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Pharmacists play a critical role in preventing medication ordering errors during residency onboarding through proactive training, system safeguards, and interdisciplinary collaboration.
Each summer, a predictable shift takes place in teaching hospitals across the country: a fresh class of medical residents, fellows, and pharmacy trainees arrives, eager and energetic—but often unfamiliar with hospital systems, workflows, and medication safety protocols. Although this seasonal transition is vital for education and growth, it is also accompanied by a well-documented rise in ordering errors, sometimes referred to as the “July Effect.”1-3
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From a pharmacist’s perspective, the beginning of the academic year represents both an opportunity and a challenge. It’s a time when our role as patient safety advocates is most visible—and most needed. Through intentional collaboration, structured education, and system-level safeguards, pharmacy departments can play a pivotal role in helping new learners transition smoothly while minimizing risk to patients.2
At our institution, an academic medical center with both PGY1 and PGY2 pharmacy residents as well as multiple medical and surgical fellowship programs, we’ve observed several recurring themes in ordering errors during July and August. Many of these stem from lack of familiarity with our electronic health record (EHR), Epic, and the specific workflows used to place medication orders:
These errors are rarely due to carelessness. They usually reflect gaps in EHR navigation skills, limited familiarity with institutional formulary nuances, and the pressure to act quickly in fast-paced clinical environments.
Recognizing these patterns, our pharmacy department has implemented several proactive strategies to support incoming learners and reduce preventable errors:
Our experience shows that technology can either contribute to or prevent ordering errors—depending on how it’s configured. Working with informatics and Epic analysts, pharmacy teams can advocate for system-level safeguards. These include deprioritizing investigational or nonformulary medications in search results, embedding warnings for route-specific formulations, and defaulting to preservative-free for flagged indications.5
Nan Li, PharmD, is a clinical oncology pharmacist at University of Chicago Medicine (UCMC), specializing in the outpatient management of thoracic oncology. She is actively involved in clinical coordination, supportive care optimization, and formulary management. Li completed her post-residency training at UCMC and now serves as a co-preceptor for oncology residents and contributes to institutional initiatives focused on quality improvement in cancer care.
Technology and teaching are only part of the solution. Equally important is the pharmacy team’s interpersonal presence and approachability. Introducing pharmacists early as allies fosters a culture of learning and open communication. Encouraging questions builds psychological safety and helps learners catch their own mistakes before they reach patients. Finally, modeling collaboration for pharmacy residents reinforces a shared responsibility for patient safety.
Transitions are hard, but predictable. With thoughtful planning, pharmacy departments can play a key role in smoothing the path for new learners while protecting patients from preventable harm. By combining proactive education, strategic technology use, and a supportive culture, we can transform the 'July effect' from a warning sign into a call to collaborate.
Let’s make sure our newest team members don’t just survive their first month—they thrive in it.
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