Sleep is a need, even for medical trainees

These days, amid pandemics and floods and that one little ache in your back you just can't seem to figure out no matter how much physio you do or turmeric you eat, science appreciates a truth we all intuitively know.

Going without sleep is bad for us. Thanks to those like "sleep diplomat" Matthew Walker, our appreciation of this truth is increasingly empirical. His book "Why We Sleep" is an encompassing summary of the research to date outlining the ways in which sleep deprivation both physiologically and psychologically harms the human animal. If you haven't read it yet, pick it up and give it a read.

But don't lose sleep over it.

The irony, though, is that those in our society supposed to have the greatest authority on evidence-based health practices - medical doctors - so infrequently practice what they preach. Indeed, doctors are socialized by their training to systematically undervalue sleep and minimize it as a biological necessity. And no one is immune to our cultural icons who value productivity at all costs.

As others have pointed out, the Canadian medical education system is one in which medical clerks and residents are regularly scheduled to undertake 26 hour "call" shifts, frequently working diligently, without sleep, the entire time. If you're lucky, you get a chance to grab a bite on the run, and a 2-3 hour nap.

During your medical training, you can have these call shifts as often as every fourth day for months at a time, or even more frequently in some small (usually surgical) residency programs. As all medical trainees know, the official "max" 26 hours call-shift length tends to be a loose one, frequently pushed longer into your "post-call" day by the need to see patients, review cases with your staff doctor (i.e. your boss), and various other tasks. Moreover, many of our surgical colleagues even forego the coveted "post-call" day, pushed by competitive career pressures and training programs that value case volume over personal health.

Anecdotally, when you ask the powers that be about the rationale for this, your answer is frequently: "it used to be worse".

Despite the seeming absurdity to the outside observer, there are many complex reasons why medical trainees are so sleep deprived - some of them good, some of them not. A lot of them not.

One crux of the problem, it seems, is balancing on the one side:

• The need for large volumes of hours on the part of trainees to achieve sufficient medical expertise +

• Our system's need for large volumes of cheap medical labor to care for patients in our publicly-funded healthcare system

And on the other side:

• The needs of medical trainees for basic health maintenance activities.

I would argue that the increasing rates of burnout, mental illness, and suicide among physicians, as well as the not-insignificant risks posed to patients being cared for by severely sleep deprived teams constitute a tip in this balance too far in one direction.

Earlier this year, I pitched the idea for a paper on sleep in medical training to my peers at UBC Wellness Initiative Network. We formed a crack team of UBC medical trainees and sleep enthusiasts, and over the year we put together a position paper making a case for rethinking the approach to sleep within medical education, and medical culture more broadly.

You can read it here.

The solutions will not be straightforward - the systemic pressures at root of our tiredness won't change by writing an article or demanding wellness rights for medical trainees. We'll have to be creative.

To this end, in our paper, we made some recommendations to Canadian medical institutions. They're not perfect, but they're a start. Just over a month ago, we presented the position paper to the annual CFMS AGM, where it was adopted unanimously.

Pandemic or no, in the era of evidence-based medicine, it's time for our medical system to begin practicing what it preaches. Sure, it used to be worse, but we know better now.