Medical Resident Fatigue Assessment Form

Medical Resident Fatigue Assessment Form
Please complete this assessment to help identify patterns and factors related to fatigue during your medical residency.
What is your current postgraduate year (PGY) level?
On average, how many hours of sleep do you get per 24-hour period?
How often do you feel fatigued during your residency duties?
Rate the following symptoms you have experienced in the past month.
Rows Never Rarely Sometimes Often Always
Difficulty concentrating
Falling asleep during work hours
Irritability
Physical exhaustion
How many consecutive hours do your longest shifts typically last?
During which type of shifts do you feel most fatigued?
Other
How would you rate the impact of fatigue on your work performance?

1
2
3
4
5
1 is No impact, 5 is Severe impact
Which strategies do you use to manage fatigue? (Select all that apply)
Other
How satisfied are you with your current work-life balance?
Please share any additional comments or observations about fatigue during your residency.
Should be Empty:

Select theme:

Rows	Never	Rarely	Sometimes	Often	Always
Difficulty concentrating
Falling asleep during work hours
Irritability
Physical exhaustion