John Q. Young, MD, MPP; Andrew D. Auerbach, MD; Sumant R. Ranji, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1015.
Young JQ, Auerbach AD, Ranji SR. Impact of the “July Effect” on Patient Outcomes. Ann Intern Med. 2012;156:168. doi: 10.7326/0003-4819-156-2-201201170-00023
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Published: Ann Intern Med. 2012;156(2):168.
We fortunately note that graduate medical education programs in the United States heeded Dr. Glick's prescient recommendation in 1966; interns typically report 9 days before July 1. However, we agree with Drs. Vaughan, Bell, and McAlister that implementing staggered start schedules over months (rather than weeks) is a promising strategy to mitigate the impact of cohort turnover. We also agree with Dr. Jarrett that more rigorous orientations that incorporate simulation and focus on essential clinical skills (procedural and cognitive), patient safety concepts, and systems knowledge need to be developed. These orientations, or “boot camps,” should use competency-based assessments to determine when an intern is ready to “graduate” from orientation. We also believe that the fourth year of medical school should be reexamined in light of these concerns. Medical schools should consider requiring more uniformly rigorous clinical training, especially during the last 6 to 9 months. This would not only better prepare students for internship, it would also guard against the degradation of clinical skill that can occur when students spend too much of their fourth year in roles that do not require authentic responsibility for patient care (for example, the responsibility of a subintern).
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