We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Black Clouds Work Load, Sleep, and Resident Reputation

Robert R. Tanz, MD; Joel Charrow, MD
Am J Dis Child. 1993;147(5):579-584. doi:10.1001/archpedi.1993.02160290085032.
Text Size: A A A
Published online


• Objective.  —Although it is assumed that residents in a specific training program will have comparable experiences, residents commonly perceive that some have consistently more difficult times on call. Such residents in our program are said to have "black clouds." We sought to determine if these perceptions were related to differences in real work load.

Methods.  —We collected data about the on-call experiences of our first-year pediatric residents (PL-1s) for 358 days (1355 on-call experiences) during the 1984-1985 academic year. Every PL-1 (n=19) reported the following data the morning after each night on call: hours of sleep, number of admissions, total number of patients, number of deaths, number of transfers to the pediatric intensive care unit, number of delivery room trips, and a subjective assessment of work load, using a three-point scale. The reputation of each house officer was determined by asking all residents in the program (PL-1s, PL-2s, and PL-3s) to rate each other three times during the year regarding how hard they worked on call.

Results.  —There were significant differences among PL-1 s in how difficult they perceived their work load to be and in how much they slept (P<.001 using analysis of variance). However, actual work load (as measured by the number of either admissions or patients) did not vary significantly among the residents. There was a strong negative association between self-perception of worrik load and hours of sleep (r=−.75; 95% confidence interval, −0.73 to −0.76). Sleep was the major predictor of perceived work load (multiple R2=.563 using multiple linear regression analysis).The absence of an association between perceived and actual work load is attributed to large differences in the residents' working styles. This is evidenced by a wide range of correlations among PL-1s between the number of admissions and hours of sleep (range of r values, −.66 to −.16).A reputation for difficult on-call experiences was strongly associated with few hours of sleep (r=−.77; 95% confidence interval, −0.49 to −0.91), but not with actual work load measured by the number of admissions, patients, deaths, or other variables. Sleep was the major predictor of reputation (multiple R2=.567 using multiple linear regresssion analysis).

Conclusions.  —Some residents did have a black cloud; they slept less, perceived that they worked harder than average, and had a reputation for having difficult on-call experiences. Residents with a black cloud function differently from their colleagues; for example, some may be inefficient, while others may create extra work for themselves. Residency program directors must recognize these functional differences to effectively evaluate and counsel house officers.AJDC. 1993;147:579-584)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.