Stanford does a funny thing. Most medical schools ascribe to an old tradition: medical students get white coats up to their waists, residents to their thighs, and attendings to their knees. It’s a quick way to maintain a hierarchy of experience and knowledge and a shorthand for who in the room bears the most responsibility.
But at Stanford, everyone gets the knee-length white coat. Other than allowing us to gloat over our friends at other schools, what does that accomplish?
Two things come immediately to mind:
First, it makes it clear that every member of the team is valued equally. As a long-coated medical student, you’re (theoretically) far less likely to be assumed to know nothing, or to be assigned orderly’s duties. Indeed, your active participation in the care process is as critical as that of the attending; your presence and learning makes the care of future patients possible.
Second, it fixes in the mind of the medical student — starkly — the fact that responsibility is shared among the team. It’s not simply up to the attending to do due diligence on the physical examination and to consider the zebras with the horses. No — it is the shared and equal responsibility of the medical student, and the resident, and the attending. This might not be true from a legal standpoint, but as a cultural element it certainly is very real in the mind of the medical student.
A very cool culture emerges from that. It’s incredibly empowering for a medical student and stands as an extremely polite middle finger to much of the traditional medical hierarchy. And at the same time, it’s incredibly emotionally intense: it’s a heavy burden, those few extra inches of fabric. Responsibility which is usually slowly accumulated over years is simply foisted upon us and it is up to us to live up to it.
It makes you grow up real quick.