What do we need to know about fatigue? Widespread, complex problem Suggestions for ongoing management Multifactorial Changes in medical working over time Negative rest culture Shifts, inadequate rest, stress, insomnia, workload, assessments, commute etc. Risks to health and safety Dangerous driving Possibility of error and suboptimal decision making Blame culture Physical and psychological health effects Ongoing sleep disturbance Personal responsibility to be rested versus organisational duty to allow rest Individual responsibility to patients, colleagues, general public and self Employer duty to provide rest facilities and opportunities Appreciate importance of circadian rhythm Daylight, feeding schedules, activity Shift work is highly unnatural – fatigue is an inevitable consequence thereof Optimise all types of rest and recovery Pre and on-shift rest, normal sleep, recovery from nights Consider individual behaviours (exercise, alcohol, screens, nutrition etc.) Nurture positive rest culture (facilities, opportunities) Support each other Expect to rest properly at work Consider useful devices (blue light cancellation, light emission) Maintaining realistic expectations whilst striving for the best