Resident physicians often work extended-duration work shifts (EDWSs) exceeding 16 hours. EDWSs are associated with fatigue, workplace errors, mental health problems, and motor vehicle incidents. A 2019 systematic review reported that resident physicians had an increased risk of motor vehicle collisions (MVCs) and of falling asleep at the wheel after EDWSs. This systematic review updates those findings with recent literature. Embase, PubMed, Cochrane Database, and Ovid Medline were searched for original research articles studying resident physician driving safety following EDWS. Two authors independently reviewed articles for inclusion. Both reviewers performed data extraction and quality appraisal for each included article. Six articles met the inclusion criteria. Three articles found associations between EDWS and increased sleepiness in resident physicians. Self-reported sleepiness was increased by 46% following an EDWS compared to a normal-length shift. Objective measures of sleepiness were also increased following an EDWS. Similarly, there was a three-fold increase in adverse driving events following an EDWS compared to pre-EDWS. One study found 3.90 higher odds of an adverse driving incident following an EDWS compared to a day shift. EDWS are associated with an increased risk of adverse driving incidents, including collisions and falling asleep while driving, in resident physicians. Possible solutions including compensation for ride-share and taxi services, scheduled breaks, education on risks of driving while fatigued, and the use of caffeine may lower the risk of adverse driving incidents post-EDWSs. Further research is needed to assess the impact of possible solutions.