Out of 100% (n=146) participants; 54% (n= 79) were females, while 46% (n= 67) were males. The average age of the participants were 27_+1 year. Surgical disciplines had a response rate of 60% (n= 87) and non-surgical disciplines had 40% (n= 59). Among them eighty-two percent (82%, n= 120) participants work for more than 80 hours a week. The variables studied (effects of long working hours) were exhaustion (46.6%, n= 68), lost in environment (41.4%, n=60), errors or negligence (25%, n=36), disturbed relations with the family (41.1%, n=60) effect on academic performance (43.2%, n=62).
Table 1
Statistical Analysis of effects of prolonged duties
Sr no. | Survey questions about effects | Frequency (n) | Percentage (%) | Median | Mode | Mann-Whitney test | [p-value] |
Rarely/ Occasionally | Frequently/ Very frequently |
1. | Feeling sleeping at work | | 72 | 50% | 3.00 | 3 | 2388.000 | .441 |
2. | Slowing of reflexes | | 55 | 37 | 4.00 | 4 | 2512.000 | .962 |
3. | Tiredness at work( during extended duties) | | 68 | 46% | 4.00 | 4 | 2415.000 | .641 |
4. | Lost from surroundings | 60 | | 41.1% | 4.00 | 4 | 2206.000 | .177 |
5. | Chances of error at work place | 71 | | 48% | 3.00 | 3 | 2393.500 | .573 |
6. | Detachment from environment | 50 | | 34% | 3.00 | 3 | 2559.000 | .975 |
7. | Strained relation with family | | 60 | 41% | 4.00 | 4 | 2478.500 | .712 |
8. | Irregular/skipping meals | | 74 | 50% | 5.00 | 5 | 2222.000 | .131 |
9. | Effects on physical & mental health | 61 | | 41.7% | 3.00 | 3 | 2326.000 | .312 |
10. | Effect on educational performance | | 63 | 43.1% | 4.00 | 4 | 2562.000 | .985 |
11. | Effect of educational failure on performance at work | | 83 | 56% | 3.00 | 3 | 2243.000 | .549 |
The coping mechanism were taking caffeinated drinks (52.7%, n=76), talking to their colleagues (35.6%, n=51) and eating/munching (41.1%, n=60). Nevertheless, majority of doctors neither smoked (79%, n=115) nor used drugs/ alcohol as coping mechanism (86%n=125), likewise, error at work place was occasional.
Table 2
Statistical analysis of web based survey about coping strategies
Sr .no | Survey Questions about coping | Frequency (n) | Percentage (%) | Median | Mode | Man-Whitney Test | [p-value] |
Occasionally/Rarely | Frequently/very frequently |
1. | Formal training/ stress management workshop at start of training | | 0 | 0% | 2.00 | 2 | 2524.000 | .626 |
2. | Frequency of power naps to remain alert | | 87 | 59.5% | 3.00 | 3 | 2536.000 | .895 |
3. | Frequency of micro breaks to remain fresh | | 92 | 63% | 3.00 | 3 | 2268.000 | .201 |
4. | Intake of caffeinated drinks | | 77 | 52% | 4.00 | 4 | 2333.500 | .311 |
5. | Help from seniors/mentors to cope with long duties | | 114 | 78% | 3.00 | 3 | 2109.500 | .058 |
6. | Seeking social support as coping mechanism | | 89 | 60% | 3.00 | 3 | 2372.000 | .420 |
7. | Talking to friends and family | | 79 | 54% | 3.00 | 3 | 2420.000 | .541 |
8. | Talking to colleagues as coping strategy | | 52 | 35% | 3.00 | 4 | 2349.000 | .461 |
9. | Food as mood elevator | | 60 | 41% | 4.00 | 4 | 2481.000 | .723 |
10. | Seeking medical advice | 47 | | 32% | 2.00 | 1 | 2044.000 | .029 |
11. | Drug/Alcohol intake as coping strategy | 126 | | 86.3% | 1.00 | 1 | 2500.000 | .657 |
12. | Smoking at work place | 115 | | 78% | 1.00 | 1 | 2507.000 | .740 |
13. | Any incentive at work | 130 | | 89% | 2.00 | 2 | 2481.000 | .357 |
*5__very frequently, 4__ frequently, 3____ occasionally, 2____ rarely, 1___ Never
Then Mann-Whitney (MWU) was applied, resultant P-values were statistically non-significant (P >0.05) in all cases, with one exception, that is, seeking medical advice to cope the deleterious effects of long duties (P= .029). Hence, there was no statistically significant difference found between the coping strategies, employed by post graduate trainees.
