Longitudinal Study of Fatigue, Stress, and Work Organization as Risk Factors for Motor Vehicle Crash Risk in Surgical Residents

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ABSTRACT This 3-year K01 proposal seeks to address the Healthcare & Social Assistance NORA sector, objective 1: “Assess how work organization impacts both worker and patient safety” specifically through its direct relevance to the Healthy Work Design and Well-being cross-sector. This proposal addresses a high priority area outlined in the 2019-2023 NIOSH strategic goals to improve safe and healthy work design and well- being in the resident population: Intermediate Goal 7.2C “Fatigue, stress, work organization as risk factors for motor vehicle crashes during commutes and shifts.” Motor vehicle crashes (MVCs) are a leading cause of death and a major contributor to MVCs is driver fatigue. Sleepiness, fatigue, and stress, common among surgical residents, negatively impact driving safety. Balancing resident well-being with the necessary training hours and caseloads during residency has long been subject to debate. Although a concern among healthcare workers, the relationship of resident well-being and work organization factors with crash risk have received little study. The study's central hypothesis is that measures of well-being and work organization predict crash risk among surgical residents, and because resident well-being and work organization may change over time, crash risk changes over time. The long-term goal of the research program and career training is to characterize the trajectory of injury risk as a function of well-being and work organization and translate findings to evidence-based interventions implemented in healthcare work settings. In this first-of-its kind longitudinal study, the well-being, work organization, and driving performance of 50 surgical residents will be monitored over 18 months. The longitudinal design permits the study of resident well-being and crash risk through shifting work organization factors. Multiple methods will measure well-being and driving outcomes at 4 time points over 18 months, including objective measurements of sleep (wristwatch actigraphy), occupational stress (salivary cortisol), and a high fidelity driving simulator with advanced eye tracking providing detailed metrics of crash and drowsy driving risk. Aim 1: Characterize the trajectory of worker well-being (sleep, fatigue, and stress) and work organization (case load, duty start/end times, shift duration) on crash risk over 18 months of residency. Aim 2: Characterize the trajectory of crash risk over 18 months of residency. MVCs are costly to society and understudied in surgical residents. The findings of the proposed work have the potential to reduce MVCs by shaping standards regarding duty hours and caseloads during residency training. This K award will propel the next step of the PI's career: submitting an R grant using a Research to Practice (r2p) approach to conduct an intervention study developing and evaluating training for residents on long work hours. This future research will examine effectiveness of work designs informed by the findings of the proposed research and reduce the burden of motor vehicle crashes sustained by healthcare workers.