title: Effect of Home-Call on Otolaryngology Resident Education: A Pilot Study.
abstract: OBJECTIVE
  To inform institutional policies regarding call encounters through an evaluation of the effect of home-call on academic experience and fatigue among surgical residents. This study conducted an assessment of the nature of resident call encounters premidnight and postmidnight and a comparative analysis of sleep deprivation and efficiency in residents during home-call and off call.
  
  
  METHODS
  All Otolaryngology-Head and Neck Surgery residents (n = 9) at single Canadian institution were asked to establish the time and nature of call encounters during home-call. Residents completed the Stanford Sleepiness Scale precall and postcall to measure sleepiness and wore an Actigraph device to measure sleep efficiency to establish fatigue in the setting of home-call as compared with residents off call. Home-call and off call patterns were studied using a random computer-generated selection of days for participants in both study groups. Analysis was conducted from December 1, 2013 to December 30, 2014.
  
  
  RESULTS
  Residents received on average 7 pages per night, of which 78.5% of pages were for nonurgent issues. On an average, change in sleep deprivation scores postcall was 3.0 points higher (95% CI: 2.48-3.57, p < 0.0001) in residents who were qualified for a postcall day compared with residents who did not qualify for a postcall day and residents off call according to the Stanford Sleepiness Scale. Postcall sleep deprivation was significantly associated with number of encounters managed after midnight, regardless of management through telephone or in-hospital (p = 0.01). The Actigraph device identified a significant decrease in sleep efficiency in residents who were qualified for a postcall day compared with residents off call (mean = -31.1; 95% CI: -38.9, -23.4; p < 0.001).
  
  
  CONCLUSIONS
  This is the first study to evaluate surgical residents' home-call experience. We identified a high proportion of nonurgent encounters that residents managed on call and increased postcall fatigue associated with postmidnight telephone encounters. This study highlights the detrimental effects of frequent sleep interruptions because of encounters on call and suggests the need for institutional guidelines to help minimize these interruptions.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Caulley
authors.affiliation: Department of Undergraduate Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Quimby
authors.affiliation: Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
authors.forename: Nick
authors.initials: N
authors.lastname: Barrowman
authors.affiliation: Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Moreau
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: vaccani@cheo.on.ca.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Vaccani
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000706:statistics & numerical data*; D002170:Canada; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D010036:Otolaryngology / Q000193:education*; D010865:Pilot Projects; D012892:Sleep Deprivation / Q000453:epidemiology*; D014940:Work Schedule Tolerance
keywords: Medical Knowledge; Practice-Based Learning and Improvement; Systems-Based Practice; duty-hour restrictions; home-call; surgical education