Fatigue Risk Management in PGME
In the fall of 2018 a Fatigue Risk Management (FRM) toolkit for Residents, Leaders, and Policy Makers in Canadian Postgraduate Medical Education was launched building on the recommendations of the National Steering Committee (NSC) on Resident Duty Hours' 2013 report, Fatigue, Risk and Excellence: Towards a Pan-Canadian Consensus on Resident Duty Hours. The toolkit was based on combined efforts, support, and project leadership of Canadian Postgraduate Deans, Resident Doctors of Canada (RDoC) and Provincial Housestaff Organizations with key input from multiple organizations within the medical education community, FRM industry expertise and researchers, residents and educators.
The aim of the toolkit is to help trainees, leaders, policy makers, and educators better understand the impacts of physician fatigue and to provide guidance on how best to manage it. To best accomplish this goal, the toolkit revolves around three central ideas: Acknowledge, Act, and Adapt.
Acknowledge. Act. Adapt.
Acknowledge: Fatigue risk affects us all
Medical residency training, like many occupations with demanding work hours, poses a safety risk to trainees; fatigue is one of these risks. In the past, and in some current situations, residents have been scheduled for duty periods of 24 or more consecutive hours without restorative sleep.
The toolkit highlights evidence of the effects of fatigue on healthcare worker performance, indicating that fatigue increases the risk of medical error, compromising patient safety while increasing the risk to the personal safety and wellbeing. Although discussion thus far has centred around a restriction on resident duty hours, the NSC report noted that a one-size-fits-all approach to resident duty hours will not be effective or appropriate in Canada. Therefore, the shift to managing fatigue related risk during residency training is essential to supporting the dual role of learner and care provider.
Act: Tools are available to foster change
Managing fatigue signals a turning point for Canadian medical training as we move to join leading countries and best practices in the management of fatigue risk. The toolkit promotes the establishment of training environments where fatigue risk is acknowledged, individuals and teams are enabled to recognize the risks and empowered to take action to apply adaptive strategies suited to local contexts. Focusing on fatigue risk management does not imply that long work hours are acceptable; rather, this approach recognizes the risk associated with extended work hours and aims to identify practical approaches to managing the risk.
Recognizing that there are many factors that contribute to fatigue during residency, a comprehensive approach to minimize fatigue and fatigue-related risks should be developed and implemented in residency training in all jurisdictions in Canada. Strategies must be adaptive to specific contexts and specialties. This national tool-box resource of fatigue mitigation strategies and techniques, adaptable in a variety of settings and for a variety of disciplines, has been created to support this change.
Adapt: It’s our responsibility to make a just culture
Whilst recognizing that change requires some investment, this approach centres primarily on a change in thinking and some new behaviours. This toolkit is designed to help residents, programs and leaders get started today, and shares effective, simple strategies that can be easily implemented now. The risk of doing nothing is greater, and the status quo is not acceptable.
We are currently working with two residency programs to implement and study fatigue risk management: Pediatrics at the University of Ottawa and Obstetrics and Gynecology at the University of Calgary. We’ll keep you updated on the progress of implementation!