Sleep healthNov 25, 2023

Predicting doctors' mental and behavioral performance during a trial of different work schedules

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 29, 2026

Abstract

Resident physicians on an extended duration work roster may spend significantly more time at moderate performance impairment than those on a rapidly cycling work roster.

Extended duration work rosters (24-28 hours of continuous duty) are associated with worse predicted performance due to increased attentional failures.
The model predicts that physicians on extended rosters could experience more time at moderate impairment (p = .02) compared to those on rapidly cycling rosters.
Performance impairment is most pronounced during the circadian night (p < .001).
Performance is predicted to decline significantly from weeks 1 and 2 to weeks 3 and 4 (p < .001), with a greater rate of decline on extended rosters (p < .01).
Predicted performance impairment is inversely related to prior sleep duration (p < .001).

Simplified

OBJECTIVES: Mathematical models of human neurobehavioral performance that include the effects of acute and chronic sleep restriction can be key tools in assessment and comparison of work schedules, allowing quantitative predictions of performance when empirical assessment is impractical.

METHODS: Using such a model, we tested the hypothesis that resident physicians working an extended duration work roster, including 24-28 hours of continuous duty and up to 88 hours per week averaged over 4weeks, would have worse predicted performance than resident physicians working a rapidly cycling work roster intervention designed to reduce the duration of extended shifts. The performance metric used was attentional failures (ie, Psychomotor Vigilance Task lapses). Model input was 169 actual work and sleep schedules. Outcomes were predicted hours per week during work hours spent at moderate (equivalent to 16-20 hours of continuous wakefulness) or high (equivalent to ≥20 hours of continuous wakefulness) performance impairment.

RESULTS: The model predicted that resident physicians working an extended duration work roster would spend significantly more time at moderate impairment (p = .02, effect size=0.2) than those working a rapidly cycling work roster; this difference was most pronounced during the circadian night (p < .001). On both schedules, performance was predicted to decline from weeks 1 + 2 to weeks 3 + 4 (p < .001), but the rate of decline was significantly greater on extended duration work roster (p < .01). Predicted performance impairment was inversely related to prior sleep duration (p < .001).

CONCLUSIONS: These findings demonstrate the utility of a mathematical model to evaluate the predicted performance profile of schedules for resident physicians and others who experience chronic sleep restriction and circadian misalignment.

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Predicting doctors' mental and behavioral performance during a trial of different work schedules

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