Duty hour literature often focuses on residents’ need for sleep in recovering after lengthy shifts, but are there other methods of recovery that are also valuable to residents? A recent study on residents’ activities post-call identified two processes in addition to sleep for how residents want to recover. Learn what they are and see how you compare.
Why residents need more than sleep to recover
Medical researchers conducted a study of residents across six surgical and non-surgical specialties, examining their post-call activities immediately following a 24-hour overnight shift, what motivates them to prioritize certain activities post-call, and the personal impact these decisions have on residents’ recovery of sleep and self. The study took place from 2012 to 2014 at a Canadian medical school accredited by the Liaison Committee on Medical Education.
Based on an analysis of interview transcripts, study authors found that residents juggle competing priorities and often use “trade-off orientations”—in which they barter crucial sleep hours for personal time—to determine how to recover after overnight shifts. While sleep is always a precious commodity for residents, the study revealed that residents’ recovery processes also entail activities that are far more complex.
“The duty hours literature tends to focus exclusively on the recovery of sleep, which can be at odds with the recovery of self,” wrote authors of the study, which was recently published in Academic Medicine. “Based on our findings, we propose a preliminary dual recovery model that includes both the recovery of sleep and the recovery of self.”
Residents identify how they want to recover after shifts
To recharge after overnight shifts, residents in the study often participated in three key recovery processes:
- The recovery of self: “Participants in our study seemed highly motivated to spend their post-call day doing things other than sleeping or resting, which suggests that residents are working with a broader notion of recovery,” study authors wrote. “We have named this broader notion of recovery the recovery of self. Within this recovery framework, residents are intending to reconnect with their identities, roles and relationships that exist outside of the hospital.” To accomplish this, residents often used “psychological detachment,” a process in which “one deliberately mentally disengages from work to facilitate recovery from workplace demands,” according to the study. Establishing this psychological boundary is crucial to resident wellness. In fact, the study authors noted that previous research has shown common associations between a failure to psychologically disconnect from work and emotional exhaustion, dissatisfaction and poor sleep quality.
- The recovery of study: Although studying “did not feature predominantly in residents’ accounts of how they spent their post-call time,” the authors noted, residents still expressed a desire to study despite lacking the time or energy for it. “For those residents in our study who raised the issue of studying post-call, they often reasoned that their fatigue precluded them from engaging meaningfully in such a cognitively demanding task. Spending time with loved ones or tending to personal needs was feasible because it did not require the same cognitive resources,” according to the study.
- The recovery of sleep: While residents valued time for personal relationships and goals, resting post-call still emerged as a common way for residents to mitigate fatigue and recover from strenuous shifts. “Where other studies have assumed that residents may be unwilling or unable to ‘recover their lost sleep’ on post-call days, residents in our study agreed that post-call days were useful (and often necessary) to catch up on sleep,” study authors wrote. “However, there was great variability in how residents translated this into practice. Even when residents are motivated to reduce their fatigue, some of them believed they got a better night’s sleep if they restricted their daytime sleep to preserve their sleep-wake rhythm.”
Read the full study for additional observations.
More resources on balancing wellness and residency
- Find out how residents use “trade-off” approaches to determine how to spend time post-call.
- Learn how duty-hour restrictions are impacting crucial resident outcomes, including patient safety.
- See how physicians rank residency work-life balance based on specialties.
- Educate yourself on the signs of burnout and how to increase satisfaction in training.
- Check out these tips from residents who have conquered burnout.