Lead author, year (country) |
Methodology |
Findings |
Ardolino, 2009 (UK)1 |
Survey (n = 100): Pts Re: Preference for MD attire before/after awareness of BBE policy |
Before BBE policy: prefer suit more than WC but WC preferred for junior MD, scrubs not preferred as unprofessional and difficult to distinguish MDs After BBE policy: prefer short-sleeve shirt without tie (older Pts); prefer scrubs (younger Pts) |
Baevsky, 1998 (US)2 |
Survey (n = 596): Urgent care Pts seen by MD in WC and on alternating days, scrubs vs formal attire Re: Satisfaction for courtesy, concern, skill, and likelihood Pt would return/recommend ED |
No difference in satisfaction elements for scrubs vs formal attire WC ranked higher when MD broke protocol and did not wear, although when stratified by scrubs vs formal, higher mean ranks for WC noted only when MDs wore scrubs Attitude, mannerism, and professionalism likely more important than attire |
Bond, 2010 (UK)3 |
Survey (n = 160): ENT InPts, OutPts Re: Attitudes toward MD attire with photos of male MD in scrubs, formal, and BBE |
Most professional: formal 72%, scrubs 23%, BBE 5% Most hygienic: formal 10%, scrubs 87%, BBE 3% Ease to identify as MD: formal 59%, scrubs 35%, BBE 6% Overall preference: formal 48%, scrubs 41%, BBE 11% |
Cha, 2004 (US)4 |
Survey (n = 184): OutPts in predominantly resident-run OB/GYN clinic Re: Preference for MD attire and confidence and comfort with photos of MD in various attire |
Attire preference: no preference 60%, WC 38% Pt comfort level: attire does not affect 63% vs does affect 28% Confidence level in MD: attire does not affect 62% vs does affect 24% Mean scores for comfort and confidence levels decreased as attire moved from clinical/formal (scrubs/WC) to casual |
Ditchburne, 2006 (UK)5 |
Survey (n = 100): Public in hospital concourse Re: Attitudes to MD not wearing ties |
93% did not object to tieless MD, but for staff more likely considered as professionalism factor Most important: wearing shirt and dress trousers (vs denim), being clean, tidy, formal, wearing clear identifications |
Fischer, 2007 (US)6 |
Survey (n = 1,136): Pts and OB/GYN MD before/after randomization of MD attire type Re: Pt satisfaction with MD attire; MDs asked for their preference |
Pt satisfaction overall was high and did not change with different MD attire No difference for perceived MD competency and professionalism MD preference: 8 casual, 7 business, 5 scrubs |
Gallagher, 2008 (Ireland)7 |
Survey (n = 124): OutPts Re: Preference and ranking of MD attire with photos (formal, casual, WC, scrubs) |
Prefer WC, formal, and semiformal vs scrubs and casual WC most preferred; scrubs and casual least preferred |
Gherardi, 2009 (UK)8 |
Survey (n = 511): InPts Re: Rated photos of MD in various attire to inspire confidence |
WC ranked highest and most confidence inspiring All dress styles rated above neutral except casual (rated lower) Older Pts found scrubs less appealing |
Gonzalez del Rey, 1995 (US)9 |
Survey (n = 360): Parents of pediatric ED Pts shown pictures of MD dressed in various types of attire Re: Which doctor would they prefer for their child, does attire matter, do clothes affect trust in MD? |
Most preferred attire: formal 44% (P < .001) selected for all shifts but less likely selected for Pt seen by night shift Least preferred attire: casual without WC 64% (P < .001) Overall, 69% of "most-liked" pictures had WC, and 89% of "least-liked" pictures did not have WC Pictures with scrubs favored by parents with children seen for surgical emergencies Majority did not consider most formally attired as most capable, did not matter how MD dressed and did not influence trust |
Hennessy, 1993 (UK)10 |
Survey (n = 110): 2 groups of pre-op Pts, seen by same anesthetist, dressed formal vs casual Re: Select adjectives to describe anesthetist/visit, graded 15 dress items as desirable, neutral, or undesirable |
No difference between adjective choices (professionalism, approachability) of anesthetist in formal vs casual dress Desirability: name tag (90%), WC (66%), polished shoes (62%), short hair (57%), suit (36%) (suit and tie selected more likely desirable if viewed) Undesirability: clogs (84%), jeans (70%), trainers (67%), earrings (64%), long hair (62%), open-necked shirt (36%) |
Hueston, 2011 (US)11 |
Survey (n = 423): OutPts Re: Preference for MD attire before/after being informed of possible microbial contamination |
Before education: no clear attire preference but did not favor scrubs (6%), poor agreement with Pt preference and what their MD wears After education: decrease preference for WC/tie/formal attire Conclusion: attire preferences may change with awareness for contamination |
Ikusaka, 1999 (Japan)12 |
Survey: OutPts seen by groups of MD in WC or private clothes Re: Pt tension/satisfaction, preference for MD attire |
Tension: WC group 42%, private clothes group 33% Satisfaction: no significant difference between attire groups WC preference: WC group (older Pts more likely to prefer WC) 71%, private clothes group 39% (P < .001) |
Li, 2005 (US)13 |
Before/after trial (n = 111) of Pt opinion in ED Re: ED MDs wore WC/formal vs scrubs |
No significant difference in scores between 2 dress styles in appearance, satisfaction, or professionalism |
Major, 2005 (US)14 |
Survey (n = 410): InPts, surgeons, and public Re: Surgeons' attire |
WC necessary: surgeons 72%, InPts 69%, public 42% Scrubs appropriate: surgeons 73%, InPts 41%, public 33% (P < .05) Clogs appropriate: surgeons 63%, InPts 27%, public 18% (P < .05) Denim appropriate: surgeons 10%, InPts 22%, public 31% |
Matsui, 1998 (Canada)15 |
