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    Is the July phenomenon a myth? An ob/gyn resident speaks out



    photo of Yalda Afshar, MD, PhDYalda Afshar, MD, PhD




    Come July 1st, thousands of newly minted interns with freshly pressed long white coats, but experience-green, flood the floors of teaching hospitals around the country. For most of the country July 1st means another glorious summer day of basking in the bliss of summertime sun. For the labor and delivery floor this is NOT the case.

    The lure of the July phenomenon—the day that the most inexperienced physicians hit the floorlooms over the nursing stations, operating rooms and cafeteria for weeks before D-day. The senior residents have created biased assumptions, the L&D nursing staff have sharpened their sassiness, and the OR techs are ready to make the medical students feel godly in comparison to the intern. New prey is in town. By the fall of the year, all above-mentioned parties will have transformed into a chummy family and this dark transition period will be suppressed deep in the brain where dark secrets live. Everybody comes out stronger; but nobody talks about the transformation because it’s really a supernatural phenomenon and nobody can point to what it was, or who said what, but everyone’s changed and everyone’s stronger because of it. “You’re welcome, newbies,” say the above-mentioned parties.

    Despite several studies that have attempted to look at data that point to differential outcomes associated with the July phenomenon, no study has shown a striking difference (or any) in morbidity, mortality or efficiency, though some allude to it. The only weak piece of possible correlation that exists is a 2011 systematic review that assessed 39 studies.1 It concluded that efficiency decreases with year-end change-overs, but alluded to heterogeneity in the existing literature that does not permit firm conclusions. One of the largest studies compared hospital deaths and lengths of stay from July to September to the rates for other months in teaching and nonteaching hospitals, looking at 48,000 patients admitted to the ICU in 28 hospitals from 1991 to 1997.2 There was no significant difference in mortality rates or lengths of stay.

    The case in obstetrics is even clearer. The July phenomenon is not seen.3. A retrospective review of data from the Nationwide Inpatient Sample, for the years 1998 to 2002 looked at the 26,175 singleton live birth admissions in July compared to 266,158 such admissions in August to June. There were no statistically significant differences in the rates of cesarean delivery, urethral/bladder injury, third- or fourth-degree lacerations, wound complications, postpartum hemorrhage, transfusion, shoulder dystocia, brachial plexus injury, birth asphyxia, chorioamnionitis, or anesthesia-related complications.

    So patients, senior residents, and attendings, fear not. The July phenomenon is most likely a myth. I’d argue that the reason the phenomenon is not seen is directly related to the counter-coup phenomenon of July: more hand-holding and more vigilance from above. What the new residents lack in medical experience is more than made up for in supervision from their seniors and attending physicians.

    Interns, as for you, please do not be the “n-value” that adds to the body of evidence that provides validity to the July phenomenon in the year to come. Congratulations on starting the most exciting journey in medicine. You’re a physician. But please, don’t let it get to your head. 

    NEXT: Dr. Afshar's Top 5 Rules for the Intern Year

    Yalda Afshar, MD, PhD
    Dr. Afshar is a Maternal-Fetal Medicine Fellow in the Department of Obstetrics and Gynecology, University of California, Los Angeles


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