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Fitness For Duty / Fatigue

The program director and institution must ensure a culture of professionalism that supports patient safety and personal responsibility.

Residents and faculty members must demonstrate an understanding and acceptance of their personal role in:

  • The assurance of safety and welfare of patients entrusted to their care
  • Provision of patient- and family-centered care
  • Assurance of their fitness for duty
  • Management of their time before, during, and after clinical assignments
  • Recognition of impairment, including illness and fatigue, in themselves and in their peers
  • Attention to lifelong learning
  • The monitoring of their patient care performance improvement indicators
  • Honest and accurate reporting of duty hours, patient outcomes, and clinical experience data

For further details on the Department of Medicine's Fitness for Duty Policy, please refer to the document below:


I suspect we have all been fatigued at some point in our lives, either physically, mentally, or both. While the career we have chosen requires that we operate under conditions of stress, we must be mindful that there comes a point where we need to step back and recognize our professional limitations.

It is critically important, therefore, that fatigue be recognized and, more importantly, avoided as your education and, most importantly, the care of your patients may suffer.

Situations that lend themselves to fatigue:

  • Abrupt changes in your work schedule
  • Changes in your diurnal cycle (i.e. night shifts)
  • Extended call beyond your normal sleep-wake cycle
  • Challenging work conditions (i.e. busy service, complex patients)

Signs and symptoms of fatigue:

  • Feeling tired
  • Inability to focus or concentrate on your job
  • Drifting/nodding off to sleep
  • Impairment in cognition
  • Personality changes
  • Emotional lability
  • Poor work performance

The potential complications of fatigue:

  • Harm to yourself (i.e. work-related injury or while driving a vehicle)
  • Harm to your patients (i.e. procedure-related complication, medication errors)
  • Alterations in lifestyle choices (i.e. alcohol or illicit drug abuse)
  • Difficulty with mood management (i.e. anger, depression)
  • Poor work performance

If you are fatigued:

  • You should immediately ask for help from a colleague.
  • You should immediately contact a member of the Educational Programs Office (Chief Resident, Associate Program Director, Residency Program Director) so that arrangements can be made to relieve you from your duties.

If you recognize fatigue in another individual:

  • You should ask that individual if they are indeed fatigued.
  • If the individual answers yes, you should ask that individual to relieve him/herself from his/her responsibilities.

(If the individual refuses to do, you should contact his/her superior)

  • If the individual answers no, but you are still concerned, you should contact the individual's superior.

For further information on fatigue, please go the Graduate Medical Education course on the Upstate Blackboard Learning System, or: