Quantifying Radiology Resident Fatigue: Analysis of Preliminary Reports

Radiology. 2021 Mar;298(3):632-639. doi: 10.1148/radiol.2021203486. Epub 2021 Jan 26.


Background Workloads in radiology departments have constantly increased over the past decades. The resulting radiologist fatigue is considered a rising problem that affects diagnostic accuracy. Purpose To investigate whether data mining of quantitative parameters from the report proofreading process can reveal daytime and shift-dependent trends in report similarity as a surrogate marker for resident fatigue. Materials and Methods Data from 117 402 radiology reports written by residents between September 2017 and March 2020 were extracted from a report comparison tool and retrospectively analyzed. Through calculation of the Jaccard similarity coefficient between residents' preliminary and staff-reviewed final reports, the amount of edits performed by staff radiologists during proofreading was quantified on a scale of 0 to 1 (1: perfect similarity, no edits). Following aggregation per weekday and shift, data were statistically analyzed by using simple linear regression or one-way analysis of variance (significance level, P < .05) to determine relationships between report similarity and time of day and/or weekday reports were dictated. Results Decreasing report similarity with increasing work hours was observed for day shifts (r = -0.93 [95% CI: -0.73, -0.98]; P < .001) and weekend shifts (r = -0.72 [95% CI: -0.31, -0.91]; P = .004). For day shifts, negative linear correlation was strongest on Fridays (r = -0.95 [95% CI: -0.80, -0.99]; P < .001), with a 16% lower mean report similarity at the end of shifts (0.85 ± 0.24 at 8 am vs 0.69 ± 0.32 at 5 pm). Furthermore, mean similarity of reports dictated on Fridays (0.79 ± 0.35) was lower than that on all other weekdays (range, 0.84 ± 0.30 to 0.86 ± 0.27; P < .001). For late shifts, report similarity showed a negative correlation with the course of workweeks, showing a continuous decrease from Monday to Friday (r = -0.98 [95% CI: -0.70, -0.99]; P = .007). Temporary increases in report similarity were observed after lunch breaks (day and weekend shifts) and with the arrival of a rested resident during overlapping on-call shifts. Conclusion Decreases in report similarity over the course of workdays and workweeks suggest aggravating effects of fatigue on residents' report writing performances. Periodic breaks within shifts potentially foster recovery. © RSNA, 2021.

MeSH terms

  • Adult
  • Data Mining
  • Fatigue / epidemiology*
  • Female
  • Humans
  • Internship and Residency*
  • Male
  • Radiology / education*
  • Workload*