The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index; 1 of the 25 sources its claims cite were checked for support.
Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures
Open accessAbstract
Background Knowledge of the physiological effects of extended (24 hours or more) work shifts in postgraduate medical training is limited. We aimed to quantify work hours, sleep, and attentional failures among first-year residents (postgraduate year 1) during a traditional rotation schedule that included extended work shifts and during an intervention schedule that limited scheduled work hours to 16 or fewer consecutive hours. Methods Twenty interns were studied during two three-week rotations in intensive care units, each during both the traditional and the intervention schedule. Subjects completed daily sleep logs that were validated with regular weekly episodes (72 to 96 hours) of continuous polysomnography (r=0.94) and work logs that were validated by means of direct observation by study staff (r=0.98). Results Seventeen of 20 interns worked more than 80 hours per week during the traditional schedule (mean, 84.9; range, 74.2 to 92.1). All interns worked less than 80 hours per week during the intervention schedule (mean, 65.4; range, 57.6 to 76.3). On average, interns worked 19.5 hours per week less (P Conclusions Eliminating interns' extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours.
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The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“The increased incidence of attentional failures during night work among interns during the traditional as compared with the intervention schedule may impede their ability to care for patients and their education.27 , 37”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
What the sources say
- Could not verifycites [27] sourceExperimental — accuracy not yet measured
The Results and Discussion passages (page not provided) concern sleep-dependent motor-skill learning, not interns’ night work. Searches for attentional failures, traditional versus intervention schedules, patient care, and interns’ education found no passage addressing the claim. (LLM, conf=0.75)
- Not checked — no full text of the sourcecites [37] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Could not verify
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In the paper
“The traditional schedule had three times as many shifts that were prefaced by fewer than 2 hours of sleep in the preceding 24 hours and more than twice as many attentional failures during night work as did the intervention schedule.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Furthermore, during both the traditional and the intervention schedule, reported work hours often exceeded both the scheduled weekly hours and the number of consecutive work hours scheduled, owing to the interns' obligation to ensure the continued care of their patients after their own shift was over.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and 1.5 times the rate during the day (7 a.m. to 10 p.m.) (P=0.07).”
- Also stated in: § attentional failures · hedged
“a trend (P=0.07)toward a reduction in attentional failures during day and evening call (7 a.m. to 10 p.m.) was also apparent”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Also stated in: § attentional failures · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“slept more in the 24 hours preceding each working hour (P<0.001)”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“All interns worked less than 80 hours per week during the intervention schedule (mean, 65.4; range, 57.6 to 76.3).”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The percentage of work hours preceded by more than 8 hours of sleep in the prior 24 hours was 17 percent during the traditional schedule and 33 percent during the intervention schedule (P<0.001)”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > duration of work and sleep
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“with 21 percent of these work hours logged after more than 24 hours of continuous duty.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > work hours
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Attentional failures occurred at more than double the rate during the night (from 11 p.m. to 7 a.m.) on the traditional schedule as compared with the intervention schedule (P=0.02)”
- Also stated in: § attentional failures · plain
“more than twice as many attentional failures during night work as did the intervention schedule.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § attentional failures · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“On average, interns worked 19.5 hours per week less (P<0.001)”
- Also stated in: § work hours · plain
“All 20 interns worked longer during the traditional schedule (mean, 84.9±4.7 hours per week; range, 74.2 to 92.1) than during the intervention schedule (mean, 65.4±5.4hours per week; range, 57.6 to 76.3; P<0.001)”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § work hours · plain
- It may state two separate claims as one. 17
- Probably not a substantial claim. 7
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“During the traditional schedule, 31 percent of work hours were preceded by 4 or fewer hours of sleep in the preceding 24 hours and 19 percent of work hours were preceded by 2 or fewer hours of sleep in the previous 24 hours, as compared with 13 percent and 6 percent, respectively, during the intervention schedule (P<0.001 for both comparisons)”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > duration of work and sleep
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“On average, interns slept for 1.76±1.04hours between 9 p.m. and 8 a.m. during the traditional schedule, significantly longer than they slept while working the corresponding hours during the intervention schedule (1.29±0.90hours per shift, P=0.02).”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > duration of work and sleep
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The weekly durations of sleep and work were significantly inversely correlated (r=¡0.57,P<0.001), with a predicted loss of 19.2 minutes of sleep per week for each additional hour of work per week (Fig. 3C).”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > duration of work and sleep
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The intervention schedule had no extended work shifts (Fig. 4B), and 96 percent of work hours occurred within the 16 hours scheduled, in contrast to the traditional schedule, in which only 58 percent of work hours occurred within the first 16 hours on duty.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > work hours
