• Sarah Edgerley, Conor McKaigney, Devon Boyne, Darrell Ginsberg, Dagnone J Damon JD Department of Emergency Medicine, Queen's University, Kingston General Hospital, Victory 3, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. Electronic, and Andrew K Hall.
• Queen's University School of Medicine, Undergraduate Medical Education, 80 Barrie Street, Kingston, ON, K7L 3N6, Canada. Electronic address: sedgerley@qmed.ca.
• Resuscitation. 2018 Jun 1; 127: 26-30.

AimEmergency medicine (EM) trainees often work nightshifts. We sought to measure how this circadian disruption affects EM resident performance during simulated resuscitations.MethodsThis retrospective cohort study enrolled EM residents at a single Canadian academic centre over a six-year period. Residents completed twice-annual simulation-based resuscitation-focused objective structured clinical examinations (OSCEs) with assessment in four domains (primary assessment, diagnostic actions, therapeutic actions and communication), and a global assessment score (GAS). Primary and secondary exposures of interest were the presence of a nightshift (late-evening shifts ending between midnight and 03h00 or overnight shifts ending after 06h00) the day before or within three days before an OSCE. A random effects linear regression model was used to quantify the association between nightshifts and OSCE scores.ResultsFrom 57 residents, 136 OSCE scores were collected. Working a nightshift the day before an OSCE did not affect male trainee scores but was associated with a significant absolute decrease in mean total scores (-6% [95% CI -12% to 0%]), GAS (-7% [-13% to 0%]), and communication (-9% [-16% to -2%]) scores among women. Working any nightshift within three days before an OSCE lowered absolute mean total scores by 4% [-7% to 0%] and communication scores by 5% [-5% to 0%] irrespective of gender.ConclusionOur results suggest that shift work may impact EM resident resuscitation performance, particularly in the communication domain. This impact may be more significant in women than men, suggesting a need for further investigation.Copyright © 2018 Elsevier B.V. All rights reserved.

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