title: Effect of pharmacological enhancement on the cognitive and clinical psychomotor performance of sleep-deprived doctors: a randomized controlled trial.
abstract: OBJECTIVE
  To investigate the effect of modafinil 200 mg on the performance of a cohort of healthy male doctors after 1 night of supervised sleep deprivation.
  
  
  BACKGROUND
  Sleep-deprived and fatigued doctors pose a safety risk to themselves and their patients. Yet, because of the around-the-clock nature of medical practice, doctors frequently care for patients after periods of extended wakefulness or during circadian troughs. Studies suggest that a group of substances may be capable of safely and effectively reversing the effects of fatigue. However, little work has been done to investigate their role within our profession.
  
  
  METHODS
  We conducted a parallel, double-blind, randomized, and placebo-controlled study to investigate the effect of pharmacological enhancement on performance doctors. Thirty-nine healthy male resident doctors received either lactose placebo (n = 19) or modafinil 200 mg (n = 20) after 1 night of sleep deprivation. A selection of CANTAB neuropsychological tests was used to assess higher cognitive function. Clinical psychomotor performance was assessed using the Minimally Invasive Surgical Trainer Virtual Reality. Assessments were carried out between 6.00 AM and approximately 8.00 AM.
  
  
  RESULTS
  Modafinil improved performance on tests of higher cognitive function; participants in the modafinil group worked more efficiently when solving working memory (F1,38 = 5.24, P = 0.028) and planning (F1,38 = 4.34, P = 0.04) problems, were less-impulsive decision makers (F1,37 = 6.76, P = 0.01), and were more able to flexibly redirect their attention (F1,38 = 4.64, P = 0.038). In contrast, no improvement was seen in tests of clinical psychomotor performance.
  
  
  CONCLUSIONS
  Our results suggest that fatigued doctors might benefit from pharmacological enhancement in situations that require efficient information processing, flexible thinking, and decision making under time pressure. However, no improvement is likely to be seen in the performance of basic procedural tasks.
authors: Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom. c.sugden@imperial.ac.uk
authors: Colin
authors: C
authors: Sugden
authors: Charlotte R
authors: CR
authors: Housden
authors: Rajesh
authors: R
authors: Aggarwal
authors: Barbara J
authors: BJ
authors: Sahakian
authors: Ara
authors: A
authors: Darzi
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001559:Benzhydryl Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D000697:Central Nervous System Stimulants / Q000494:pharmacology / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003198:Computer Simulation; D003657:Decision Making / Q000187:drug effects; D004311:Double-Blind Method; D006801:Humans; D007396:Internship and Residency; D008297:Male; D000077408:Modafinil; D010820:Physicians / Q000523:psychology; D011597:Psychomotor Performance / Q000187:drug effects*; D012892:Sleep Deprivation / Q000188:drug therapy*; D014940:Work Schedule Tolerance
chemical_list: D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D000077408:Modafinil