All ETDs from UAB

Advisory Committee Chair

Despina Stavrinos

Advisory Committee Members

Karen Heaton

John R Porterfield

Sylvie Mrug

Mark C Schall

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

The Accreditation Council for Graduate Medical Examination recently revised and implemented duty hour standards that increased maximum duty hours for first year medical residents and reduced the minimal amount of time off between duty periods for all medical residents. The new standards were introduced largely without consideration of empirical research on objectively measured occupational health and safety factors for medical residents, particularly in contexts where their safety may be at-risk such as driving. Little work has examined driving performance in medical residents at multiple periods surrounding duty, including in reference to off-duty driving performance as a baseline. Certain work-related factors such as sleep quality, fatigue, and stress are known to affect mental and physical performance, and may further exacerbate driving risks. The overall objective of this study was to examine driving performance in medical residents off duty, pre-duty and post-duty using a high-fidelity driving simulator. Both self-reported and objective estimates of sleep quality, fatigue, and stress were collected at off-duty, pre-duty, and post-duty points of time. There were three specific aims: 1) To examine differences in simulated driving performance among off days, pre-duty, and post-duty; 2) To determine the effect of sleep, fatigue, and stress on driving performance at each time point; and 3) To determine how post-duty period driving performance is affected by sleep, fatigue, and stress. Findings indicated that medical residents experienced the highest levels of stress and sleep propensity pre-duty and displayed riskier driving behaviors post-duty. More senior medical residents were less affected by the negative effect of stress on driving performance, and increased sleep quality may buffer the negative effects of increased stress on driving outcomes. The impact of occupational demands on psychophysiological outcomes require further investigation to better understand the mechanisms of how work demands affect these psychophysiological outcomes. Understanding how to mitigate high job strain may have several implications in improving psychophysiological functions impacted by occupational demands, namely sleep quality and stress, and subsequently improving driving safety outcomes that may also be negatively affected by the duty demands.

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