Fatigue Management and Mitigation

Across most CLEs, assessment of resident fatigue appears to be largely limited to monitoring the number of hours worked. Yet there are many other factors that can cause fatigue, including task or mental overload due to high-volume or high-acuity patient activity, circadian rhythm disruption, chronic sleep deficit, and non-work related activities. Moreover, “fatigue” can also be a precursor to burnout or a marker for depression. CLEs should be encouraged to train residents, fellows, faculty members, and other clinical staff to consider such factors—and not only work hours—in determining a provider's “fitness for duty.”