It’s 10:42 p.m., and I am a second-year medical student shadowing on the ENT night float service. A page to the resident relays a pediatric airway emergency, causing us to immediately jump in the car and drive to the children’s hospital. Flying down the hallways, gowning up, and scrubbing in were second nature to me as I was used to the ENT night float rush, and it was exhilarating!
Suddenly, my high was crashed as the scrub nurse reprimanded me for my waist-length box braids not fitting completely inside the disposable scrub cap. Instead of offering solutions so that I could continue with my learning opportunity, I was chastised about my selection of hairstyle and it not being fit for the OR.
I’m not the only one who’s had this experience. Black medical students, residents, and doctors across the country have faced hair-based discrimination that targets natural hairstyles — especially the ones that reflect our culture and identity. The Create a Respectful and Open World for Natural Hair (CROWN) Act stands at the forefront of the conversation surrounding hair-based discrimination, and it is time for critical reevaluation of what constitutes “professionalism” in health care.
In medicine, “professionalism” is defined by compassion, accountability, teamwork, respect, and continuous improvement — all qualities unrelated to appearance. Yet within many medical circles, “professionalism” includes unspoken standards on image that lead to many Black trainees being discriminated against, specifically targeting natural hairstyles. This concept of “professionalism” has often forced Black medical students and residents to choose between their cultural identity and their career goals. There is an expectation to meet these invisible standards by altering our natural hair texture and styles to fit a standard that is a relic of exclusionary norms. This issue is more than just a hairstyle debate; it’s about identity and feeling like we belong. It’s about whether we can show up as our true selves without being told that who we are isn’t good enough.
The CROWN Act prohibits hair-based discrimination on race-associated styles and textures. It has been quickly adapted in other professional fields but remains largely absent in health care. Medicine must adopt the CROWN Act if we are to create an equitable environment for all future doctors.
A 2018 JAMA study found that there is extreme pressure for residents to assimilate as they are often seen as race ambassadors. One such example was a quote from their thematic interview analysis: “Yeah, you just told someone who’s had an afro for the last two years who finally got their hair flat ironed once, and you’re like ‘Oh, your hair looks so professional!’”
On #MedTwitter, Black medical students and residents frequently share their struggles with hair-based discrimination, describing the pressure to straighten, cover, or style their hair. It’s become a common conversation topic, with many of us calling for an end to this kind of discrimination, especially in spaces like residency interviews, where these microaggressions can feel even more intense.
Hair-based discrimination discourages diversity within medicine and stifles trainees’ cultural identity. The medical training path is extremely laborious, and these issues only exacerbate the mental health challenges trainees already face. Constant pressure to conform to these rigid standards diverts focus from learning and patient care, the very heart of medical training. If we’re serious about creating a more inclusive and equitable health care system, the medical field must embrace the CROWN Act.
I am calling on the AAMC to embed the CROWN Act principles directly into their accreditation standards for medical schools and residency programs. This aligns with the AAMC’s robust efforts to include diversity, equity, and inclusion frameworks into medical curricula in order to prepare future physicians to address the health inequities and racial bias that are frequently encountered in patient care in order to form a more competent and empathetic medical workforce. Mandating the CROWN Act principles will further equip students and residents to understand and address hair-based discrimination, supporting professionalism standards that respect cultural identity and release a burden of self-advocacy from trainees from underrepresented groups.
We can also do our part by speaking out and using our voices. Physicians and medical trainees can support the CROWN Act by signing petitions, sending letters of support to elected representatives, and joining the CROWN Coalition, an alliance of advocacy and nongovernmental organizations advancing antihair discrimination legislation in a variety of ways as highlighted by Lee, et al. And let’s not forget the power of social media, where a wider form of conversation can occur with health care workers vocalizing their discontent with hair discrimination in their workplaces and communities.
As we work to create a medical field that reflects the diversity of the people we serve, we must understand that professionalism isn’t one-size-fits-all. Yes, standards of safety, sterility, and respectability must remain. However, these standards should not include arbitrary appearance-based judgments. School and hospital policies must be adaptable to account for cultural expression, especially when it has no direct impact on patient care or performance ability. Hair coverings and proper scrub attire can easily be adapted to accommodate all hair types, making it possible to respect both hygiene and diversity.
The CROWN Act challenges the medical community to rethink “professionalism.” If we truly want to break down barriers in health care, we must start by embracing each other’s full identities — only then can we create a medical system that provides the best care for everyone.
Sydney Sharp is a medical student at the University of Pittsburgh School of Medicine and a public policy master’s student at NYU Robert F. Wagner School of Public Service. She is currently interested in the intersection of medicine and health policy implementation/development and hopes to include governmental work into her future practice as a physician to create meaningful change in the health care system for patients from marginalized communities.
Image by Liana2012l / Getty Images
