Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion

Context Concern exists about the effect of extended resident work hours; however, no study has evaluated training-related performance impairments against an accepted standard of functional impairment. Objectives To compare post-call performance during a heavy call rotation (every fourth or fifth night) to performance with a blood alcohol concentration of 0.04 to 0.05 g% (per 100 mL of blood) during a light call rotation, and to evaluate the association between self-assessed and actual performance. Design, Setting, and Participants A prospective 2-session within-subject study of 34 pediatric residents (18 women and 16 men; mean age, 28.7 years) in an academic medical center conducted between October 2001 and August 2003, who were tested under 4 conditions: light call, light call with alcohol, heavy call, and heavy call with placebo. Interventions Residents attended a test session during the final week of alight call rotation (non-post-call) and during the final week of a heavy call rotation (post-call). At each session, they underwent a 60-minute test battery (light and heavy call conditions), ingested either alcohol (light call with alcohol condition) or placebo (heavy call with placebo condition), and repeated the test battery. Performance self-evaluations followed each test. Main Outcome Measures Sustained attention, vigilance, and simulated driving performance measures; and self-report sleepiness, performance, and effort measures. Results Participants achieved the target blood alcohol concentration. Compared with light call, heavy call reaction times were 7% slower (242.5 vs 225.9 milliseconds, P<001); commission errors were 40% higher (38.2 % vs 27.2 %, P<.001); and lane variability (7.0 vs 5.5 ft, P<.001) and speed variability (4.1 vs 2.4 mph, P<.001) on the driving simulator were 27% and 71 % greater, respectively. Speed variability was 29% greater in heavy call with placebo than light call with alcohol (4.2 vs 3.2 mph, P=.01), and reaction time, lapses, omission errors, and off-roads were not different. Correlation between self-assessed and actual performance under heavy call was significant for commission errors (r=-0.45, P=.01), lane variability (r=-0.76, P<.001), and speed variability (r=-0.71, P<001), but not for reaction time. Conclusions Post-call performance impairment during a heavy call rotation is comparable with impairment associated with a 0.04 to 0.05 g% blood alcohol concentration during a light call rotation, as measured by sustained attention, vigilance, and simulated driving tasks. Residents' ability to judge this impairment may be limited and task-specific.