Principle

Fatigue is a significant risk factor and a potential obstacle to the delivery of safe and effective health care, as well as, a risk to learner’s well-being. Successful fatigue risk management is a shared responsibility between learners, hospitals, regional health authorities and the Faculty of Medicine. Fatigue can be attributed to many factors. 

Purpose

To prevent, mitigate and manage the hazard of fatigue during postgraduate training; support the health and wellbeing of learners and ensure safe and effective patient care.

Scope

This policy applies to all postgraduate learners and those involved in postgraduate medical education at Memorial University

Definitions

Fatigue — An acute or chronic condition characterized by a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of weariness and tiredness. Fatigue can be both mental and physical.

Fatigue Risk Management — A set of ongoing fatigue mitigation practices and procedures initiated to monitor and minimize the effects of fatigue and associated risks for the health and safety of both learners and patients.

Learner — A trainee registered in a postgraduate training program accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC).

Postgraduate Training Program — A period of training in a specific discipline of medicine prescribed by the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family Physicians of Canada (CFPC) leading to certification by one of these bodies.

Program Director — The faculty member assigned responsibility for the overall conduct of the residency program in a given clinical discipline.

Policy

1.0 Learner Roles and Responsibilities

1.1 Learners have a key role in reporting their fatigue to their supervisors, peers and others on their health care team.

1.2 Learners have a responsibility to obtain sufficient sleep and rest and identify when they have not been able to do so.

1.3 Learners will use time outside of work, where possible, to obtain adequate rest and to ensure their fitness for work.

1.4 Learners will complete all training required by PGME related to fatigue-risk mitigation.

1.5 Learners will employ fatigue-risk mitigation strategies (Appendix A) and continuously monitor issues impacting risk for fatigue.

2.0 Program Director Roles and Responsibilities

2.1 Responsible for role modelling and supporting fatigue-risk management strategies and practices, and following the Faculty of Medicine's Fatigue Risk Management Assessment Tool (Appendix B) and Fatigue Risk Management Assessment Algorithm when serious fatigue has been identified.

2.2 Program Directors will advise the Associate Dean, PGME of any barriers or issues related to preventing fatigue-related risks.

2.3 Program Directors will ensure postgraduate learners have access to educational resources on fatigue prevention and mitigation.

2.4 Ensure processes and procedures are developed that are fit-for-context aimed at mitigating the risks associated with fatigue in leaners within their training programs.

2.5 Systematically evaluate above strategies and implement changes as necessary.

3.0 Faculty of Medicine – PGME Office Roles and Responsibilities

3.1 Promote the principles of fatigue risk management and support a PGME-wide approach to these principles.

3.2 Support Program Directors to develop fatigue risk management strategies specific to their areas of work and contexts.

3.3 Ensure that declarations of fatigue are responded to in a manner that upholds patient safety and learner well-being.

Appendix A: Summary of General Fatigue Risk Mitigation Strategies

Pre-Call:

1. Complete self-assessment
2. Use time outside of work to obtain adequate rest and ensure fitness to work
3. Report to clinical supervisor or program director when at risk for making fatigue-related errors

On-Call:

1. Eat healthy snacks and ensure adequate hydration
2. Take breaks/naps as workflow allows
3. Write clear and detailed orders to avoid follow-up pages
4. Appropriate use of caffeine to help alertness and wakefulness 
5. Stretch or do 10 minutes of light activity

Post-Call:

1. Rest in call room if required prior to going home 
2. Plan ahead for getting home safely
3. Prioritize rest and ensure good sleep hygiene post-call

Appendix B: Fatigue Risk Mitigation Assessment Tool

_{Resident Assessment Tool}  

How Sleepy Are You? 

How likely are you to doze off or fall asleep in the following situations? You should rate your chances of dozing off, not just feeling tired. Even if you have not done some of these things recently try to determine how they would have affected you. For each situation, decide whether or not you would have: 

No chance of dozing              = 0

Slight chance of dozing         = 1

Moderate chance of dozing  = 2

High chance of dozing          = 3

Write down the number corresponding to your choice in the right-hand column and total your score below

 ESS Total Score: ________

Analyze your score:

 0-7:  It is unlikely that you are abnormally sleepy

8-9:  You have an average amount of daytime sleepiness

10-15:  You may be excessively sleepy depending on the situation.  You may want to consider seeking medical attention

16-24:  You are excessively sleepy and should consider seeking medical attention

Fatigue Severity Scale:

FSS total Score: __________    VAS value: ___________

Related Documents

“Acknowledge. Act. Adapt” .Fatigue Risk Management Toolkit.2018. 

Eastern Health Fatigue Risk Management Disclosure

Faculty of Medicine Resident Fatigue Risk Management Assessment Tool

Fatigue Risk Management Assessment Algorithm 

Resident Doctors of Canada

Procedures:

There are no procedures associated with this policy.