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April 10, 2018

Why Johns Hopkins just abolished the short white coat

Daily Briefing

    Breaking with tradition, Johns Hopkins Hospital's Osler Medical Training Program—the oldest residency program in the country—beginning in July will no longer require first-year residents to wear short white coats.

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    The significance of the white coat

    According to Wolfgang Gilliar, dean of the NYIT College of Osteopathic Medicine, physicians have worn white coats since the 1900s, first at hospitals and then eventually at medical schools as well. Physicians wore the white coat as a sign of cleanliness and scientific learning, Ken Ludmerer, a medical historian at Washington University in St. Louis, explained.

    Richard Heitmiller, chief of surgery at Medstar's Union Memorial and Franklin Square hospitals, explained that coat lengths used to vary by job, with bedside physicians—who typically do more hands-on work—wearing short white coats to keep them off of the ground. "You had the long coat on because you were directing traffic rather than doing the work," Heitmiller said.

    Today, the length of a physician's white coat can vary by institution and job type—with some specialties—including pediatrics and psychiatry—eliminating them entirely to appear more welcoming.

    The short white coat at Johns Hopkins

    In the past, first-year residents in the Osler Medical Training Program have worn a short white coat to distinguish them from more advanced residents, who wear longer coats. According to the Sun, the short white coat was viewed as a "rite of passage" for first-year residents who needed spend at least a full year caring for patients to qualify for a longer coat, the Sun reports.

    However, residents have long raised concerns that the short white coats unfairly separate first year residents from others within the hospital and could make patients think they weren't prepared to provide medical care. Residents also pointed out that ancillary staff also wore long coats, which made the overall hierarchy unclear, according to Mickey Brener, one of four chief residents at Johns Hopkins.  

    Johns Hopkins retires the short white coat

    In response, Sanjay Desai, director of the residency program, in an email to residents earlier this month said the short coat would be retired.

    "Today, [the short white coat] does not promote the values which it was intended to promote," he wrote. "Instead, it represents a physical symbol of the past, and of an excessive rigidity and hierarchy. This is unfortunate, but it is real. All institutions have to adapt to stay relevant and to ensure their traditions continue to uphold their core values. It would be a mistake for us not to."

    Mark Anderson, director of the department of medicine at the Johns Hopkins University School of Medicine and the physician-in-chief at Johns Hopkins Hospital, said a resident survey found that a vast majority did not like the short white coat. "You want to be careful when you change a historical tradition," Anderson said. "The signal of discontent rose above the noise and became clear over the last several years, so we made this decision."

    Sandra Zaeh, another chief resident at the program, added that while ending the tradition is "a little bit sad in a way," the "program is about so much more than the length of the coat. And enough people were not supportive of the tradition that it wasn't worth it. It's an article of clothing at the end of the day."

    According to Anderson, the tradition when retired will join several others that the hospital system has done away with. In the past, residents had to be male, unmarried, and live at the hospital facility itself. "That was what society expected at the time," said Anderson. "It was considered this complete personal commitment."

    And the latest change could help with recruiting efforts as well, Brener, said, since prospective students may not understand the tradition. "We don't want to turn people off since the value of the program is much more than the length of the coat," Brener said (AP/U.S. News & World Report, 4/2; McDaniels, Baltimore Sun, 4/2).

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