Black clouds. Work load, sleep, and resident reputation
R. R. Tanz and J. Charrow
Division of General Academic and Emergency Pediatrics, Children's Memorial Hospital, Chicago, IL 60614.
OBJECTIVE--Although it is assumed that residents in a specific training
program will have comparable experiences, residents commonly perceive that
some have consistently more difficult times on call. Such residents in our
program are said to have "black clouds." We sought to determine if these
perceptions were related to differences in real work load. METHODS--We
collected data about the on-call experiences of our first-year pediatric
residents (PL-1s) for 358 days (1355 on-call experiences) during the
1984-1985 academic year. Every PL-1 (n = 19) reported the following data
the morning after each night on call: hours of sleep, number of admissions,
total number of patients, number of deaths, number of transfers to the
pediatric intensive care unit, number of delivery room trips, and a
subjective assessment of work load, using a three-point scale. The
reputation of each house officer was determined by asking all residents in
the program (PL-1s, PL-2s, and PL-3s) to rate each other three times during
the year regarding how hard they worked on call. RESULTS--There were
significant differences among PL-1s in how difficult they perceived their
work load to be and in how much they slept (P < .001 using analysis of
variance). However, actual work load (as measured by the number of either
admissions or patients) did not vary significantly among the residents.
There was a strong negative association between self-perception of work
load and hours of sleep (r = -.75; 95% confidence interval, -0.73 to
-0.76). Sleep was the major predictor of perceived work load (multiple R2 =
.563 using multiple linear regression analysis). The absence of an
association between perceived and actual work load is attributed to large
differences in the residents' working styles. This is evidenced by a wide
range of correlations among PL-1s between the number of admissions and
hours of sleep (range of r values, -.66 to -.16). A reputation for
difficult on-call experiences was strongly associated with few hours of
sleep (r = -.77; 95% confidence interval, -0.49 to -0.91), but not with
actual work load measured by the number of admissions, patients, deaths, or
other variables. Sleep was the major predictor of reputation (multiple R2 =
.567 using multiple linear regression analysis). CONCLUSIONS--Some
residents did have a black cloud; they slept less, perceived that they
worked harder than average, and had a reputation for having difficult
on-call experiences. Residents with a black cloud function differently from
their colleagues; for example, some may be inefficient, while others may
create extra work for themselves. Residency program directors must
recognize these functional differences to effectively evaluate and counsel
house officers.
