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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

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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”

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Medical Student Work Hours LCME Guidelines, Feb 2004 Duty hours should be set Not longer than residents 26% of medical schools had written work hours policy in 2003-4 LCME Part II survey Monitored? Enforced?

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U Hawaii Work Hours Policy Developed Fall 2003 Guidelines specify Average <80 hours/wk Leave early post-call Eliminate non- educational activities 1 day/week off

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Faculty and residents were advised of the work hours policy Students were encouraged to report transgressions Students rarely reported noncompliance (….. to US)

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Pilot study using PDA to record work hours data September 2004 – March 2005 7 consecutive days in mid-point of clerkship HanDBase software Students logged real- time work and sleep hours

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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

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Logs reviewed Identify transgressions from work hours policy Correlate logged work hours with Estimated work hours Sleep hours NBME subject exam score Clinical evaluation by faculty

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All students successfully collected work hours data Better compliance than with patient logs 3 of 35 students failed to log sleep hours at home Only positive comments about PDA log system

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Transgressions from Work Hour Policy 24 students (69%) deviated from the written work hour policy 12 students worked >80 hours 17 students worked late post-call 49% of students reported non- educational activities No two students reported the same activity on the same day

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

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Sleep Average sleep over 7 days ranged from 3.9-8.25 hours / 24-hour period (median 5.5 hrs) No significant correlation with work hours

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NBME Subject Exam Scores No significant correlation with work hours Trend toward positive correlation with more sleep (r=0.25)

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NBME Scores: Effects of more work and less sleep HOURS WORKED / HOURS SLEPT nMEAN NBME EXAM SCORE NATIONAL PERCENTILE RANK 80 work AND <5.5 sleep 766.6*40 th % <80 and/or 5.5 2372.7*70 th % *p<.05 by t-test

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Clinical Evaluations Directly Correlated with Work Hours HOURS WORKED HONORS NOT HONORS >75 8 3 <75 3 9 *P<.05 Fisher’s Exact Test

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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

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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 knowledge Receive higher ratings of their knowledge and clinical skills by faculty surgeons

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Get it as it happens Be aware.. the pitfalls of overextension

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