Research Award Details

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Does it Matter What You Wear to Clinic? What Pediatric Orthopaedic Surgery Patients and Parents Think

Grant Recipient: Jennifer Bauer, MD, MS

Seattle Children's Hospital, University of Washington Department of Orthopaedic Surgery
Presentations & Publications:
Further Funding:
Additional Information:
2018 POSNA Spring Micro Grant Award Report
Jennifer M. Bauer, MD, MS

“Does it Matter What You Wear to Clinic? What Pediatric Orthopaedic Surgery Patients and Parents Think”

Background: A number of factors have been shown to affect how surgeons are subjectively viewed, including their appearance in clinic. Momentum continues to build behind using subjective patient and family-reported satisfaction scores as benchmark quality measures for surgeons. This study aims to determine if there is a bias toward pediatric orthopaedic surgeons based only on clinical dress and a preference for a particular dress style.
Methods: At 5 different pediatric regional sites across the USA, families presenting to the pediatric orthopaedic clinic were given anonymous surveys regarding their preferences on surgeons’ clinical dress. The first consecutive completed 100 parent and 100 patient (over 7yr old) surveys were included from each site with comparisons made between regions and with respect to demographic characteristics. Subjects were shown eight photos of surgeons in different clinical dress (four male, four female), and asked to rate various characteristics of the surgeons in the photos on a 5-point Likert scale, as well as choose their one most preferred photo.

Results: 300 parents and 300 children were surveyed from orthopaedic clinic visits at three major pediatric centers in different regions of the USA: northeast, pacific northwest, and south. (**Still pending – Midwest and west regional data sets still pending to complete the data set at 1000 surveys. This will provide sufficient power analysis to include evaluation of other demographic variables across all groups, including all scrubs vs all whitecoat options, race/ethnicity differences, education-based, etc**). Overall, 223 (37%) had no stated preference for the surgeons’ outfit. Of those who had a preference, females in scrubs+WC (15%) and females in business+WC (14%) were the most popular (Figure 1). There was a difference between male and female rankings (p<0.0001), though both ranked female in scrubs as their first preferred. Preference for clinical dress was different between patients and their parents (p=0.026) with patients preferring female business+WCfirst, while parents preferred female in scrubs first. The sites were different with respect to expectation of discussing surgery (p<0.0001), race/ethnicity (p<0.0001), and home location for urban/suburban/rural (p<0.0001). Men across the different sites preferred different photos, while women in the northeast and south preferred female in scrubs first. In the pacific northwest (p=0.002) and the south (p=0.038) there were differences based on sex, with men choosing the male in scrubs+WC and women choosing female in business outfit at each. The majority of families felt a surgeon’s clinical dress would not affect how they are cared for and that it was ok to wear scrubs to clinic, without a majority finding it necessary to be in a WC if in scrubs, and no difference between geographic regions for these questions (p=0.4 to 0.7).
Figure 1.

Table 1. Study population characteristics by center/location (n=600)
Variable Northeast Northwest South p-value
Age, n=600 (%)       0.0952
      8-13 47 (23.50%) 43 (21.50%) 46 (23.00%)  
      14-18 51 (25.50%) 54 (27.00%) 51 (25.50%)  
      19-30 17 (8.50%) 14 (7.00%) 11 (5.50%)  
      31-40 41 (20.50%) 44 (22.00%) 50 (25.00%)  
      41-50 35 (17.50%) 32 (16.00%) 32 (16.00)  
      51-60 6 (3.00%) 11 (5.50%) 9 (4.50%)  
      60+ 3 (1.50%) 2 (1.00%) 1 (0.50%)  
Sex, n=596 (%)       0.682
      Male 62 (31.31%) 55 (27.64%) 56 (28.14%)  
      Female 136 (68.69%) 144 (72.36%) 143 (71.86%)  
I expect to talk about surgery today, n=587 (%)       <0.0001
      Yes 35 (17.95%) 90 (45.96%) 66 (33.85%)  
      No 160 (82.05%) 107 (54.04%) 129 (66.15%)  
Race, n=590 (%)       <0.0001
      Caucasian 117 (59.39%) 112 (56.85%) 135 (68.88%)  
      Hispanic/Latino(a) 23 (11.68%) 25 (12.69%) 14 (7.14%)  
      African American 29 (14.72%) 7 (3.55%) 33 (16.84%)  
      Asian/Indian 7 (3.55%) 19 (9.64%) 0 (0.00%)  
      Other 21 (10.66%) 34 (17.26%) 14 (7.14%)  
Highest level of school completed, n=592 (%)       0.440
      Grade 1-8 70 (35.18%) 64 (33.33%) 64 (32.16%)  
      High school 50 (25.13%) 48 (24.62%) 68 (34.17%)  
      Trade school 6 (3.02%) 7 (3.59%) 4 (2.01%)  
      College 49 (24.62%) 44 (22.56%) 41 (20.60%)  
      Graduate 24 (12.06%) 31 (15.90%) 22 (11.06%)  
I live in the . . . , n=589 (%)       <0.0001
      City/urban 21 (10.55%) 62 (32.12%) 49 (24.87%)  
      Town/suburbs 144 (72.36%) 101 (52.33%) 87 (44.16%)  
      County/rural 34 (17.09%) 30 (15.54%) 61 (30.96%)  
Annual household income, n=526 (%)       0.971
      Excellent/good 149 (83.24%) 143 (80.34%) 140 (81.40%)  
      Fair/poor 29 (16.20%) 34 (19.10%) 31 (18.02%)  
With final receipt of data from the last 2 sites, we will submit this month to POSNA. Afterwards we will submit the abstract to the AAP and AAOS annual meetings.  Manuscript will be submitted to either JBJS or JPO for initial submission.
We also plan to make our results known to the other divisions at our hospital, encourage the other sites to do the same, and help support a similar study for other subspecialties interested.
Challenges, delays:
We ran into challenges with coordinating between the multiple study sites, particularly the IRB commissions. Several wanted changes to our survey wording, causing us re-do the IRB process at sites that had already approved prior versions, then further change requests ensued, and the cycle repeated. One original site eventually refused to approve the study on the ground that the study was not in keeping with their mission, and so we had to restart the process and find a new site in that region.
Because of difficulty of collecting completed surveys without helping the patients fill them out and therefore bias their selections by having the patients see what the staff and surgeons are wearing while filling these out, we did decrease out expectation of 300 completed surveys per site to 200. A total of 1000 surveys will still provide power to make the comparisons of interest.
Expense report:
Current to-date expense report attached. Reserving several hours of work worth to complete statistic analysis with the complete 5-center data set.
To leverage our funds, we used local printing and scanning capabilities to avoid any printing or mailing charges, and instead used all funds on staffing single-center centralized data-entry and statistical support.