Sleepy "residents" are dangerous motorists.

• Position: Fatigue

Medical residents who drive home after a month-long rotation of on call duty may be a threat behind the wheel. In driving simulations, fatigued residents performed equally or worse than when they were moderately intoxicated, according to a Brown University, Providence, R.I., study. This is the first study to compare resident fatigue to an accepted standard of functional impairment: moderate alcohol intoxication (blood alcohol concentration of 0.04% to 0.06%).

"Sleep loss and its consequences are an occupational hazard in [the medical field]," report study co-leaders Judith Owens, associate professor of pediatrics, and J. Todd Arnedt, assistant professor of psychiatry and human behavior. "Federal work-hour changes to address fatigue among medical residents were necessary, but they are not sufficient to ensure that residents are well rested."

Residency programs must do a better job "of educating residents about sleep deprivation, the consequences for driving home safely, and about countermeasures that mitigate the effects of fatigue," Owens argues. "I don't think this is discussed in residency programs. Medical education programs don't talk about it, either." Planned naps and calculated use of caffeine are two of several strategies that may temporarily offset the effects of sleep loss, she explains.

Medical rotations typically last about a month. Even with new work hour guidelines in place as of July 1, 2003, a heavy on-call schedule can entail up to four...