Long shifts are a dreary reality of residency. We spoke with a few residents about their methods for maintaining their energy levels and alertness into the wee hours of the morning.
In 2017, the Accreditation Council for Graduate Medical Education reverted to prior requirements that permitted interns to work a 24-hour shift. For more seasoned residents, that maximum can extend up to 30 hours, though overnight shifts are limited to one in three days. Considering the time and intensity of these longer shifts, physicians who have worked them recommend arriving with a surplus of rest.
“Be in the fresh air,” said Jordan Warchol, MD, who completed her residency in emergency medicine in 2016 at the University of Nebraska Medical Center in Omaha. “Go to Target. Go to dinner with friends. Run errands. Clean your house. Spend time with your kids.”
Know when to call for relief
The opportunities for sleep during a daylong shift are few and far between. A study of 200-plus internal medicine residents in the February 2017 issue of Sleep found that during overnight calls they were sleeping fewer than three hours per overnight shift. “As a senior resident it has been easier to get some sleep,” said Tani Malhotra, MD, who is finishing her stint as a chief resident in the ob-gyn program at York Hospital in central Pennsylvania. “The juniors aren’t quite as lucky. The junior residents that take call with me, I definitely try to make sure that they get at least some sleep. They all know that if they are exhausted that they can absolutely tell me, ‘Hey, I absolutely cannot carry on. Can you please cover for me?’”
Your mind might not move as quickly as a lengthy shift gets toward its final hours. Keeping organized, according to Stephanie Lee, MD, a preventive medicine resident at Palmetto Health-University of South Carolina School of Medicine.
“Once you reach about the 24-hour mark, you start to feel like your brain is a little bit slower,” Dr. Lee said. “It still works—you remember the correct treatment and workup—but it can be like molasses.
“I keep trying to focus by writing lists,” she added. “And even if I feel like I’m working a little bit slower, I have a list in front of me and I can see the boxes I need to check to get through it. I’ll also try to write the list ahead of time. So if we have a day shift that goes into night shift, I’ll write the list of what I need to do in the morning. No matter how busy it gets at night, I’m not going to forget when I need to follow up.”
Monitor your intake
Most residents are going to drink caffeine, but don’t overdo it. Taylor George, a third-year emergency medicine resident at the Naval Medical Center in Portsmouth, Virginia, said she drank so much at one point that she started have heart palpitations.
“I need to pace my caffeine intake,” she said. “Having small snacks is also important. Particularly when you get really tired, having a healthy snack can be helpful. Eating big meals can be kind of detrimental because you can get kind of sleepy after eating a big meal.”