July Hospitalizations: Inexperienced Doctors Make Them Riskier, Analysis Says

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Individual Studies Inconclusive, But Systematic Review Strengthens Evidence for July Effect

"Patients and physicians have suspected this, but the individual studies often offered inconclusive findings. Now we have the evidence," they wrote. They found particularly unsettling the notion that patient safety has been at stake during the 20-year span of "the debate over the existence, magnitude and impact of the July Effect."

The new review "clearly traces the worsening in patient quality and safety by new interns and residents as they advance toward mastering patient care," Barach and Philibert wrote. They suggested that "patients would not consent to care if they knew that the opportunities for residents to learn come at the expense of their welfare."

Earlier this month, U.S. teaching hospitals implemented new regulations from ACGME, which included limiting interns to no more than 16 hours of continuous duty, and requiring direct supervision of interns "until they demonstrate competency that allows them to be supervised indirectly," Young said.

Young said additional studies need to be done to determine which techniques can increase patient safety and mitigate the risks posed by teaching hospitals' July turnover. He suggested that the U.S. medical system has been slow to adopt new technologies and approaches to improving quality of care: "The whole history of medicine in the United States has stressed the autonomy of the physician ? the inerrancy almost of the physicians. It turns out health care in the United States is unreliable and has a lot to learn from other industries."

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