Principles of fatigue in residency education: a qualitative study

Background: Proposals to implement fatigue-management strategies in residency education assume that medicine shares the view<br/>of other risk-adverse industries that fatigue is hazardous. This view is an essential underpinning of fatigue-management strategies<br/>that other industries have embedded as part of their workplace occupational health and safety programs. We sought to explore how<br/>residents understand fatigue in the context of their training environment.<br/><br/>Methods: We interviewed 21 residents in 7 surgical and nonsurgical programs at Western University in 2014. All participants met the<br/>inclusion criteria of routinely working 24-hour call shifts while enrolled in their training program. Data collection and analysis occurred iteratively in keeping with constructivist grounded theory methodology and informed theoretical sampling to sufficiency.<br/><br/>Results: Four predominant principles of fatigue captured how the social learning environment shaped residents’ perceptions of<br/>fatigue. These included the conceptualization of fatigue as (a) inescapable and therefore accepted, (b) manageable through experience, (c) necessary for future practice and (d) surmountable when required.<br/><br/>Interpretation: This study elaborates our understanding of how principles of fatigue are constructed and reinforced by the training<br/>environment. Whereas fatigue is seen as a collective hazard in other industries, our data showed that, in residency training, fatigue<br/>may be seen as a personal challenge. Consequently, fatigue-management strategies that conceptualize fatigue as an occupational<br/>threat may have a limited impact on resident behaviour and patient safety.