“July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes

Young, John Q.; Ranji, Sumant R; Wachter, Robert M.; Lee, Connie M.; Niehaus, Brian; Auerbach, Andrew D.

doi:10.7326/0003-4819-155-5-201109060-00354

Cited by 286 publications

(227 citation statements)

References 63 publications

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“…The existence of the "July effect" (whereby medical trainees beginning new clinical roles affect medical error rates, patient outcomes, and departmental productivity) remains uncertain in the literature. 19 Third, in the post-implementation group, a substantial proportion of patient data was excluded, mostly due to clerical and administrative data error. It is impossible to determine what impact this may have had on the results.…”

Section: Quality Assessmentmentioning

confidence: 99%

SGEM Hot Off the Press: Computer provider order entry (CPOE) and emergency department flow

Lin

Chan

Mohindra

et al. 2017

CJEM

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As part of the Canadian Journal of Emergency Medicine (CJEM) developing social media strategy, 1 we are collaborating with the Skeptics' Guide to Emergency Medicine (SGEM) to summarize and critically appraise the current emergency medicine literature using evidence-based medicine principles. In the Hot Off the Press (HOP) series, we select original research manuscripts published in CJEM to be summarized and critically appraised on the SGEM website/podcast 2 and discussed by the study authors and the online EM community. A similar collaboration is underway between the SGEM and Academic Emergency Medicine. What follows is a summary of the selected article and the immediate post-publication critical appraisal from the SGEM podcast, as well as an overview of the subsequent discussion from the SGEM blog and other social media. Through this series, we hope to enhance the value, accessibility, and application of important, clinically relevant EM research. In this, the fourth SGEM HOP hosted collaboratively with CJEM, we discuss Gray et al.'s paper 3 evaluating the impact of computerized provider order entry on patient flow through a quaternary emergency department in London, Ontario.

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Section: Quality Assessmentmentioning

confidence: 99%

SGEM Hot Off the Press: Computer provider order entry (CPOE) and emergency department flow

Lin

Chan

Mohindra

et al. 2017

CJEM

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“…A recent systematic review supported the existence of a ''July effect'' with a higher incidence of errors and adverse events in the early months of the academic year, particularly in studies with higher-quality designs and larger samples. 64 Studies that have explored the effect of transitions in anesthesiology across the educational continuum are relatively rare, although an Australian study found that the adjusted risk for adverse events from care provided by anesthesiology residents was significantly higher at the start of the academic year. 65 Also, a study in the United States showed that more than one-half of anesthesiology residents failed to adhere to the standard of care for preoperative cardiac evaluation.…”

Section: Transitions Across the Medical Education Continuummentioning

confidence: 99%

Review article: Closing the research gap at the interface of learning and clinical practice

Philibert

2011

Can J Anesth/J Can Anesth

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Purpose The dialogue at the interface of education and clinical practice highlights areas of critical importance to the development of new approaches for educating anesthesiologists. The purpose of this article is to examine the literature on education and acquisition of competence in three areas relevant to the interface of learning and clinical practice, with the aim to suggest a research agenda that adds to the evidence on preparing physicians for independent practice. The three areas are: 1) transitions across the continuum of education; 2) the effect of reductions in hours of clinical training on competence; and 3) efforts to incorporate the competencies and CanMEDS roles into teaching and evaluation. Principal findings Fifty-six articles relevant to one or more of the themes were identified in the review, including 21 studies of transitions (in, during, and after residency education), 19 studies on the effects of duty hour limits on residents' acquisition of competence, and 16 articles that assessed competency-based teaching and assessment in anesthesiology. Overall, the findings suggested a relative paucity of scientific evidence and a need for research and the development of new scientific theory. Studies generally treated one of the themes in isolation, while in actuality they interact to produce optimal as well as suboptimal learning situations, while medical education research often is limited by small samples, brief follow-up, and threats to validity. This suggests a ''research gap'' where editorials and commentaries have moved ahead of an evidence base for education. Promising areas for research include preparation for care deemed important by society, work to apply knowledge about the development of expertise in other disciplines to medicine, and ways to embed the competencies in teaching and evaluation more effectively. Conclusion Closing the research gap in medical education will require clear direction for future work. The starting point, at an institution or nationally, is dialogue within the specialty to achieve consensus on some of the most pressing questions.

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“…The individual nuances of working in specific departments are left out due to issues of generalisability and time constraints. The lack of familiarity with location and staff in addition to the lack of information and guidance regarding proper documentation, ordering and sending lab tests, and so on leaves residents unacceptably overwhelmed and unprepared to handle their duties, when they start work [3]. Interns are an integral part of healthcare delivery – they work closely with patients and other members of the healthcare delivery team.…”

Section: Introductionmentioning

confidence: 99%

“…Adequate training of interns regarding proper documentation is an integral part of the safe and efficient care of patients and is closely related to hospital compliance with regulations and thus hospital reimbursement. The time period corresponding to the beginning of residency training in July is associated with reduced quality of healthcare delivery and patient outcomes [3]. This reduction in quality is well known and documented in the medical literature and is known collectively as the ‘July Effect’ [4–9].…”

Section: Introductionmentioning

confidence: 99%

A quality improvement intervention to enhance performance and perceived confidence of new internal medicine residents

Otokiti

Sideeg

Ward

et al. 2018

Journal of Community Hospital Internal Medicine Perspectives

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Background: Orientation for new medical residents is challenging due to the diversity of prior experiences and cultural backgrounds and is compounded by a lack of orientation curricula that adequately addresses the needs of the medical residents to allow them to perform their duties in an efficient manner from the start. The beginning of residency training is associated with reduced quality of healthcare widely referred to as the ‘July effect’.Objective: To assess the impact of a peer-led orientation for new interns on (a) self-reported confidence level, (b) improvement in performance of first-year residents in appropriate clinical documentation and efficient discharge procedures and protocols.Design/methods: In June 2016, a hybrid of interactive teaching and simulation exercises was used to teach documentation of critical information, such as discharge medication reconciliation and discharge summary. A handout of an intern guide/manual was also provided. The previous year’s data served as comparison/control data. Comparison data were obtained for both groups from hospital’s utilisation review department.Results: Twenty-one of 23 expected new interns (91%) participated in the intervention. There was a significant decrease in non-compliance for clinical documentation in the intervention group compared to the control group. The self-reported confidence level in the intervention group increased 34%.Conclusions: Such peer-to-peer orientation has the potential to effectively improve appropriate documentation and discharge process by new residents and may help to reduce the ‘July effect’.

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“July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes

Abstract: National Heart, Lung, and Blood Institute.

Cited by 286 publications

References 63 publications

SGEM Hot Off the Press: Computer provider order entry (CPOE) and emergency department flow

SGEM Hot Off the Press: Computer provider order entry (CPOE) and emergency department flow

Review article: Closing the research gap at the interface of learning and clinical practice

A quality improvement intervention to enhance performance and perceived confidence of new internal medicine residents

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