Susan George, FACP, was reviewing some data before patient safety rounds with residents at Saint Vincent Hospital when she noticed a slight uptick in medication reconciliation errors during July and August of last year.

 

  There were no serious adverse events and the discrepancies were typically minor, involving omission of vitamins or as-needed medications rather than more worrisome medications like beta blockers, said Dr. George, associate program director of the internal medicine residency program at the Worcester, Mass. hospital. Still, medication reconciliation is just one example of the many tasks and skills new doctors have to pick up during residency that can greatly impact patient safety.

 

   At teaching hospitals, the learning process restarts each summer, when a new brood of freshly hatched medical students fills the hallways and other residents move a rung up on the teaching ladder. The effect of that transition on hospital quality has been a long-standing question. Does it dip at this crucial point in the learning cycle?

 

  Opinions vary widely about whether the phenomenon dubbed “the July effect” even exists, and if it does, about its underlying causes and the best solutions to it. Dr. George believes in the July effect, which is why her hospital has additional checks in place until the new interns and residents are comfortable in their roles. Joanne Conroy, MD, chief health care officer for the Association of American Medical Colleges, is more doubtful, saying it “may fall more into that urban legend category. We've never really been able to prove it. And it's not for lack of trying.”

 

  Until recently that was generally true. A series of studies—mostly focused on specific specialties such as obstetrics or trauma—revealed no summertime pattern. Last August, though, a large-scale study published in the Journal of General Internal Medicine reached a different conclusion. The analysis, based on nearly three decades of death certificate data, identified a 10% spike in fatal medication errors during the month of July in counties with teaching hospitals. Counties without teaching hospitals showed no spike. Contact for complete article.