The millennial generation is known for its desire and ability to change the status quo. As this group continues to enter and dominate the workforce, particularly as our current residents and medical students, employers are adjusting their long-held practices to reinvent their culture and ensure long-term access to young, top talent. Can you give this generation the same dress code as you did the baby boomers and expect the same result? While the answer is unsurprisingly no, considerations to update hospital policies for this generation have largely not been taken. Organizations within business, finance, technology, and more are now moving from a formal and regulated dress, to more casual, millennial-friendly expectations. This trend has been flourishing within the millennial landscape, and makes us wonder: should medicine follow suit? What does “professional dress,” as it is often phrased without specifics, mean to this generation? The intersection of millennial-desired guidelines and the infinite permutations of fashion Today’s medical learners expect and need specific instruction, clear expectations, and feedback. This presents a set of issues with regard to professionalism and professional dress. Firstly, professional behavior and dress cannot be drilled into a concise set of expectations, given the innumerable variations within fashion. In some instances, creating a concrete set of expectations can turn into restrictive rules and, especially when gendered, may cause confusion and constriction that threatens performance and personal wellbeing. Many dress codes emphasize the traditional gender binary, to which a growing number of millennials either do not conform or feel comfortable challenging on behalf of others. Entrapping a millennial learner back into a mold they fought to break out of can lead to frustration and distress. Additionally, feedback on issues of dress can be uncomfortable, especially across gender and power hierarchies. It is unlikely a male attending would feel comfortable giving feedback to a female medical student that her dress is not appropriate. Freedom and choice Although clear expectations and guidelines are of value to millennials, this preference is situated alongside the desire to express freedom and choice. Specifically, personal expression is of high importance. Many agree that millennials, more so than generations past, feel as though they do not need to pay any “dues” or reach a certain threshold to earn the right to be unapologetically themselves. For some, this may be viewed as a sense of entitlement; however, in many ways, this is a strength of the generation. Millennials are excellent at empowering themselves with information and questioning why things are done. The old answer of “this is just how it’s always been” is no longer acceptable. In many instances, this has benefited society, and a lot of progress has been made where a rule or restriction had previously been set. A great example of this is the millennial-driven integration of technology into the practice of medicine. While some may say millennials are glued to their phones or tablets, the incorporation of these devices into everyday practice in ways that may have previously been discouraged has expanded the individual limits of young physicians. Medical students and residents could still be gathering numbers for patient rounds at 4 a.m. to print and distribute to the medical team. This age-old practice was a rite of passage and an expectation for many years. Creating efficient rounds reports within the EMR made information more accessible and efficient for all providers. The evolving physician-patient relationship Medicine has become less paternalistic, and the physician-patient relationship has changed. Patients now turn to the wealth of information on the internet and are empowered by online support groups. This changes the dynamic of medical appointments, with patients coming prepared with questions and suggestions. Although the physician is still seen as an authoritative figure, the nature of encounters is becoming more collaborative and team-like than in the past. Those who oppose changes in dress may argue strict, “traditional” presentations of a professional self are critical for navigation of the physician-patient relationship, while those open to dress code adjustments often recognize the need to be seen as relatable and like a teammate to patients. Society’s definition of professional dress Beyond any theoretical discussions about dress, we must also situate this issue within a broader context and consider what is actually available to millennials. The fashion and retail industries have varying definitions of professional dress and market products as such. This is particularly true for women. A large proportion of professional dresses and many blouses are sleeveless. Skirts and dresses are shorter in general, and necklines are generally more open and lower. It’s not surprising to see millennials in these types of clothing options due to availability or what is labeled as “work dress” in digital advertisements, Instagram posts, and online retailers. It’s also necessary to consider the accessibility of higher-end, more traditionally professional garments to millennials. Medical trainees, residents, and very early career physicians may not be in a financial situation in which they can afford tailored pieces, full ensembles, and other, more formal options. What do we do? Issues of professionalism, personal expression, gender identity, questioning of the status quo, and medical practice all exist within an intersectional space. All must be considered when determining what it means to present oneself professionally and in creating a dress “code” for millennial medical trainees (and established medical professionals) to follow. To medical educators, it may be time to adjust your thinking about current learners and allow for your dress code and teachings on professionalism to intertwine with their perspectives on the world. It is alright to set guidelines, as millennials will appreciate the clear expectations, however, to foster a healthy environment of self-expression and overall wellbeing, it’s imperative these guidelines do not feel like a set of rigid rules. This is especially true for individuals with varying identities who may feel oppressed by traditional, binary regulations like “dresses and skirts for women, slacks and ties for men.” Instead of pushing concrete rules, it may be beneficial to instead emphasize personal identity within the context of earning trust and respect. Dress code policy should be less about the precise measurement of skirts and dresses and more about creating rapport between physicians and their patients and peers. A shifting perspective may need to be adopted by the next generation of physicians as well. Personal expression and fashion choices can be less about who you are and more about creating an appearance that is trustable by those seeking your guidance. This differing mindset may seem difficult at first. However, it may actually provide a sense of personal empowerment and care toward patients. It is possible to be expressive in medicine and may even be encouraged by some patients and superiors. It’s crucial not to lose sight of the space in which you are working. Although it’s important to create a space for yourself in which you can personally flourish, it’s just as important to create a safe and trusting space for your patients. Politicians and business professionals are far more advanced at this mentality than medical professionals. Instead of asking yourself, “Can I get away with this?” try, “Does this project the image I want, trustworthy and intelligent?” While our personal identities can, and should, be incorporated into our professional appearance, we must also consider the work in which we’re doing and how to best create a sense of trust and respect. Carolyn S. Quinsey is a neurosurgeon. Casey Hribar is a medical writer. Source
