Fatigue as impairment or educational necessity? Insights into surgical culture.

The authors examine fatigue culture among surgical residents and faculty members and whether it squares with recent, fatigue-focused Accreditation Council for Graduate Medical Education (ACGME) policies and educational initiatives. Field observations of an academic general surgery program were supplemented with interviews (52 residents and 58 faculty members) conducted as part of a study of 15 general surgery programs. Field notes and interviews were analyzed for main themes. Most believe that fatigue surfaces after 24 hours of work and has minor consequences. Surgeons believe that residents can learn to manage fatigue and that surgical practice requires that capacity. Proper training implies that residents experience fatigue, learn to perform capably and confidently while fatigued, and recognize their limits. Encountering and learning to manage fatigue are seen as educational necessities by surgeons, a view that runs counter to ACGME initiatives, requires reconsideration, and demands that attention be directed to professional and organizational practices that sustain fatigue culture.