ABSTRACT
INTRODUCTION: The purpose of this study was to determine which components of sports medicine fellowships are most important to applicants when reviewing fellowship websites during the application process. METHODS: An anonymous survey was distributed to 492 fellowship applicants from the 2017-2018 and 2018-2019 cycles. The survey included questions about the importance of including components of fellow education, recruitment, and experience on program websites. The weighted average of responses determined each component's rank, with 5 being "very important" and 1 being "not at all important." Responses were analyzed by application cycle, current position, and sex using the Wilcoxon rank-sum test. RESULTS: Sixty-five applicants participated in the survey and completed the demographics section, resulting in a 13.2% response rate. According to participants, the most important components to include on fellowship websites were exposure to advanced operative sports medicine techniques (weighted average, 4.62), complexity of cases performed (4.52), and number of cases performed (4.50). Analysis demonstrated statistically significant differences in opinion between application cycles for flexibility for conducting a remote interview (P = .0074), jobs obtained by previous fellows (P = .019), national rank of department (P = .021), program's geographic location (P = .026), protected academic time (P = .038), current positions for criteria for fellows' performance evaluations (P = .028), program's geographic location (P = .0097), and protected academic time (P = .0079). There were statistically significant differences in opinion between current positions regarding flexibility for conducting a remote interview (P = .0026), jobs obtained by previous fellows (P = .012), and national rank of department (P = .0013). CONCLUSIONS: Orthopaedic sports medicine fellowship applicants believe that it is most important to include information about the volume and complexity of fellows' cases and their day-to-day commitments on program websites. CLINICAL RELEVANCE: This information would enable applicants to identify programs that will support professional development and allow program directors to communicate expectations.
ABSTRACT
BACKGROUND: Minimum rest is mandated in high stake industries such as aviation. The current system of healthcare provision permits on-call surgeons to work in sleep deprived states when performing procedures. Fatigue has been demonstrated to negatively affect performance. This study aimed to explore measurements of sleep deprivation and their impact on simulated performance. METHODS: This was a single site study conducted between September 2019 and February 2020. Surgical trainee and consultants were conveniently sampled from a single site. All testing was done between 7 AM and 9 AM. Participants completed electroencephalogram testing using a modified Multiple Sleep Latency Test testing for objective sleep measurement, the Pittsburgh Sleep Quality Index, Chalder Fatigue Scale and Epworth Sleepiness Scale for subjective sleep measurement. The Psychomotor Vigilance Task and the SIMENDO simulated tasks were used for standardized performance assessment. RESULTS: Surgeons entered sleep in 6 min, on average pre-call. This significantly decreased to an average of 164 s post-call (P = 0.016). Pittsburgh Sleep Quality Index scoring was 5, indicating poor baseline sleep quality. There was higher self-reported fatigue and sleepiness in post-call states. Performance decrements were noted in cognitive performance reaction time and aspects of technical instrument proficiency. CONCLUSIONS: Surgeons are objectively sleep deprived pre-call according to internationally recognized guidelines. This sleep deprivation increases significantly in post-call states. Tasks with higher cognitive demands showed greater levels of diminished performance compared to those with lower cognitive demands. Current models of provision of surgical on-call are not conducive to optimizing sleep in surgeons. Prioritization of workload in post-call states, focusing on preserving individuals cognitive resources and utilizing lower cognitively demanding aspects of work is likely to have positive impacts on performance outcomes.
