Guidance on professional appearance varies between medical schools. Kathy Oxtoby explores what is appropriate attire for practical exams and being on the wards “Appearances count”—or so the saying goes. The stereotypical image of a doctor is generally one of a man wearing a white coat, with a stethoscope slung around his neck, or a surgeon in scrubs and a mask. But in a fast changing world where fewer people dress formally, one in five people in the UK have a tattoo, and 57% of doctors in training are women, how should medical students dress? “I was specifically told to take off my crucifix and a singular ear (helix) piercing out, or I would fail my objective structure clinical examination,” says one UK based student, who prefers not to be named. She believes “dress rules are archaic,” particularly the negative attitudes from medical students’ assessors and supervisors towards piercings and tattoos. She’s not alone. Increasing numbers of students are claiming that dress codes are confusing, sometimes infuriating, and might even be discriminatory. In April this year, the question of what medical students should and should not wear prompted a motion by the University of Plymouth’s medical school at the BMA’s annual medical student committee conference. The motion read: “This conference recognises that professional appearance guidelines are often vague and vary between organisations. Interpretation of these guidelines can result in unfair penalisation of medical students by assessors/supervisors. (Students’ dress and appearance is influenced by religion, culture, age, gender and socio-economic background.) This conference calls the BMA to: ● Write clear, detailed guidelines on what constitutes professional dress, which acknowledge variation in modern social norms, with particular reference to tattoos, piercings, jewellery, and hairstyle; ● Lobby medical schools and trusts to acknowledge these guidelines; ● Support medical students in appealing academic penalisation on the grounds of professional appearance.” According to Charlie Bell, co-chair of the BMA Medical Students Committee, the motion was passed as a “reference.” This means “we will take into account what the motion says and then try to provide nationwide guidance on dress in general rather than focusing on specifics,” he says. Inconsistent rules Attire for medical students is a “minefield,” says Bell, because each school and hospital trust has a different set of guidelines. “Policies vary so much, it’s almost impossible for students to work out what they should wear,” he says. For example, some medical schools say piercings are appropriate. Others have strong views about what can or cannot be covered. “There’s no uniformity and with that comes a sense of frustration,” he adds. The University of Manchester has detailed guidelines, which include banning T shirts with slogans, visible body art, extremes of hairstyles, and clothing that covers most of the face. In contrast, the University of Nottingham’s medical student dress code is not as detailed, but it emphasises that students avoid jewellery and dress smartly when attending clinical visits and do not wear clothing that will cause offence to patients by being inappropriate or revealing. Bell says some students were told by their medical schools that it is unsafe to perform surgical procedures while wearing religious dress, such as the hijab (a veil traditionally worn by Muslim women in the presence of men outside their immediate family, which usually covers the head and chest). Appearance as a form of communication Marina Soltan, an academic foundation year 2 doctor based at Burton Hospital, says, “A dress code for doctors has to be one which all patients find professional.” It should also “inspire confidence, be in keeping with different cultures, values and beliefs, compatible with infection control and appropriate for breaking bad news.” For a female doctor working on the wards, Soltan suggests smart dresses, skirts at least on the knee or trousers, black tights, and plain shoes—not high heels. “Your uniform has to be practical—for example, if you have to race to a cardiac arrest or treat an acutely unwell patient,” she says. As for a medical school’s clothing policy, “It should be uniform and integrated into a student’s training at the earliest possible stage,” says Soltan. “If the student doesn’t meet professional standards of dress as outlined by the General Medical Council, they should be offered guidance to help them achieve this,” she says. When Andrew Slater, a second year medical student at Leicester, wore an earring and sported a bright red Mohican hairstyle he was barred from a dissection teaching session. “I was told how I looked was inappropriate. I was made to feel unwelcome and uneasy. I didn’t want to appear as disrespectful, so I took out my earring—it wasn’t worth the fight,” he admits. Now, Slater has short black hair and no longer wears an earring. His change of appearance was prompted by what he describes as “the socialisation” process of becoming a doctor and advice from colleagues and friends. “A consultant took me aside and said I would face a lot of difficulty as a trainee because of the way I looked,” he says. Slater says he misses “the way I looked coming into the profession but it seems easier to live with having a normal appearance and to be another face in the crowd.” He says, “It’s petty to say someone can’t do their job on the basis of their appearance. Skills are more important than appearance, and looking good doesn’t mean you are good.” Senior doctors’ views What do senior doctors think is appropriate dress on the wards? David Evans, vice president for training and assessment at the Royal College of Paediatrics and Child Health, says comfort is key, and nobody today needs to be “dressed up in pin striped suits.” “Historically paediatricians have always dressed less formally,” he says. “You don’t want to intimidate patients or create a barrier between yourself and parents and families. Also, restrictive formal clothing impedes your ability to move about when you’re looking after children,” Evans says. John Abercrombie, a general surgeon at Nottingham University Hospitals NHS Trust, says students need to “think about their appearance through the prism of the patient and tailor what they wear to put them at ease.” Abercrombie says that students should avoid wearing T shirts and anything that could be perceived as upsetting patients, such as facial piercings, and should stick to a “smart-casual dress code, which is bare below the elbows.” Mark Salter, a consultant psychiatrist in east London, says that in his specialty, clothing should be as neutral as possible. “You want something that’s safe, that’s bland, that doesn’t draw attention to your own individuality because it’s all about the person you’re talking to and you need to be presenting a ‘blank screen,’” he says. For Salter that means wearing a shirt and smart trousers and “looking tidy, not scruffy, to instil confidence.” Patients’ views Research in the UK and the US indicates that patients prefer a doctor to wear a white coat. A systematic review of literature, which included 11 533 patients, found that formal attire and white coats were preferred in 18 of the 30 studies analysed. And in a study at Edinburgh medical school, 110 orthopaedic patients were surveyed with pictures of medical students in different attire and asked to rate them in terms of confidence, cleanliness, and professionalism and whether or not they were more intimidating. Students wearing white coats scored highest in trust and confidence, cleanliness, and professionalism. But as with doctors, patients’ views differ about attire. Liz Salmi, who serves on the patient panel for The BMJ and is based in California, says she is comfortable with “doctors being more relaxed in their work wear. “What’s important to me is to interact with clinicians as human beings, to get to know their personalities, to trust them. I feel comfortable with physicians having tattoos or changes of hair colour. What I find as a patient is the great value the individual gives to my care, and if they have a stripe of pink hair or a tattoo I 100 percent support that,” she says. Anya de longh is a self management coach supporting people with long term conditions. She works in Dorchester, Dorset, and is also a member of the patient panel of The BMJ. She views student doctors’ clothing as “a minor issue. “What matters when patients are sick is their healthcare, and the quality of the conversation they have with doctors—not how they look,” she says. Thinking about your appearance Given the absence of national guidance and varied views on what is and is not appropriate attire, medical students and doctors need to be mindful of the population they are treating and that your appearance is part of your communication. According to NHS Digital, patients aged 65 to 69 made up the single largest group of hospital admissions in 2015-16 (1.3 million), and this was followed by patients in older age ranges. With this in mind, Salter says that “you also need to establish a link and a bond with your patients. An older generation, for example, might find unusual markers of independence hard [to deal with] and it is the responsibility of a doctor to meet patients’ expectations with what they wear. First impressions count.” For those who want to express who they are through what they wear and their body art, as an aspiring doctor and without clear guidance that means striking a balance between being an individual and ensuring your appearance will reassure a diverse patient group that you are both competent and confident. Source
