Medical decisions of pediatric residents turn riskier after a 24-hour call with no sleep

Adi Aran*, Netanel Wasserteil, Itai Gross, Joseph Mendlovic, Yehuda Pollak

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background. Despite a gradual reduction in the workload during residency, 24-hour calls are still an integral part of most training programs. While sleep deprivation increases the risk propensity, the impact on medical risk taking has not been studied. Objective. This study aimed to assess the clinical decision making and psychomotor performance of pediatric residents following a limited nap time during a 24-hour call. Methods. A neurocognitive battery (IntegNeuro) and a medical decision questionnaire were completed by 44 pediatric residents at 2 time points: after a 24-hour call and following 3 nights with no calls (sleep ≥5 hours). To monitor sleep, residents wore actigraphs and completed sleep logs. Results. Nap time during the shift was <1 hour in 14 cases (32%), 1 to 2 hours in 16 cases (35%), and 2 to 3 hours in 14 cases (32%). Residents who napped less than 1 hour chose the riskier medical option in 50% of cases compared with 36% when answering the same questionnaire after 3 nights with no calls (P = 0.002). This effect was not found in residents who napped 1 to 2 hours (no change in risk taking) or 2 to 3 hours (4% decreased risk taking) (difference between groups, P = 0.001). Risk-taking tendency inversely correlated with sustained attention scores (Pearson = -0.433, P = 0.003). Sustained attention was the neurocognitive domain most affected by sleep deprivation (effect size = 0.29, P = 0.025). Conclusions. This study suggests that residents napping less than an hour during a night shift are prone to riskier clinical decisions. Hence, enabling residents to nap at least 1 hour during shifts is recommended.

Original languageAmerican English
Pages (from-to)127-133
Number of pages7
JournalMedical Decision Making
Issue number1
StatePublished - Jan 2017

Bibliographical note

Publisher Copyright:
© The Author(s) 2016.


  • Decision making
  • Duty hours
  • Neurocognitive assessment
  • Residents
  • Sleep
  • Sleep deprivation


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