An extensive literature exists regarding the potential effect of sleep loss on human performance and the recent regulatory changes that now limit the duty hours of resident-physicians. Recent studies and reviews emphasize the effects of sleepiness on medical errors of commission and to a lesser extent omission. This review focuses on an emerging literature on the effects of sleep loss on personal, social and professional growth and development of residents. As with the early literature on sleep loss and resident performance, this literature is largely at an observational level, but there is sufficient evidence from other professions to indicate that sleep loss will affect post-graduate career and life skills. A multidimensional approach is needed to counter the adverse outcomes of sleep loss and fatigue and might consist of education on healthy sleep habits, family outreach, personal alertness strategies, and reversal of bias if sleepiness is personally disclosed. The multi-dimensional approach might include not only resident physicians, but also residency program directors and attending physicians at their institutions. (C) 2006 Elsevier Ltd. All rights reserved.