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Conceptual Frameworks in the Study of Duty‐Hour Changes in Graduate Medical Education: A Review

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Title: Conceptual Frameworks in the Study of Duty‐Hour Changes in Graduate Medical Education: A Review
Author(s): Schwartz, Alan; Pappas, Cleo; Bashook, Philip G.; Bordage, Georges; Edison, Marcia; Prasad, Bharati; Swiatkowski, Valerie
Abstract: Purpose Conceptual frameworks are approaches to a research problem that specify key entities and their relationships. The 2009 Institute of Medicine (IOM) report on resident duty hours, subsequent studies, and published responses to the report present a variety of conceptual frameworks for the study of the impact of duty-hour regulations. The authors sought to identify and describe these conceptual frameworks and their implications. Method The authors reviewed the IOM report and articles in both peer-reviewed and non-peerreviewed literature for the period January 2008 through April 2010, identified using multiple electronic databases including Pubmed, EMBASE, CINAHL, BEME, and PsycInfo. Studies that explicitly described or argued for the effect of resident duty hours on any other outcome, as judged by consensus of multiple reviewers, were included. The authors selected 239 of 858 studies reviewed. Several of the authors reviewed articles to identify conceptual frameworks used implicitly or explicitly to describe the relationship between duty hours (or duty-hours regulations) and outcomes. Identification was by consensus. Results Twenty-three conceptual frameworks were identified, several of which made contradictory predictions about the impact of duty-hour regulations on patient outcomes, resident education, and other key outcomes. 4 Conclusions The concept of duty hours itself is contested, and little attention has been paid to the nature and intensity of the activities that occupy residents' hours. Much research focuses on isolated outcomes of duty-hour changes without considering mediation or moderation. More studies are needed to define tradeoffs between outcomes and the value society places on these tradeoffs.
Issue Date: 2011-01
Publisher: Association of American Medical Colleges
Citation Info: Schwartz, A., Pappas, C., Bashook, P. G., Bordage, G., Edison, M., Prasad, B., & Swiatkowski, V. 2010. Conceptual Frameworks in the Study of Duty Hours Changes in Graduate Medical Education: A Review. Academic Medicine. 86(1):18-29. DOI: 10.1097/ACM.0b013e3181ff81dd
Type: Article
Description: This is a non-final version of an article published in final form in Schwartz, A., Pappas, C., Bashook, P. G., Bordage, G., Edison, M., Prasad, B., & Swiatkowski, V. 2010. Conceptual Frameworks in the Study of Duty Hours Changes in Graduate Medical Education: A Review. Acad.Med.Post print version of article may differ from published version. The definitive version is available through Association of American Medical Colleges at DOI: 10.1097/ACM.0b013e3181ff81dd
URI: http://hdl.handle.net/10027/8456
ISSN: 1040-2446
Sponsor: This study was funded in part by a contract from the Accreditation Council for Graduate Medical Education to the Department of Medical Education at the University of Illinois at Chicago (Schwartz, PI).
Date Available in INDIGO: 2012-08-15
 

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