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Philadelphia, July 12, 2011 - According to an article published
early online in Annals of
Internal Medicine, the flagship journal of the American
College of Physicians (ACP), year-end changeovers in medical
trainees are associated with increased mortality and decreased
efficiency at teaching hospitals during the month of July.
Researchers reviewed 39 published studies to determine the
effect of trainee changeover on patient outcomes. While the
research results are mixed, the authors found evidence of increased
patient mortality and lower efficiency (longer hospital stays and
surgical times and higher hospital charges) in July.
Dubbed "The July Effect," the phenomenon occurs in teaching
hospitals when experienced trainees (residents) graduate and new
interns begin their training. As a result, the average experience
of the teaching hospital's workforce abruptly declines, established
teams are disrupted, and many of the remaining trainees are
promoted to assume new roles in the care delivery process.
"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 John Q. Young, MD,
MPP, Associate Program Director, Residency Training Program,
Department of Psychiatry at UCSF School of Medicine, and co-author
of the study. "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
Some training programs make efforts to safeguard patients
against the July Effect. Some hospitals have their "best"
attendings on service throughout the month, while others alter
rounding practices to provide additional oversight for new
physicians. These changes may mitigate the effects of the
According to the editorialists, these findings are fertile
ground for developing approaches to reducing potential harms of the
July Effect. First, emphasizing graded responsibility, or increased
autonomy based on level of competency, may help ensure that
individual residents are entrusted with a level of responsibility
appropriate for their skill level. Second, developing changeover
systems that account for human factors and emphasize avoiding
cognitive overload and fatigue may also have benefit. Finally,
taking practical measures to reduce system disruption, such as
staggering start schedules for trainees, could be helpful.
About Annals of Internal MedicineAnnals of Internal Medicine is one of the five most widely
cited peer-reviewed medical journals in the world, with a current
impact factor of 16.7. The journal has been published for 82 years.
It accepts only 7 percent of the original research studies
submitted for publication. Follow Annals on Twitter and Facebook.