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The residency period of medical training frequently requires continuous on-call periods, with sleepless intervals lasting up to 36 hours or longer. Such intense work schedules frequently encourage the development of attitudes contrary to the intended one of dedication to serving man. The opposite effect, callous indifference or inadequate care, is more often encountered. The effect this extended period of on-call attendance, with its accompanying sleeplessness, has on the individual, his mental functional capacity, short term memory, coordination, judgment and his ability to perform the duties of a physician, was studied. The participants in the study were drawn from the house staff of Cook County Hospital, while on either the internal medicine or pediatric rotations. Sixty-three residents volunteered for the project, which was conducted from October through December of 1988. The Neurobehavioral Evaluation System 2 (NES2) was employed for central nervous system (CNS) testing. This instrument consists of 15 computerized behavioral and mood evaluation tests. The self-administered NES2 tests employed in this study were intended to measure vigilance, dexterity, speed and coding ability. Mental manipulation was evaluated using the Horizontal Addition Test. The examinations were conducted three times. Various personal habits and behavioral patterns were documented and the individual responses to the questionnaires closely monitored. The rigors of extended sleep depravation and challenges of the constant decision processes showed up in the statistically significant decreases in the performance quality in all areas of the test. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sixty-three medical residents were tested on a battery of computer-based, self-administered neurobehavioral tests before and after a 36-hour in-hospital call plus postcall day to assess the central nervous system effects of the call experience and its accompanying sleep deprivation. Statistically significant decreases in performance were found postcall on tests of sustained visual attention (P < 0.0001), speed and coding ability (P < 0.0001) and short-term recall (P < 0.0001). Hand-eye coordination improved (P < 0.02).