Sleep is essential to physicians’ alertness and performance and a severe shortage of rest can affect the quality of patient care they provide. Yet many physicians, particularly during residency training, don’t get enough sleep.
That reality has led to a push for a more robust curriculum surrounding the importance of sleep. One such resource is a module on sleep deprivation in the AMA GME Competency Education Program.
“Sleep deprivation is a time-honored tradition in medicine,” said Karen Miotto, MD, interim director of the Behavioral Wellness Center at the David Geffen School of Medicine at the University of California, Los Angeles. “It breeds a kind of we’re-in-the-trenches-together collegiality. The problem with such a time-honored tradition is the emotional, technical, cognitive labor of medicine and of many other industries has gone up so dramatically.”
With contributions by subject-matter experts from around the country, the AMA GME Competency Education Program offerings include more than 25 courses that residents can access online, on their own schedule. Among the experts are several who contributed to the AMA’s Health Systems Science textbook, which draws insights from faculty at medical schools that are part of the Association’s Accelerating Change in Medical Education Consortium.
Modules cover five of the six topics—patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice—within the ACGME’s core competency requirements. The sixth requirement, medical knowledge, is one that is typically addressed during clinical education.
Signs of sleep deprivation
Sleep deprivation is the result of not getting enough sleep. If that lack of sleep continues long term, it can become chronic and lead to symptoms of heightened anxiety, depression and even burnout. Outlined below are some of the symptoms of sleep deprivation highlighted in the AMA GME Competency Education module, which many programs require residents to complete prior to the outset of residency training.
Fatigue. This one might be the most obvious sign of sleep deprivation. It is literally being so tired you can’t stay awake. Physicians who are fatigued “space out” of conversations and activities and often nod off, even during important discussions with other members of the health care team.
Severe mood changes. This includes things like snapping or yelling at other residents, nurses or even patients; getting angry more quickly than normal; and laughter and amusement at inappropriate times.
Weight gain. Unhealthy eating and a lack of impulse control can be a sign of sleep deprivation. A lack of sleep will affect the hormones to hunger and also contribute to lacking energy, which is likely to result in fewer calories burned.
Struggling to reason and make decisions. Information takes longer to process, and you can sometimes forget what the next steps should be. This can result in poor patient care follow-up.
Combating sleep deprivation
The AMA GME Competency Program module offers a number of strategies for residents to improve their sleep habits. Among them:
- Take strategic naps whenever possible during long shifts, especially if you feel fatigued.
- Ask for a break when you need it. Take a short walk, or simply change your environment for a little while before you return to your patient-care responsibilities.
- Take time out for food or a healthy snack to keep up your energy.
- Ask for help when you need it. Talk to another resident, a senior resident, a trusted faculty member, or program director.
- After a long shift, ask to nap in a call room until you feel safe to drive home.
- Don’t go it alone. Seek counseling if you need it.