Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion.
BACKGROUND
Concern exists about the effect of extended resident work hours; however, no study has evaluated training-related performance impairments against an accepted standard of functional impairment.


OBJECTIVE
To compare post-call performance during a heavy call rotation (every fourth or fifth night) to performance with a blood alcohol concentration of 0.04 to 0.05 g% (per 100 mL of blood) during a light call rotation, and to evaluate the association between self-assessed and actual performance.


METHODS
A prospective 2-session within-subject study of 34 pediatric residents (18 women and 16 men; mean age, 28.7 years) in an academic medical center conducted between October 2001 and August 2003, who were tested under 4 conditions: light call, light call with alcohol, heavy call, and heavy call with placebo.


METHODS
Residents attended a test session during the final week of a light call rotation (non-post-call) and during the final week of a heavy call rotation (post-call). At each session, they underwent a 60-minute test battery (light and heavy call conditions), ingested either alcohol (light call with alcohol condition) or placebo (heavy call with placebo condition), and repeated the test battery. Performance self-evaluations followed each test.


METHODS
Sustained attention, vigilance, and simulated driving performance measures; and self-report sleepiness, performance, and effort measures.


RESULTS
Participants achieved the target blood alcohol concentration. Compared with light call, heavy call reaction times were 7% slower (242.5 vs 225.9 milliseconds, P<.001); commission errors were 40% higher (38.2% vs 27.2%, P<.001); and lane variability (7.0 vs 5.5 ft, P<.001) and speed variability (4.1 vs 2.4 mph, P<.001) on the driving simulator were 27% and 71% greater, respectively. Speed variability was 29% greater in heavy call with placebo than light call with alcohol (4.2 vs 3.2 mph, P = .01), and reaction time, lapses, omission errors, and off-roads were not different. Correlation between self-assessed and actual performance under heavy call was significant for commission errors (r = -0.45, P = .01), lane variability (r = -0.76, P<.001), and speed variability (r = -0.71, P<.001), but not for reaction time.


CONCLUSIONS
Post-call performance impairment during a heavy call rotation is comparable with impairment associated with a 0.04 to 0.05 g% blood alcohol concentration during a light call rotation, as measured by sustained attention, vigilance, and simulated driving tasks. Residents' ability to judge this impairment may be limited and task-specific.
Arnedt
J Todd
JT
Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA. tarnedt@med.umich.edu
Owens
Judith
J
Crouch
Megan
M
Stahl
Jessica
J
Carskadon
Mary A
MA
D000328:Adult; D000428:Alcohol Drinking / Q000503:physiopathology*; D001288:Attention; D003071:Cognition; D005221:Fatigue; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics; D011446:Prospective Studies; D011597:Psychomotor Performance; D012892:Sleep Deprivation; D014940:Work Schedule Tolerance / Q000502:physiology*