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Association of Resident Fatigue and Distress With Occupational Blood and Body Fluid Exposures and Motor Vehicle Incidents



      To evaluate the effect of resident physicians' distress on their personal safety.

      Participants and Methods

      We conducted a prospective, longitudinal cohort study of internal medicine residents at Mayo Clinic in Rochester, Minnesota. Participants completed surveys quarterly from July 1, 2007, through July 31, 2011, during their training period. Frequency of self-reported blood and body fluid (BBF) exposures and motor vehicle incidents was recorded. Associations of validated measures of quality of life, burnout, symptoms of depression, fatigue, and sleepiness with a subsequently reported BBF exposure or motor vehicle incident were determined using generalized estimating equations for repeated measures.


      Data were provided by 340 of 384 eligible residents (88.5%). Of the 301 participants providing BBF exposure data, 23 (7.6%) reported having at least 1 BBF exposure during the study period. Motor vehicle incidents were reported by 168 of 300 respondents (56.0%), including 34 (11.3%) reporting a motor vehicle crash and 130 (43.3%) reporting a near-miss motor vehicle crash. Other than the low personal accomplishment domain of burnout, distress and fatigue at one time point exhibited no statistically significant associations with BBF exposure in the subsequent 3 months. However, diminished quality of life, burnout, positive screening for depression, fatigue, and sleepiness were each associated with statistically significantly increased odds of reporting a motor vehicle incident in the subsequent 3 months.


      Exposures to BBF are relatively uncommon among internal medicine residents in current training environments. Motor vehicle incidents, however, remain common. Our results confirm the importance of fatigue and sleepiness to resident safety concerns. In addition, higher levels of distress may be contributory factors to motor vehicle crashes and other related incidents. Interventions designed to address both fatigue and distress may be needed to optimally promote patient and resident safety.

      Abbreviations and Acronyms:

