July Effect? Maybe not
By: Emily Hughes
In the UK they call it The Killing Season; in North America it’s called The July Effect.
It’s the time of year when newly minted physicians traditionally begin their residency training, other medical trainees advance to the next year of training, and senior residents graduate to begin their professional careers. Interest in the potential effect on patient care during this large changeover has produced a body of research. Media has been quick to pick up on some of that research indicating a possible adverse effect.
Is The July Effect something to be concerned about?
“I think it is a topic that is complex and over sensationalized,” says Dr. Salvatore Spadafora, who oversees all residency programs, fellowships and continuing professional education at the University of Toronto. “Whenever you’ve got a complex topic or problem you usually never have a simple answer … it’s probably better to take a breath, step back, and say, ‘Ok, what are the actual facts? What are the variables in the complexity?’”
The most rigorous publication on the topic to date is a systematic review published in 2011 in the Annals of Internal Medicine which found that increased mortality is associated with year-end physician changeovers. However, this finding came with the limitation that, “heterogeneity in the existing literature does not permit firm conclusions about the degree of risk posed, how changeover affects morbidity and rates of medical errors, or whether particular models are more or less problematic.”
A 2016 analysis in the Journal of Patient Safety pooled data collected between 2011 and 2015 from nearly 120 academic medical centres and more than 333 affiliated hospitals from all geographic regions in the United States. It concluded that there was no evidence to support a July effect on survival outcomes at US academic medical centres. Studies focused on specific specialties and patient populations have indicated mixed results.
Despite this lack of strong supporting evidence, a national survey of US academic leaders in internal medicine, published in 2016 in The American Journal of Medicine, revealed that most internal medicine residency program leaders believe in the potential for a July effect.
Source: Canadian Medical Association Journal (CMAJ)
