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Work patterns and fatigue-related risk among junior doctors
  1. Philippa Gander1,
  2. Heather Purnell2,
  3. Alexander Garden1,
  4. Alistair Woodward3
  1. 1
    Sleep/Wake Research Centre, Massey University, Wellington, New Zealand
  2. 2
    Centre for Public Health Research, Massey University, Wellington, New Zealand
  3. 3
    School of Population Health, University of Auckland, Auckland, New Zealand
  1. Dr Philippa Gander, Sleep/Wake Research Centre, Massey University, Private Box 756, Wellington, New Zealand; p.h.gander{at}


Background: To reduce fatigue-related risk among junior doctors, recent initiatives in Europe and the USA have introduced limits on work hours. However, research in other industries has highlighted that other aspects of work patterns are important in generating fatigue, in addition to total work hours. The Australian Medical Association AMA has proposed a more comprehensive fatigue risk management approach.

Objectives: To evaluate the work patterns of New Zealand junior doctors based on the AMA approach, examining relationships between different aspects of work and fatigue-related outcomes.

Methods: An anonymous questionnaire mailed to all house officers and registrars dealt with demographics, work patterns, sleepiness, fatigue-related clinical errors, and support for coping with work demands. Each participant was assigned a total fatigue risk score combining 10 aspects of work patterns and sleep in the preceding week.

Results: The response rate was 63 1366 questionnaires from doctors working 40 hours a week. On fatigue measures, 30 of participants scored as excessively sleepy Epworth Sleepiness Score >10, 24 reported falling asleep driving home since becoming a doctor, 66 had felt close to falling asleep at the wheel in the past 12 months, and 42 recalled a fatigue-related clinical error in the past 6 months. Night work and schedule instability were independently associated with more fatigue measures than was total hours worked, after controlling for demographic factors, The total risk score was a significant independent risk factor for all fatigue measures, in a dose-dependent manner all p<0.01. Regular access to adequate supervision at work reduced the risk of fatigue on all measures.

Conclusions: To reduce fatigue-related risk among junior doctors, account must be taken of factors in addition to total hours of work and duration of rest breaks. The AMA fatigue risk assessment model offers a useful example of a more comprehensive approach.

  • fatigue
  • work patterns
  • fatigue risk management
  • national fatigue survey
  • junior doctors

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  • Funding: This project was funded by the Health Research Council of New Zealand, project grant 02/249. The Medical Assurance Society provided the incentive prize.

  • Competing interests. None to declare.

  • Abbreviations:
    Australian Medical Association
    Epworth Sleepiness Score
    independent odds ratio
    Resident Doctors Association

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