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Fatigue guidelines negatively impact neurosurgery residents

The delicate nature of neurosurgery requires that a professional in the field be well-prepared for lengthy and complex procedures. Patient care in an Arizona hospital also depends on consistency and competency after such procedures. While an effort to improve patient outcomes by reducing fatigue in those training to be doctors might seem sensible, the practice of neurosurgery may actually be less safe when residents' hours are limited.

Individuals training to be doctors are limited to no more than 80 hours of work in a week's time. This applies to all training disciplines, but some areas require that students be prepared to deal with heavier demands on their time, endurance, and concentration. Neurosurgery, for example, can involve lengthy surgeries with critical care periods following procedures. A limitation of hours for residents in this area can prevent their continuing involvement in some cases. Having to hand care off to another resident can create opportunities for errors such as failing to transfer all relevant data. In surveys about the issue, a large majority of residents and their faculty members indicate that they believe patient care suffers because of this time limit.

During one's training, hour restrictions could limit opportunities to be involved in procedures that are particularly complex. Additionally, program coordinators may have difficulty in identifying the best candidates for specializing in neurosurgery because of limited ability to evaluate endurance in challenging surgical scenarios. Some medical professionals believe that the ability to regulate duty hours should be addressed by those most familiar with the demands of the specialty in question.

While fatigue might be a concern because of the potential for surgical errors, other issues can also contribute to problems in operating rooms. Maintaining a sterile operating environment, using appropriate medications, and ensuring that the correct patient is being treated are among serious concerns. A lack of appropriate oversight could leave a hospital and its employees vulnerable to medical malpractice.

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