Impact of an Asynchronous Fatigue Mitigation Curriculum for Graduate Medical Education.

Abstract

Background: Sleep deprivation in medical trainees is associated with negative outcomes for both trainees and patients. Despite duty hour limitations, sleep deprivation is still common among residents and fellows. The Accreditation Council for Graduate Medical Education requires training programs to educate trainees and faculty members in recognizing fatigue and fatigue mitigation strategies, although there is no guidance on how this education should occur.

Objective: To measure the impact of an asynchronous fatigue mitigation curriculum administered to trainees in graduate medical education at a large academic medical center.

Methods: In the 2023-2024 academic year, all resident and fellow trainees at a large academic medical center were asked to complete an asynchronous curriculum comprising three instructional videos with teaching on sleep structure and function, recognizing and reporting fatigue, and how to improve sleep. Impact on knowledge and trainee-assessed comfort were assessed via needs assessment, pretest, and posttest surveys. An annual survey was distributed 14 weeks after the initial curriculum launch to assess decay in knowledge and comfort.

Results: A total of 970 trainees participated in our asynchronous fatigue mitigation curriculum. Before curriculum launch, trainee comfort with the recognition of fatigue was low (53.5%) and baseline sleep habits were poor, with only 36% of trainees reporting at least 7 hours of sleep each night. After completion of the asynchronous curriculum, there was a significant improvement in trainee knowledge assessed via a six-question test (mean score, 2.87-3.59; P < 0.01), and this knowledge improvement was sustained over 14 weeks (P < 0.01). There were significant improvements in trainee comfort with all five fatigue-related tasks comparing pre- and posttests, with sustained improvement in four of these topics after 14 weeks. There was no significant change in trainee attitudes regarding comfort in reporting concerns about fatigue or requesting coverage when too fatigued to work.

Conclusion: Our asynchronous fatigue mitigation curriculum successfully and durably improved knowledge and trainee comfort with fatigue-related tasks in its first year. The asynchronous curriculum offers a sustainable solution to ensure this education reaches medical trainees across a large population of the graduate medical education population encompassing multiple subspecialties.