Does Simulator-Based Clinical Performance Correlate With Actual Hospital Behavior? The Effect of Extended Work Hours on Patient Care Provided by Medical Interns
- 1 October 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Academic Medicine
- Vol. 85 (10), 1583-1588
- https://doi.org/10.1097/acm.0b013e3181f073f0
Abstract
Purpose The correlation between simulator-based medical performance and real-world behavior remains unclear. This study explored whether the effects of extended work hours on clinical performance, as reported in prior hospital-based studies, could be observed in a simulator-based testing environment. Method Intern volunteers reported to the simulator laboratory in a rested state and again in a sleep-deprived state (after a traditional 24- to 30-hour overnight shift [n=17]). A subset also presented after a shortened overnight shift (16 scheduled hours [n=8]). During each laboratory visit, participants managed two critically ill patients. An on-site physician scored each case, as did a blinded rater later watching videotapes of the performances (score=1 [worst] to 8 [best]; average of both cases=session score). Results Among all participants, the average simulator session score was 6.0 (95% CI: 5.6–6.4) in the rested state and declined to 5.0 (95% CI: 4.6–5.4) after the traditional overnight shift (P<.001). Among those who completed the shortened overnight shift, the average postshift simulator session score was 5.8 (95% CI: 5.0–6.6) compared with 4.3 (95% CI: 3.8–4.9) after a traditional extended shift (P<.001). Conclusions In a clinical simulation test, medical interns performed significantly better after working a shortened overnight shift compared with a traditional extended shift. These findings are consistent with real-time hospital studies using the same shift schedule. Such an independent correlation not only confirms the detrimental impact of extended work hours on medical performance but also supports the validity of simulation as a clinical performance assessment tool.Keywords
This publication has 13 references indexed in Scilit:
- Comment of the American Board of Surgery on the recommendations of the Institute of Medicine Report, “Resident Duty Hours: Enhancing Sleep, Supervision, and Safety”Surgery, 2009
- Simulation-Based Education Improves Quality of Care During Cardiac Arrest Team Responses at an Academic Teaching HospitalSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2008
- PER3 Polymorphism Predicts Sleep Structure and Waking PerformanceCurrent Biology, 2007
- Teaching Surgical Skills — Changes in the WindThe New England Journal of Medicine, 2006
- Incorporating Simulation-Based Objective Structured Clinical Examination into the Israeli National Board Examination in AnesthesiologyAnesthesia & Analgesia, 2006
- Approval of Virtual Reality Training for Carotid StentingJAMA, 2004
- Effect of Reducing Interns' Work Hours on Serious Medical Errors in Intensive Care UnitsThe New England Journal of Medicine, 2004
- Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional FailuresThe New England Journal of Medicine, 2004
- The certification examination in emergency medicine: An updateAnnals of Emergency Medicine, 1982
- Assessment of clinical competence on the emergency medicine specialty certification examination: The validity of examiner ratings of simulated clinical encountersAnnals of Emergency Medicine, 1981