Why July Matters

Abstract

Each July, new graduates from premedical, medical, and residency programs, along with junior and midcareer faculty, acclimatize to their changing roles. During this month, overall efficiency, quality, and patient safety may suffer, a problem dubbed the "July effect." The many transitions that occur in teaching hospitals during July are often implicated as the root cause of this problem. The question, then, of how best to improve the team-based clinical care provided in July remains important. In this Commentary, the authors outline a model that combines the team-based care paradigm with effective leadership, followership, and communication-based strategies and propose some actionable steps.A key first step to enhancing patient safety in July is improving effective leadership through use of a select group of attendings whose teaching style empowers learners within a framework of close supervision. Second, programmatic efforts to pair these leaders with good followers are needed. Senior residents in July should be selected on their ability to mentor, guide, and support interns. Third, a system of free-flowing, bidirectional communication must be nurtured to ensure optimal outcomes. Adapting strategies from the airlines (e.g., interdisciplinary conferences to discuss optimal patient care approaches; checklists for daily activities such as sign-outs; directed feedback and debriefing techniques emphasizing actionable areas for improvement) is promising and worth studying.Available data suggest that the "July effect" is real. Developing new and exploring existing approaches for allaying this phenomenon are important areas of further investigation.

“Doing it Right” Overnight: a Multi-perspective Qualitative Study Exploring Senior Medical Resident Overnight Call

“…Existing interventions include participation in an on-call simulation, 25 introduction of a "buddy-system" overnight where a more experienced SMR is paired with a newly minted SMR, 26 or the use of additional "float" senior residents during the first couple of weeks of a junior resident's transition to the senior role. 27…”

The “July effect”: Outcomes in microvascular reconstruction during resident transitions

“…Whether or not the July effect is myth or a clinically relevant entity remains to be determined; however, it is logical to employ rational safeguards at times of workforce transition. Actionable steps for an institution concerned with the July effect include designing simulation‐based training for incoming interns, fostering strong team dynamics, and safeguarding open‐bidirectional communication between attendings and residents . Our relatively small and insular specialty (i.e., a large program has five residents per year) may be insulated from the July effect due to our strength in those specific areas.…”

“…Actionable steps for an institution concerned with the July effect include designing simulation-based training for incoming interns, fostering strong team dynamics, and safeguarding open-bidirectional communication between attendings and residents. 25 Our relatively small and insular specialty (i.e., a large program has five residents per year) may be insulated from the July effect due to our strength in those specific areas. For example, within the otolaryngology community, simulation training is a rich area of research, with over 64 published simulators, and academic programs should continue incorporating it into residency programs.…”

Transforming Chief Residents into Chief Scholars

“…An internal medicine Chief Resident drew upon his clinical experiences to inform broader conversation in two ways. First, through reflection on his own experiences as an early July resident, he worked with a coach and sponsor to generate a meaningful letter on the topic [27]. Second, drawing from clinical observations made serving in the roles of resident and Chief Resident attending, he collaborated with CMR #1 to develop a value-focused framework for evaluating a set of laboratory tests.…”