Qualitative Results:
Total six FGDs were carried out, with twenty-four (24) PGTs. In these FGDs female response rate was higher (n=14, 58%) as compare to males (n=10, 42%). After data analysis, four main themes were developed; self-regulation, tailor made strategies, educational focus and support system.
Table 3
Qualitative study Findings
Themes | Sub- themes | Axial coding | Open coding |
Self- regulation | | Time management | Extended duties, compromised self- care and sleep |
Self-control | Reflection on actions, controlling mood swings, Requesting rotational duties |
Countering negative emotions | Regret in carrier selection (negative coping), self-counselling, seeking senior help, fed-up from duty |
Tailor made strategies | Dietary | Caffeinated drinks | Tea/coffee resulted in improved decision making, better critical thinking and increase alertness |
Eating/Binging | Munching freshens, lessen effects of fatigue |
Smoking/Alcohol | Nicotine, stimulant |
Self- survival | Micro naps | Small sleep spells controls altered circadian rhythm, headaches due to sleeplessness |
Water splashes/ablution | water splashes maintain alertness/freshness, washes for praying to relive anxiety and anger |
Praying | Spiritualism cope negative emotion, enhances positivity |
Micro breaks | Little breaks and small pauses, relaxation |
Social media usage | Using internet, face book keeps up-to-date and alert |
Controlling digital clock | Shrinkage of personal time, reducing sleep time and self-care |
Walking | Physical exercise maintain alertness and relieve mental exhaustion |
Educational Focus | Prioritizing studies | Sufferings due to studies | Compromise on sleep time, personal time, family and friend time, leisure time |
Policy makers concentrate | Increase human resource (doctors), reduction in working hours, MOCK exams |
Support System | Consulting seniors and Peers | Seeking help from colleagues | Seeking seniors’ help, taking little breaks, talking to staff around |
Support of friends and family | Family matters | Hanging out with friends, obeying spouses quietly, Doubling duties so can take day off, talking to friends and family, leisure time with family |
Self-Regulation:
The mental, physical and psychological status along with circadian rhythm was altered due to frequent, long working hours. Most of PGTs adopted the regulation of time to handle deleterious effects efficiently. So, they pre-planned and handled their concerns tactfully. Similarly, reflection on their own actions and self-control was another approach which produced a win-win situation.
Tailor Made Strategies:
The adaptation of coping strategies by post-graduate trainees is found as per their requirement/ preference. Majority of PGTs practice frequent caffeine intake, eating/ binging, water splashes on face and ablution to avoid sleepiness especially, during night calls. Some seek refuge in praying. However, some believe in taking micro- breaks (breaks for 10—15 mins) and micro naps (sleep for 10----15 mins) to combat tiredness and sleepiness. Boys prefer smoking whereas, girls use social media to freshen up during long exhaustive duties. As these tactics maintains alertness, decision making and critical thinking of the PGTs on call. Using humour, joking with staff and laughing about the stressful incidences were also the coping strategies used by the residents.
Educational Focus:
The prolonged duty hours have grave consequences on the educational activities of these residents. They usually miss teaching rounds/morning classes and elective operation lists, due to late night calls. Furthermore, reported by many that they are physically present in class but mentally absent, therefore don’t learn much. Nevertheless, PGTs counter these difficulties by reducing their sleep time (spending more time on studies), reducing time for self-care, spending less time with friend and family and shrinkage of leisure time.
Support System:
Support system encourages one to swim swiftly through the tiresome ocean of training. This support system comprises of family and friends, colleagues, peers and staff on duty. Similarly, seeking advice from seniors/ colleagues for patient safety was frequently stated by many. This support system has been identified as an important pillar of professional support. Where seniors and colleagues definitely helped their juniors, in times of need (exhaustion, poor alertness or sleepiness). Similarly, leisure time with family and hanging out with friend kept the boat rowing. Moreover, debriefing by the consultant after a challenging case, provided unconditional emotional & educational support to the residents, as stated by participants.