This study, deemed exempt under Category #1 of the 2018 revision of the Common Rule 45 CFR 46, was designed to investigate how implementing “Doctor Badges” altered the educational training environment at the Harvard South Shore Psychiatry Residency Training Program. Psychiatry resident physicians, from postgraduate year one to four, engaged in this research while rotating through various services—inpatient, outpatient, and emergency psychiatry—within the VA Boston Healthcare System. Participation was voluntary and anonymous, commencing with a pre-survey conducted between December 3, 2020, and December 14, 2020. This initial survey aimed to capture their baseline experiences concerning role identification and the occurrence of gender-based microaggressions and macroaggressions in their recent work environment over the preceding two months.
Following the pre-survey, an intervention was introduced: residents were offered a distinctive 2×4 inch red badge, designed to be worn beneath their standard hospital identification, prominently displaying the word “doctor” in capital letters. It is important to note that these badges were a novel introduction initiated by the study authors, as such designations were not previously provided to resident physicians at this VA medical center. Typically, employee badges, including those for doctoral-level clinicians, only included the individual’s first and last name, omitting professional credentials like “doctor,” M.D., or D.O. Approximately two months after the distribution of the “doctor badge,” a follow-up, voluntary, and anonymous post-survey was administered between March 17, 2021, and March 24, 2021. This post-survey was crucial in determining whether the introduction of the badge had any perceptible impact on residents’ role identification and overall work experience.
The survey instrument was adapted from a questionnaire utilized in a 2019 study by Foote and colleagues, ensuring a foundation in prior research. The survey questions were meticulously crafted and reviewed by the study authors, incorporating a mix of Likert scale questions, multiple-choice formats, and open-ended questions. This design allowed participants to articulate their emotions and detailed experiences throughout the study period. Administered electronically via Microsoft Forms, the surveys focused on assessing several key areas: the presence and frequency of instances where residents were misidentified in their roles, the sources of this misidentification, the occurrence and frequency of gender-based aggressions, residents’ perceptions regarding the badge’s effectiveness in improving patient communication and care, and its impact on their workplace experiences. Categorical variables from the survey data were presented as frequencies and proportions, with results further segmented by self-reported gender. To determine statistical significance, Chi-square tests were performed using Excel, setting the significance threshold at 0.005. For the qualitative free-text responses, a directed content analysis approach was employed, utilizing pre-established codes focusing on (i) experiences and impacts of role misidentification and (ii) experiences and impacts associated with wearing the “doctor badge”. Data relevant to each code were then analyzed to pinpoint significant themes, supported by the selection of illustrative verbatim responses. The entire process of data coding, theme identification, and response selection was systematically documented in Excel, primarily conducted by the first author, and subsequently reviewed and discussed among all authors to ensure consensus and reliability in the findings.
