How Should We Treat the July Effect?

Caution! The doctor you see in July was a medical student just last month. That wouldn't be an issue if they were competent to take care of you, but, unfortunately, in most instances the research indicates they are not. That results in the July effect.

Medical graduate training works as an apprentice system designed to provide oversight by more experienced attending staff. In most instances, that is the case. However, there are many instances when first year postgraduate residents (interns) have to make decisions and perform procedures on their own. I know I did when I was a resident and I felt very insecure doing so.

So, is there a way to address the July effect and minimize its impact? Here are some suggestions.

1. Be sure medical students get the technical training they need to start seeing patients.

2. Mandate a digital health curriculum and measure competencies during medical school.

3. Use a clinical learning management system to track medical student performance during their clinical rotations.

4. Send medical students to clinical boot camps during the time between graduation (usually sometime in May) and the first day of their PGY 1 year July 1.

5. Use teaching and learning technologies and simulations to speed getting the necessary skills.

6. Do not shield patients from the reality of how medical education and training is done. Some will refuse to be treated by trainees, even though they realize they are in a "teaching" hospital. In fact, some teaching hospitals have created the academic oxymoron of "the non-teaching service."

7. Improve team-based communications so students who want help can get it.

8. Keep track of performance more frequently during July and August than we usually do as trainees get more experience.

9. Designate a "rover" attending, free of other responsibilities to be available when necessary.

10. Rehabilitate those trainees who are lagging in their performance during the first year before it's too late to fire them later.

The July effect is not inevitable. We owe it patients to not have to postpone their surgery until October of November to avoid it.