title: Quantification of surgical resident stress "on call".
abstract: BACKGROUND
  We hypothesized that surgical resident stress involves both psychologic and physiologic components that manifest as changes in heart rate (HR) and circulating white blood cell (WBC) count. The purposes of this series of experiments were to monitor HR as a measure of stress "on call"; to monitor WBC count (1,000 cells/microL) during "on call" periods as a measure of stress; and to relate maximum HR and WBC count "on call" to surgical resident training level.
  
  
  METHODS
  HR was continuously documented by Holter monitor for 24hours "on call" in interns (n = 6), junior residents (n = 5), and senior residents (n = 5). Interns (n = 4), junior residents (n = 4), and senior residents (n = 4) during periods devoid of clinical responsibilities served as controls. WBC counts were obtained from residents "off" and "on call" for interns (n = 5) and junior residents (n = 5).
  
  
  RESULTS
  Mean HR "on call" increased in all resident groups as compared with controls: intern mean HR increased from 71 +/- 3 to 87 +/- 2 beats per minute (bpm) (p = 0.003), junior resident mean HR increased from 74 +/- 3 to 88 +/- 4 bpm (p = 0.03), and senior resident mean HR increased from 69 +/- 2 to 80 +/- 2 bpm (p = 0.004). Intern maximum control HR was 119 +/- 3 and increased to 149 +/- 6 bpm (p = 0.005). The increase in maximum HR (control versus "on call") did not reach significance in junior residents (123 +/- 5 to 136 +/- 6 bpm, p = 0.14) and senior residents (115 +/- 6 to 116 +/- 3 bpm, p = 0.9). WBC count in interns increased from control values of 5.2 +/- 0.6 x 1,000 cells/microL to 7.5 +/- 0.9 x 1,000 cells/microL"on call" (p = 0.005). The WBC change in juniors was not significant (control: 6.8 +/- 0.7 x 1,000 cells/microL, "on call": 7.1 +/- 0.7 x 1,000 cells/microL; p = 0.37).
  
  
  CONCLUSIONS
  When heart rate is used as an indicator of combined physiologic and psychologic stress, surgical residents achieve stress levels of tachycardia "on call." Surgical residents also exhibit an increase in circulating WBC count "on call." Both the degree of tachycardia and the increase in WBC count are inversely related to the level of training. Senior residents cope better with stress "on call" than junior residents and interns.
authors.affiliation: Department of Surgery, University of California, San Francisco - East Bay, Oakland 94602, USA.
authors.forename: Amod P
authors.initials: AP
authors.lastname: Tendulkar
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Victorino
authors.forename: Terry J
authors.initials: TJ
authors.lastname: Chong
authors.forename: M Kelley
authors.initials: MK
authors.lastname: Bullard
authors.forename: Terrence H
authors.initials: TH
authors.lastname: Liu
authors.forename: Alden H
authors.initials: AH
authors.lastname: Harken
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015716:Electrocardiography, Ambulatory; D005260:Female; D013502:General Surgery / Q000193:education*; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007396:Internship and Residency; D007588:Job Satisfaction; D007958:Leukocyte Count; D008297:Male; D010561:Personnel Staffing and Scheduling; D012892:Sleep Deprivation; D013312:Stress, Physiological / Q000209:etiology* / Q000503:physiopathology*; D013610:Tachycardia / Q000209:etiology* / Q000503:physiopathology*; D014940:Work Schedule Tolerance; D016526:Workload