"20% of all residents reported sleeping an average of 5 hours or less per night, with 66% averaging 6 hours or less per night. Residents averaging 5 or fewer hours of sleep per night were more likely to report serious accidents or injuries, conflict with other professional staff, use of alcohol, use of medications to stay awake, noticeable weight change, working in an "impaired condition," and having made significant medical errors." - http://www.ncbi.nlm.nih.gov/pubmed/15124713

A Wikipedia article focused on medical resident work hours: http://en.wikipedia.org/wiki/Medical_resident_work_hours

And, as other posters have pointed out, this is despite legislation limiting the number of work hours. The fact of the matter is that if you were to actually work to the letter of the law you'd be sneered at, receive poor evaluations, and patients would suffer because there'd be no one around to do the work.

Most programs argue that these hours are necessary to train surgeons since there's not only the usual cognitive side of medicine, but also the technical side of cutting, sewing, etc. That being said, 70% of the hours I put in at the hospital are BS "scut" work which could be automated, streamlined, or passed off to assistants. The actual challenging decision points are few and far between.

Thus, even the 10,000 hour rule--which a lot of programs use to defend their dismal hours--misses the mark completely since, well, the practice isn't focused.

I don't think surgeons are going to be replaced by robots in a significant way for some time, but I would like to see the hands-on part of surgery being performed by techs. A three year, well planned course would be plenty to turn you into a competent operator--as competent as many just-licensed MDs. After all, do you really need 10 years of academic training (four year undergrad, fours of medical school, two years of little operating as a junior resident) to screw bones back together? Why should we expect surgeons to be technically AND intellectually gifted?

We are expecting new duty regulations later this year in response to scientific data on fatigue and the crash of Colgan 3407. Currently the data shows that on a four-day trip we are equivalently drunk with fatigue by the afternoon of day three even with around eight hours of sleep. Most people really need about nine.

Personally, I've never intentionally flown fatigued but I have been surprised by it. By the time I notice I'm fatigued the heading indicator looks like alphanumeric soup and I cannot differentiate 030 from 300 from 330 without the utmost concentration. I tell myself to "THINK, DAMN IT", but that is futile. It is something that cannot be overcome.

Having this experience, there is no way I'd want medical attention from fatigued doctors. Sleep is important for any safety sensitive job. It's always better to error on the side of safety.

Absolute bunk. Doctors are the last people in the world who should "insist they are not affected by sleep deprivation." Their whole job is to make decisions based on medical evidence. It doesn't affect you? Prove it. Show me a study looking for correlations between medical errors and sleep deprivation. Show me a study measuring alertness at the end of an 80-hour work week. Don't give me anecdotes. Give me proof. To do otherwise, as a doctor, is hypocritical.

Here's my anecdote: my wife is a resident, and she comes home from a 30-hour shift so tired, she's nervous about driving and sometimes feels like she has the flu.

Is she just weak? Should other doctors look down on her?

Not without a rock-solid study to prove their point. Instead, doctors seem to have a hazing mentality - "I survived this, so you should have to, too." But it's really a question of medical fact: how do medical work schedules affect patient outcomes? Any doctor who doesn't see that is being dangerously irrational.

A simple test, that worked very well for me, was testing my reading speed (I know it is only a weak indicator for mental acuity, but it is easy and fast to test).

Under perfect conditions (well rested, optimal nutrition, completely silent room, no visual distractions, after mediation and a good cup of green tea) I am able to read about 800 WPM (which is not to bad) of the kind of text I usually need to read with good retention. For me this declines rapidly to less than 200 WPM (which is quite bad for a "knowledge worker") with sleep deprivation and/or a noisy environment, even though I believe I am doing fine.

That being said, even though I would say that doctors are handicapped "mental performance" is handicapped by their working conditions, I fully agree that it is better for patient safety to not hand off a patient to a new doctor say every 8 or 12 hours due to the amount implicit knowledge that a doctor gathers during a >24h time period about his patients that can't be transferred in a handoff.

Software Developers, imagine what a screw up it would be if you'd have to hand off your code every 8h to another developer, who'd have to continue right were you left... add to this not having a version control system, spotty test coverage and highly ambiguous specifications

While this may be true, the process of the handoff could be vastly improved. My wife is a resident, and the quality of info she gets during a patient handoff varies drastically, from detailed notes in a computer, correlated to medical history, to scrawled notes on paper. Sometimes she has to start from square 1.

Maybe the reason handoffs are harmful is because they're done poorly. And maybe they're done poorly because the doctor who's handing off is freaking exhausted.

