Background Accreditation standards in residency education are calling for initiatives to promote the wellness of resident physicians including the implementation of fatigue risk management plans (FRMPs). We sought to conduct a realist evaluation of a FRMP within a five-year Obstetrics and Gynecology (OBGYN) residency training program in labour and delivery units.

Method Realist inquiry askes what works, for whom, in what circumstances, and why? through examining contexts, mechanisms, and outcomes. Using a mixed method study design, we collected quantitative and qualitative data from OBGYN residents sequentially across three time points.

Results There were n=19 unique participants (60% response rate). Most of the participants identified as women (93.7%), single (56.2%) and without children (93.7%). Participants mean age was 28.5 years and ranged from junior to senior residents. We found no significant difference between median sleepiness scores across three timepoints (p=0.17) however 20% of residents reported starting and ending shifts with high sleepiness scores signaling impairment that is hazardous to both residents and patients. The n=6 resident interview participants, reported overlooking patient details (forgetting to order tests, and delaying care) as well as personal safety issues such as driving home whilst fatigued despite FRMP implementation.

Discussion Specific aspects of the OBGYN FRMP such as the nap model and nutrition could help with decreasing perceptions of fatigue related to lack of sleep and lack of available food. While FRMPs might be helpful in de-stigmatizing fatigue in residency, FRMPs are unlikely to decrease levels of resident fatigue because of systemic, structural, and cultural barriers.

The authors have declared no competing interest.

This study was funded by the Royal College of Physicians and Surgeons of Canada.

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This study was approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB19-2033).

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