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The hidden curriculum: requiem for a surgical dream
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    The effect of sleep deprivation on surgical skill can be measured

    A study performed in the United States lends support to the recommendations made by the European Working Time Directive regarding "ring fencing" of rest times for surgical trainees. In that study the effect of daytime sleepiness(measured on the Epworth Sleepiness Scale(ESS) was measured in 19 surgical trainees in otolaryngology-head and neck surgery programmes in 2 academic institution. ESS was documented, and surgical skill(in performig septoplasty) was evaluated by attending physicians using a global assessment tool and a skill-based visual analog scale. The attending physicians were unaware of the trainees' report on the ESS. Trainees, themselves, were also required to rate their own performance. The outcome was that , in regression analysis, there was a statistically significant inverse association between ESS scores and attending physician-rated technical skill both for the global assessment tool(p < 0.001), and for the visual analog scale(p=0.03)(1). Using both parameters the self-rated scores obtained by the trainees did not reach statistical significance(1). In other words, the trainees did not recognise the effect that daytime sleepiness was having on their surgical performance.
    The wider inference that can be drawn is as follows:-
    Daytime sleepiness impairs performance even though the trainee may be unaware of this adverse effect
    These observations are generalisable both to trainees and to consultant staff

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    Conflict of Interest:
    None declared.