It's like a guy who's driving home after a 20 hour day that ended with a couple of drinks at the bar, calling home from the car to tell the wife that he's on his way and his driving is perfectly safe. In reality, he is so impaired by the tiredness, the alcohol, and the distraction of the call that he can no longer even understand how far off his game he must be, nor judge the horrific risk he must be taking by driving in that way.

http://news.ycombinator.com/item?id=652650

Still, it's rather hard to see a way for a sleep schedule like this to be viable for most people unless it becomes the dominant way that people find their rest (which is hardly likely).

http://en.wikipedia.org/wiki/Power_nap

I don't have any personal experience with this though.

(just for kicks, if you worked 10hour days for 7 days a week that is only 70 hour work week... doctors work at least 12 hour days, and usually 16 hour days to get to the full 80 hours!)

Oh and as far as weeding out?

Most 'weeding' out happens first and second year of medical school. In my class alone about 10% of the class failed first year exams, and they were forced to repeat or retake the whole year. (which SUCKS when you just paid $37,000 for a year of school that meant nothing). Then Second year weeding happens again with STEP1 licensing exam:

"Overall pass rates for first time USMLE Step 1 test takers are: 92% for U.S. M.D. medical school graduates, 81% for U.S. D.O. osteopathic medical school graduates, and 73% for international medical school graduates" http://en.wikipedia.org/wiki/United_States_Medical_Licensing...

Fail a year or a board exams? You pretty much can only be a psychiatrist or family doctor with little or no hope of every specializing.

My SO is a medical resident. They really are placed in unstable situations (to use a math/physics term). They are required to work 80 hr/week. If they report working more than 80 hr/week they get into trouble for a duty hours violation and yelled at for being "inefficient". If they report less than 80 hr/week they get in trouble for being slackers (a.k.a. "unprofessional", actually that's a catch-all phrase for anything the speaker doesn't like). No serious thought seems to be given to increasing staff levels.

And that's the problem (not your problem but the profession's problem) - the hope is to specialize whereas being a family doctor is the booby prize.

Well I know abut family but why psych?

I know one person who dropped out, but was at married to another resident, so has a safety net. Another resident dropped out due to a medical condition that prevented him from standing for hours a day and landed a job at McKinsey. Another friend dropped out and became a receptionist! Eventually she went into a residency for a lower stress specialty (surgery -> psychiatry).

The only area that learning how to deal with sleep deprivation would be a benefit is surgery and critical care areas (ICUs). But then again, if you could schedule things better and get more doctors in, maybe these doctors don't have to learn how to function on 5 hours of sleep.

I think you're right to the extent that the current medical service system requires doctors to learn to sleep less and less while functioning on an acceptable level (note that I didn't say satisfactory or even exceptional). But I think that's begging the question. Shouldn't we be able to change the current system and allow doctors to focus on building skills/knowledge, not the ability to function without sleep.

tl;dr: sleep deprivation is not a necessary part of being a doctor if we change the system, so saying that doctors must learn how to deal with sleep deprivation is a circular argument.

http://www.npr.org/templates/story/story.php?storyId=1135711...

Frankly, I'm surprised that as many doctors make it through - the working conditions are pretty terrible. Maybe the pay makes up for it, but you only get paid well once you get out of your residency or fellowship.

Better conditions will probably produce better doctors, not subpar doctors.

EDIT: Applied s/two/too

(I'm not specifically picking on Caltech undergrads, BTW. I'm fairly sure this is typical at most schools.)

This may be true, but there are also plenty of students who work from the moment they wake up until the moment they go to bed and still don't have enough time to get all of their assignments done. The problem is that functionally there isn't really any difference between having a 3.5 GPA and a 2.0 GPA, so at some point most people figure out that what they're being asked to do is impossible so they might as well just do their own thing.

Once you're doing real work, turning down work will not make you lazy; it will be an opportunity to say, "Sure, I might be able to assist you with that, but you will have to talk to <important person> and <other important person> about the impact on my work on <important project> and <other important project>."

"Oh... no chance of my project taking priority over those. Shoot, and I really need it done this quarter."

"I think <junior developer> can do the job for you. He might need a little guidance, but if he does, I will be happy to make myself available to answer his questions and point him in the right direction."

"Wonderful, thank you!"

If you postpone things that aren't important to you, but are important to your boss, that's not going to go well. If you postpone things your boss doesn't care about, in order to do a better/quicker job on something the boss considers important, that'll probably make your boss happy.

