For years, first-year residents in the Johns Hopkins’ Osler Medical Residency Training Program have worn short white coats to represent their recent transition from medical school and their commitment to learning. However, first-year residents, beginning with the next cohort in July, will wear white coats that are 12 inches longer, the same style as more experienced residents.
Dr. Mark Anderson, physician-in-chief at the Johns Hopkins Hospital and the director of medicine at the School of Medicine, discussed the main reason for enacting this change in an email to The News-Letter.
“Our surveys suggested that applicants to our program perceived the short coats as emblematic of a hierarchy, rather than a marker of a transition from medical student to resident,” he wrote.
In addition, Anderson explained that the shorter coat length did not have many positive benefits and was not necessary to uphold the values of the Hospital.
“Because the short coat was dispensable for maintaining our core values (Respect, Integrity, Service, Excellence and Equity) we determined its continuance had become a net negative,” he wrote.
Anderson also explained that there are some who do not welcome the change and stated that the Hospital also acknowledges those views.
“However, we recognize that many of our trainees and graduates feel differently, and are sorry to see this change,” he wrote. “We also respect their dissent.”
Dr. Sanjay Desai, the director of the residency program, contextualized the change to the history of the program. As a former resident, Desai said that he liked to wear the short coat because he felt that it denoted his distinct position.
“The short white coat had been discussed since I was training — so for decades. However, it was a small concern by a small group of people that I think didn’t represent a collective trend amongst the intern class,” he said. “More recently, I think it has to be taken in the context of changes in society as well, where symbols are looked upon differently.”
Desai connected the coats with the values behind the resident program.
“It is not worth it for us to lose even one highly talented potential intern,” he said. “It is not the coat we are beholden to: It is the other values of patient ownership, excellence in patient care and compassion that we want to make sure we continue to nurture.”
He reflected on his personal experience with the short white coats during his time as a resident at the Hospital. He said it was a symbol that he was a lifelong learner.
“Even though we have MDs, it is really that year that teaches us how to compassionately care for patients at the bedside. That short white coat represented that learning process, and it also represented a shared experience I had with a group of 40 other people, which was one of the most meaningful in my life,” Desai said.
Chief Resident Dr. Michael Brener commented on the mixed response to the change in an email to The News-Letter.
“Our program’s spirit is much bigger and deeper than the length of our interns’ coats, so there remains a lot to be proud about the program, even though our wardrobe is changing a bit,” he wrote.
Desai said that some patients do notice the difference in coats and may think that those with shorter coats are medical students. Now that all residents will wear the same coat, patients will not be able to tell who interns are simply from their attire. He described the uniformity that longer white coats will introduce among hospital staff.
“It is natural for them to think that this is a less qualified practitioner or clinician than the others they will interact with. I think from a patient perspective and even from a professional perspective, I think this will elevate the impression of an intern in their minds,” Desai said.
Chief Resident Dr. Alex Ambinder explained that the alteration relates to the program’s focus on changing with the times.
“It is one more thing that indicates to people that we are not too steeped in culture. Tradition is an important part of what we do, and it is something that makes us unique, but is not something we are bound by,” he said.
Ambinder also explained that accommodating the views of first-year residents is important and is in line with the program’s commitment to its interns.
“Some of the culture in medicine is changing a bit with respect to hierarchy. There is a new emphasis on wellness among physicians,” he said. “Recently, like many other programs, we have been thinking a lot about how to improve resident wellness. This was something that we could change that was concrete that I think signifies how serious the program is about improving things.”