School of Medicine

Objective : The Accreditation Council on Graduate Medical Education, ACGME, duty hour limitations have been resisted for various reasons, including the belief that fatigue does not affect our profession's core skills duty hour limitations will affect patient safety due to increased handoffs and decreased training and patient care opportunities for residents. This paper will examine the recent evidence on fatigue and sleep deprivation in both the medical and military aviation professions. These professions have been compared and contrasted before because of their requirement for a high level of training and competence as well as their profound responsibility for the lives of others. It is our desire to highlight recent literature in both professions so that one may inform the other. Method : The authors conducted a search on MEDLINE for English-language literature from 2007-2012 for articles about the effects of fatigue on medical residents. The articles were limited to those from North American, Australian, and European programs. In addition, inclusion criteria included the measurement of physical and/or cognitive function as a reported outcome. Articles regarding military aviation were limited to those from the United States Navy. Results : The search found 157 articles on the effects of resident fatigue and 22 met inclusion criteria. Of the 22 reviewed articles, 13 showed a significant effect of fatigue on technical skills, cognitive function or medical error rates while 9 articles found no statistically significant effect. Articles involving Naval Aviation included relevant research and regulations. The review found a longstanding organizational acceptance of the effects of fatigue, accident data that reported fatigue as a causal factor in nearly 25% of aviation mishaps, and increased scientific understanding of the complex nature of fatigue when compared to medical research. Conclusions : To our knowledge, this is the first review to compare medical and aviation research and regulations regarding fatigue. T.