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“During the traditional rotation, over half of work shifts (133 of 223, or 60 percent) were extended (more than 24 hours) and 84 percent of work hours (4255 of 5036) occurred during these shifts”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > work hours
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“he accreditation council for Graduate Medical Education (ACGME) has recently limited work hours for U.S. medical residents to less than 320 hours in a four-week period, with up to 32 additional hours for programs granted exceptions. 1”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > results
What the sources say
- Not matchedcites [1] Common program requirements (resident duty hours). Chicago: Accreditation Council for Graduate Medical Education, February 2003. (Accessed October 4, 2004, at http://www.acgme.org/DutyHours/dutyHoursCommonPR.pdf.)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
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In the paper
“considering the fact that caffeine use, compliance with the protocol, and individual differences in the need for sleep among subjects could not be controlled in this field study.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our findings may apply not only to residents working in critical care units but also to those on other rotations and specialties and to more senior residents, attending physicians, nurses, and others.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Strength:hedged· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“It is noteworthy that interns took prophylactic naps before two thirds of the overnight shifts during the intervention schedule, thereby preemptively attenuating the deleterious effects on alertness and neurobehavioral performance of continuous wakefulness and blunting the circadian performance nadir.38”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
What the sources say
- Not matchedcites [38] Jewett ME. Models of circadian and homeostatic regulation of human performance and alertness. (Ph.D. thesis. Cambridge, Mass.: Harvard University, 1997.)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This sizable and unidentified proportion of the population may be particularly vulnerable to the effects of extended work shifts and chronic sleep restriction imposed during residency training, possibly unwittingly placing themselves and their patients at markedly increased risk for fatigue-related errors.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes? Checkable: unclear? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Slow eye movements are correlated with performance failures on the psychomotor vigilance task 21 and are reduced by treatments that counteract fatigue and thus improve neurobehavioral performance.[34][35][36]”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
What the sources say
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The number of slow eye movements recorded during all waking polysomnographic epochs was determined by a single scorer according to established criteria in an unblinded fashion.21 Results were then validated in a blinded fashion by an independent scorer who compared them with the rates recorded from 9 p.m. to 3 p.m. in a subgroup (10 percent) of EOG recordings (r=0.94,P<0.001).”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional-failure measurements
What the sources say
- Not checked — no full text of the sourcecites [21] Cajochen C, 1999, Am J Physiol source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our data on actual work hours reveal that the max-imal number of scheduled work hours must be much lower to allow for this inevitability.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Using a within-subjects design, we studied 20 interns during two three-week rotations in the medical intensive care unit (MICU) and coronary care unit (CCU) while they followed a traditional schedule with extended work shifts of 30 consecutive hours scheduled every other shift and an intervention schedule in which work shifts were a maximum of 16 consecutive hours scheduled.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > coverage schedules
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The presence of slowrolling eye movements during wakefulness is indicative of profound fatigue in both occupational settings 29 and laboratory settings 21 and parallels subjective sleepiness, theta activity on electroencephalography, and impaired neurobehavioral performance 21,29”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
What the sources say
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“we believe it unlikely that simply decreasing the number of hours worked in a week without incorporating the underlying principles of sleep physiology would yield a similar increase in sleep or reduction in attentional”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study provides objectively validated data on work hours, sleep, and attentional failures among medical trainees in situ and quantifies the effects of eliminating extended work shifts on these measures.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Eliminating interns' extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours.”
- Also stated in: § attentional failures · plain
“The elimination of extended work shifts had a significant effect on the number of hours worked by interns, the duration of sleep, and the rate of attentional failures.”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § attentional failures · plain
In the paper
“Since nearly a third of their work hours (31 percent) were thus preceded by 6 or fewer hours of sleep in the preceding 24 hours, they continued to carry a substantial sleep debt, accounting for the high residual rate of attentional failures on both schedules, even during the day.22”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > attentional failures
What the sources say
- Not checked — no full text of the sourcecites [22] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Subjective reports indicated that, before the new regulations were implemented, some trainees worked up to 140 hours per week, [12][13][14][15][16] although the validity of such reports has been questioned.3,17”
§ Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures > results
What the sources say
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
Knowledge of the physiological effects of extended (24 hours or more) work shifts in postgraduate medical training is limited.
