Mental Health Issue related to Night Shift among Medical Student

Lefkothea Zacharopoulou MD

Faculty of Medicine, Medical University of Sofia, Bulgaria

Health is a basic human right. To ensure the quality of a good life and well-being, the World Health Organization has addressed major health issues on Sustainable Development Goals.  The third goal includes mental health. Data from the World Health Organization showed that progress has been made in reducing the global suicide rate (from 12.9 per 100,000 in 2000 to 10.6 per 100,000 in 2016). However, in young people aged 15-29 years old, suicide remains the second-highest cause of death (WHO, 2018).

The number of students reporting mental health condition is increased five times in the last decade, and around a third of those studying medicine worldwide suffer from depression, at the same time 11% have suicidal thoughts (Rotenstein et al, 2016). The student can suffer from mental health because of stress to studying medicine, a lot of homework, being far away from parents make the student have to deal with their own problems may cause anxiety and depression. In the end, an imbalance between work and enjoying life may cause a mental health issue. This was seen a lot in the clinical medical student who has burnout because of night shift work.

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The Hong Kong Public Doctors’ Association (HKPDA) recommended limiting the working hours for at most 65 hours in a week. This recommendation is different from the regulation from the Accreditation Council for Graduate Medical Education (ACGME) to limit work-hours to 80 hours a week (Hospital Authority, 2009; ACGME, 2011).

The curriculum of clinical clerks in Indonesia is nearly the same in all Indonesian medical school. The curriculum consists of 2 major activities, the morning lessons and the night shift rotation. Morning lessons start every weekday from 7 o’clock till 2 or 3 o’clock in the afternoon. These morning lessons include lecture, bedside teaching, morning report, and case discussion. Besides the morning lessons, clinical clerks also sometimes take turns in night shift rotation each day. A number of turns of night shift rotation per week for a clinical clerk depended on the department they currently are. In the major departments like internal medicine, pediatric, obstetric-gynaecology, anaesthesia, and general surgery, each clinical clerks can have up to 3-4 turns of night shift rotation per week.

The night shift rotation usually starts from 3 p.m. until 7 a.m. on the next day. So, to sum it up, each clinical clerks are required to attend morning lessons every weekday and take turns in doing night shift clinical rotation. It means if a clinical clerk is having schedule to do night shift rotation in that day, the total hours of the work are approximately 32 hours each time comprised of morning lessons from 7 a.m. to 3 p.m., then night shift rotation from 3 p.m. to 7 a.m. the next day, and next day morning lessons from 7 a.m. to 3 p.m. (FK UNAIR, 2013). Imagine, if the average of clinical clerks is doing night shift rotations 3-4 times a week, then the total hours of work in a week can nearly reach 100 hours a week or maybe more. In western countries, medical students were experienced night shift by work with the resident. The hospital shift takes 24 to 36 hours to include overnight cal (Alexander and Bushell, 1999; Petersdorf and Bentley 1989). However, there is no official guideline about night shift hours in medical students yet. This is important because medical students have to join a class the next day while working on the previous night.  

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Evidence had shown the imbalance between workload and night shift hours can damage both patients and clinical clerks. Some studies showed that physicians-in-training that have been working for more than 24 hours shift has been found to make 36% medical errors, five times diagnostic errors, and at great risk injuring themselves with sharp injuries. They also had a twice greater risk of experiencing motor vehicle crash when driving homes (Landrigan C.P., et al., 2004; Lockley S.W., et al, 2004; Ayas N.T., et al., 2006; Barger L.K., et al., 2005). To ensure the safety of the patient and clinical clerks, the government and related stakeholders should pay attention to policymakers regarding the issues.

Future projects about social aspects and country culture should be considered as part of the policy in order to create a better national health system in the future. To reduce burnouts, an official night shift hours for medical students should be made. Also, a routine counselling program regarding mental health issue in medical students should be available for free at every university in order to improve the mental health and wellbeing of medical students.

References:

ACGME. ( 2011). The ACGME 2011 Duty Hour Standard; Enhancing Quality of Care, Supervision and Resident Professional Development. Accreditation Council for Graduate Medical Education. Chicago, IL.

Alexander D, Bushell IW. (1999). Coping with night call: part 1: understanding the benefits and challenges of traditional call. Hosp Physician. 53–69.

Ayas N.T., et al. (2006). Extended work duration and the risk of self-reported percutaneous injuries in interns. JAMA 296:1055–1062.

Barger L.K., et al. (2005). Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 352:125–134.

Fakultas Kedokteran Universitas Airlangga. (2013). Buku Pedoman Kepaniteraan (Dokter Muda) Kurikulum Berbasis Kompetensi: Departemen Anestesiologi dan Reanimasi. Surabaya: FK UNAIR-RSUD Dr. Soetomo

Hospital Authority. (2009). Final Report on Doctor Work Reform 2009/10. Hospital Authority. Hongkong.

Landrigan C.P., et al. (2004).  Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 351:1838–1848.

Lockley S.W., et al. (2004).  Effect of reducing interns’ weekly work hours on sleep and attentional failures. N Engl J Med 351:1829–1837.

Petersdorf RG, Bentley J. (1989). Residents’ hours and supervision. Acad Med. Apr; 64(4):175-81.

Rotenstein LS, Ramos MA, Torre M, et al. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students. JAMA. 316:2214-36.

World Health Organization. (2018). Draft thirteenth general programme of work 2019–2023. Report by the Director-General. Geneva. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA71/A71_4-en.pdf?ua=1or [cited 2019 October 26].

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