Evaluating Fitness to Perform in Surgical Residents after Night Shifts and Alcohol Intoxication: The development of a "Fit-to-Perform" test

Coen R H Huizinga; Marieke L de Kam; Hein B A C Stockmann; Joop M A van Gerven; Adam F Cohen; Koen E A van der Bogt

doi:10.1016/j.jsurg.2018.01.010

Evaluating Fitness to Perform in Surgical Residents after Night Shifts and Alcohol Intoxication: The development of a "Fit-to-Perform" test

J Surg Educ. 2018 Jul-Aug;75(4):968-977. doi: 10.1016/j.jsurg.2018.01.010. Epub 2018 Feb 2.

Authors

Coen R H Huizinga¹, Marieke L de Kam¹, Hein B A C Stockmann², Joop M A van Gerven¹, Adam F Cohen¹, Koen E A van der Bogt³

Affiliations

¹ Centre for Human Drug Research, Leiden, The Netherlands.
² Patient Safety Committee, Association of Surgeons of the Netherlands, Utrecht, The Netherlands; Dept of surgery, Spaarne Gasthuis, Haarlem, The Netherlands.
³ Centre for Human Drug Research, Leiden, The Netherlands; Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands; Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: k.e.a.van_der_bogt@lumc.nl.

PMID: 29396276
DOI: 10.1016/j.jsurg.2018.01.010

Abstract

Objective: To develop a self-test to measure clinical fitness to perform in surgical residents, with alcohol-induced impairment as reference.

Design: Observational, exploratory study to evaluate night shift-induced impaired performance in surgical residents followed by a randomized blinded, placebo-controlled, crossover study to evaluate impaired performance as a result of ethanol intoxication. Impairment was quantified using the Mini-NeuroCart, a psychomotor and cognitive test battery for assessment of subjective and objective measures of alertness, concentration, eye-hand coordination, mood, and self-assessed ability to perform. Surgical performance was tested in the randomized study with a laparoscopy surgical trainer.

Settings: Level-I trauma hospital and a clinical research unit.

Participants: Surgical residents (n = 12 for the observational study, n = 18 for the randomized study).

Results: High alcohol levels (0.6gL^-1) impaired adaptive tracking, reduced objective and subjective alertness, and increased slowness. Moreover, laparoscopy depth perception was impaired in the 0.6gL^-1 group. No significant within-subject correlation between subjective and objective measures of alertness was found. Performance of postcall surgeons was similar to, or even worse than, the performance of intoxicated surgeons.

Conclusions: The Mini-NeuroCart detected ethanol-induced performance effects that were similar to the effects of working a 14-hour night shift. Social (ethanol), personal (mood), and professional (laparoscopic skills) standards of fitness can in this manner be related to accepted deleterious effects of alcohol. The Mini-NeuroCart is, therefore, a potential noninvasive test for assessing "fitntness to perform" in healthcare professionals.

Keywords: Fatigue; Patient Care; Professionalism; Systems-Based Practice; performance; physician burnout; surgical training; work hour limits; work hour reform.

Publication types

Observational Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Alcoholic Intoxication*
Clinical Competence
Cross-Over Studies
Female
Humans
Internship and Residency*
Laparoscopy / education*
Laparoscopy / standards*
Male
Physician Impairment*
Psychomotor Performance*
Single-Blind Method
Sleep Deprivation*
Trauma Centers