July Effect in Obstetric Outcomes

Abstract

The July effect represents the month when interns begin residency and residents advance with increased responsibility. This has not been well studied in Obstetrics and Gynecology residencies and no study has been conducted evaluating obstetric outcomes. The purpose of this study was to evaluate the July effect on obstetric outcomes. Women who delivered between July and September (quarter 1) were compared to those delivering between April and June (quarter 4). Methods: This retrospective cohort study compared outcomes of deliveries between quarter 1 and quarter 4 from 2017 to 2020. Outcomes evaluated were postpartum length of stay (LOS), postpartum readmission, wound complication, wound infection, blood transfusion, estimated blood loss, 3rd and 4th degree lacerations, 5 min APGAR scores, and cesarean delivery rates. Results: There were 3693 deliveries in quarter 1 and 3107 deliveries in quarter 4. There was a higher incidence Of wound infection during the April-June period (N = 21; 0.68%) compared to July-September (N = 10; 0.27%; p = 0.0135). Although LOS for both periods were the same, the average postpartum LOS during July-September was slightly longer than April-June (1.7 days; SD = 1.1 vs 1.6 days; SD = 1.2; p = 0.0026). All other pregnancy outcomes were similar between the two groups. Conclusion: Overall, the July effect is minimal on obstetric complications. However, LOS between July and September may differ because all residents are less experienced in quarter 1. Wound infection rates were higher in April-June, perhaps because new PGY-1s went from assisting to primary on cesarean surgeries starting in the 4th quarter of the year.

Knowledge and confidence levels improvement among obstetrics residents regarding caesarean section training using video-mannequins combination

“…When performing a safe cesarean section, doctors are required to have proper and adequate practice [ 4 , 5 ]. Training in surgery was an important component of obstetrics and gynecology resident education, to serve optimum care for patients [ 6 ]. COVID-19 is an obstacle for medical students because they have to learn several special skills when providing care to patients in health facilities [ 7 , 8 ].…”

A Nationwide Study of the “July Effect” Concerning Postpartum Hemorrhage and Its Risk Factors at Teaching Hospitals across the United States

“…Researchers suggested that the arrival of new and inexperienced residents and interns may increase adverse patient outcomes [ 13 , 14 , 15 ]. July is the month that the academic year begins, experienced residents and fellows depart, and new residents and interns arrive [ 13 ].…”

“…Researchers suggested that the arrival of new and inexperienced residents and interns may increase adverse patient outcomes [ 13 , 14 , 15 ]. July is the month that the academic year begins, experienced residents and fellows depart, and new residents and interns arrive [ 13 ]. Some studies observed increased adverse patient outcomes or inefficient care during this transition, known as the “July effect” [ 13 , 14 , 15 ].…”

“…July is the month that the academic year begins, experienced residents and fellows depart, and new residents and interns arrive [ 13 ]. Some studies observed increased adverse patient outcomes or inefficient care during this transition, known as the “July effect” [ 13 , 14 , 15 ]. A previous study using 2018 Nationwide Inpatient Sample (NIS) data to examine the association of the risk of PPH with hospital characteristics found that teaching hospitals across the U.S. had the highest adjusted odds of increased risks of PPH [ 16 ].…”