“Don’t get sick in July.”

This is a common refrain in teaching hospitals. It’s driven by the academic calendar: July is when the new interns — fresh out of medical school — start work. It’s also when the senior trainees, the residents and fellows, graduate to supervisory, self-managed patient care roles. In other words, it’s when everyone is most inexperienced. The worry is that this inexperience leads to mistakes.

But what is less clear is how a doctor’s experience influences the quality of their care. On its face, it makes sense that the longer a doctor practices, the more expertise she gains — which means better care for you. But, in reality, it’s not that simple.

Say, for instance, your doctor tells you: “In my experience, this antibiotic works great for sinus infections.” Fair enough. It may also be completely true from your doctor’s perspective: when she has prescribed antibiotics in the past for sinus infections, patients got better. But statements like this make us cringe, for two reasons.

First, as it turns out, antibiotics don’t actually work for most sinus infections. In a large study published in the Journal of the American Medical Association earlier this year, people with sinusitis were randomly assigned to take antibiotics or a placebo. People treated with antibiotics did no better than those who got the sugar pill. The reason that bacteria-killing antibiotics don’t help when you have sinusitis is because the infection is almost always caused by a virus.

The second — and perhaps more cringe-worthy — part is the summoning of the phrase “in my experience” as the major reason to prescribe the drug. In the case of sinus infections and antibiotics, doctors’ experiences (and those of patients) support the wrong decision. Here’s why: the natural course of most sinus infections is to resolve on their own over time. People tend to go to the doctor — and get their antibiotics — when they are at their sickest. So they and their doctors falsely attribute their improvement to the antibiotic pills. Here, experience gets in the way of the right medical decision, which is to avoid antibiotics in the first place.

So let’s get back to the July effect and the inexperienced, error-prone interns. On one hand, some studies suggest that the July effect is a myth: a recent study examining 10 years of data on patients undergoing neurosurgery showed that July was no more dangerous than other months. On the other hand, reports have found that July patients do indeed fare worse: in a study of patients undergoing surgery for spine-related cancer, July patients were more than twice as likely to have a surgical complication and 81% more likely to die, compared with August or June patients.

A recent systematic review of all the research done on the topic concluded that many of the studies showing no July effect had small sample sizes and were not rigorously done, but the bigger and better investigations leaned toward finding that July is truly a more dangerous month in teaching hospitals.

More.

TORONTO -- It's a pivotal event that comes in the education of all would-be surgeons. At some point, medical students who plan to make a career of opening up and fixing other human beings have to make that first cut.

If Drs. Teodor Grantcharov and Vanessa Palter have their way, however, that first application of scalpel to skin will occur on a computer screen, not on the torso of a living, breathing person. And not just the first cut. They believe surgical residents ought to achieve an established level of proficiency in a virtual operating room before they start plying their scalpel in a real OR.

"There are studies that show that in the first 50 cases, the risk of major complications is significantly higher than after the next 30 cases. And all these studies are done on real patients," says Grantcharov, an associate professor of medicine at the University of Toronto and a surgeon who specializes in minimally invasive procedures at St. Michael's, one of the university's teaching hospitals.

To Grantcharov, the idea of allowing surgical residents to operate before they've met a set skill level in a virtual OR is outdated.
Simulation tools are now available and are found with increasing frequency in medical schools across North America. They provide an alternate route for surgical residents to climb the early -- and risk-filled -- part of the learning curve.

"I always found it ridiculous to talk about learning curves on real patients," says Grantcharov, a towering figure decked out in clogs, scrubs and a Toronto Maple Leafs surgical cap. We want to see the learning curve in the simulation theatre or on the computer. Talking about learning curves of procedures on patients -- I think it's unethical."

And inefficient. Grantcharov and Palter -- a surgical resident who is also working on a PhD -- recently published a study showing that surgical residents who train first in a simulation lab significantly outperform colleagues who receive only standard surgical training.

The study compared University of Toronto surgical residents who completed a five-month long simulation training module to residents who received conventional surgical training. All the residents performed a laparoscopic right hemicolectomy -- an operation where a tumour is removed from the right side of the colon using small incisions, not the large cuts commonly used for operations in the past.

The procedures were videotaped and graded by outside experts. Residents who had trained on the simulators scored an average of 16 points (out of 20) where surgical residents who didn't get the additional virtual training scored an average of eight.

More.

Newswise — DETROIT – A Henry Ford Hospital study found that simulation training improved the critical decision-making skills of medical residents performing actual resuscitations in the Emergency Department.

Researchers say the residents performed better in four key skill areas after receiving the simulation training: leadership, problem solving, situational awareness and communication. Their overall performance also sharpened.

While many studies have shown the benefits of simulation training for honing the skill level of medical professionals, Henry Ford’s study evaluated residents’ decision-making skills before performing simulated resuscitations and then performing the real-life emergency procedure.

The study will be presented Friday at the Society for Academic Emergency Medicine’s annual meeting in Chicago.

“The improved performance from simulation to actual clinical practice was telling,” says Sudhir Baliga, M.D., senior staff physician in Henry Ford’s Emergency Department and the study’s lead author. “This is another important example of simulation training as a teaching tool to prepare residents for actual bedside care.”

Fifteen second-year Emergency Department residents were evaluated during three simulated resuscitations performed in May and June 2011 at Henry Ford’s Center for Simulation, Education and Research, one of the largest simulation facilities in the United States. The residents also received classroom training.

Two months later, the residents were evaluated during three live resuscitations to determine a change in performance.

Source.