Emergency Medicine Residents Experience Acute Stress While Working in the Emergency Department

Author Affiliation
Matthew L. Wong, MD, MPH Beth Israel Deaconess Medical Center, Department of Emergency Medicine, Boston, Massachusetts
Leon D. Sanchez, MD, MPH Brigham and Women’s Faulkner Hospital, Department of Emergency Medicine, Boston, Massachusetts
Gregory A. Peters, MD Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts


We were very interested to read the manuscript by Janicki and colleagues, and we are grateful for their contribution to the literature.1 We agree that stress is a major problem for emergency physicians.2 But we had two concerns with the study design.

We performed a similar study with wearable devices and photoplethysmography but had a problem with motion artifact that precluded using all of the collected data in analysis.3 Did the authors also experience any problems with motion artifact interfering with data analysis? It is hard to imagine that there were no problems.

We do not think that the authors made a fair comparison when they measured the heart rate and heart rate variability of subjects during didactics and compared them to clinical shift work. We have previously found that our residents walk on average 2.6 miles per shift, 588 steps per hour.4 The simple physical activity of clinical shift work should cause some change in heart rate variability, which may account for a lot of the observed difference and not stress.


Section Editor: Mark I. Langdorf, MD, MHPE

Full text available through open access at http://escholarship.org/uc/uciem_westjem

Address for Correspondence: Matthew L. Wong, MD, MPH, Beth, Israel Deaconess Medical Center, Department of Emergency, Medicine, 1 Deaconess Road, Rosenberg 2nd Floor, Boston, MA, 02215. Email: mlwong@bidmc.harvard.edu. 5 / 2021; 22:801 – 801

Submission history: Revision received January 28, 2021; Submitted January 28, 2021; Accepted February 5, 2021

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.


1. Janicki AJ, Frisch SO, Patterson PD, et al. Emergency medicine residents experience acute stress while working in the emergency department. West J Emerg Med. 2020;22(1):94-100.

2. Wong ML, Anderson J, Knorr T, et al. Grit, anxiety, and stress in emergency physicians. Am J Emerg Med. 2018;36(6):1036-9.

3. Peters GA, Wong ML, Joseph JW, et al. Pulse rate variability in emergency physicians during shifts: pilot cross-sectional study. JMIR Mhealth Uhealth. 2019;7(10):e13909.

4. Peters GA, Wong ML, Sanchez LD. Pedometer-measured physical activity among emergency physicians during shifts. Am J Emerg Med. 2020;38(1):118-21.