Perceptions of US and Australian Medical Students and Instructors About Clinical Professional Attire: LAPEL Study

Context: White coats have long been the professional uniform of physicians. However, when physicians opt to remove the white coat, their clothing underneath is brought to the forefront and can influence how they are perceived by their patients. Objective: To explore the perceptions of medical students and their instructors about appropriate clinical professional attire. Methods: An anonymous, voluntary 55-question survey was electronically distributed to medical students and their instructors at 2 US and 2 Australian medical schools. The survey incorporated 30 images of sample attire, 9 demographic questions, and 16 questions regarding culture and context of clothing and accessories. Results: In total, 411 students and 73 instructors participated in this study. The data revealed that white coats and neckties are nearly absent in Australian clinical attire. Overall, students were significantly more supportive of full facial coverage due to religious or cultural values compared with instructors (P<.001), and US medical students were significantly more supportive than Australian students (P<.001). All cohorts preferred dress code policies that directed students to avoid but not prohibit the use of perfume or cologne. Nose rings were controversial with significantly more support for use from medical students than instructors (pooled cohorts, P=.002). Medical students in both the United States and Australia indicated that they were most influenced by observing the attire of physicians at work (155 [38%]), compared with courses in medical ethics (19 [5%]), school policy (16 [4%]), or hospital policy (9 [2%]). Conclusion: Although regional dress code practices are different in the United States compared with Australia, medical students were overall most influenced by their instructors' attire in clinical settings.