By: Taryn S. Taylor, MD
T.S. Taylor is a fifth-year obstetrics and gynecology resident at Western University, London, Ontario, Canada, and a PhD candidate in health professions education at Maastricht University, Maastricht, the Netherlands. Her doctoral research seeks to understand what motivates residents’ decisions around managing fatigue both inside and outside of the workplace learning environment.
After spending the last 26 hours as Dr. Taylor, senior obstetrics and gynecology resident, I get into my car and suddenly my mind is racing. The rest of the day is all mine! How many things can I knock off my to-do list? Could I meet up with a friend for breakfast while I get my tires changed and still make it to my dentist appointment? The sheer exhaustion I felt moments ago is replaced by a sense of purpose and glee. All that time spent fretting over a questionable fetal heart rate tracing or sweating my way through a difficult cesarean section strengthens my resolve to make the most of my postcall day.
You might wonder why, after 26 hours of sleep deprivation, anyone would consider prioritizing a tire change over going home to bed. And yet, during our recent study of residents’ postcall decision-making, we found that sleep is not necessarily the default postcall priority for residents. At first glance, this is worrisome. Critics of resident duty hour restrictions argue that the potential benefits of reduced duty hours will only be realized if residents use their additional off-duty time for sleeping. But it may not be that simple.
Our work frames residents’ postcall decisions as a trade-off between recovery of sleep and recovery of self. In essence, residents in our study explained that they could choose between thinking of themselves as personnel who should sleep so they could return to work rested, or thinking of themselves as people who should attend to their relationships and needs outside of their work. Research in other fields strongly suggests that deliberately switching out of work mode to engage in other activities ultimately improves workplace performance. Yet detachment from work through recovery of self may be seen as a threat to the traditional ideals of self-sacrifice and self-denial in the medical profession.
Our research draws attention to an important trade-off residents make when they decide how to spend their postcall time. In the focus on optimizing resident performance, failing to recognize the nature of this trade-off risks losing sight of the “resident-as-person.” Both recovery of sleep and recovery of self provide a useful framework to help move us beyond oversimplified assumptions about how residents should be spending their off-duty time.