“Knowledge of the physiological effects of extended (24 hours or more) work shifts in postgraduate medical training is limited.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A randomised controlled trial found that limiting first-year resident physicians to 16 consecutive work hours significantly improved resident alertness and patient safety.”
From National improvements in resident physician-reported patient safety after limiting first-year resident physicians’ extended duration work shifts: a pooled analysis of prospective cohort studies (2023) · cites this paper as [7]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Diaries were based on ones previously validated against the gold-standard for sleep assessment (polysomnography) in resident physicians55 and used in shift-workers56.”
From Irregular sleep/wake patterns are associated with poorer academic performance and delayed circadian and sleep/wake timing (2017) · cites this paper as [55]
In the citing paper
“Young children, being unmarried (19,26), working long hours (11,27,28), overweight and obesity (3-5), and measures of poor health (13,14,16,20,37,38,40) including acute and chronic respiratory conditions, pain, and anxiety increase the odds of short sleep and have a null or inverse association with long sleep.”
From Sleep Duration in the United States: A Cross-sectional Population-based Study (2009) · cites this paper as [11]
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“Lockely et al showed similar values in interns on call.(15)”
BackgroundBurnout syndrome among medical residents: A systematic review and meta-analysis
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Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attentional Failures
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Self-citationSleep and Circadian Rhythms in Humans
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Self-citationEffects of Critical Care Nurses’ Work Hours on Vigilance and Patients’ Safety
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Self-citationEffects of Health Care Provider Work Hours and Sleep Deprivation on Safety and Performance
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“98) with continuous observation and polysomnographically determined sleep, respectively.(5) The number of work hours reported on the survey per month (mean S.”
BackgroundSelf-citationPatient Safety in the Cardiac Operating Room: Human Factors and Teamwork
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“Elimination of extended work hour shifts for interns did show an increase in sleep along with decreased attentional failures during night work hours in the ICU.(57)”
BackgroundInfluentialHigh risk of near-crash driving events following night-shift work
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“Overall, the results of this study corroborate previous findings that increased nurse work hours are related to adverse events in patients (Landrigan et al., 2004; Lockley et al., 2004; Rogers et al., 2004; Scott et al., 2006).”
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Circadian and wakefulness-sleep modulation of cognition in humans
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Possible Broad Impacts of Long Work Hours
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Accidental Deaths, Saved Lives, and Improved Quality
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Self-citationNaps, cognition and performance
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Demographic factors, fatigue, and driving accidents: An examination of the published literature
Milia, L. V. D., Smolensky, M. H., Costa, G., Howarth, H. D., Ohayon, M. M., & Philip, P. (2010) · Accident Analysis & Prevention · doi:10.1016/j.aap.2009.12.018 · Cited by 206
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Self-citationImpact of long work hours on police officers and the communities they serve
Vila, B. (2006) · American Journal of Industrial Medicine · doi:10.1002/ajim.20333 · Cited by 179
Disturbed Sleep in Shift Workers, Day Workers, and Insomniacs
Åkerstedt, T., Ingre, M., Broman, J., & Kecklund, G. (2008) · Chronobiology International · doi:10.1080/07420520802113922 · Cited by 180
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“[12] Data suggest that psychological morbidities and burnout among medical professionals are often associated with more medical errors and poor patient outcomes.[13-15]”
BackgroundSurgeons’ Non-technical Skills
Yule, S., & Paterson‐Brown, S. (2011) · Surgical Clinics of North America · doi:10.1016/j.suc.2011.11.004 · Cited by 180
Rodríguez‐Rey, R., Palacios, A., Alonso‐Tapia, J., Pérez, E., Álvarez, E., Coca, A., Mencía, S., Marcos, A., Colunga, J. M., Fernández, F., et al. (2018) · Australian Critical Care · doi:10.1016/j.aucc.2018.02.003 · Cited by 180
Sleep and errors in a group of Australian hospital nurses at work and during the commute
Dorrian, J., Tolley, C., Lamond, N., van den Heuvel, C. J., Pincombe, J. I., Rogers, A. E., & Dawson, D. E. (2008) · Applied Ergonomics · doi:10.1016/j.apergo.2008.01.012 · Cited by 166
Assessing Quality in Obstetrical Care: Development of Standardized Measures
Mann, S., Pratt, S. D., Gluck, P., Nielsen, P. E., Risser, D. T., Greenberg, P., Marcus, R. G., GOLDMAN, M. B., Shapiro, D. E., Pearlman, M. D., et al. (2006) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(06)32065-x · Cited by 164
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A Pilot Study of the Safety Implications of Australian Nurses' Sleep and Work Hours
Dorrian, J., Lamond, N., van den Heuvel, C. J., Pincombe, J. I., Rogers, A. E., & Dawson, D. E. (2006) · Chronobiology International · doi:10.1080/07420520601059615 · Cited by 162
“This significantly increased the amount of sleep interns received and reduced the number of attentional failures they experienced by over 50% (Lockley et al., 2004).”
