PubMed · 14225453
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M K DISTEFANO, M W PRYER. 1964. BASIC ISSUES AND PROBLEMS IN ATTENDANT TRAINING.. https://pubmed.ncbi.nlm.nih.gov/14225453/
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STUDY OBJECTIVES: To examine the relationship between residents' self-reported sleep hours, work hours, and other empirical correlates. DESIGN: Using the American Medical Association's Graduate Medical Education database, a national, random sample of PGY (postgraduate year) 1 and PGY2 residents in the 1998-1999 training year was surveyed by mail. MEASUREMENTS AND RESULTS: Residents completed a 5-page survey with 44 questions requiring 144 separate responses about their residency experience. Completed surveys were received from 3,604 of 5,616 residents contacted, a 64.2% response rate. Although work hours and sleep hours were significantly correlated (r = -.39), this relationship was less robust than is generally assumed. Total average sleep hours varied across specialties but also within specialties. Just over 20% of all residents reported sleeping an average of 5 hours or less per night, with 66% averaging 6 hours or less per night. Residents averaging 5 or fewer hours of sleep per night were more likely to report serious accidents or injuries, conflict with other professional staff, use of alcohol, use of medications to stay awake, noticeable weight change, working in an "impaired condition," and having made significant medical errors. CONCLUSIONS: Reduced sleep hours were significantly related to a number of work-related, learning, and personal health variables. Capping residents' work hours is unlikely to fully address the sleep deficits and resulting impairments reported by residents.
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The development of Rasch models in educational and psychologic measurement in the 1960s coincided with the introduction of other similar models, now described as models of item response theory (IRT). The application of IRT models has now extended to other social sciences, including health. Originally, there was substantial controversy between those who saw Rasch models as simply special cases of IRT models and those who saw them as essentially different. Because these different perspectives continue to manifest themselves in various ways, it seems relevant to understand the source of the original controversy. This paper attempts to do so by invoking Kuhn's studies in the history and philosophy of science at 3 levels. First, it suggests that the 2 perspectives reflect Kuhn's concept of legitimate, incompatible paradigms in which controversy is a typical manifestation. Second, because Kuhn recognizes individual histories in the development of paradigms, Rasch's own shift in perspective is summarized. Third, because proponents of the Rasch models emphasize the models' compatibility with fundamental measurement found in physical science, an analogy is made between how Kuhn explains the role of measurement in the physical sciences and how proponents of Rasch models explain the role of these models in the social sciences. In particular, these roles cannot be gleaned from textbooks in science and statistics, respectively.