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Worn Out by Fatigue Training

      I was sitting quietly in our department’s faculty meeting, trying to surreptitiously catch up on some reading while appearing politely attentive. This is academic medicine’s equivalent of “just walking down the street, minding my own business”—when the equivalent of “…and then some dude shot me” jolted me back to the meeting; it was the distantly heard phrase “mandatory training.” My heart sank. Another half day, or maybe even a day, where nothing productive would be accomplished save to fill the tick boxes on some apparatchik’s checklist. But I was quickly cheered by the information that the training consisted only of viewing a mandatory video, which we could do later on our computers (wink, wink). Someone puckishly suggested that we could project it now, during our meeting, (with the sound turned down low, of course) to kill 2 birds with 1 stone—after all, most of us were multitasking anyway. This met with general acclaim, but was ruled out of order as too flagrantly subversive, although a group viewing at lunch was deemed admissible.
      I went back to my office to do my duty. The video was called “Fatigue Training,” so napping through it somehow seemed just right. I propped my feet on my desk and settled down to protect myself against that demon, fatigue.
      As I was “training,” I drifted off, no doubt because—surprise—I was fatigued. I began to dream about all the mandatory training I’ve taken in the past few years, and the pile of official-looking certificates I’ve got to keep track of, and to produce at a moment’s notice to maintain hospital privileges, board eligibility, or general membership in polite society. They seemed to float in front of me.
      First, there were the usual suspects: ATLS, ACLS, and the various other subgroup “LS-es.” While I’ve often complained of the “merit badge medicine” approach these courses induce, it turns out they were by far the least objectionable; the litany of remaining items led to a progressively deepening weariness.
      Next, there came multiple repeat performances of Medicare Module A and Module C Training. I vaguely wondered, “Whatever happened to poor Module B?” but suppressed that thought for fear I would have to take it as well.
      Then there appeared to me multiple repeat engagements for HIPAA Training, in 2 varieties, HIPAA for ordinary people (107 slides, no ability to click ahead) and HIPAA for researchers; blessedly, the former was finally swallowed up by the latter as they floated by. Then there were numerous, self-inflicted trainings; I say self-inflicted because I chose to do research and so have no one to blame but myself and my own ignorance.
      The NIH’s “Protecting Human Subjects” seemed good enough several years back, but not anymore; before my eyes, it mushroomed into 4 subspecies that must be repeated at intervals: Foundations of Good Research, Human Subjects Protection in Biomedical Research, Human Subjects Protection in Behavioral and Social Science Research, Research Administration, and Conflict of Interest Training. To make things worse, silly me, I collaborate with other investigators in other universities, each having its own variants of the foregoing. Of course, no university in its right mind would accept another university’s certification in these important matters, so they each had to be repeated at least once, to be sure the right imprimatur would appear on my certificates.
      I then saw Blood Borne Diseases Training, in which I “learned” that it’s bad to touch wet stuff, and also Domestic Violence, Preventing Medical Errors, Patient and Family Communication Training, and my personal favorite, Sexual Harassment Training. I actually took Sexual Harassment twice; even though the first version was said to offer lifelong immunity, it turns out that the medical-training complex had oversold its performance, so a booster course was needed—at least for people like me.
      Going still farther back, I relived my reentry into clinical work after spending a year’s sabbatical in England, during which time I touched not a single patient. I was admittedly a bit nervous about returning to the ED and so voluntarily sat in on our PGY 1s’ summer “boot camp,” to practice intubations and the like in the simulator before heading back to the real world. The day before my first shift, I got a panicked call from administration: I could not be allowed to practice, they said, because my HIPAA training had expired. They could defer the current year’s required training until the next scheduled offering, but were gobsmacked by the idea that I had gone without HIPAA training for the year in which I was not even in the US and saw no patients. Ultimately, reason—in a limping and limited form—prevailed and they admitted that it might be okay for me to have skipped HIPAA that year, but I could tell it made them itch to think about it.
      I heard a tramping noise outside my door and peeked out. There was an infernal queue of zombie-like safety and quality Nazis halting toward me…each carrying a DVD, or murmuring a Web site’s URL for yet another training module, and waving a 10-question multiple choice test. MRI Safety Training, ICD-10 Training, Billing and Coding Training, Teamwork Training (to be taken individually), Effort Reporting Training—like the bewitched brooms in Walt Disney’s Fantasia, the line stretched down the hall as far as I could see, an infinite regress of training upon training, tramping toward me; somewhere in it, I felt sure, there was Training Training. I had a brief hope that the Sepsis Training zombie might tangle with the Antibiotic Stewardship zombie and the battle might stop the whole line, but they made peace and the entire gang came lurching for me.
      Panicked, I decided to make a run for my car, although I was so exhausted I could scarcely move. They came after me, relentless. I was tackled by the Fatigue Training zombie, who kept mindlessly mumbling, “Don’t drive home unrested.” Looking around, I spied a wooden stake and, with one mighty desperate heave, thrust it through where I thought would be its heart, when, with a shudder, I suddenly awoke—alone, in my office, sweating, mildly tachycardic, but blessedly alone.
      My secretary came in to ask if I was all right. “I thought I heard you call out,” she said. “No, not me; must have been the wind,” I lied. “But I’m going to take the rest of the day off. Fatigue Training has worn me out.”