VCOM College Catalog and Student Handbook

information to others. In general, students are permitted to discuss patient information with medical personnel who are directly involved in providing the patient's care. In some cases, in making a medical presentation, a patient’s condition may be discussed but must be presented without any personally identifiable information. Students must obtain permission for presentations and should not divulge a patient's name or other identifying information that is considered confidential information. Students should not divulge a patient's confidential information whether in formal or in casual comment in any other arena in which they do not have the patient or physician’s permission to do so. Any discussion of a patient, peer, physician or healthcare facility should be a professional discussion and not cause misunderstanding or distrust of the medical care offered at the site. Failure to adhere to this professional behavior constitutes a violation of the VCOM Honor Code. Fatigue Mitigation Providing medical care to patients is physically and mentally demanding. Night shifts, even for those who have had enough rest, cause fatigue. VCOM has adopted fatigue mitigation processes and ensures that there are no negative consequences and/or stigma for using fatigue mitigation strategies. It is important for physicians and students to have adequate rest before and after clinical responsibilities. Signs of fatigue include: • Involuntarily nodding off

• Decreased startle response • Anxiety • Social withdrawal • Degraded motor skills • Tenseness and tremors • Slower reaction time • Labile mood • Poor coordination

• Waves of sleepiness • Problems focusing • Frequent unexplained headaches • Muscular aches and pains • Blurred/double vision • Loss of appetite • Irritability/intolerance • Reduced short-term memory • Lack of interest and drive • Confusion and fearfulness

• Difficulty with short-term recall • Tardiness or absences from work

Fatigued physicians/students typically have difficulty with: • Appreciating a complex situation • Avoiding distraction • Keeping track of the current situation and updating strategies • Thinking laterally and being innovative • Assessing risk and/ or anticipating consequence • Maintaining interest in outcome • Controlling mood and avoiding inappropriate behavior High risk times for fatigue-related symptoms: • Midnight to 6 am • Early hours of day shift • First night shift or call night after a series of day shifts • Change of service • First 2 to 3 hours of a shift or end of shift • Early in the clinical years • When new to the night call experience

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