title: Fatigue and training of obstetrics and gynaecology trainees in Australia and New Zealand.
abstract: BACKGROUND
  Several studies have linked doctor fatigue with adverse patient events and an increase in risk to doctors' personal safety and wellbeing. The present study assesses the rostering structure of Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) trainees and its association with trainees' reported fatigue levels, training opportunities and wellbeing, which were secondary outcomes of a larger study of trainee working hours which has been separately reported.
  
  
  METHODS
  An anonymous, online survey of RANZCOG trainees was conducted. Demographic data collected included: age, gender, level of training and current rotation. Data were also collected on hours worked per week, long shifts (>12 h), self-reported fatigue levels, and opinions regarding current rostering and training.
  
  
  RESULTS
  A majority (72.9%) of respondents regularly felt fatigued, with higher fatigue levels being associated with more hours worked per week (P = <0.001) and working long shifts (>12 h) (P = 0.007). Fatigue was associated with an increased risk of dozing while driving (P = 0.028), with 56.1% of respondents reporting that this occurs. Trainees appeared to be less confident in achieving their technical skill requirements, with increasing hours not increasing confidence in achieving these skills (P = 0.594). Trainees who worked under 50 h per week were less likely to report fatigue (P = <0.001) and more likely to report greater work enjoyment (P = 0.043), and working hours being conducive to learning (P = 0.015).
  
  
  CONCLUSIONS
  Fatigue was frequently reported by RANZCOG trainees with increased working hours and long shifts being significant factors in fatigue levels. Strategies should be developed and trialled to enable trainees to obtain adequate case exposure and teaching without compromising patient and doctor safety.
authors.affiliation: King Edward Memorial Hospital, Subiaco, WA, Australia.|St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.|School of Medicine, University of Notre Dame, Fremantle, WA, Australia.
authors.forename: Paige E
authors.identifier: http://orcid.org/0000-0001-7918-9499
authors.initials: PE
authors.lastname: Tucker
authors.affiliation: King Edward Memorial Hospital, Subiaco, WA, Australia.|St John of God Hospital Bendat Family Comprehensive Cancer Centre, Subiaco, WA, Australia.|Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Cohen
authors.affiliation: Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
authors.forename: Max K
authors.initials: MK
authors.lastname: Bulsara
authors.affiliation: King Edward Memorial Hospital, Subiaco, WA, Australia.
authors.forename: Jade
authors.initials: J
authors.lastname: Acton
mesh_terms: D001315:Australia; D001334:Automobile Driving; D005221:Fatigue / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006176:Gynecology / Q000193:education* / Q000458:organization & administration; D006801:Humans; D007588:Job Satisfaction; D007858:Learning; D008297:Male; D009520:New Zealand; D009774:Obstetrics / Q000193:education* / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D013997:Time Factors; D014940:Work Schedule Tolerance / Q000502:physiology / Q000523:psychology; D000072358:Work-Life Balance
keywords: fatigue; obstetrics and gynaecology; sleep; training; work hours