Please assist us by completing the following confidential survey. Thank you in advance for your help.


Demographic Information

Age:
Gender:
Professional Status:
Specialty/Position:



Sleepiness Scale


How likely are you to doze off or fall asleep in the following situations? (In contrast to just feeling tired.) Please refer to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you.

SituationWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing
  1. Sitting and reading
  1. Watching TV
  1. Sitting and inactive in a public place (theater or meeting)
  1. As a passenger in a car for an hour without a break
  1. Lying down to rest in the afternoon when circumstances permit
  1. Sitting and talking to someone
  1. Sitting quietly after lunch (without alcohol)
  1. In a car, while stopped for a few minutes in the traffic
  1. Grand rounds or noon conferences
  1. Writing up a patient history and physical
  1. Talking on the telephone
  1. Preparing for a presentation





Sleep Behavior


Please select the answer which best describes your sleep/wake behavior:

  1. The average number of hours of sleep I get on non-call weeknights is:
 < 4 hrs 4 - 6 hrs 6 - 7.5 hrs 7.5 - 9 hrs > 9 hrs
  1. The average number of hours of sleep I get on non-call weekends is:
 < 4 hrs 4 - 6 hrs 6 - 7.5 hrs 7.5 - 9 hrs > 9 hrs
  1. The average number of hours of sleep I get on call nights is:
 < 4 hrs 4 - 6 hrs 6 - 7.5 hrs 7.5 - 9 hrs > 9 hrs
  1. The average number of hours of sleep I get on post-call nights is:
 < 4 hrs 4 - 6 hrs 6 - 7.5 hrs 7.5 - 9 hrs > 9 hrs
  1. The average number of hours of sleep I need to feel rested is:
 < 4 hrs 4 - 6 hrs 6 - 7.5 hrs 7.5 - 9 hrs > 9 hrs
  1. I need an alarm clock to wake up:
 never 1 - 2 days/wk 3 - 4 days/wk 5 - 6 days/wk everyday
  1. I use caffeinated products (i.e., coffee, tea, chocolate, soda) to help maintain alertness at work:
 never 1 - 2 cups/wk 3 - 4 cups/wk 5 - 6 cups/wk > 6 cups/day
  1. I use napping as a way of making up sleep loss:
 never rarely occassionally often always





Sleep Attitudes


How strongly do you agree/disagree with the following statements pertaining to sleep in residency training?

  1. Sleep loss and fatigue have a major impact on my personal life
 Strongly Disagree Strongly Agree
  1. My body has adapted to less sleep during residency training.
 Strongly Disagree Strongly Agree
  1. Sleep loss and fatigue affect my medical decisions.
 Strongly Disagree Strongly Agree
  1. My family understands my demanding job and sleep needs.
 Strongly Disagree Strongly Agree
  1. Sleep loss and fatigue have a major impact on my work.
 Strongly Disagree Strongly Agree
  1. I sometimes look forward to sleeping at grand rounds.
 Strongly Disagree Strongly Agree
  1. I chose my medical field, in part, because I function well on little sleep.
 Strongly Disagree Strongly Agree
  1. I have made medical errors because of sleep loss and fatigue.
 Strongly Disagree Strongly Agree
  1. I have effective countermeasures to sleep loss.
 Strongly Disagree Strongly Agree
  1. I have heard about others making medical errors due to sleep loss and fatigue.
 Strongly Disagree Strongly Agree
  1. I can tell when I am too tired to drive home.
 Strongly Disagree Strongly Agree
  1. I have worried about having a car accident driving home post-call.
 Strongly Disagree Strongly Agree