TITLE:
Shift Patterns, Fatigue, and Cognitive Performance in Junior Anesthetists: Evidence from a Stroop Test-Based Pilot Study
AUTHORS:
Rachel Rui Zhi Lim, Sheryl Wei Lin Chee, Xuan Han Koh, Yanzhi Zeng
KEYWORDS:
Anesthesia, Cognitive Performance, Fatigue, Stroop Color and Word Test, Occupational Health
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.16 No.4,
April
24,
2026
ABSTRACT: Background: Fatigue in anesthesia is a significant concern, impacting patient safety and practitioner well-being due to the demanding nature of the work and irregular, extended hours. This pilot study evaluates the effect of different shift types on fatigue and cognitive performance in junior anesthetists, using the Stroop Color and Word Test (SCWT) as a surrogate for cognitive performance. Methods: A prospective observational crossover pilot study was conducted with eight trainees at a tertiary hospital. Participants completed sixty-three post-shift surveys and the SCWT after various shift types, including 8h-Short Day, 12h-Long Day, 12h-Night Shift, 24h-Weekday Call, and 24h-Weekend Call. Subjective fatigue (Relative Perceived Exhaustion, RPE), perceived workload, sleep duration, and SCWT performance (Inverse Efficiency Score, IES) were measured. Linear mixed-effects regression was used to assess associations between shift type and performance, adjusting for learning effects. Results: Shift type was independently associated with cognitive performance as measured by IES (P Conclusions: Extended shifts are associated with increased fatigue and reduced cognitive performance in anesthetists. The SCWT/IES and RPE are feasible tools for assessing fatigue-related performance, supporting the need for evidence-based rostering and fatigue management strategies in anesthesia.