Improving upon the ‘July effect’: a collaborative, interdisciplinary orientation for internal medicine interns

U S teaching hospitals orient interns each year, usually in the summer months (June July). These new physicians have usually just finished with their medical school training and do not have any other clinical experience outside of medical school (i.e., without supervision). They are asked to begin seeing patients on day 1 of their internship without having formed relationships with other clinical staff such as nursing and without knowing the hospital system. It is also commonly believed that the ‘quality of health care decreases during trainee academic year-end changeovers’ (1). Yet the overwhelming phenomenon continues. Traditionally intern orientation has consisted of long hours sitting through lectures resulting in information overload, followed by a brief tour of the hospital with their attending physician or chief resident. The interns begin their clinical experiences with patient responsibilities without any collegial relationships with the clinical team who carry out their orders, nor any familiarity with the hospital protocols or culture and flow of hospital life. Many interns admit later that the first few months were an overwhelming experience and one that could certainly fail to meet patient needs. Experienced nurses in teaching hospitals are also challenged during this time. As part of this phenomenon, nurses often become the middle-person advocating for the patient and sometimes the new intern. Interns may also be hesitant to question the suggestions of nurses and are unfamiliar with nursing roles and responsibilities. Certainly during this critical time, there is no opportunity to leverage team building. Building inter-professional collaboration between physicians and nurses is just what is needed in the very beginning of July to exponentially improve upon this introductory transition within and between professional cultures while still ‘containing cost and insuring better patient outcomes’ (2). Literature suggests an active orientation, which provides improved communication between caregivers, and growth of collegial relationships between physicians and nurses will ultimately improve patient outcomes (3). High-quality communication and strong relationships are the foundation for coordinated action in high-stress hospital settings (3). From 2010 to 2012, the University of Texas Southwestern Austin internal medicine program and nursing at University Medical Center Brackenridge developed an intern orientation program that was multi-disciplinary and collaborative in nature. Our hypothesis was that the program would engage the interns and foster the development of collegial relationships with nursing and support staff as well as provide real-time clinical practice and feedback through simulation. We also believed that interns would feel more adjusted to the program and hospital system.