BackgroundEffects of the 2011 Duty Hour Reforms on Interns and Their Patients
Sen, S., Kranzler, H. R., Didwania, A. K., Schwartz, A. C., Amarnath, S. R., Kolars, J. C., Dalack, G. W., Nichols, B., & Guille, C. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.351 · Cited by 158
Interns' Compliance With Accreditation Council for Graduate Medical Education Work-Hour Limits
Landrigan, C. P., Barger, L. K., Cade, B. E., Ayas, N., & Czeisler, C. A. (2006) · JAMA · doi:10.1001/jama.296.9.1063 · Cited by 150
“In addition, house officers are typically unwilling to depart precipitously at the scheduled change of shift when an emergent patient care situation demands their continued presence.(18) Such situations are common in high intensity settings, yet most scheduling systems do not account for these commonplace emergencies.”
BackgroundSelf-citationSanthi, N., Horowitz, T. S., Duffy, J. F., & Czeisler, C. A. (2007) · PLoS ONE · doi:10.1371/journal.pone.0001233 · Cited by 152
“While these results together with data from other studies [24,41] suggest that the risk for errors and accidents may be substantially higher on the first night shift than on any other night shift, there is some evidence to the contrary from field studies [44].”
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“We identified 3 studies reported in 4 articles describing a 16-hour shift (43, 44, 51, 93), which is the shift duration recommended by the IOM (1) and adopted for interns in the new ACGME standards (2, 3).”
MethodThe Attitudes and Experiences of Trainees Regarding Disclosing Medical Errors to Patients
White, A. A., Gallagher, T. H., Krauss, M. J., Garbutt, J. M., Waterman, A. D., Dunagan, W. C., Fraser, V. J., Levinson, W. S., & Larson, E. B. (2008) · Academic Medicine · doi:10.1097/acm.0b013e3181636e96 · Cited by 148
Circadian misalignment affects sleep and medication use before and during spaceflight
Flynn-Evans, E. E., Barger, L. K., Kubey, A. A., Sullivan, J. P., & Czeisler, C. A. (2016) · npj Microgravity · doi:10.1038/npjmgrav.2015.19 · Cited by 148
Self-citationHuman Performance and Patient Safety
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Bargaining and trust: the effects of 36‐h total sleep deprivation on socially interactive decisions
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Factors associated with burnout among US neurosurgery residents: a nationwide survey
Attenello, F. J., Buchanan, I. A., Wen, T., Donoho, D. A., McCartney, S., Cen, S. Y., Khalessi, A. A., Cohen-Gadol, A. A., Cheng, J. S., Mack, W. J., et al. (2018) · Journal of Neurosurgery · doi:10.3171/2017.9.jns17996 · Cited by 145
“15,17,28,39,59, 60,69 Burnout is the by-product of unchecked professional and emotional distress in the context of workplace dissatisfaction.”
BackgroundSelf-Reported Changes to Nighttime Sleep After Traumatic Brain Injury
Parcell, D. L., Ponsford, J. L., Rajaratnam, S. M. W., & Redman, J. R. (2006) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2005.10.024 · Cited by 145
Long Working Hours and Cognitive Function: The Whitehall II Study
Virtanen, M., Singh‐Manoux, A., Ferrie, J. E., Gimeno, D., Marmot, M. G., Elovainio, M. J., Jokela, M. M., Vahtera, J., & Mika Kivimaki, B. (2008) · American Journal of Epidemiology · doi:10.1093/aje/kwn382 · Cited by 161
The Effects of On-Duty Napping on Intern Sleep Time and Fatigue
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Rajaram, R., Chung, J. W., Jones, A. T., Cohen, M. E., Dahlke, A. R., Ko, C. Y., Tarpley, J. L., Lewis, F. R., Hoyt, D. B., & Bilimoria, K. Y. (2014) · JAMA · doi:10.1001/jama.2014.15277 · Cited by 139
Intraoperative Transitions of Anesthesia Care and Postoperative Adverse Outcomes
Saager, L., Hesler, B. D., You, J., Turan, A., Mascha, E. J., Sessler, D. I., & Kurz, A. M. (2014) · Anesthesiology · doi:10.1097/aln.0000000000000401 · Cited by 140
Work patterns and fatigue-related risk among junior doctors
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The relationship between long working hours and depression among first-year residents in Japan
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“Extended work shifts lasting for 24 h or more are associated with higher rates of attentional failure during night work hours compared with shifts of consecutive 16 h or fewer [10].”
