Fatigue Risk Management

To provide guidance to residents and programs in reducing resident fatigue and to promote resident fatigue risk awareness and management within residency training.

This policy is being written in accordance with the CanRAC accreditation requirements and with the recommendations put forward in the Fatigue Risk Management Toolkit, a National resource for Canadian postgraduate medical education.

This policy is a reflection of the University of Saskatchewan Postgraduate Medical Education (PGME) Resident Resource Office’s (RRO) commitment to the support of resident’s well-being and to the fatigue risk management of all residents.  Fatigue is an occupational risk in medical education that impacts residency training and workplace health and safety, with potential implications for patient safety.  Successful management of fatigue risk is a shared responsibility among all those who have a role within medical education.  The Postgraduate Medical Education Office, residency training programs, faculty and staff must work alongside residents to provide ongoing fatigue management strategies to identify, assess and reduce the effects of fatigue.

Fatigue A subjective feeling of tiredness that is experienced physically and mentally. It ranges from tiredness to exhaustion, creating an unrelenting overall condition that interferes with individuals’ physical and cognitive ability to function to their normal capacity. Its experience involves some combination of features: physical (e.g. sleepiness) and psychological (e.g. compassion fatigue, emotional exhaustion) (FRM Toolkit; Adapted from RNAO, 2010).

Fatigue Risk Management A set of ongoing fatigue prevention and mitigation practices, principles, and procedures integrated throughout all levels of the clinical and academic work environment, and are designed to monitor, ameliorate and manage the effects of fatigue and associated risks for the health and safety of healthcare personnel and the patient population they serve (FRM Task Force, 2016).

Program is the Royal College of Physicians and Surgeons of Canada (RCPSC) or the College of Family

Physicians Canada (CFPC) accredited residency training program at the College of Medicine.

Resident refers to postgraduate medical trainee enrolled in the RCPSC or the CFPC program.

The Resident Resource Office (RRO) refers to the Resident Wellness Coordinator and administrative personnel within PGME who provide non-academic support in a safe and confidential environment to residents who may be coping with professional or personal challenges throughout residency training.

This policy applies to all residents in all residency training programs at the College of Medicine, University of Saskatchewan as well as all residency training programs and faculty that provide academic and clinical direction to medical residents.

This policy refers to the PGME Resident Wellness Policy and has been adapted with permission from the Northern Ontario School of Medicine Fatigue Risk Management/Resident Wellness policy.

1. The Role of the PGME/Resident Resource Offices:

1. To support the application of Fatigue Risk Management practices amongst programs.
2. To distribute an annual wellness survey that will include exploration of issues regarding resident fatigue, burnout, discrimination & harassment etc. Survey results will be provided to programs for their reflection and understanding.
3. To ensure learning sites regularly review the safety (physical, psychological, and professional, as appropriate) of the learning environment for residents.
4. The RRO will support the delivery of wellness, safety, and fatigue risk management education to residents and programs.
5. The RRO will provide resources for residency programs and residents to help support, develop, and implement Fatigue Risk Management Plans.

 

2. Residency Program Responsibilities:

1. To be aware of the various aspects that may influence the health and safety of residents.
2. Ensure the curriculum plan includes fatigue risk management education, specifically, education addressing the risks posed by fatigue to the practice setting, and the individual and team-based strategies available to manage the risk.
3. Ensure a program specific policy and procedure is in place to address Fatigue Risk Management. This is to enable and protect every resident’s ability to fulfill their role in the management of resident wellness, safety, and fatigue risk.
4. Program Directors, faculty members and staff are encouraged to recognize signs of resident fatigue and/or burnout that may be affecting the performance of a resident. They must take steps to ensure the safety of residents and patients and to provide resources and/or referrals to residents when needed. Refer to the Fatigue Risk Management Toolkit and/or the PGME Resident Wellness Policy.
5. To be aware of the services & educational opportunities offered by the Resident Resource Office and should encourage residents to access those programs and supports available to them.
6. To ensure faculty have access to information or other resources to support education of resident regarding fatigue risk management. 
7. To have clinical duty and on-call schedules consistent with the RDoS collective agreement. Programs have a duty to release residents post-call as outlined in the ‘work hours’ section of the RDoS collective agreement. Refer to link in resources.
8. To advise the PGME Associate Dean of any barriers preventing effective fatigue risk management.

3. Role of the Resident:

1. To be aware of and adhere to the various health, safety and wellness policies and reporting mechanisms of the University of Saskatchewan, Saskatchewan Health Authority, and affiliated training site(s).
2. To be responsible for presenting themselves fit for work and be able to perform their clinical and educational duties in a safe and effective manner. Residents should aim to be free from the adverse effects of physical, mental, emotional and/or personal difficulties during training. Residents have a key role in managing their time and to report their own fatigue to their supervisors, peers and to the healthcare team. 
3. Residents can access the RDoC Mental Health Continuum Scale to reflect on their current state of well-being. The scale is not a diagnostic tool but can be used for self-reflection and options to act upon. 
4. Residents are responsible for recognizing signs of impairment in themselves and their peers, including that which is due to fatigue. If a resident themselves is experiencing any difficulties that they feel could impact their ability to perform their duties due to fatigue, they are encouraged to seek assistance as soon as possible. Residents who recognize impairment due to fatigue in their peers should notify their supervisor immediately. Residents can seek help through the Resident Resource Office, Program Director, Program Coordinator, PGME office, RDoS office, SMA Physician Health Programs, EFAP, or faculty member as appropriate.
5. Residents who feel they are unsafe to drive their vehicle from the training facility to their residence after working an in-house or converted call shift will be reimbursed by the employer for taxi service to their home residence. Refer to the RDoS collective agreement. 

4. Resources:

• PGME Resident Resource Office (RRO)
• University of Saskatchewan Employee and Family Assistance Program (EFAP)
• Saskatchewan Medical Association – Physician Health Program (PHP)
• Resident Doctors of Saskatchewan (RDoS) – Work Hours
• Resident Doctors of Canada (RDoC)
• CanRAC
• Fatigue Risk Management Toolkit

5. Related Documents:

The following related documents are referenced throughout this policy:

• PGME Health & Safety Policy
• University of Saskatchewan policies on health, safety and environment
• PGME Resident Wellness Policy
• PGME Policies & Procedures

Instances or concerns of non-compliance with this policy should be brought to the attention of the Associate Dean, PGME.

Coordinator for Academic and Non-academic Processes, PGME Office
Phone: 306-966-6145