Patients at teaching hospitals don't fare worse with trainee doctors, research shows
(Medical Xpress)—A University of Florida physician and colleagues have "mythbusted" a notion long held in medical circles: patients at teaching hospitals fare worse in July when new medical graduates start their residency training and older residents take on more responsibilities. A large national study revealed no such "July phenomenon" or "July effect"—at least not in the field of neurosurgery.
The findings are published today in the journal Neurosurgery.
"If anything goes wrong in July, then everyone's quick to say 'Do you see? It's because of the July effect'—but we saw no evidence for that,' said senior author Dr. Brian Hoh, the William Merz associate professor of neurological surgery at the UF College of Medicine. "This study will raise thoughts and ideas about how we can improve training for residents and improve safety for patients."
The July phenomenon is infamous both among physicians and patients. Conventional wisdom has it that if you are going to be a patient at a teaching hospital, try not to go in July.
The graduate medical year starts on July 1, at which time recent medical school graduates start bearing responsibility for patients for the first time, and previous interns and residents move up a level, taking on new and unfamiliar tasks.
Previous studies of the July phenomenon in fields such as general surgery, obstetrics, gynecology and internal medicine have yielded inconsistent results, some finding an effect and others finding none. Hoh, a member of UF's McKnight Brain Institute, wanted to see what happens in neurosurgery, where doctors train for many years to gain proficiency in complex and delicate brain surgeries. One earlier study of pediatric neurosurgery found no effect, whereas another study found a small effect.
Seeking a clearer view, Hoh and colleagues at UF and Harvard's Massachusetts General Hospital analyzed more than 850,000 teaching hospital admission and patient-outcome records from a database called the National Inpatient Sample. They assessed the rates of patient deaths and surgical complications in July compared with all other months, from 1998 to 2008.
The researchers evaluated four brain conditions that were representative of diseases commonly treated at teaching hospitals: nontraumatic hemorrhage, central nervous system trauma, central nervous system tumor and hydrocephalus.
After taking variations in patient demographics and hospital characteristics into account, the researchers found that the risk of death or complications at teaching hospitals was the same in July as in other months. The results reflected those at nonteaching hospitals used for comparison.
"If you've got new physicians on the job and you've got physicians that have just been promoted to a new level, it's sort of the perfect storm for medical errors—it makes intuitive sense, but for a variety of peculiar reasons it's just not the case," said Dr. Hunt Batjer, the Lois C.A. and Darwin E. Smith Distinguished Chair in Neurological Surgery at the University of Texas Southwestern Medical Center and chair of the Residency Review Committee for neurological surgery of the Accreditation Council for Graduate Medical Education, the body that certifies post-medical school training for the entire U.S. Batjer was not involved in the study.
The authors say multiple layers of supervision seem to more than compensate for the inexperience of young physicians, providing a safety net for patients.
"Maybe in July, that oversight is heightened because supervising physicians pay more attention to what new residents and interns are doing," said Hoh, who practices at Shands at UF medical center.
Still, the researchers point out, there might have been near misses in which errors or complications were averted, but there was no way to identify from the database whether such occurrences increased in July compared with other months.
"In some ways, I hope people continue to talk about the July effect or the August effect," Batjer said. "It will force us to remain vigilant."
Provided by University of Florida
- Researchers evaluate impact of July effect in teaching hospitals Jul 13, 2011 | not rated yet | 0
- New medics in death spike Jun 02, 2010 | not rated yet | 0
- New limits on physician training hours could prove costly for US teaching hospitals Sep 08, 2011 | not rated yet | 0
- White patients benefit more than blacks in surviving surgical complications at teaching hospitals Feb 16, 2009 | not rated yet | 0
- Fewer prostate cancer surgery complications found in teaching hospitals with fellowship programs May 15, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Calculating on-axis elements of a solenoid
7 hours ago I wanted to mention that this solenoid has many winds over many layers. The thickness of the windings is 2.4 inches coming off of the engineering...
latitude & longitude & air pressure
8 hours ago Hi there, I have a peculiar question. Imagine that you are in a earth position, obtained by google, that gives you the latitude and longitude....
Differences of Classical Mechanics when learned with Calc vs algebra?
11 hours ago what are the differences? Every example I find usually has a derivative or integral or some kind of calculus defined concept that seems to make it...
what is the distance traveled
15 hours ago A rough sketch of experiment. Image: http://i43.tinypic.com/14t4sk5.png the red dots represent a side view of path traveled, F is downward force...
Image of a Convex Lens Cut in Half Horizontally
19 hours ago Hello everyone, A friend of mine came up with this question in class and I really do not have a good answer. Suppose you have a convex lens...
Ray tracing through optical system of thick lenses
19 hours ago Can you advise me a free software that allow to draw rays passed throught system of thick lenses (preferable in 3D)?
- More from Physics Forums - Classical Physics
More news stories
Johns Hopkins researchers have developed new guidelines—the first in more than 35 years—to govern the amount of blood ordered for surgical patients. The recommendations, based on a lengthy study of blood use at The Johns ...
Surgery 14 hours ago | 4 / 5 (1) | 0
Indian doctors said Wednesday they have successfully carried out a first round of reconstructive surgery on the skull of a baby suffering from a rare disorder that caused her head to nearly double in size.
Surgery 18 hours ago | not rated yet | 0
A 33-year-old Polish man received a face transplant just three weeks after being disfigured in a workplace accident, in what his doctors said Wednesday is the fastest time frame to date for such an operation. ...
Surgery 19 hours ago | not rated yet | 0
Surgeons investigated sexual function in 62 patients, 50 years and older, who had received extensive spinal–pelvic instrumentation for spinal deformity at the University of Virginia Health Center. Based on their results, ...
Surgery May 21, 2013 | not rated yet | 0
Physicians at Monash University and The Alfred Hospital in Melbourne, Australia describe the logistic, medical, and societal challenges faced in treating spine trauma in morbidly obese patients. Based on a case series of ...
Surgery May 21, 2013 | not rated yet | 0
Swiss scientists reveal the mechanism responsible for aging hidden deep within mitochondria—and dramatically slow it down in worms by administering antibiotics to the young.
14 hours ago | 4.9 / 5 (7) | 0 |
Existing research shows that bicyclists who wear helmets have an 88 percent lower risk of brain injury, but researchers at Boston Children's Hospital found that simply having bicycle helmet laws in place showed a 20 percent ...
3 hours ago | not rated yet | 0
Researchers from Queen Mary, University of London have led the largest sequencing study of human disease to date, investigating the genetic basis of six autoimmune diseases.
14 hours ago | 4.7 / 5 (3) | 0 |
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
11 hours ago | 5 / 5 (2) | 2 |
(HealthDay)—Migraines and depression can each cause a great deal of suffering, but new research indicates the combination of the two may be linked to something else entirely—a smaller brain.
11 hours ago | 4 / 5 (2) | 0 |
A new approach for immunizing against influenza elicited a more potent immune response and broader protection than the currently licensed seasonal influenza vaccines when tested in mice and ferrets. The vaccine ...
12 hours ago | not rated yet | 0 |