What is the July Effect?

It’s summertime! We all know what that means.

Fun.

Sun.

And new residents!

In North America, it’s called The July Effect. In the UK, they call it The Killing Season. (Wow, UK nurses, tell us how you really feel!) Here’s what you need to know about this phenomenon and what to do about it.

What is the July Effect?

The July Effect happens at the end of the academic year (hence the name) in large health networks and teaching facilities. Recent graduates and medical interns are learning, while senior residents are taking on more responsibilities. The transition can mean higher risks for errors and decreased efficiency. Both negatively affect patient care.

Errors that may be more prevalent during this time include:

• mistaken diagnoses
• preventable complications of care
• system failures leading to patient injury or death

Dr. Matt McCarthy, author of The Real Doctor Will See You Shortly: A Physician’s First Year, said that during his first year, he could “recite pages from a journal article on kidney chemistry or coagulation cascades.” Still, he had not learned how to keep patients alive, draw blood, or put in a Foley. 

As Dr. Edwin Leap puts it in his article titled “Nurses are always right. And 28 other tips for new residents”, “future family physicians and pediatricians, plastic surgeons and laser tattoo removal specialists (OK, not a specialty, just a sideline) learn how to be physicians,” during this time. While they are doctors, new residents still have a lot to learn.

“Having completed four years of expensive college and four years of even more expensive medical school, anxiety-filled and debt-ridden, they will embark on four to seven (or even more) years of training to make them knowledgeable, technically proficient physicians.”

Each class moves up the food chain. Medical students become interns, residents level up, and fellows are just starting out in their specialties. This changing of the guard can be an uncertain time for facility staff as everyone gets to know each other and adjusts.

Internist Anupam Jena, told Yahoo, “If you talk to anyone who works in a hospital unequivocally they will tell you care is worse in July, the intern knows less than the physicians who were there two or three months before.” 

How Nurses Can Handle the July Effect

Recent studies say the July Effect is a myth and seek to debunk it. Is it, though? Common sense would say there is a reasonable expectation that less experience equals more mistakes. Either way, real or not, it is worth taking note of this season. Here are a few tips to handle the resident change-over this summer.

• Check and double check. Nurses administering medications should be diligent in verifying orders and checking references for safe doses when working with an unfamiliar medication. You can also check with the pharmacy when you have questions. Careful scrutiny by nurses can help lessen the July Effect. It is called “The Nurse Effect.”

• Be kind. New interns and residents will have questions, but they may not know who to ask or may not want to ask. They won’t likely know about unit routines or nursing protocols. No one wants to be humiliated or feel ashamed. 

• As professional nurses, hold yourselves and others accountable for high-quality patient care. Acknowledge errors rather than overlooking them by talking to your manager about them in a non-judgmental way. Think of how you would want someone to approach you about a mistake, and then do that. 

• Effective teamwork is necessary for optimal patient care. Remember, you are on the same team. Work isn’t a game of staff nurses versus incoming medical residents. Work together to make sure your patients get great care. Foster a culture of collaboration.

• Exude gratitude. Everyone wants to feel helpful and appreciated. If a colleague does something right or good, be sure to let them know you appreciate them. 

In short, cut the interns and residents some slack this July. Nurses and residents can make it a great summer for patients and staff by working together. 

Resources:

July Effect? Maybe not – PMC, ncbi.nlm.nih.gov.

July Phenomenon Impacts Efficiency of Emergency Care – PMC, ncbi.nlm.nih.gov.

Matt McCarthy: The Real Doctor Will See You Shortly — MedHumChat, medhumchat.com

Nurses are always right. And 28 other tips for new residents, kevinmd.com

Headed to the Hospital? Beware the ‘July Effect’, yahoo.com

‘July Effect’ is a Fallacy, New Study Shows | HealthLeaders Media, healthleadersmedia.com

New Medical Residents and Patient Mortality—Does the ‘Nurse… : AJN The American Journal of Nursing, journals.lww.com

Interdisciplinary team interactions: a qualitative study of perceptions of team function in simulated anesthesia crises, pubmed.ncbi.nlm.nih.gov