317 — Evaluating Fitness to Perform in Surgical Residents after Night Shifts and Alcohol Intoxication: The development of a “Fit-to-Perform” test

Huizinga et al (10.1016/j.jsurg.2018.01.010)

Read on 03 July 2018
#surgery  #medicine  #laproscopy  #alcohol  #intoxication  #exam  #fatigue  #hospital 

One of the most common complaints about the state of medical training in the US (and of course elsewhere in the world too!) is that surgeons are expected to perform outrageous, long, onerous work hours. The literature generally suggests that continuity of care is extremely valuable for patient care and clinical outcomes, and the health-risk cost of switching physicians out is very high.

But in many cases, this leads to residents taking double-digit-hour shits at a time. Surely a 16th-hour surgeon performs at less than ideal capacity.

But in order to counter the knowlege that tag-teaming physicians is bad for patients, we need to know that sleepy surgeons are worse. So these researchers have proposed a “Fit-to-Perform” test, which compares the surgical abilities of a resident and benchmarks it with… booze.

The Mini-NeuroCart test evaluates concentration, coordination, mood, and other metrics (in some cases, self-evaluated). The authors compared a dozen surgical residents after a long shift, and after a few drinks.

The results are pretty clear: After long shifts (~14h), surgeons performed about as well as if they were at the legal blood-alcohol level limit (~0.5-0.8g/L). In many cases, the drunk residents performed better.