3 ways to battle the “July effect” in teaching hospitals

Each summer new residents and faculty figure out the layout of large facilities and meet a host of new teammates and patients. They also struggle with efficiency, quality and patient safety during the dawn of the academic year.

But there are ways to combat the legendary “July effect” that involve a more collaborative mindset among internal medicine trainees, attending physicians and faculty. A new report calls for novel strategies, some borrowed from aviation and other industries with a keen concern for safety, and all designed to boost teamwork, communications and effectiveness among the key players in the clinical setting.

“While teaching hospitals have long relied on the triad of attending physician, senior resident and intern to provide team-based care, new teams providing care in July are paradoxically part of the problem,” said the authors of a commentary published in Academic Medicine.

The authors said that studies show costs, hospital stays and patient mortality peak in July. They outlined three policies to roll back the July effect:

• Improving leadership. A select group of “July-able” attendings, known for their dynamic style, teaching prowess and ability to foster camaraderie, take the lead in teaching trainees. They encourage autonomous decision making, with early and direct feedback as a tool for improvement. Teaching hospitals identify and develop these master educators and put them in place well before July.
• Pairing good leaders with good followers. Senior residents are groomed and selected on the basis of their ability to mentor new interns. Grooming includes interdisciplinary rounds, which cultivate resident education and improve relationships with nurses. “Taking full advantage of nurses’ experience is of paramount importance,” the authors said.
• Cultivating bidirectional communication. A free-flowing, bidirectional communications system is nurtured, encouraging a willingness to report unexpected events to attendings. Health care institutions can borrow from other “institutions that seek to avoid catastrophe,” such as aviation, nuclear power and firefighting. Airlines, with their interdisciplinary conferences, checklists for daily activities, directed feedback and debriefing methods that focus on actionable improvement ideas, are worth studying as a model.

The authors called for further study of the July effect, especially determining whether reproducible and transferable practices are already in use and worth adopting in more hospitals.

The authors said the reforms they propose could transform the troubled academic year transition into a positive mentoring and growth experience for interns, faculty and senior residents.

“Most important, such reforms will allow teaching hospitals to provide consistent care to our patients 365 days per year,” the authors concluded. “As we do so, getting sick in July may become problematic for one reason only—missing the fireworks.”

• 10 concepts that will help you thrive as an intern
• 7 things you need to know to succeed as a medical intern
• 6 key factors that build residents’ trust in interns
• The physician’s essential art of balancing emotion and logic
• Resident burnout: Unearthing the bigger picture
• Making residency more family friendly