Evaluating Fitness to Perform in Surgical Residents after Night Shifts and Alcohol Intoxication: The development of a "Fit-to-Perform" test.

OBJECTIVE

To develop a self-test to measure clinical fitness to perform in surgical residents, with alcohol-induced impairment as reference.

DESIGN

Observational, exploratory study to evaluate night shift-induced impaired performance in surgical residents followed by a randomized blinded, placebo-controlled, crossover study to evaluate impaired performance as a result of ethanol intoxication. Impairment was quantified using the Mini-NeuroCart, a psychomotor and cognitive test battery for assessment of subjective and objective measures of alertness, concentration, eye-hand coordination, mood, and self-assessed ability to perform. Surgical performance was tested in the randomized study with a laparoscopy surgical trainer.

SETTINGS

Level-I trauma hospital and a clinical research unit.

PARTICIPANTS

Surgical residents (n = 12 for the observational study, n = 18 for the randomized study).

RESULTS

High alcohol levels (0.6gL) impaired adaptive tracking, reduced objective and subjective alertness, and increased slowness. Moreover, laparoscopy depth perception was impaired in the 0.6gL group. No significant within-subject correlation between subjective and objective measures of alertness was found. Performance of postcall surgeons was similar to, or even worse than, the performance of intoxicated surgeons.

CONCLUSIONS

The Mini-NeuroCart detected ethanol-induced performance effects that were similar to the effects of working a 14-hour night shift. Social (ethanol), personal (mood), and professional (laparoscopic skills) standards of fitness can in this manner be related to accepted deleterious effects of alcohol. The Mini-NeuroCart is, therefore, a potential noninvasive test for assessing "fitntness to perform" in healthcare professionals.