Painful losses

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International patient preferences for physician attire: results from cross-sectional studies in four countries across three continents.

OBJECTIVE The patient-physician relationship impacts patients' experiences and health outcomes. Physician attire is a form of nonverbal communication that influences this relationship. Prior studies examining attire preferences suffered from heterogeneous measurement and limited context. We thus performed a multicentre, cross-sectional study using a standardised survey instrument to compare patient preferences for physician dress in international settings. SETTING 20 hospitals and healthcare practices in Italy, Japan, Switzerland and the USA. PARTICIPANTS Convenience sample of 9171 adult patients receiving care in academic hospitals, general medicine clinics, specialty clinics and ophthalmology practices. PRIMARY AND SECONDARY OUTCOME MEASURES The survey was randomised and included photographs of a male or female physician dressed in assorted forms of attire. The primary outcome measure was attire preference, comprised of composite ratings across five domains: how knowledgeable, trustworthy, caring and approachable the physician appeared, and how comfortable the respondent felt. Secondary outcome measures included variation in preferences by country, physician type and respondent characteristics. RESULTS The highest rated forms of attire differed by country, although each most preferred attire with white coat. Low ratings were conferred on attire extremes (casual and business suit). Preferences were more uniform for certain physician types. For example, among all respondents, scrubs garnered the highest rating for emergency department physicians (44.2%) and surgeons (42.4%). However, attire preferences diverged for primary care and hospital physicians. All types of formal attire were more strongly preferred in the USA than elsewhere. Respondent age influenced preferences in Japan and the USA only. CONCLUSIONS Patients across a myriad of geographies, settings and demographics harbour specific preferences for physician attire. Some preferences are nearly universal, whereas others vary substantially. As a one-size-fits-all dress policy is unlikely to reflect patient desires and expectations, a tailored approach should be sought that attempts to match attire to clinical context

Understanding patient preference for physician attire in ambulatory clinics: a cross-sectional observational study

OBJECTIVES We explored patient perceptions regarding physician attire in different clinical contexts and resultant effects on the physician-patient relationship. SETTING The 900-bed University Hospital Zurich, Switzerland. PARTICIPANTS A convenience sample of patients receiving care in dermatology, infectious diseases and neurology ambulatory clinics of the University Hospital Zurich participated in a paper-based survey. PRIMARY AND SECONDARY OUTCOME MEASURES The survey instrument was randomised and showed photographs of male or female physicians wearing various forms of attire. On the basis of the respondents' ratings of how the physician's attire affected perceptions across five domains (knowledgeable, trustworthy, caring, approachable and comfort with the physician), a composite preference score for attire was calculated as the primary outcome. Secondary outcomes included variation in preferences by respondent characteristics and context in which care was provided. RESULTS Of 834 patient respondents (140 in dermatology, 422 in infectious diseases and 272 in neurology), 298 (36%) agreed that physician attire was important. When compared with all available choices, the combination of white scrubs with white coat was rated highest while a business suit ranked lowest. Variation in preferences and opinions for attire were noted relative to respondent demographics and the clinical setting in which the survey was administered. For example, compared with younger patients, respondents ≥65 years of age more often reported that physician dress was both important to them and influenced how happy they were with their care (p=0.047 and p=0.001, respectively). CONCLUSIONS Outpatients at a large Swiss University hospital prefer their physicians to be dressed in white scrubs with white coat. Substantial variation among respondents based on demographics, type of physician and clinical setting were observed. Healthcare systems should consider context of care when defining policies related to dress code

Association between mentorship and mental health among junior residents: A nationwide cross‐sectional study in Japan

