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Medical Error as a Collaborative Learning Tool
Published in Fritz Allhoff, Sandra L. Borden, Ethics and Error in Medicine, 2019
Epistemic humility is an important virtue to develop for health-care professionals, especially when phenomena such as the “July Effect” exist. Also called the “August killing season” in the United Kingdom, the July Effect occurs when hospitals undergo cohort turnover (this is when an organization loses many experienced workers and gains many inexperienced workers at roughly the same time).17 This phenomenon is commonplace in many teaching hospitals, as well as other health-care settings. In these hospitals, July is typically the month that freshly minted MDs graduate from medical school and join the workforce. These new health-care professionals have the knowledge required for proper healthcare, but they lack the skill that comes from experience and making mistakes. Skill and knowledge are vastly different. Knowledge is something that can be gained from studying books and attending lectures, but skill is something that only experience can grant. So, when new health-care professionals take over in these teaching hospitals, they know what to do, but they do not know how to do it. This naturally leads to a spike in medical errors.
July effect in clinical outcomes of esophagogastroduodenoscopy performed at teaching hospitals in the United States
Published in Baylor University Medical Center Proceedings, 2023
Karthik Gangu, Sanket Basida, Rehmat Ullah Awan, Mohammad Ali Butt, Austin Reed, Rao Afzal, Rahul Shekhar, Harleen Kaur Chela, Ebubekir S. Daglilar, Abu Baker Sheikh
An important association between these complications is the timing during the academic year that these procedures are performed. The “July effect” is a term in the medical literature that describes the phenomenon of increased rates of complications in the early months of the academic cycle due to the transition of new trainees. Although this phenomenon is well published, the overall data concerning the “July effect” remain unclear. While some international studies have shown adverse outcomes, retrospective cohort studies in the US have shown no clear impact on morbidity and mortality.3,4 When specifically examining deaths from medication errors, one retrospective cohort study published by Phillips and Baker found an increase in July deaths across the years 1979 to 2006; the increased deaths correlated to counties with teaching hospitals.5 However, no other causes of death were reported, such as surgical or procedural complications leading to death. Petrilli et al specifically evaluated the July effect among surgical specialties and found no increase in adverse outcomes during July.3 Overall, studies on the July effect have not consistently shown a correlation with increased adverse events in early academic training months, yet procedure-based medicine specialties have not been thoroughly evaluated.
Differences between medical school and PGY1 learning outcomes: An explanation for new graduates not being “work ready”?
Published in Medical Teacher, 2020
Pete M. Ellis, Tim J. Wilkinson, Wendy C-Y. Hu
Denigration of the quality of contemporary medical education compared to the apocryphal past is commonplace. The increasing prominence of claims that medical graduates are not as work ready as in the past (e.g. Sturman et al. 2017) is attributed to a variety of causes (AHMAC 2015). Concerns about patient safety during the month that new graduates enter the workforce, driven by trends in mortality and morbidity data, has been termed the ‘July effect’ (or the ‘December/January effect’ depending on global location) (Young et al. 2011). Although the evidence that graduating doctors are less prepared than they used to be is largely unsubstantiated and the evidence for the ‘July effect’ has been challenged (Wei et al. 2019), it has nonetheless stimulated ‘remedial’ actions. Internal medicine program directors in the USA consider targeted educational interventions justified (Levy et al. 2016). Similar UK concerns about new graduates (Monrouxe et al. 2017) have led to mandatory competency assessments in prescribing (Prescribing Safety Assessment 2014) and policies to share information between medical schools and health services about graduating medical students (UK Foundation Programme 2018).
A quality improvement intervention to enhance performance and perceived confidence of new internal medicine residents
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Ahmed Otokiti, Abdelhaleem Sideeg, Paulisa Ward, Merina Dongol, Mohamed Osman, Oloruntobi Rahaman, Syed Abid
The ‘July effect’ results in decreased quality of medical care during the months following commencement of residency training, with direct effects on patient care, patient safety, and hospital reimbursement. One of the reasons identified in the literature is a deficiency in the orientation of new interns [1,11]. We set out to study the effects of a well-structured intern to intern peer orientation using interactive learning techniques, simulation modalities, and distribution of intern manual on new interns’ confidence levels and in decreasing errors in documentation during the early months of residency. These modes of delivery have been validated as highly effective in delivering medical education [12]. There was a considerable decrease in noncompliance rates in the intervention group, which seemed to level off by the third month. This is in agreement with Haller and colleagues who found that the risk of undesirable events during the early months of training is independent of clinical experience or residents’ seniority level but is rather more dependent on the familiarity of residents with the particular hospital system [13]. Consequently, it is not surprising that the difference observed in the first and second months between the intervention and control group seemed to level off at the third month due to increasing familiarity with the system by both group members.