Is it a "nap"? Or a "break"?
Our English teachers were right: Words matter. In the duty hours debate, the distinction between the words "nap" and "break" is important.
On her blog, duty hours researcher Vineet Arora, MD, MPP asks, "Can we mandate residents take naps (for 5 hours!)? No, you can't force anyone to sleep. But, you can mandate break time."
Dr. Arora's study on naps found that they can alleviate resident fatigue but that trainees' adherence to the nap schedule was quite low.
In considering the recommendations of the IOM the term "nap" is problematic. To many, it conjures mandatory naps in kindergarten.
For example, writes one blog respondent, "It's ludicrous to make napping mandatory. What’s next? Telling residents when to use the bathroom or when to eat milk and cookies?"
What do you think? Would changing the terminology help? We asked the readers of the AMA GME e-Letter for their feedback; following are the responses received.
At our radiology residency we call the break a “siesta.” We instituted it about three years ago. The resident can go home and basically rest for a few hours. They can sleep if they want or just relax.
I believe we should change the terminology from “nap” to “rest.”
“Fatigue mitigation” is the phrase we're using.
In my experience, the thing that would help the most would be to leave the duty hours as they are. We all need to do a better job of education about the current system so that all residents and instructors understand and adhere to these requirements. In reviewing our duty hours very closely (in our community-based family medicine program), we rarely see residents working more than 60 or 65 hours as it is. We are trying to send family doctors to rural areas, where the only work restrictions will be self-induced. We need to teach people how to be more efficient, how to manage stress and fatigue more effectively, and how to know yourself and your own limits.
How about "mandated nap opportunity?”
I would suggest that breaks are mandatory; “taking a snooze” or “catching some Zs” is recommended.