The Overhyping of the July Effect and What to Do About It

By HEMANT SINDHU, MD

Filing into the auditorium, scanning the room hoping to spot a familiar face, there is a generalized sense of anxiety. Today is orientation, a day that marks the beginning of a new chapter in the lives of these bright-eyed young doctors, but also evokes an old story.

Every year around this time, there is a rash of news coverage and discussion about the “July Effect,” a term used to characterize the increased risk of medical errors as interns begin their residency training and the demands on their supervising residents and attendings increase.

While I believe the July Effect is overhyped (and the literature does not clearly support an increase in errors in July), I am not discounting the fears of patients who worry about being treated by newly-minted physicians.

However, what many people don’t know is that these new resident physicians are actually leading the charge in making sure that patients are safe. In hospitals across the country, it is the residents who are spearheading innovative solutions to limit medical errors, communicate better with patients so they understand their conditions and can follow a course of treatment, and identifying ways to work safer and smarter. When I entered residency seven years ago this was not the case. Doctors were not encouraged to report errors and institutions did not foster transparency. The culture was completely different. Today, however, resident physicians see themselves as playing a pivotal role as front-line providers in improving patient safety and hospitals are more receptive to change.

What has emerged in hospitals across the country, organically and through the efforts of this youngest generation of physicians, are potential models that could make a significant difference to improving patient outcomes.  Here are some examples:

• In Brooklyn, NY, a resident led effort to report errors or potential errors is a large-scale project in its eighteenth month since implementation and has led to system improvements including the use of bladder scanners to avoid unnecessary urinary catheterizations, which are painful and can lead to infection.
• At a Queens, NY hospital, CIR members have launched the iListen Movement, a curriculum addressing the critical importance that effective physician communication plays in optimizing patient safety, achieving desired medical outcomes, reducing costs of care and enhancing physician career satisfaction.
• In Boston and the San Francisco Bay Area, residents are identifying the health impacts of poverty, housing insecurity, and other social determinants of health and connecting patients with resources to address those underlying issues.
• At Boston Medical Center, an adverse event reporting initiative identified barriers to house staff reporting of adverse events and near misses, thus allowing for the creation of a set of educational interventions that has consistently increased house staff reporting – doubling and tripling it in most departments.

The cumulative outcome of these efforts and many others has earned young physicians a seat at the table when administrators are discussing policies and practices that affect patients. Not only does resident leadership in safety and quality help make the voices of our patients heard, it helps a new generation of doctors take more ownership of where healthcare is headed.

I believe there is reason to be optimistic, and even inspired this July.

Instead of branding this period as a hazard for patients, teaching hospitals should seize the opportunity to embed patient safety in the curriculum and culture of residency programs, building on the innovative work that is currently underway. We, as resident physicians, should continue working collaboratively with our predecessors to find even more novel ways of improving patient safety and quality in our hospitals, teaching and non-teaching alike.

Hemant Sindhu, MD, is the president of the Committee of Interns and Residents/SEIU Healthcare. He completed his internal medicine residency and Hematology-Oncology fellowship in New York City and has been closely involved in health advocacy and resident-led quality improvement initiatives across the country.