Does being on call the night before an exam affect the results?

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The effect of post-call status of surgery residents on their score in the end-of-year examination.

Learning can be defined as ‘acquiring new, or modifying and reinforcing, existing knowledge, behaviours, skills, values, or preferences’.1 Human learning may occur as part of education, personal development, schooling or training. In 1956 the psychologist Benjamin Bloom suggested three domains of learning: cognitive, affective and psychomotor.2 Cognitive function is ‘an intellectual process by which one becomes aware of, perceives or comprehends ideas. It involves all aspects of perception, thinking, reasoning, and remembering’.3

There are a number of factors affecting cognitive function, including non-modifiable factors (age, genetics and congenital syndromes) and modifiable factors (social network, prior knowledge and sleep deprivation).4 Sleep deprivation can alter the ability of a human to perceive, think, reason and remember. Residents who had been up the night before made significantly more errors than rested residents on reading a standardised electrocardiogram.5 All over the world, surgery is notorious for its hectic schedule and long working hours, with different on-call systems at different hospitals.

Summative assessment at the end of the year is common practice in training programmes to assess the basic and clinical knowledge of the residents. This examination is usually compulsory and may be conducted on the same day for all candidates. Some of the residents may have to sit the exam directly after having been working overnight as part of an on-call shift whereas others may come from a relaxed home environment. As a result, the cognitive skills of one group of trainees may be impaired relative to the other group. The aim of our study was to compare the difference in mean scores of the two groups of residents for the end-of-year examination.


The Bulletin of the Royal College of Surgeons of England