Interview Season: Combating Natural Hair and Cultural Headwear Discrimination

As I glance through #MedTwitter admiring the Electronic Residency Application Service, better known as ERAS photographs of 2022 applicants, I quickly realized it’s been a year since I had submitted my ERAS application for pediatric residency programs. This time last year, I was anxiety stricken over the process with thoughts of whether I would receive an interview ran laps throughout my mind. Despite all of this, I was most terrified of getting interviews from dream programs and “not looking” the part.

In my limited free time, I scanned through images of current residents at these programs, tallying the number of persons of color with hopes of looking for representation, yet also observing, of those persons of color, how many were comfortable enough to embrace their natural hair or cultural headwear?

To some this may appear as a minute aspect in residency season, in the grand scheme of USLMEs, MPSEs, personal statements, and letter of recommendations. For many applicants, seeing current residents embracing their natural hair and/or cultural headwear at their programs, can tell them all they need to know about whether the culture of a program or what we love to call “the feel or vibe” of the program embraces natural hair and/or cultural headwear.

When it’s not embraced, there is an internal message whether intentional or not, programs send to applicants which is:

“I need to alter my appearance (whether it’s natural hair or cultural headwear) to fit into the “culture” of your program to advance my career in medicine”.

Natural hair and culture headwear discrimination has been a topic of debate since 2019 passage of CROWN (Create a Respectful and Open Workplace for Natural Hair) Act in California. As of now several states, cities, and counties, across the United States, have passed various forms of the CROWN Act, in efforts to combat natural hair and cultural headwear discrimination in the workplace. Though this movement has been dynamic and transformative, with adoption of this act in 12 states and the American Academy of Pediatrics (AAP) to address it among children through school and sport activities it has not yet cracked the glass ceiling in medicine and medical education.

Lack of this acknowledgement have left many applicants in both undergraduate and graduate medical education sensing the need to change their appearance once the interview is granted. Though many in medical leadership deem this is unnecessary or overblown, they risk creating a less inclusive, diverse residency class by not acknowledging this issue. In 2020, researchers at Duke’s Fuqua School of Business studied the impact of The Natural Hair Bias in Job Recruitment. They discovered that natural Black hairstyles are perceived as less professional, and this effect was most seen in industries (such as medicine) where a more “conservative” or Eurocentric appearance is common. With the increase desire to show 2020 anti-racist statements and pledges are beyond performative, it is important for leadership involved in graduate medical education, to then take the necessary steps to create environments and cultures within programs where acceptance of natural hair and cultural headwear is a normality.

So how can these residency programs embrace natural hair and cultural headwear? As someone who has been frontline advocate on this issue for some time, I recommend the following, inclusive acknowledgments:

• Openly acknowledgment of the acceptance of natural hair and cultural headwear on residency websites on interview day.
• Acknowledgement that natural hair and/or cultural headwear is considered medically professional.
• Revising Diversity, Inclusion, and anti-discrimination statements to include natural hair and cultural headwear.

The acknowledgment that natural hair and/or cultural headwear is accepted during interview process without the applicant having to determine themselves, will decrease their anxiety and allows them to focus more on what the programs has to offer overall to them. Most importantly, it shows these programs are supportive of the CROWN ACT at large and have a desire to combat the conservative, professionalism ideas in medicine that tend to harm applicants of color. Though residency leadership can promote inclusiveness long-term policy changes at their own institutions, an expansive movement is required in medicine to change this perception in medical professionalism.

To combat natural hair and cultural headwear discrimination at large, we must embrace sustainable policy among medical education stakeholders such as the Association of American Medical Colleges (AAMC), and American Medical Association (AMA). Passage of these policies not only protects medical students and trainees, but also creates a more inclusive physicians’ workforce that knows medicine will no longer natural hair and cultural headwear discrimination within the healthcare setting.