July? No big deal
UF study finds no difference in patient safety when residents start training
By Czerne M. Reid
Briah Hoh, M.D.
A UF physician and colleagues have “mythbusted” a notion long held in medical circles: patients at teaching hospitals fare worse in July when new medical graduates start their residency training and older residents take on more responsibilities. A large national study revealed no such “July phenomenon” or “July effect” — at least not in the field of neurosurgery.
The findings were published in the journal Neurosurgery in September.
“If anything goes wrong in July, then everyone’s quick to say ‘Do you see? It’s because of the July effect’ — but we saw no evidence for that,” said senior author Brian Hoh, M.D., the William Merz associate professor of neurological surgery at the UF College of Medicine. “This study will raise thoughts and ideas about how we can improve training for residents and improve safety for patients.”
The July phenomenon is infamous both among physicians and patients. Conventional wisdom has it that if you are going to be a patient at a teaching hospital, try not to go in July.
The graduate medical year starts on July 1, at which time recent medical school graduates start bearing responsibility for patients for the first time, and previous interns and residents move up, taking on new tasks.
Previous studies of the July phenomenon have yielded inconsistent results.
Hoh and colleagues at UF and Harvard’s Massachusetts General Hospital analyzed more than 850,000 teaching hospital admission and patient-outcome records from a database called the National Inpatient Sample. They assessed the rates of patient deaths and surgical complications in July compared with all other months, from 1998 to 2008.
After taking variations inpatient demographics and hospital characteristics into account, the researchers found that the risk of death or complications at teaching hospitals was the same in July as in other months. The results reflected those at nonteaching hospitals used for comparison.