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Editors Selection IGR 13-1
Surgical Treatment: Effect of sleep deprivation on surgical tasks
Comment by Jonathan Wong on:
27696 Effect of sleep deprivation on the performance of simulated anterior segment surgical skill, Erie EA; Mahr MA; Hodge DO et al., Canadian Journal of Ophthalmology, 2011; 46: 61-65
Erie et al. (469) examines the effect of sleep deprivation on the ability of residents to perform simulated surgical tasks on an ophthalmic surgical simulator. Nine residents were assessed on three separate occasions, pre-call, post-work and post-call. The number of sleep hours and level of sleep deprivation, as measured by the Eppworth sleepiness scale, was recorded. The residents were assessed on their technical abilities using the Eyesi surgical simulator. While residents had significantly fewer hours of sleep and higher levels of sleep deprivation on post-call occasions, technical performance did not differ significantly.
Limitations of this study are acknowledged. First, resident performance was only assessed by simulated anterior segment tasks. Real-world surgical performance may not be reflected by this simulation and other critical skills, cognition and decision-making, were not assessed. Second, testing was done over a relatively short period of twenty minutes. Task performance may differ over a longer time period. Third, the small sample size meant that only a statistical power to detect ≥ 15% deterioration in surgical skills was possible. The clinical relevance of this is unknown.
Limiting resident work hours has been driven by the need to ensure patient safety. Residents are often responsible for providing significant amounts of patient care. However, limits to work hours may hamper the ability to provide adequate training and patient coverage. Currently, evidence to determine the limits of resident performance and the effects of longer work hours is lacking.
The authors should be commended for their efforts in highlighting an important area of debate in medical education. This study is one of the first to examine resident performance of surgical ophthalmic tasks in a common sleep-deprived state, i.e. Post-call. It highlights the need for further study of the effects of resident work hours on surgical performance and the provision of patient care.
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