July effect: New interns 'perfect storm' for higher mortality rates

A new study published today in the Annals of Internal Medicine confirms the notorious "July effect" in which mortality rates rise and efficiency declines during the summer month as the new class of medical trainees enter teaching hospitals.

"Patients and physicians have suspected this, but the individual studies often offered inconclusive findings. Now we have the evidence," in an editorial wrote Dr. Paul Barach, a specialist in perioperative and emergency medicine at the University Medical Center in Utrecht, the Netherlands, and Ingrid Philibert, a top official of the Accreditation Council for Graduate Medical Education in Chicago, reports ABC News.

Researchers reviewed 39 published studies to determine whether the academic changeover when residents graduate and interns start their training actually affects patient outcomes, as many have suspected for years. They found that mortality rates did increase between 8 and 24 percent in July, according to a Time blog post.

"At year-end, teaching hospitals experience a massive exodus of highly experienced physician trainees who are also familiar with the working environment of the hospital," said study coauthor John Q. Young, MD, MPP, associate program director, residency training program at the Department of Psychiatry at University of California San Francisco School of Medicine, in a press release. "The 'July Effect' occurs when these experienced physicians are replaced by new trainees who have little clinical experience, may be inadequately supervised in their new roles, and do not yet have a working knowledge of the hospital system. It's a perfect storm."

Researchers recommend that residents have increasing autonomy based on competency, institutions develop changeover systems to avoid fatigue, and systems to prevent system disruption, such as staggered start times for trainees.

Researchers do not recommend that patients avoid care when they need it, even during July.

"Patients shouldn't delay care, but they should be aware," said Young in a Wall Street Journal article. "It's always helpful to have a family member or friend present to serve as an advocate," he said. And "know that every team does have an experienced attending" physician, he says. "You can always ask to speak with that physician."

Study authors said, "Anecdotally, we are aware of training programs that make concerted efforts to have the 'best' attending physicians on service in July or alter rounding practices to provide additional oversight for new physicians," reports The Boston Globe.

To learn more:
- here's the study abstract
- read the editorial brief
- check out the press release
- read the TIME blog post
- read the WSJ blog post
- see the ABC report
- check out the Boston Globe article

Related Articles:
Residents' inexperience, fatigue concern physicians and the public
New resident duty-hour limits not enough: Fatigue, errors still rampant
Children's hospitals to lose funds for residency training