Survey (n = 220): OutPt pediatric children/parents Re: Asked who they would like as their MD from photos of MD with and without WC; parents also rated attire appropriateness |
Selected MD in WC: children 69%, parents 66% Most appropriate and favored: name tag, WC, well groomed Neutral: scrubs, formal dress Not favored: open-toed sandals, clogs, shorts |
McKinstry, 1991 (UK)16 |
Survey (n = 475): OutPts in 5 practices Re: Pt acceptability for different styles of attire (photos of male and female MDs) for different attire and whether attire influenced their respect for MD |
Formal dress favored (suit/tie or WC) 28% would be unhappy seeing one of MDs shown, more likely those dressed informally 64% thought how their MD dressed was important Practice to which a Pt belonged was an independent factor in Pt choice of dress |
Mistry, 2009 (UK)17 |
Survey (n = 200): Pediatric dental parents/children Re: Attitudes on MD attire using photos |
WC and mask most popular overall but children favor casual attire Formal WC preferred over pediatric coat by parents and children Mask preferred over visor (eye contact potentially important) |
Monkhouse, 2008 (UK)18 |
Survey (n = 50): Surgical Pts random survey (ER and elective admits) Re: Attitudes toward dress (formal vs scrubs) before/after educational intervention on transmission of microorganisms on ties |
Before education: prefer formal for professionalism and approachability; prefer scrubs for hygiene, equal for identifiability; prefer formal dress overall After education: prefer scrubs (24% before to 62% after); formal preference decreased (52% before to 22% after) Authors' conclusions: if rationale behind modes of surgical dress are explained, Pts are more likely to prefer scrubs to formal clothes |
Nair, 2002 (Australia)19 |
Survey (n = 1,680): InPts after discharge with crossover trial of MDs in varying attire Re: Pt confidence/trust in MD in informal vs "respectable" attire |
Pt confidence highest with "respectable" dress Loss of WC or tie did not deteriorate confidence significantly Informal dress protocol "affront to sensitivities" and presence of nose ring most deleterious |
Niederhauser, 2009 (US)20 |
Survey (n = 328): Pts at naval OB/GYN clinic Re: Preference for MD attire and effect on comfort or confidence using pictures |
86% neutral whether MD wore a WC 88% said attire did not impact confidence in MD ability Active-duty women were more likely than dependent wives to say MD attire influenced their comfort discussing general/sexual/psychological/personal topics Authors conclude active-duty women may withhold pertinent medical information (eg, personal, sexual history) due to intimidation from military uniform of officer MD Aspect of military uniform unique to this study |
Palazzo, 2010 (UK)21 |
Survey (n = 75): InPts Re: Attitudes of MD attire Randomly chosen medical/surgical InPts rated 6 statements (modal responses provided) and provided reasons for importance of MD dress code; opinions solicited after education of new dress code policy |
"MD dress important"—strongly agree (reason: dress code instills confidence) "Your MD this admission dressed professionally"—strongly agree "Scrubs are acceptable form of dress"—strongly agree (reason: appears clean) "MD should wear WC"—strongly disagree (reason: sleeves might encourage infection spread, might induce fear and anxiety in Pts) "MD should wear ties"—strongly disagree (reason: unnecessary, uncomfortable) "Is it easy to distinguish between different grades of doctor based on their dress?"—strongly disagree (hard to differentiate MD vs the public) No Pts noticed dress code change prior to being informed of the change All Pts favored dress code change when the suggested impact on infection was explained Conclusions: MD attire important but necktie and WC not expected |
Rehman, 2005 (US)22 |
Survey (n = 400): Pts/visitors in OutPt clinic Re: Preference, trust, willing to discuss sensitive issues with photos of MDs in various attire |
Preferences: professional attire with WC 76%, scrubs 10%, business dress 9%, casual 5% Trust and willing to share sensitive information significantly associated with professional attire (P < .001) Female MD dress significantly more important than male MD |
Shelton, 2010 (UK)23 |
Survey (n = 100): InPts Re: Rate MD attire with photos of male and female MDs before/after being informed of microbial contamination |
Before information: no significant difference between most attire except casual dress and short sleeves (considered less appropriate) After information: scrubs and short sleeves considered most appropriate, scrubs preferred for females |
Baxter, 2010 (UK)24 |
Survey (n = 480): InPts Re: Attitudes toward MD attire using photos of male MDs in long sleeves/tie, scrubs, short sleeves |
Most professional: long sleeves/tie 77%, scrubs 22%, BBE 1% Greatest transmission risk: long sleeves/tie 30%, scrubs 33%, BBE 37% Preference for MD attire: long sleeves/tie 63%, scrubs 33%, BBE 4% |
Toquero, 2011 (UK)25 |
Survey (n = NA): orthopedic InPts Re: Awareness/preference for recent BBE policy |
Unaware of policy: 86% Attire preference: shirt/tie 63%, suits 22%, short sleeve shirt 6%, Pt trust high despite change to less preferred attire |
Garvin, 2012 (US)26 |
Survey (n = 1,494): InPts, MDs, RNs Re: Attitudes toward MD attire |
MD appearance important for Pt care: MDs/RNs 93%, InPts 83% (P < .001) Concerned with appearance of other provider but did not engage them: MDs 39%, RNs 43%, Pts 16% (P < .001) Concerned with appearance of other provider but did not engage them: MDs 39%, RNs 43%, Pts 16% (P < .001) |
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