Fatigue in Residency Education: Understanding the Influence of Work Hour Regulations in Europe

Purpose:
Although one proposed solution to the problem of fatigued medical trainees is the implementation of work hour regulations, concerns about their effectiveness are growing. Canada remains one of the few Western jurisdictions without legislated regulation. Recent research suggests that fatigue is a complex social construct, rather than simply a lack of sleep; thus, the authors explored how regulations and fatigue are understood in countries with established work hour frameworks to better inform other jurisdictions looking to address trainee fatigue.

Method:
Using constructivist grounded theory methodology, the authors conducted individual, semi-structured interviews in 2015-16 with thirteen postgraduate medical trainees from four European countries with established work hour regulations. Data collection and analysis proceeded iteratively, and the authors used a constant comparative approach to analysis.

Results:
Trainees reported that they were commonly fatigued and that they violated the work hour restrictions for various reasons, including educational pursuits. Although they understood the regulations were legislated specifically to ensure safe patient care and optimize trainee well-being, they described implicit meanings (e.g., monitoring for trainee efficiency) and unintended consequences (e.g., losing a sense of vocation) as well.