      BBF (blood and body fluid), MVC (motor vehicle crash), QOL (quality of life)
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        • Shanafelt T.D.
        • Sloan J.A.
        • Habermann T.M.
        The well-being of physicians.
        Am J Med. 2003; 114: 513-519
        • Thomas N.K.
        Resident burnout.
        JAMA. 2004; 292: 2880-2889
        • Dyrbye L.N.
        • Thomas M.R.
        • Massie F.S.
        • et al.
        Burnout and suicidal ideation among U.S. medical students.
        Ann Intern Med. 2008; 149: 334-341
        • Shanafelt T.D.
        • Balch C.M.
        • Bechamps G.
        • et al.
        Burnout and medical errors among American surgeons.
        Ann Surg. 2010; 251: 995-1000
        • West C.P.
        • Shanafelt T.D.
        • Kolars J.C.
        Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents.
        JAMA. 2011; 306: 952-960
      1. Kohn L.T. Corrigan J.M. Donaldson M.S. To Err Is Human: Building a Safer Health System. National Academy Press, Washington, DC1999
        • Landrigan C.P.
        • Rothschild J.M.
        • Cronin J.W.
        • et al.
        Effect of reducing interns' work hours on serious medical errors in intensive care units.
        N Engl J Med. 2004; 351: 1838-1848
        • Barger L.K.
        • Ayas N.T.
        • Cade B.E.
        • et al.
        Impact of extended-duration shifts on medical errors, adverse events, and attentional failures.
        PLoS Med. 2006; 3: e487
        • Lockley S.W.
        • Barger L.K.
        • Ayas N.T.
        • Rothschild J.M.
        • Czeisler C.A.
        • Landrigan C.P.
        Effects of health care provider work hours and sleep deprivation on safety and performance.
        Jt Comm J Qual Patient Saf. 2007; 33: 7-18
        • Agency for Healthcare Research and Quality
        Making health care safer: a critical analysis of patient safety practices.
        (2001) (Accessed April 5, 2012)
        • West C.P.
        • Huschka M.M.
        • Novotny P.J.
        • et al.
        Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study.
        JAMA. 2006; 296: 1071-1078
        • West C.P.
        • Tan A.D.
        • Habermann T.M.
        • Sloan J.A.
        • Shanafelt T.D.
        Association of resident fatigue and distress with perceived medical errors.
        JAMA. 2009; 302: 1294-1300
        • Fahrenkopf A.M.
        • Sectish T.C.
        • Barger L.K.
        • et al.
        Rates of medication errors among depressed and burnt out residents: prospective cohort study.
        BMJ. 2008; 336: 488-491
        • Shanafelt T.D.
        • Bradley K.A.
        • Wipf J.E.
        • Back A.L.
        Burnout and self-reported patient care in an internal medicine residency program.
        Ann Intern Med. 2002; 136: 358-367
        • Haas J.S.
        • Cook E.F.
        • Puopolo A.L.
        • Burstin H.R.
        • Cleary P.D.
        • Brennan T.A.
        Is the professional satisfaction of general internists associated with patient satisfaction?.
        J Gen Intern Med. 2000; 15: 122-128
        • Institute of Medicine
        Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.
        Institute of Medicine, Washington, DC2008 (Accessed April 5, 2012)
        • Barger L.K.
        • Cade B.E.
        • Ayas N.T.
        • et al.
        Extended work shifts and the risk of motor vehicle crashes among interns.
        N Engl J Med. 2005; 352: 125-134
        • Ayas N.T.
        • Barger L.K.
        • Cade B.E.
        • et al.
        Extended work duration and the risk of self-reported percutaneous injuries in interns.
        JAMA. 2006; 296: 1055-1062
        • Fisman D.N.
        • Harris A.D.
        • Rubin M.
        • Sorock S.
        • Mittleman M.A.
        Fatigue increases the risk of injury form sharp devices in medical trainees: results from a case-crossover study.
        Infect Control Hosp Epidemiol. 2007; 28: 10-17
        • Pigeon W.R.
        • Sateia M.J.
        • Ferguson R.J.
        Distinguishing between excessive daytime sleepiness and fatigue: toward improved detection and treatment.
        J Psychosom Res. 2003; 54: 61-69
        • Shen J.
        • Barbera J.
        • Shapiro C.M.
        Distinguishing sleepiness and fatigue: focus on definition and measurement.
        Sleep Med Rev. 2006; 10: 63-76
        • Johns M.W.
        A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.
        Sleep. 1991; 14: 540-545
        • Johns M.W.
        Reliability and factor analysis of the Epworth Sleepiness Scale.
        Sleep. 1992; 15: 376-381
        • Tan A.D.
        • Novotny P.J.
        • Kaur J.S.
        • et al.
        A patient-level meta-analytic investigation of the prognostic significance of baseline quality of life (QOL) for overall survival (OS) among 3,704 patients participating in 24 North Central Cancer Treatment Group (NCCTG) and Mayo Clinic Cancer Center (MC) oncology clinical trials.
        J Clin Oncol. 2008; 26: 9515
        • Gudex C.
        • Dolan P.
        • Kind P.
        • Williams A.
        Health state valuations from the general public using the visual analogue scale.
        Qual Life Res. 1996; 5: 521-531
        • Shanafelt T.D.
        • Novotny P.
        • Johnson M.E.
        • et al.
        The well-being and personal wellness promotion strategies of medical oncologists in the North Central Cancer Treatment Group.
        Oncology. 2005; 68: 23-32
        • Rummans T.A.
        • Clark M.M.
        • Sloan J.A.
        • et al.
        Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial.
        J Clin Oncol. 2006; 24: 635-642
        • Ware J.E.
        • Kosinski M.
        • Dewey J.E.
        • Gandek B.
        How to Score and Interpret Single-Item Health Status Measures: A Manual for Users of the SF-8 Health Survey. QualityMetric Inc, Lincoln, RI2001
        • Maslach C.
        • Jackson S.E.
        • Leiter M.P.
        Maslach Burnout Inventory Manual. 3rd ed. Consulting Psychologists Press, Palo Alto, CA1996
        • Gopal R.
        • Glasheen J.J.
        • Miyoshi T.J.
        • Prochazka A.V.
        Burnout and internal medicine resident work-hour restrictions.
        Arch Intern Med. 2005; 165: 2595-2600
        • Rosen I.M.
        • Gimotty P.A.
        • Shea J.A.
        • Bellini L.M.
        Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns.
        Acad Med. 2006; 81: 82-85
        • Spitzer R.L.
        • Williams J.B.
        • Kroenke K.
        • et al.
        Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study.
        JAMA. 1994; 272: 1749-1756
        • Whooley M.A.
        • Avins A.L.
        • Miranda J.
        • Browner W.S.
        Case-finding instruments for depression.
        J Gen Intern Med. 1997; 12: 439-445
        • Williams Jr, J.W.
        • Noel P.H.
        • Cordes J.A.
        • Ramirez G.
        • Pignone M.
        Is this patient clinically depressed?.
        JAMA. 2002; 287: 1160-1170
        • Diggle P.J.
        • Liang K.Y.
        • Zeger S.L.
        Analysis of Longitudinal Data. Clarendon Press, Oxford, England1994
        • Liang K.Y.
        • Zeger S.L.
        Longitudinal data analysis using generalized linear models.
        Biometrika. 1986; 73: 13-22
        • Panlilio A.L.
        • Orelien J.G.
        • Srivastava P.U.
        • et al.
        Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998.
        Infect Control Hosp Epidemiol. 2004; 25: 556-562
        • Henderson D.K.
        Management of needlestick injuries: a house officer who has a needlestick.
        JAMA. 2012; 307: 75-84
        • Gaba D.M.
        • Howard S.K.
        Patient safety: fatigue among clinicians and the safety of patients.
        N Engl J Med. 2002; 347: 1249-1255
        • Philibert I.
        • Friedmann P.
        • Williams W.T.
        • ACGME Work Group on Resident Duty Hours, Accreditation Council for Graduate Medical Education
        New requirements for resident duty hours.
        JAMA. 2002; 288: 1112-1114
        • Kellerman S.E.
        • Herold J.
        Physician response to surveys: a review of the literature.
        Am J Prev Med. 2001; 20: 61-67
        • Handel D.A.
        • Raja A.
        • Lindsell C.J.
        The use of sleep aids among emergency medicine residents: a web based survey.
        BMC Health Serv Res. 2006; 6: 136
        • Gander P.
        • Purnell H.
        • Garden A.
        • Woodward A.
        Work patterns and fatigue-related risk among junior doctors.
        Occup Environ Med. 2007; 64: 733-738