title: Graduating Pediatrics Residents' Reports on the Impact of Fatigue Over the Past Decade of Duty Hour Changes.
abstract: OBJECTIVE
  Concern about resident and patient safety has led to changes in Accreditation Council on Graduate Medical Education requirements over the past decade, with duty hour limitations in 2003 and 2011. This study examines pediatric residents' experiences on the impact of fatigue before, during, and after this time.
  
  
  METHODS
  An annual survey of graduating pediatrics residents was administered to a national, random sample in 2002, 2004, and 2013. Respondents were asked about the impact of fatigue. Multivariable logistic regression was conducted to compare differences between survey years.
  
  
  RESULTS
  The combined response rate for all 3 years was 62.6% (1,251 of 2,000). In multivariable analyses, residents were less likely in both 2004 and 2013 than in 2002 to fall asleep during an educational conference (adjusted odds ratio [aOR] 0.61, 95% confidence interval [CI] 0.41-0.91 and aOR 0.32, 95% CI 0.22-0.45, respectively) and to fall asleep while driving from work (aOR 0.55, 95% CI 0.37-0.81 and 0.43, 95% CI 0.31-0.60, respectively). Residents were less likely in 2004 than in 2002 to report making an error in patient care due to fatigue (aOR 0.46, 95% CI 0.27-0.76); however, in 2013 resident report of making an error in patient care due to fatigue returned to levels similar those reported in 2002.
  
  
  CONCLUSIONS
  Surveys of graduating pediatrics residents over the past decade (2002-2013) indicate overall reduced fatigue effects. During this same time frame, however, reports about making patient care errors improved but then returned to a level not significantly different from 2002, a finding warranting further exploration.
authors.affiliation: Boston Combined Residency Program in Pediatrics, Boston Children's Hospital/Boston Medical Center, Boston, Mass; Department of Pediatrics, Boston Medical Center, Boston, Mass. Electronic address: daniel.schumacher@bmc.org.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Schumacher
authors.affiliation: Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill.
authors.forename: Mary Pat
authors.initials: MP
authors.lastname: Frintner
authors.affiliation: Boston Combined Residency Program in Pediatrics, Boston Children's Hospital/Boston Medical Center, Boston, Mass; Department of Medicine, Boston Children's Hospital, Boston, Mass.
authors.forename: Ariel
authors.initials: A
authors.lastname: Winn
authors.affiliation: Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill.
authors.forename: William
authors.initials: W
authors.lastname: Cull
mesh_terms: D000328:Adult; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000193:education*; D010561:Personnel Staffing and Scheduling; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload
keywords: duty hours; fatigue; residents