Medical schools spend a considerable amount of effort and expense to ensure that physicians are rated regularly to monitor the quality of instruction. Additionally, these ratings are used as sources of promotion or as sources to determine educational awards.
While our initial hypothesis that white coats would alter students’ perceptions of physicians was disproven, our study demonstrated that gender and possibly race altered students’ ratings of the physicians in simulated clinical scenarios. The strength of the relationship between these attributes was variable but explained up to 52% of the variance in the context of trustworthiness. Notably, the perception of medical error in our cases was correlated with gender and case/Caucausian race, albeit weak.
As suggested by Rannelli et al., our study adds to the literature by suggesting that superficial physical traits may have an impact on physicians’ ratings by medical students . While students may not be conscious that they are influenced by physical characteristics, these observations seem consistent with the theory of impression formation, a dual processing model used to rate other individuals [10, 11]. This theory suggests that impressions start with stereotypes, which inform the rater’s initial a priori expectations of the situation. However, raters alter their appraisal of an individual as they gain insight into their behaviour. This dual model is based on the presence of both implicit and explicit memory [12, 13]. Implicit memory enables storage of previous experiences which inform our average expectations of any given context. In contrast, explicit memory provides rules which we apply when rating others’ behaviours. In our situation, the effect of gender and case/race persisted despite clinical information suggesting that these biases may be strong. While it is impossible for medical schools to eliminate bias in the evaluations process, it is possible that medical schools could monitor for bias in evaluations and act accordingly. At the very least, schools should be aware that bias could be having an impact on the evaluation of their faculty.
The presence of a white coat did not portend a better rating in our study. Even if an effect existed at a superficial level, it is appears to have been washed away by the context of the clinical information provided to the students. As to why white coats had a minimal impact on the results, it is possible that learners’ pre-exposure to white coats may have resulted in a decreased association of this symbol as a marker of competency and professional behaviour. Additionally, physicians’ behaviour or dressing habits in the hospital could have resulted in a diminished symbolism of the white coat in our center, or alternatively students now feel incorporated into this group.
Our study has limitations that may impact the interpretation of our results. The analyses in this paper are exploratory and should be interpreted with caution. While we tried to create realistic clinical scenarios, it is possible that students’ impressions would have been different in a real-life context after talking or interacting with a physician. Unfortunately, we did not collect the gender or race of students that completed the survey and therefore we are unable to tease out the effect that these had on the outcomes. However, based on class demographics we can be confident that there was a majority of women who completed the study due to the fact that even if all the men in the class had participated (which is unlikely) they still would have formed a minority of participants. It could be argued that we did not show students the pictures without clinical information to determine a baseline rating to allow further interpretation of the results. We feel this condition was completely unrealistic and only biases that endure despite clinical information would have any real world implications. Finally, while we tried to standardize the seriousness of errors across the groups, however, there may have been variability in how the students would have viewed the seriousness of these errors. It should also be noted that this study was completed in a single centre which limits the generalizability of our results. Finally, only second year medical students were included and while it is unlikely that experience would alter ratings, it is possible that more experienced learners or other allied health professionals may have different results.