Monitoring for Fatigue & Burnout

Internal Medicine residency training is rigorous.  While works hours and the like will help, we are in the unique position of monitoring the “front lines”.  

• Try to ensure that everyone on the team gets, on average, one day off per week.  You can accomplish this by means of the “calendar” of team activities mentioned earlier. 
• Encourage compliance with work hours restrictions—usher them out the door at noon post call (when on overnight call) or remind them to be out of the hospital by 9:30 (when signing out to night float).

Be alert for signs of excessive stress: 

• Mention of strained relationships at home
• Negative attitude or poor performance at work
• Reduced conference attendance; showing up late
• Signs of substance abuse 

Be alert for signs of sleep deprivation and fatigue: 

• Mood changes (negative/cynical mood or an unusually elevated mood)    
• Somatic complaints (back pain, headaches)
• Decreased efficiency or accuracy of tasks
• Medical errors
• Pregnancy related complications (HTN)
• Driving accidents or “near misses”

Offer to assist the residents in times of need.  Early intervention is the key to preventing burnout and its consequences.   

• Speak with them in person (see section on feedback).  Try to find out what else might be going on—a family or home situation, medical illness, depression, substance abuse.
• Recommend that they meet with their advisor or one of the program directors.
• Discuss the situation with the chief residents at your site.
• Refer them to RAP (Resident Assistance Program): phone # 651-430-3383 or 1-800-632-7643.

Timely completion of E*Value resident evaluations will allow the program directors and chief residents to identify problems and work on solutions before the situation gets out of hand.

 Updated: 12/20/06