title: Recovery of Sleep or Recovery of Self? A Grounded Theory Study of Residents' Decision Making Regarding How to Spend Their Nonclinical Postcall Time.
abstract: OBJECTIVE
  As resident work hours policies evolve, residents' off-duty time remains poorly understood. Despite assumptions about how residents should be using their postcall, off-duty time, there is little research on how residents actually use this time and the reasoning underpinning their activities. This study sought to understand residents' nonclinical postcall activities when they leave the hospital, their decision-making processes, and their perspectives on the relationship between these activities and their well-being or recovery.
  
  
  METHODS
  The study took place at a Liaison Committee on Medical Education-accredited Canadian medical school from 2012 to 2014. The authors recruited a purposive and convenience sample of postgraduate year 1-5 residents from six surgical and nonsurgical specialties at three hospitals affiliated with the medical school. Using a constructivist grounded theory approach, semistructured interviews were conducted, audio-taped, transcribed, anonymized, and combined with field notes. The authors analyzed interview transcripts using constant comparative analysis and performed post hoc member checking.
  
  
  RESULTS
  Twenty-four residents participated. Residents characterized their predominant approach to postcall decision making as one of making trade-offs between multiple, competing, seemingly incompatible, but equally valuable, activities. Participants exhibited two different trade-off orientations: being oriented toward maintaining a normal life or toward mitigating fatigue.
  
  
  CONCLUSIONS
  The authors' findings on residents' trade-off orientations suggest a dual recovery model with postcall trade-offs motivated by the recovery of sleep or of self. This model challenges the dominant viewpoint in the current duty hours literature and suggests that the duty hours discussion must be broadened to include other recovery processes.
authors.affiliation: T.S. Taylor is a resident, Department of Obstetrics and Gynaecology, and research fellow, Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. J. Nisker is professor, Department of Obstetrics and Gynaecology, Schulich School of Medicine & Dentistry, and scientist, Children's Health Research Institute, Western University, London, Ontario, Canada. P.W. Teunissen is associate professor of medical education, Maastricht University, Maastricht, the Netherlands, and gynecologist, VU University Medical Center, Amsterdam, the Netherlands. T. Dornan is professor of medical and interprofessional education, Centre for Medical Education, Queen's University, Belfast, Northern Ireland, and emeritus professor, Maastricht University, Maastricht, the Netherlands. L. Lingard is professor of medicine, senior scientist, and director, Centre for Education Research and Innovation, Schulich School of Medicine & Dentistry, and professor, Faculty of Education, Western University, London, Ontario, Canada.
authors.forename: Taryn S
authors.initials: TS
authors.lastname: Taylor
authors.forename: Jeff
authors.initials: J
authors.lastname: Nisker
authors.forename: Pim W
authors.initials: PW
authors.lastname: Teunissen
authors.forename: Tim
authors.initials: T
authors.lastname: Dornan
authors.forename: Lorelei
authors.initials: L
authors.lastname: Lingard
mesh_terms: D000328:Adult; D002170:Canada; D003657:Decision Making; D005221:Fatigue / Q000517:prevention & control; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007396:Internship and Residency; D007899:Leisure Activities; D008019:Life Style; D008297:Male; D012890:Sleep; D055815:Young Adult