title: Association of resident fatigue and distress with occupational blood and body fluid exposures and motor vehicle incidents.
abstract: OBJECTIVE
  To evaluate the effect of resident physicians' distress on their personal safety.
  
  
  METHODS
  We conducted a prospective, longitudinal cohort study of internal medicine residents at Mayo Clinic in Rochester, Minnesota. Participants completed surveys quarterly from July 1, 2007, through July 31, 2011, during their training period. Frequency of self-reported blood and body fluid (BBF) exposures and motor vehicle incidents was recorded. Associations of validated measures of quality of life, burnout, symptoms of depression, fatigue, and sleepiness with a subsequently reported BBF exposure or motor vehicle incident were determined using generalized estimating equations for repeated measures.
  
  
  RESULTS
  Data were provided by 340 of 384 eligible residents (88.5%). Of the 301 participants providing BBF exposure data, 23 (7.6%) reported having at least 1 BBF exposure during the study period. Motor vehicle incidents were reported by 168 of 300 respondents (56.0%), including 34 (11.3%) reporting a motor vehicle crash and 130 (43.3%) reporting a near-miss motor vehicle crash. Other than the low personal accomplishment domain of burnout, distress and fatigue at one time point exhibited no statistically significant associations with BBF exposure in the subsequent 3 months. However, diminished quality of life, burnout, positive screening for depression, fatigue, and sleepiness were each associated with statistically significantly increased odds of reporting a motor vehicle incident in the subsequent 3 months.
  
  
  CONCLUSIONS
  Exposures to BBF are relatively uncommon among internal medicine residents in current training environments. Motor vehicle incidents, however, remain common. Our results confirm the importance of fatigue and sleepiness to resident safety concerns. In addition, higher levels of distress may be contributory factors to motor vehicle crashes and other related incidents. Interventions designed to address both fatigue and distress may be needed to optimally promote patient and resident safety.
authors.affiliation: Division of General Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA. west.colin@mayo.edu
authors.forename: Colin P
authors.initials: CP
authors.lastname: West
authors.forename: Angelina D
authors.initials: AD
authors.lastname: Tan
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D017848:Blood-Borne Pathogens; D001826:Body Fluids; D002055:Burnout, Professional / Q000453:epidemiology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D016272:Occupational Health; D011446:Prospective Studies; D011788:Quality of Life; D012892:Sleep Deprivation / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology*