title: The effect of call on neurosurgery residents' skills: implications for policy regarding resident call periods.
abstract: OBJECTIVE
  Although fatigue and its effects on surgical proficiency have been an actively researched area, previous studies have not examined the effect of fatigue on neurosurgery residents specifically. This study aims to quantify the effect of fatigue on the psychomotor and cognitive skills of neurosurgery residents.
  
  
  METHODS
  Seven neurosurgery residents performed a minimum of 3 and a maximum of 4 sessions of 6 surgical exercises precall and postcall. The simulation exercises were designed to measure a surgeon's cognitive abilities, such as memory and attention, while performing simulated surgical tasks and exercises that have been previously validated in several studies, including studies measuring the impact of fatigue on general surgery residents. Each exercise measured tool-movement smoothness, time elapsed, and cognitive errors. The change in surgical skills in precall and postcall conditions was assessed by means of an ANOVA, with p < 0.05 considered statistically significant.
  
  
  RESULTS
  The neurosurgery residents did not show a statistically significant difference in their surgical skills between the pre- and postcall states (p < 0.3, p < 0.4, and p < 0.2 for movement smoothness, time elapsed, and cognitive errors, respectively). The mean decrement for all residents in the postcall condition was 13.1%.
  
  
  CONCLUSIONS
  Postcall fatigue is associated with a marginal decrease in proficiency during simulated surgery in neurosurgery residents. In a similar study, general surgery residents showed a statistically significant decrement of 27.3% in the postcall condition. The impact of fatigue on different specialties should be further investigated prior to implementation of a national physician work-hour policy.
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. aganju@nmff.org
authors.forename: Aruna
authors.initials: A
authors.lastname: Ganju
authors.forename: Kanav
authors.initials: K
authors.lastname: Kahol
authors.forename: Peter
authors.initials: P
authors.lastname: Lee
authors.forename: Narina
authors.initials: N
authors.lastname: Simonian
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Quinn
authors.forename: John J
authors.initials: JJ
authors.lastname: Ferrara
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
mesh_terms: D000068:Accreditation / Q000331:legislation & jurisprudence; D000328:Adult; D003071:Cognition / Q000502:physiology*; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration; D009493:Neurosurgery / Q000193:education* / Q000458:organization & administration; D011361:Professional Competence; D000078329:Workforce; D016526:Workload