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Study dispels myth that new residents cause increase in medical errors in July

September 25, 2009

New study in Journal of the American College of Surgeons finds no evidence of 'July Phenomenon' in trauma centers with constant resident supervision

CHICAGO - New research published in the September issue of the Journal of the American College of Surgeons challenges the widely held belief that more medical errors occur in teaching hospitals during the month of July due to the influx of new graduates from medical and nursing schools - also known as the "July Phenomenon." The study shows no differences in in-hospital mortality rates, number of days in the intensive care unit (ICU) or on ventilator support, or minutes spent undergoing resuscitation for trauma patients in July compared with results for other months of the year.

"The results of our study add to a growing body of evidence suggesting that the July Phenomenon does not exist in major trauma centers with appropriate guidance and supervision of residents," said Peter E. Fischer, MD, MS, Department of Surgery, University of Tennessee Health Science Center. "Our center, for example, has taken multiple steps, including constant attending physician supervision and a regimented team approach, to ensure quality care for our patients, regardless of the experience of the treating physician. It is time to put the myth of the July Phenomenon to rest."

Using data from a trauma registry, researchers compared outcomes by month and quarter in blunt trauma patients admitted to a Level I trauma center during a five-year period between July 1, 2001, and June 30, 2006. During the study period, residents completed one-month rotations through the trauma center. Only patients who were admitted and discharged during the same month were included in the initial analysis. A total of 12,525 patients were included in the monthly analysis. When the patients were separated by quarters, 14,798 were available for analysis. A secondary analysis was also performed by quarter to include patients whose stay crossed the monthly border. Outcomes evaluated included in-hospital mortality, ICU days, ventilator-support days, and minutes in the resuscitation room.

Multivariable logistic regression suggested that the month or quarter of the academic year was not an independent predictor of mortality after adjusting for age, injury severity, level of consciousness, and blood transfusion requirements (c=0.97). Linear regression revealed no monthly variation of ventilator-support days (p=0.574), ICU days (p=0.225), or minutes in the resuscitation room (p=0.497).

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