Principles of fatigue in residency education: a qualitative study

Taryn S. Taylor; Christopher J. Watling; Pim W. Teunissen; Tim Dornan; Lorelei Lingard

doi:10.9778/cmajo.20150086

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Table 1: Four principles of fatigue

Principle	Quotation (anonymous resident no.)
Fatigue is inescapable and therefore accepted	I think it's kind of expected. Everyone knows you're going to be tired. (012)
Fatigue is inescapable and therefore accepted	I don't think, culturally, talking about being tired is really appropriate in my program. We accept it. (013)
Fatigue is manageable through experience	You just can't stand up anymore. You can't keep your eyes open anymore. You feel like you are going to pass out or whatever. A lot of people have those sensations after staying up for 24 hours. We learn to manage that. (017)
Fatigue is manageable through experience	I'm sure people will disagree, and this seems silly, but being able to tolerate sleep deprivation and being able to do high-level performance while tired is trainable like fitness or something, I think. (019)
Fatigue is necessary for future practice	The program and consultants will make that statement, saying, we need to have a residency program where our residents are tired, because they need to be trained for the situation when they're in their community or they're in an environment where they don't have the luxury of sleep. (013)
Fatigue is necessary for future practice	In times of crisis, you need to still be able to make decisions and not freeze and be like, "Oh, I'm tired. I have to go to bed." I think that is what part of this training is ... we all learn to manage this in some way, I think. We all learn. (005)
Fatigue is surmountable when required	I think recognizing that you are tired but then, also recognizing that there is a job to be done. You are looking after patients. And so someone is there for your services. ... So, you just get to a point where ... you are just able to put your own needs secondary. "Hey, I'm tired. I'm not thinking quite the same and all of those things. But I have a job to do here." (018)
Fatigue is surmountable when required	Recently, as a senior resident you don't have as many nights where you are up all night, but you have way more longer stretches where you are going 3 or 4 hours a night every night for 7 or 8 days. And you are amazed at the levels you can push yourself. (019)