Med Educ. 2021 Jun 26. doi: 10.1111/medu.14591. Online ahead of print.
OBJECTIVES: Ongoing calls to implement fatigue risk management in residency education assume a shared understanding of physician fatigue as a workplace hazard; yet we lack empirical evidence that all healthcare team members maintain this assumption. Thus, this study seeks to explore how healthcare team members understand the role of physician fatigue in an effort to inform the implementation of fatigue risk management in residency training and medical practice.
METHODS: This study uses Constructivist Grounded Theory to explore perceptions of workplace fatigue and its impact on clinical practice. We conducted individual semi- structured interviews with physicians, nurses, and senior residents across four hospitals in 8 different specialties for a total of 40 participants. Constant comparative analysis guided data analysis and led to the final grounded theory.
RESULTS: While participants outlined multiple problematic manifestations of physi- cian fatigue on clinical performance, they were reluctant to acknowledge any negative impact of fatigue on patient care. We refer to these contradictions as the fatigue paradox. Four key themes sustain the fatigue paradox: the indefatigable physician, blind spots, faith in safety nets, and the minimization of fatigue-related events.
CONCLUSIONS: This study suggests that healthcare team members do not universally feel that physician fatigue is problematic for patient care, despite providing multiple ex- amples to the contrary. This paradoxical understanding of fatigue likely exists because the system relies on fatigued physicians, particularly trainees, and provides few mechanisms to critically examine fatigue. Successful implementation of fatigue risk management in residency training may prove elusive if clinical supervisors are skeptical of the potentially negative impact of workplace fatigue.