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Volume 352:125-134 January 13, 2005 Number 2
Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns
Background Long work hours and work shifts of an extended duration (24 hours)
remain a hallmark of medical education in the United States. Yet their effect
on health and safety has not been evaluated with the use of validated
measures.
Methods We conducted a prospective nationwide, Web-based survey in which 2737
residents in their first postgraduate year (interns) completed 17,003 monthly
reports that provided detailed information about work hours, work shifts of
an extended duration, documented motor vehicle crashes, near-miss incidents,
and incidents involving involuntary sleeping.
Results The odds ratios for reporting a motor vehicle crash and for reporting
a near-miss incident after an extended work shift, as compared with a shift
that was not of extended duration, were 2.3 (95 percent confidence interval,
1.6 to 3.3) and 5.9 (95 percent confidence interval, 5.4 to 6.3),
respectively. In a prospective analysis, every extended work shift that was
scheduled in a month increased the monthly risk of a motor vehicle crash by
9.1 percent (95 percent confidence interval, 3.4 to 14.7 percent) and
increased the monthly risk of a crash during the commute from work by 16.2
percent (95 percent confidence interval, 7.8 to 24.7 percent). In months in
which interns worked five or more extended shifts, the risk that they would
fall asleep while driving or while stopped in traffic was significantly
increased (odds ratios, 2.39 [95 percent confidence interval, 2.31 to 2.46]
and 3.69 [95 percent confidence interval, 3.60 to 3.77], respectively).
Conclusions Extended-duration work shifts, which are currently sanctioned by
the Accreditation Council for Graduate Medical Education, pose safety hazards
for interns. These results have implications for medical residency programs,
which routinely schedule physicians to work more than 24 consecutive hours.
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