(Note, I'm using "boss" as short-hand for "your boss, and all the other interested parties, customers, etc. who can affect your boss's opinion of you".)

[Actually watching TV does provide a benefit: it's relaxing. The same is not true for assignments.]

``We are writing this sentence two days before the deadline. Unfortunately that sentence (and this one) are among the first that we have written. How could we have delayed so much when we have known about this deadline for months? (...)''

Certain classes are worse than others and it doesn't usually depend on the content of the course, but the people teaching it. I'd blame the culture of the faculty above the school, although the school likely influences said culture.

The faculty contributed from what I could see, but primarily in indulging procrastination by students. It was quite common for students to hand in the majority of a terms problem sets in the last week, and the professors would accept them even if there was a stated class policy that late assignments would not receive credit. (Of course, I acknowledge that this was particularly onerous to me, because I would be the one who then had to grade a full term worth of assignments in a week.)

I find that I need a pretty consistent 8 hours of sleep a night for normal operation. However, I've found that when I'm doing something challenging (say, a startup or a new project at work, or learning a new programming framework), this spikes upwards fast. I need about 9.5 hours when doing something moderately challenging, and up to 11 hours if it's a problem that requires my absolute full attention.

I remember reading somewhere a hypothesis that sleep exists so that your mind can convert short term working memory into long-term memory. Naturally, you would need more of this if your short-term working memory is more filled up with complicated stuff. But this goes at odds with the cultural practices at Caltech or MIT or med school - if it's true, you should structure the curriculum so that students work very hard during the day, but then have enough time to go home and sleep it off before learning the next day's lesson. I wonder if there's any research on this.

I find I also dream very vividly when working on a hard problem, but this could just be correlation, as REM cycles increase in frequency toward the end of the night, and if the night is extended, there ought to be more of them.

It rings very true to me. I believe that people who have trouble sleeping are often people who didn't learn that much that day, and conversely, people who learn on a given day seem to need more sleep.

I noticed this with my kids. A few months before they started learning to talk, say, at about 13 months, they seemed to need more sleep, even though they weren't exercising any more. This is the period that you can really begin to see them starting to "get it", about a lot of things in their world. Even though they aren't talking yet, they are beginning to understand what you are saying, so they are learning fast.

13 months has to be within a month or so of the median age for starting to walk (in my country at least, I know some start much younger) but you say your kids didn't increase their exercise; presumably then they were already walking at that age?

We have 2 boys that have been treated almost identically, obviously there have been differences and only one of them is a first child. However they have so far had vastly different sleep patterns. The one who sleeps least appears to have developed fastest in linguistic terms. His brother, the slower, was certainly no slouch (and without wishing to boast) is pretty close to top of his class for reading despite being one of the youngest.

I meet quite a lot of different parents & babies/toddlers from different backgrounds and find there are a lot of variations in sleep pattern - I don't have anywhere near enough contact with them to establish correlations with development and sleep pattern though.

My kids could be outliers. I'm sure such studies must have been done?!

tl;dr anecdotes are anecdotal and my experience doesn't bear out your hypothesis

You don't hear the student bragging about how he got enough sleep last night and got all of his work done ahead of time.

I'm an undergrad at Stanford and I think that if you plan ahead well enough it isn't difficult to get enough sleep and get all your work done. It's not only about managing time during the term, but also about managing which classes you take together term-to-term.

There is also something to be said for developing endurance. Eventually you're going to have to do something you don't want to do while incredibly tired.. so pulling all-nighters is a kind of training for that.

Top colleges, military training, and most early stage start-up environments all have either explicit or implicit cultures where part of the values indoctrination is to "achieve under fatigue".

It isn't about what's optimal for long-term productivity or health. It's about gauging mental toughness and weeding out those individuals without an adequate level of committment to that particular community's values.

If the individual can perform adequately under an extreme depravity of conditions, then they can be expected to excel, or at the very least, fall back to an acceptable baseline of trained performance when provided the surfeit of resources available under day-to-day tasking.

</socially undesirable fact of the day>

I sleep much more now. Left to my own devices, I adjust to a roughly 28-hour clock during which I sleep 9-10 hours a cycle.

What we humans fail to see is that running out of hours in a day to study (work et al) should not equal to cutting back on sleep. Cutting back on sleep is a quick & dirty approach but has its negatives which the article pointed out. If only we could see our consequences of these actions using some monitoring tool/data I'm certain many folks would be in a better position to balance/optimize their study and sleep patterns.

So, both the article and these schools can be right ;-)