title: Examining the July Effect: A National Survey of Academic Leaders in Medicine.
abstract: Whether the "July Effect" affects perspectives or has prompted changes in US Internal Medicine residency programs is unknown.
  
  
  
  We designed a survey-based study to assess views and efforts aimed at preventing harm in July. A convenience sampling strategy (email listserv and direct messages to program leaders via the Electronic Residency Application Service) was used to disseminate the survey.
  
  
  
  The response rate was 16% (65/418 programs); however, a total of 262 respondents from all 50 states where residency programs are located were included. Most respondents (n = 201; 77%) indicated that errors occur more frequently in July compared with other months. The most common identified errors included incorrect or delayed orders (n = 183, 70% and n = 167, 64%, respectively), errors in discharge medications (n = 144, 55%), and inadequate information exchange at handoffs (n = 143, 55%). Limited trainee experience (n = 208, 79%), lack of understanding hospital workflow, and difficulty using electronic medical record systems (n = 194; 74% and n = 188; 72%, respectively) were reported as the most common factors contributing to these errors. Programs reported instituting several efforts to prevent harm in July: for interns, additional electronic medical record training (n = 178; 68%) and education on handoffs and discharge processes (n = 176; 67% and n = 108; 41%, respectively) were introduced. Similarly, for senior residents, teaching sessions on how to lead a team (n = 158; 60%) and preferential placement of certain residents on harder rotations (n = 103; 39%) were also reported. Most respondents (n = 140; 53%) also solicited specific "July attendings" using a volunteer system or highest teaching ratings.
  
  
  
  Residency programs in Internal Medicine appear to have instituted various changes to mitigate harm in July. Further evaluation to understand the impact of these interventions on trainee education and patient safety is necessary.
authors.affiliation: Division of General Medicine, University of Michigan Health System, Ann Arbor.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Levy
authors.affiliation: Division of General Medicine, University of Michigan Health System, Ann Arbor.
authors.forename: Jessica
authors.initials: J
authors.lastname: Voit
authors.affiliation: Division of General Medicine, University of Michigan Health System, Ann Arbor.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of General Medicine, University of Michigan Health System, Ann Arbor.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Petrilli
authors.affiliation: Division of General Medicine, University of Michigan Health System, Ann Arbor; Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Mich. Electronic address: vineetc@umich.edu.
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
mesh_terms: D057286:Electronic Health Records; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D007857:Leadership; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010351:Patient Discharge; D062209:Patient Handoff; D012621:Seasons; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D057188:Workflow
keywords: Graduate medical education; July Effect; Patient safety; Residency program; Training