Do pressure and fatigue influence resident job performance?

Background: Global surveys of residents have consistently identified stress variables as important factors in resident job performance. Aims: Determine whether an association exists between resident stress and job performance. Method: Over a three month period, interns on our inpatient ward services were surveyed regarding their current call schedule, whether their prior night's sleep was sufficient, whether they felt pressed by other commitments, whether they spent enough time teaching medical students and whether they had completed all patient care issues on a given day. Multiple logistic regression was used to assess the association between call status, pressure and sleep adequacy with reported omissions in patient care and adequacy of teaching. Results: In the regression analysis, ratings of high pressure and insufficient sleep but not call status independently predicted outcomes. For example, if an intern felt both pressed and tired, they were over eight times more likely to omit a patient care issue and over four times more likely to report inadequate teaching. Conclusions: Subjective ratings of high pressure and insufficient sleep are associated with poor job performance in medical residents.