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MEdIC: Case of the Night Shift Stimulants – Expert Review and Curated Community Commentary


Our fifth case of season 5, The Case of the Night Shift Stimulants, presented the scenario of a junior emergency medicine (EM) resident who witnesses her attending physician taking stimulants in order to function during his night shift.

The MEdIC team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted an online discussion around the case over the last 2 weeks with insights from the ALiEM community. We are proud to present to you the curated commentary and our expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding this case!

This follow-up post includes

  • Responses from our solicited experts:
    • Dr. Lisa Thurgur (@ThurgurTox) is an emergency physician at The Ottawa Hospital and an Assistant Professor at the University of Ottawa. She has a Masters of Science from the University of British Columbia and a Royal College Fellowship in Clinical Pharmacology and Toxicology from the University of Toronto.  She is currently the Program Director of the Ottawa RCPSC EM Program and is a Medical Toxicologist at Alberta Poison Information Services. Academic interests, projects and publications include the areas of medical education combined with both EM and Toxicology.
    • Dr. Taryn Taylor (@tarynsuzanne) is an Obstetrician/Gynecologist at London Health Sciences Centre and scientist at the Centre for Education Research & Innovation at The Schulich School of Medicine & Dentistry, Western University. While completing her PhD in Health Professions Education she developed a fascination with how fatigue is understood in medical education and the implications for managing fatigue.
    • Dr. Marco Sivilotti is a Professor of EM and of Biomedical and Molecular Sciences at Queen’s University in Kingston, Ontario. He completed residency training in EM at McGill, and fellowship training in medical toxicology at the University of Massachusetts. He still pulls the odd night shift, but only if just back from Europe (i.e. 6 hours ahead—try it!). He also serves as medical consultant to the Ontario Poison Centre, but is contemplating jettisoning those night calls as well. His only motor vehicle collision was 1 minute from home when awoken from deep sleep to come in early for a night shift 25 years ago, predating his caffeine dependence.
  • A summary of insights from the ALiEM community derived from the Twitter and blog discussions
  • Freely downloadable PDF versions of the case and expert responses for use in continuing medical education activities
Expert Response 1: Coffee with a Side of Adderall: Sleep Deprivation Among Shift Workers (Dr. Lisa Thurgur)
Expert Response 2: Overcoming Sleep Deprivation: A Debate on Stimulant Use in Shift Workers (Dr. Taryn Taylor)
Expert Response 3: Physician, Take Care of Thyself! (Dr. Marco Sivilotti)
Curated from the Community (Dr. Alkarim Velji)

Case and Responses for Download

Click here (or on the picture below) to download the case and responses as a PDF (207 kb).

**This post was edited on March 16, 2018 after publication. Thank you to our reader Tomer Begaz who noted that we have mistakenly written dextromethorphan as opposed to dextroamphetamine in a line within Dr. Calder’s response.

Tamara McColl, MD FRCPC

Tamara McColl, MD FRCPC

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba