hours

Mean work hours = 73 (range 41-99)Estimated work hours ranged from 60-110Estimated hours did not correlate well with logged hours (r=0.19)63% of students overestimated work hoursMedian overestimated time was 19 hours/week

SleepAverage sleep over 7 days ranged from 3.9-8.25 hours / 24-hour period

(median 5.5 hrs)

No significant

correlation

with work

hours

NBME Subject Exam Scores

No significant correlation with work hours

Trend toward positive correlation with more sleep (r=0.25)

NBME Scores: Effects of more work and less sleep

HOURS WORKED/ HOURS SLEPT

n MEAN NBME EXAM SCORE

NATIONAL PERCENTILE RANK

80 work AND

<5.5 sleep

7 66.6* 40th %

<80 and/or

5.5

23 72.7* 70th %

*p<.05 by t-test

Clinical Evaluations Directly Correlated with Work Hours

HOURS WORKED

HONORS NOT HONORS

>75 8 3

<75 3 9

*P<.05 Fisher’s Exact Test

Conclusions

Students’ estimated work hours may be inaccurate

PDA may be a useful tool to monitor work hours

Sleep deprivation common, may not improve with work hour limitations

Students who spend more time at the hospital….

And who get less sleep (<5.5 hours/day) have lower scores on standardized written examinations of knowledgeReceive higher ratings

of their knowledge and clinical skills by faculty surgeons

Get it as it happens

Be aware.. the pitfalls of overextension