Modafinil, discovered in the 1970s, is currently prescribed in the UK for the treatment of sleepiness associated with narcolepsy, sleep apnoea, and shift work sleep disorder, a condition that affects people who frequently have to work at night.
In the new study of 39 people, published today in the Annals of Surgery by researchers from Imperial College London and the University of Cambridge, modafinil improved performance in a series of mental tasks when compared with placebo, but had no effect on the performance of a surgical motor skills task. The doctors did not interact with any patients during the exercise.
This study set out to explore whether modafinil, a wakefulness-promoting drug, might help doctors to perform more effectively under conditions of fatigue when their performance might otherwise be compromised.
When the study's findings are confirmed, would it be malpractice for a doctor not to take modafinil on the second day of long shifts ?
Annals of Surgery - Effect of Pharmacological Enhancement on the Cognitive and Clinical Psychomotor Performance of Sleep-Deprived Doctors: A Randomized Controlled Trial
In this randomised double-blind trial, 20 healthy male doctors took modafinil and 19 took a placebo after one night of sleep deprivation. All were asked to complete both a series of tasks that are commonly used in psychology research and a virtual reality surgical motor skills task.
In the psychological tasks, the group that had taken modafinil performed better in tests of working memory and planning, were less impulsive decision-makers, and were more responsive to changing demands during a task. However, there was no significant difference between the two groups on the surgical motor skills task.
Mr Sugden said: "Participants in the modafinil group were less impulsive, displayed greater flexibility and solved working memory and planning problems more efficiently than those in the placebo group. However, no benefit was seen in the performance of a basic motor skills task. This was a small, short-term study so we have to be very cautious about how the results are interpreted. Most importantly, it is not clear how performance on tests of mental function relate to how someone performs as a doctor."
The researchers stress that these results remain to be confirmed with a larger sample size and ideally in a longer term study.
Objectives: To investigate the effect of modafinil 200 mg on the performance of a cohort of healthy male doctors after 1 night of supervised sleep deprivation.
Summary Background Data: Sleep-deprived and fatigued doctors pose a safety risk to themselves and their patients. Yet, because of the around-the-clock nature of medical practice, doctors frequently care for patients after periods of extended wakefulness or during circadian troughs. Studies suggest that a group of substances may be capable of safely and effectively reversing the effects of fatigue. However, little work has been done to investigate their role within our profession.
Results: Modafinil improved performance on tests of higher cognitive function; participants in the modafinil group worked more efficiently when solving working memory (F1,38 = 5.24, P = 0.028) and planning (F1,38 = 4.34, P = 0.04) problems, were less-impulsive decision makers (F1,37 = 6.76, P = 0.01), and were more able to flexibly redirect their attention (F1,38 = 4.64, P = 0.038). In contrast, no improvement was seen in tests of clinical psychomotor performance.
Conclusions: Our results suggest that fatigued doctors might benefit from pharmacological enhancement in situations that require efficient information processing, flexible thinking, and decision making under time pressure. However, no improvement is likely to be seen in the performance of basic procedural tasks.
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