Device implantation complications during fellowship training: It is always the fellow's fault, or is it?

摘要

In North America, the academic year for medical training begins on or about July 1, when there is a perceived decrease in the quality of health care, the so-called July phenomenon. The effect has been largely refuted across multiple surgical specialties in both single-center and single-specialty studies. However, there is the possibility of investigators not reporting adverse outcomes by new trainees at their institutions (publication bias), and there is inconsistency about whether the July phenomenon exists in broader clinical outcomes across the health care environment. Along with various methodological difficulties in capturing its effects on morbidity and mortality in its entirety, it is nearly impossible to systematically take into account more nuanced factors such as subclinical errors, near misses, and patient dissatisfaction that may arise from daily encounters with novice physicians.