Biosensors, Biometrics and Capabilities in Practice (CiP): A WHOOP 4.0 Perspective

Abstract

Objective: This study aimed to measure physiological stress response related to Capabilities in Practice (CiPs) using wearable technology.

Design: Surgical residents wore WHOOP4.0 sensors for 6-weeks with CiP event diaries and Abbreviated Maslach Burnout Inventory (AMBI) scores recorded.

Setting: A surgical training program serving a single UK (Wales) deanery.

Participants: 23 Surgical residents participated (13 male, median age 30 [26-35] year).

Results: Median Heart Rate Variability (HRV) varied by resident grade (Core Surgical Training (CST) resident 58 vs. Higher Surgical Training (HST) resident 48 ms, p < 0.001) and duty shift (HRV: Off Duty 51 milliseconds (ms), Normal Working Day (NWD) 48, On Call Day (OCD) 45, p = 0.009) and CiP (Inpatient work 48, Elective Operating 47, Emergency Operating 44, Emergency Day Shift 46, Emergency Night Shift 63 ms, p = 0.017). Emergency shifts were associated with adverse sleep profiles with median sleep performance varying from 74.0% (Night Shift) to 98.0% (Off Duty, p < 0.001). On average, residents had 13.4% and 27.2% less sleep related to OCDs or Night Shifts respectively (p < 0.001), and 20.2% less sleep related to Emergency Night Shifts when compared with Elective Day time CiPs (p < 0.001). HRV was related to sleep efficiency (rho 0.38, p < 0.001) and REM sleep (rho 0.211, p < 0.001). AMBI score >3 (consistent with burnout) was found in 71.4% CST vs. 30.1% HST (p < 0.001) and 49.1% males vs. 60.9% females (p < 0.001) and was inversely related to HRV and sleep efficiency (p < 0.001).

Conclusions: Stress response varied by 20% (shift profile) and 30% (CiP) highlighting daily clinician physical demand. Adverse sleep profiles were seen related to emergency work, in particular night shifts, impacting sleep quantity and quality.

Keywords: Stress; Surgery; Surgical Education; Training.