Background:
Fatigue affects central nervous system function and could influence specialist performance, patient care and safety. In contrast to other industries there are no “Fit to Perform” standards in medicine. The objective of this pilot study was to gain insight in the current physiological and subjective fitness of selected medical specialists and to correlate these findings to the impairment induced by alcohol.

Material and Methods:
The extensively validated ‘Neurocart’ was used to test 15 surgical residents on measures of performance before, during, and after a 12-hour night shift. The Neurocart targets specific parameters, providing information on alertness, memory, visuomotor coordination, motor coordination and general CNS-activity. Moreover, the self-ability to predict ‘fitness-to-perform’ was assessed. Outcomes were compared with historical data on the effects of alcohol.

Result:
A significant decrease in adaptive tracking (p=0.009) and critical flicker fusion (p=0.04) was observed representing alertness, visuomotor coordination, concentration, vigilance, and reaction time. Furthermore there was a significant decrease in saccadic peak velocity, measuring sedation (p<0.0001). Moreover, the VAS scores of alertness were significantly decreased (p<0.0001), the self-ability to assess ‘fitness-to-perform’ did not always correlate to the objective measurements. These results compared equally to previously acquired effects of 0.6 g·L BAC.

Conclusion:
The results indicate that a night shift leads to a significant negative effect on performance, equivalent to the effects of 0.6g·L BAC. This study has identified parameters to assess performance in a clinical setting, offering a clear backbone for a “Fit-to-Perform” test.