Original ContributionEmergency medicine residents' use of psychostimulants and sedatives to aid in shift work
Introduction
The adverse effects of shift work on the well-being of emergency physicians (EPs) are substantial and include alterations in mood, clinical performance, and risk of motor vehicle collision [1], [2], [3], [4]. In other fields, studies correlate shift work with risk for coronary heart disease, breast cancer, and substance abuse [5], [6], [7], [8]. Because of the immutable necessity for overnight emergency department staffing, shift work will remain a continuing liability for EPs.
Previous studies investigated the potential of pharmaceuticals and dietary supplements to aid workers in shift work. Most notably, in 2004 modafinil became the first agent to receive Food and Drug Administration approval to treat shift work sleep disorder. However, the current literature regarding its efficacy is limited and diverse [9], [10], [11]. A search of the current literature identified just 2 studies that had investigated sedative use by residents [12], [13]. Only a single study had investigated physician use of modafinil [13], and no study focused on physician use of other prescription and nonprescription stimulants.
In this study, we aimed to explore, catalog, and quantify the incidence and prevalence of stimulant and sedative use by emergency medicine (EM) residents. This knowledge provides insight into how residents respond to the hazards that shift work places on patient care and their own personal health [14].
Section snippets
Study design
A convenience sample of regional EM residency directors and key residency program faculty were contacted and asked to share an online invitation with their residents. The e-mail invitation was disseminated among 485 eligible residents across 12 EM programs, and they were asked to complete an Internet-based survey (Appendix A) regarding the use of stimulants and sedatives to aid in shift work.
The 12 surveyed programs were located in 1 of 7 Northeast and Mid-Atlantic states. There was no
Results
We received responses from 226 EM residents out of the 485 eligible (47% response rate) representing 12 surveyed EM programs. Equal numbers of respondents were male (50%) and female (50%), although this represents a greater proportion (P < .005) of women than in EM residencies nationwide (40% women) [16].
We present the frequency of stimulant use in Table 1 and the frequency of sedative use in Table 2.
Discussion
This multiprogram survey of 226 participating EM residents found prescription stimulant use to be rare. Substantial minorities reported use of sedatives, with antihistamines being most frequent. Most of the respondents use caffeine every night shift.
This study contributes to our understanding of how EPs use pharmaceuticals to cope with circadian transitions. Our study found a 36% incidence of sedative use among EM residents, compared with a 56% reported incidence in an earlier study [12]. This
Conclusions
Although nightly caffeine use is very common, EM residents report little use of prescription stimulants to aid in night shifts. Sedative use is substantially more common suggesting that many residents need help initiating and maintaining sleep during circadian transitions. Further studies should investigate how these pharmaceutical interventions affect EPs' job performance, sleep duration, and quality of life.
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