Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Acad Med. 2011 Jan;86(1):18-29. doi: 10.1097/ACM.0b013e3181ff81dd.
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 hours regulations. The authors sought to identify and describe these conceptual frameworks and their implications.
The authors reviewed the IOM report and articles in both peer-reviewed and non-peer-reviewed 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.
Twenty-three conceptual frameworks were identified. Several made contradictory predictions about the impact of duty hours regulations on patient outcomes, resident education, and other key outcomes.
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 hours changes without considering mediation or moderation. More studies are needed to define trade-offs between outcomes and the value society places on these trade-offs.
概念框架是研究问题的一种方法，它指定了关键实体及其关系。2009 年，美国医学研究所（IOM）关于住院医师工作时间的报告、随后的研究以及对该报告的回应发表了各种研究工作时间规定对影响的概念框架。作者试图确定并描述这些概念框架及其影响。
作者回顾了 IOM 报告以及 2008 年 1 月至 2010 年 4 月期间同行评议和非同行评议文献中的文章，使用包括 PubMed、EMBASE、CINAHL、BEME 和 PsycInfo 在内的多个电子数据库进行了识别。根据多名审稿人的共识，选择了明确描述或认为住院医师工作时间对任何其他结果有影响的研究，包括在内。作者从审查的 858 项研究中选择了 239 项。几位作者审查了文章，以确定隐含或明确用于描述工作时间（或工作时间规定）与结果之间关系的概念框架。识别是通过共识达成的。
确定了 23 个概念框架。其中一些对工作时间规定对患者结果、住院医师教育和其他关键结果的影响做出了相互矛盾的预测。
工作时间本身的概念存在争议，很少关注占据住院医师时间的活动的性质和强度。许多研究都集中在工作时间变化的孤立结果上，而不考虑调解或调节。需要更多的研究来定义结果之间的权衡以及社会对这些权衡的重视程度。