Abstract Background Mentorship is a dynamic, reciprocal relationship in which an advanced careerist (mentor) encourages the growth of a novice (mentee). Mentorship may protect the mental health of residents at risk for depression and burnout, yet despite its frequent use and known benefits, limited reports exist regarding the prevalence and mental effects of mentorship on residents in Japan. Methods We conducted a cross‐sectional study involving postgraduate year 1 and 2 (PGY‐1 and PGY‐2) residents in Japan who took the General Medicine In‐Training Examination (GM‐ITE) at the end of the 2021 academic year. Data on mentorship were collected using surveys administered immediately following GM‐ITE completion. The primary outcome was the Patient Health Questionaire‐2 (PHQ‐2), which consisted depressed mood and loss of interest. A positive response for either item indicated PHQ‐2 positive. We examined associations between self‐reported mentorship and PHQ‐2 by multi‐level analysis. Results Of 4929 residents, 3266 (66.3%) residents reported having at least one mentor. Compared to residents without any mentor, those with a mentor were associated with a lower likelihood of a positive PHQ‐2 response (adjusted odds ratio [aOR] 0.75; 95% confidence interval [95% CI] 0.65–0.86). Mentor characteristic significantly associated with negative PHQ‐2 response was a formal mentor (aOR; 0.68; 95% CI 0.55–0.84). Conclusions A mentor‐based support system was positively associated with residents' mental health. Further research is needed to determine the quality of mentorship during clinical residency in Japan

Medical resident’s pursuing specialty and differences in clinical proficiency among medical residents in Japan: a nationwide cross-sectional study

Abstract Importance Standardized examinations assess both learners and training programs within the medical training system in Japan. However, it is unknown if there is an association between clinical proficiency as assessed by the General Medicine In-Training Examination (GM-ITE) and pursuing specialty. Objective To determine the relative achievement of fundamental skills as assessed by the standardized GM-ITE based on pursuing career specialty among residents in the Japanese training system. Design Nationwide cross-sectional study. Setting Medical residents in Japan who attempted the GM-ITE in their first or second year were surveyed. Participants A total of 4,363 postgraduate years 1 and 2 residents who completed the GM-ITE were surveyed between January 18 and March 31, 2021. Main measures GM-ITE total scores and individual scores in each of four domains assessing clinical knowledge: 1) medical interview and professionalism, 2) symptomatology and clinical reasoning, 3) physical examination and treatment, and 4) detailed disease knowledge. Results When compared to the most pursued specialty, internal medicine, only those residents who chose general medicine achieved higher GM-ITE scores (coefficient 1.38, 95% CI 0.08 to 2.68, p = 0.038). Conversely, the nine specialties and “Other/Not decided” groups scored significantly lower. Higher scores were noted among residents entering general medicine, emergency medicine, and internal medicine and among those who trained in community hospitals with higher numbers of beds, were more advanced in their training, spent more time working and studying, and cared for a moderate but not an extreme number of patients at a time. Conclusions Levels of basic skill achievement differed depending on respective chosen future specialties among residents in Japan. Scores were higher among those pursuing careers in general medical fields and lower among those pursuing highly specialized careers. Residents in training programs devoid of specialty-specific competition may not possess the same motivations as those in competitive systems

Milestones for internal medicine sub-interns

© 2015 Alliance for Academic Internal Medicine. Background As residency programs move toward measuring milestones for competency-based education assessment, medical schools will need to collaborate with residencies to determine competencies for graduating students. The objective of this study is to define the educational milestones for fourth-year medical students during an Internal Medicine sub-internship. Methods A cross-sectional Internet-based survey (with attention to validity evidence) was developed in early 2013 and administered to Internal Medicine attendings and Internal Medicine sub-interns working on an inpatient team at 3 academic medical centers. With the purpose to determine the milestones for sub-interns, items asked respondents what responsibilities a sub-intern could be entrusted to perform without direct supervision. Results Faculty responded that behaviors sub-interns could perform with indirect supervision were mostly at the reporter level, including completing a history and physical examination and collecting data such as test results. Other skills such as venipuncture and some communication skills such as calling consults, providing patient counseling, responding to pages, and creating discharge instructions were examples of tasks in which the majority of faculty felt that students were progressing toward unsupervised practice. Behaviors where the majority of faculty would always supervise a medical student performance included performance on the interpreter level, including interpreting electrocardiograms, significant physical examination findings, and laboratory results. Medical students less commonly noted needing supervision on the majority of the items when compared with faculty. Conclusion Tasks in the reporter domain such as taking a history, collecting medical records, and reporting results can be characterized as medical student milestones