Background and Objectives: Despite a gradual workload reduction during residency, 24-hour calls are still an integral part of most training programs. While sleep deprivation increases risk propensity, the impact on medical risk taking has not been studied.
This study aimed to assess clinical decision making and psychomotor performance of pediatric residents following limited nap time during a 24-hour call.
Methods: Neurocognitive battery (IntegNeuro, BRC) and a medical decision questionnaire were completed by 44 pediatric residents at two time points: after a 24-hour call and following 3 nights with no calls (night-sleep >5 hours). To monitor sleep, residents wore actigraphs and completed sleep logs.
Results: Nap time during shift was ≤ 1 hour in 14 cases (32%), 1-2 hours in 16 cases (35%) and 2-3 hours in 14 cases (32%). Residents who napped less than one hour chose the riskier medical option in 50% of cases compared with 36% when answering the same questionnaire after 3 nights with no calls (p=0.002). This effect was not found in residents who napped 1-2 hours (no change in risk taking) or 2-3 hours (4% decreased risk taking; difference between groups, p= 0.001). Risk taking tendency correlated with sustained attention scores (Pearson = -0.433, p=0.003). Sustained attention was the neurocognitive domain most affected by sleep deprivation (effect size = 0.29, p = 0.025).
Conclusion: This study suggests that residents napping less than an hour during a night shift are prone to riskier clinical decisions. Hence, enabling residents to nap at least 1 hour during shifts is recommended.
