The Effects of a Mid-Day Nap on the Neurocognitive Performance of First-Year Medical Residents: A Controlled Interventional Pilot Study
ABSTRACT PURPOSE: Despite shorter duty hours, fatigue remains a problem among medical residents. The authors tested the effect of a short, mid-day nap on the cognitive functioning and alertness of first-year internal medicine (IM) residents during normal duty hours. METHOD: This was a controlled, interventional study performed between July 2008 and April 2010. The authors recruited a nap group of 18 residents and a rest (control) group of 11 residents. Investigators connected all participants to an ambulatory sleep monitor before the beginning of their shifts in order to monitor rolling eye movements, a proxy for attention failures. At mid-day, both groups took Conner's Continuous Performance Test (CPT II) to evaluate their cognitive functioning and then were placed in a reclining chair designed for napping. The authors instructed nap group residents to nap for up to 20 minutes and chatted with control group residents to prevent them from napping. All residents took the CPT II again immediately after the intervention. Residents' attention failures were recorded until the end of the workday. The authors compared the mean outcome parameters of the two groups through analysis of variance, using effect-of-treatment and baseline covariates. RESULTS: Nap group participants slept a mean of 8.4 ± 3.0 minutes. Compared with controls whose cognitive functioning and number of attention failures did not change from morning to afternoon, the nap group's cognitive functioning improved and their number of attention failures decreased. CONCLUSIONS: A short, mid-day nap can improve cognitive functioning and alertness among first-year IM residents.
Article: Twelve tips for overnight teaching[Show abstract] [Hide abstract]
ABSTRACT: Background: The European Working Time Directive and the United States' duty hour restrictions have changed resident physicians' schedules, specifically increasing overnight shifts and decreasing overall time spent in the hospital. As residents' perception of night shifts is that they have little educational value, efforts to improve educational opportunities and night attending teaching are desirable. However, resources about and recommendations for best practices for overnight teaching by faculty are scarce. Aim: To provide 12 tips to highlight strategies intended to optimize attending physicians' overnight teaching skills and strategies. Method: The tips provided are based on our experiences and reflections as in-house faculty supervising residents working overnight, by our experience and group discussions as medical educators, and the available literature. Results: The 12 tips presented offer specific strategies to optimize attending physicians' overnight teaching for resident physicians, specifically highlighting the unique logistics, pedagogy and follow-up of overnight teaching. Conclusion: Preparation for teaching is important in any environment, but understanding the unique timing and circumstances associated with overnight teaching is vital to ensure that overnight teaching is effective. Acknowledging and addressing the physical and cognitive obstacles associated with overnight teaching and learning is necessary to maximize the educational value of overnight teaching.Medical Teacher 10/2013; 36(3). DOI:10.3109/0142159X.2013.847911 · 2.05 Impact Factor
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ABSTRACT: Awakening from different sleep stages, percentage of different stages of sleep subsumed within a sleep episode, and sleep episode length, have all been hypothesized to affect cognitive performance upon awakening. To further examine the contribution of these factors, 14 healthy participants slept for 3 h (0300-0600 hours) and 6 h (2400-0600 hours), with each sleep episode separated by 1 week. Electroencephalographic measures were taken throughout each sleep episode, and participants completed the Attentional Network Test, which measures alerting, orienting, and executive functioning (conflict) components of attention, upon awakening. Overall, mean reaction time (RT) was slower in the 3- and 6-h post-sleep conditions than in a baseline (pre-sleep) condition. Alerting, orienting, and conflict measures of attention did not significantly differ across the baseline and two post-sleep conditions. Awakening from REM sleep resulted in slower overall RT than awakening from lighter sleep (stages 1 and 2). In multiple regression analyses, overall RT was predicted by the duration of slow wave sleep (SWS), such that more time spent in SWS was associated with an overall slowing of RT. Conflict scores were predicted by the duration of REM; that is, more time spent in REM was associated with greater amounts of conflict (i.e., larger flanker effects). These data provide more information about the process of awakening and suggest that SWS and REM influence different aspects of attention upon awakening.Experimental Brain Research 12/2013; 232(3). DOI:10.1007/s00221-013-3790-z · 2.17 Impact Factor
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ABSTRACT: Protected sleep periods for internal medicine interns have previously resulted in increased amount slept and improved cognitive alertness but required supplemental personnel. The authors evaluated intern and patient outcomes associated with protected nocturnal nap periods of three hours that are personnel neutral. Randomized trial at Philadelphia Veterans Affairs Medical Center (PVAMC) Medical Service and Hospital of the University of Pennsylvania (HUP) Oncology Unit. During 2010-2011, four-week blocks were randomly assigned to a standard intern schedule (extended duty overnight shifts of up to 30 hours), or sequential protected sleep periods (phone sign-out midnight to 3:00 AM [early shift] intern 1; 3:00 to 6:00 AM [late shift] intern 2). Participants wore wrist Actiwatches, completed sleep diaries, and performed daily assessments of behavioral alertness. Between-group comparisons of means and proportions controlled for within-person correlations. HUP interns had significantly longer sleep durations during both early (2.40 hours) and late (2.44 hours) protected periods compared with controls (1.55 hours, P < .0001). At PVAMC sleep duration was longer only for the late shift group (2.40 versus 1.90 hours, P < .036). Interns assigned to either protected period were significantly less likely to have call nights with no sleep and had fewer attentional lapses on the Psychomotor Vigilance Test. Differences in patient outcomes between standard schedule months versus intervention months were not observed. Protected sleep periods of three hours resulted in more sleep during call and reductions in periods of prolonged wakefulness, providing a plausible alternative to 16-hour shifts.Academic medicine: journal of the Association of American Medical Colleges 01/2014; DOI:10.1097/ACM.0000000000000144 · 3.47 Impact Factor