BackgroundTobaldini, E., Cogliati, C., Fiorelli, E. M., Nunziata, V., Wu, M. A., Prado, M., Bevilacqua, M., Trabattoni, D., Porta, A., & Montano, N. (2013) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2013.03.011 · Cited by 127
“For instance, while some studies reported a reduction in clinical performances and cognitive functions in young resident physicians undergoing chronic sleep loss [38–40] others did not [41].”
ResultMartini, S., Arfken, C. L., & Balon, R. (2006) · Academic Psychiatry · doi:10.1176/appi.ap.30.4.352 · Cited by 128
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“While work intensification may still be a problem in a modified bolus system that uses 16-hour rotating call shifts, the risk of sleep loss is substantially lower when compared with the traditional bolus model with shifts in excess of 24 hours.(36) Missing sleep and shift duration data may have resulted in systematic…”
BackgroundPark, S., Cho, M. J., Chang, S. M., Bae, J. N., Jeon, H. J., Cho, S., Kim, B., Chung, I., Ahn, J. H., Lee, H. W., et al. (2010) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2010.00841.x · Cited by 124
“…Society 567 (Krueger and Friedman, 2009; Park et al., 2009), depression (Patel et al., 2006), automobile accidents (Pack et al., 2006), work failures (Lockley et al., 2004), learning and memory problems (Stickgold et al., 2001) and excess mortality (Ferrie et al., 2007; Kripke et al., 2002).”
BackgroundErtel, K. A., Berkman, L. F., & Buxton, O. M. (2011) · SLEEP · doi:10.1093/sleep/34.4.509 · Cited by 122
Sleep Deprivation, Physician Performance, and Patient Safety
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Effect of fatigue, workload, and environment on patient safety in the pediatric intensive care unit
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“(27) studied the same group of interns but addressed the issue of chronic sleep deprivation by having the interns work on a primarily ambulatory rotation for the 2 wks proceeding each study period.”
BackgroundAltered sleep/wake patterns and mental performance
Åkerstedt, T. (2006) · Physiology & Behavior · doi:10.1016/j.physbeh.2006.09.007 · Cited by 126
Fisman, D. N., Harris, A. D., Rubin, M. A., Sorock, G. S., & Mittleman, M. A. (2007) · Infection Control and Hospital Epidemiology · doi:10.1086/510569 · Cited by 118
Revisiting Duty-Hour Limits — IOM Recommendations for Patient Safety and Resident Education
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Metadata
- Authors
- Lockley, S. W., Cronin, J. W., Evans, E. E., Cade, B. E., Lee, C. J., Landrigan, C. P., Rothschild, J. M., Katz, J. T., Lilly, C. M., Stone, P. H., Aeschbach, D., & Czeisler, C. A.
- Affiliations
- Brigham and Women's Hospital (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2004-10-28
- Volume
- 351
- Issue
- 18
- Pages
- 1829-1837
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2166406376
- Cited by
- 913
- References
- 41
- Citations by year
- 2026: 20 · 2025: 32 · 2024: 24 · 2023: 24 · 2022: 26 · 2021: 31 · 2020: 19 · 2019: 46 · 2018: 36 · 2017: 33 · 2016: 37 · 2015: 41 · 2014: 57 · 2013: 49 · 2012: 54
- FWCI
- 87.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Funders
- National Aeronautics and Space Administration (NCC958)
- Brigham and Women's Hospital (M01 RR02635, T32 HL079010)
- National Space Biomedical Research Institute (NCC 9‐58)
- Wellcome Trust
- Agency for Healthcare Research and Quality (F32 HS14130, K08 HS13333, R01 HS 12032, RO1 HS12032)
- National Heart, Lung, and Blood Institute (T32 HL079010)
- National Center for Research Resources (M01RR002635)
- National Institute for Occupational Safety and Health (R01 OH07567)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- sleep duration, attentional failures, graduate medical education, intensive care unit, sleep deprivation, resident fatigue
- MeSH terms
- Adult, Attention, Female, Humans, Intensive Care Units, Internal Medicine, Internship and Residency, Male, Personnel Staffing and Scheduling, Sleep, Sleep Deprivation, Work Schedule Tolerance, Workload, Polysomnography
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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