Well-Being
Exhaustion, depersonalization, and lack of efficacy
what are the three cardinal symptoms of burnout?
Exhaustion - The physician's physical and emotional energy levels are extremely low and in a downward spiral.
Depersonalization - This is signaled by cynicism, sarcasm, and the need to vent about your patients or your job. This is also known as “compassion fatigue.”
Lack of efficacy - You begin to doubt the meaning and quality of your work
Myth or Fact?
Napping will make you more tired; you can get used to night shifts if you hang in there.
What is myth?
Facts
Some sleep is better than no sleep
What time and for how long you sleep are key to getting the most out of napping
Circadian rhythms and sleep patterns take at least a week to adjust
Adjustment usually includes physical and mental systems
Warning signs of workplace fatigue - list at least three
What are :
falling asleep at conference/rounds
restless, irritable w/staff, colleague, family
rechecking your work constantly
difficulty focusing on care of the patient
feeling like you just don't care
Something you can do for <30 min/day to help you feel most rested (2 words).
What is Strategic napping?
There is a 50 % greater risk of blood-borne pathogen exposure in residents between 10 PM and 6 AM.
True or False
True (Parks 2000)
Signs include changes in mood/affect, decreased productivity, increased mistakes, increased absences, complaints from patient/colleagues, evidence of diversion, deterioration in appearance/physical health, changes in social interaction
What are signs of physician substance abuse?
Addiction is a progressive disease. The earliest symptom of a substance use disorder is often discord in a primary relationship. Isolation and avoidance of peers and friends is common. The addicted physician suffers emotionally and may exhibit signs of depression, irritability, mood swings and disillusionment.
Myth or Fact? Insomnia and sleep deprivation are the same thing.
What is a myth?
Insomnia can lead to sleep deprivation
Insomnia is difficulty falling asleep or staying asleep. This differs from sleep deprivation in that it is a lack of sleep accumulating over time and cause physical symptoms.
Your options when feeling too tired or fatigued to work or drive (list at least 2)
What are:
sleep in call or sleep room
ask for a ride home
tell your attending and ask for some assistance
take an uber
The effects of consuming _________occur within 15-30 minutes; half life is 3-7 hours
What is:
(Strategic) caffeine consumption (coffee, energy drink, etc)?
But may disrupt subsequent sleep, a tolerance may be developed and has diuretic effects
Getting less than 8 hours of sleep starts to create a "_____ _______" which must be paid off.
What is a "sleep debt"?
Contact person when a resident or faculty member is concerned about another resident or faculty member that may be displaying signs of burnout, depression, substance abuse, suicidal ideation, or potential for violence
Who is the program director?
Staying awake for 20 hrs leads to reduced eye-hand coordination that's similar to having a BAC of....?
BAC= 0.1 (0.08 is legally drunk)
Being awake for 17 hours impairs performance to the same level as having a 0.05 BAC
The second leading cause of car and truck accidents
What is sleep deprivation?
In a prospective cohort study of 2737 medical interns followed for 1 year, the rates of motor vehicle collisions after working an extended shift (>24 h) were compared to rates after working a non-extended shift. The odds for having a collision after working an extended shift rather than a non - extended shift increased 66%.
3 healthy strategies to reduce fatigue and improve sleep quality
What are :
get 7-9 hours of sleep
Avoid heavy meals or exercise w/in 3 hours of sleep
Avoid ETOH to help you sleep
use guided imagery/meditation to help relax before bed
avoid caffeine or blue screen exposure prior to bed
Name at least three signs of excessive fatigue that impact patient safety
Lack of engagement,
inattention to detail,
decreased cognitive function,
increased tolerance for risk-taking,
increased errors,
irritability,
impaired ability to process information
Recognized as the leading measure of burnout validated by more than 35 years of extensive research
What is the Maslach Burnout Inventory (MBI)?
Free assessment for AAFP members that will help physicians gain understanding of how they feel about work experiences and determine risk of burnout, as well help determine strategies that will support well-being
Myth or Fact? You know when you are too tired to perform and function optimally.
Myth
Studies show sleepy people underestimate their level of sleepiness and overestimate their alertness. The sleepier you are, the less accurate your perception of impairment. In fact you may fall asleep briefly (micro-sleeps) without knowing it.
Residents are particularly prone to this.
Three short term effects of sleep deprivation on your health and well-being
AND
Three long term effects of sleep deprivation on your health and well-being
Short-term:
Long Term:
At least 2 ways to mitigate fatigue during night float
What are:
Protect your sleep
Nap before work
Consider dividing sleep into two 4 hour periods
Obtain as much exposure to bright lights as possible when you need to be alert
Avoid light exposure in the morning after night shift
Name three fatigue mitigation strategies
What are :
Get adequate (7-9) hours of sleep before anticipated sleep loss;
avoid starting out with a sleep deficit,
develop a pre sleep routine,
avoid going to bed hungry;
no heavy meals within 3 hrs of going to sleep,
get regular exercise but avoid exercising within 3 hrs of going to sleep;
strategic napping, (if possible take advantage of circadian rhythm windows of opportunity; 2-5 AM & 2-5 PM . If not, nap when you can.
protect your sleep time. Enlist the help of your family and friends.
Free 24 hour access to face-to-face emotional or work/life counseling sessions, as well as telephone conversations and online chat sessions with professional moderators for all HonorHealth employees
What is the EAP (Employee Assistance Program)?
Call The Hartford at 1-800-964-3577 for 24/7, at-the-moment, non-emergency support on the phone and face-to-face referrals.
Emergency contacts:
The percentage of sleep that newborn babies spend in REM sleep (within 5%).
Newborn babies spend amount 65% of their sleep in REM.
As for their parents:
Most parents lose between 400 and 750 hours of sleep in each child’s first year.
The average amount of time it takes people to fall asleep.
What is between 10 and 15 minutes?
If it takes you less than 5 minutes to fall asleep at night, you are sleep deprived. On average, it takes people between 10 and 15 minutes to fall asleep. If you are falling asleep faster than that it means you are sleep deprived and overtired.
Three of the ACGME Duty Hours Restrictions to address and mitigate fatigue
What are:
80 hours maximum per week (averaged over a 4 week period)
24 hrs maximum per shift (may add 4 hrs for transfer of care, pt safety, and resident education but it is not to include new pt care responsibilities; some exceptions apply
1 day in 7 free of patient care (averaged over 4 weeks)
In - house call only every 3 nights
8 hour suggested rest period between daily duty periods and after in-house call
Residents must have at least 14hrs free of clinical work and education after 24 hours of in-house call
Name at least 4 high risk times of fatigue for residents and faculty
What are:
Midnight to 6:00 AM,
Early hours of the day shift,
First night shift or call night after a break,
Change of service,
The first 2-3 hours of a shift or end of shift,
Early in residency or when new to night call,