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January 27, 2010

Resident Fatigue, Distress, and Medical Errors

JAMA. 2010;303(4):329-330. doi:10.1001/jama.2010.15

To the Editor: Dr West and colleagues1 examined the association between resident fatigue, distress, and medical errors. Although it is an important patient and clinician safety topic, we question the reliability and validity of their measures of fatigue and sleepiness.

The authors used a single question to measure fatigue via respondent self-defined perceptions regarding the week before assessment. This may not provide an accurate and reproducible measure of fatigue. The fatigue literature contains multiple measures that describe and define fatigue in different contexts and for different purposes (eg, fatigue associated with or the result of a chronic vs an acute condition).2 Standard practice in survey research dictates use of a minimum of 3 items or questions per construct,3 which facilitates examining reliability and validity of survey items across respondents and settings. It is also common practice to include items that measure other constructs for purposes of testing convergent and discriminate validity.3 Because the measurement of fatigue used by West et al appears to be a departure from conventional survey research methodology, we are uncertain what this single item of fatigue actually measured.