How Perceived Hairstyle Prejudice Influences the Hairstyling of Medical Students and Residents

Abstract

Introduction

Race-based hair discrimination has historically influenced professional advancement, pressuring individuals with natural hairstyles, braids, dreadlocks, hijabs, and dastars to conform to Eurocentric grooming standards. While the CROWN Act was introduced to protect against hairstyle-based discrimination, only 27 states have enacted it, leaving many without legal protections. This study examines how medical students and residents perceive hairstyle and head covering-related bias in clinical settings, ERAS photos, and residency interviews.

Methods

This qualitative, cross-sectional study explored perceptions of hairstyle-based discrimination among medical students and residents of color. A 22-question survey was developed and administered via Qualtrics, incorporating multiple-choice, dichotomous, Likert scale, and open-ended questions. Four key themes were assessed:

• 1.
  Demographics (e.g., year of training, natural hair texture, routine hairstyle practices).
• 2.
  Perceptions of hairstyle-based discrimination during clinical rotations, in ERAS photos, and residency interviews.
• 3.
  Medical specialties influence hairstyle choices to conform to professional expectations.
• 4.
  Definitions of professional hairstyles in medical settings.

The survey was distributed electronically via Student National Medical Association (SNMA) social media platforms, with an estimated completion time of 15–20 minutes. Participation was voluntary, with informed consent obtained prior to survey administration. Responses were anonymous, and no compensation was provided. Thematic analysis was used to analyze qualitative responses, while descriptive statistics summarized quantitative data.

Results

A total of 204 medical students and residents completed the survey. The majority (55% MS4s, 31% MS3s, 13% residents) identified as Black or African American (93%). Medical students and residents reported modifying their natural hairstyles to align with perceived professional norms, particularly during clinical rotations, ERAS photos, and residency interviews, due to concerns about implicit bias and negative evaluations. Surgical specialties, including General Surgery (80%) and Obstetrics & Gynecology (45%), were identified as settings where students most frequently altered their hairstyles, often citing the need to maintain a sterile field. Additionally, Eurocentric beauty standards significantly influenced hairstyling decisions, with many participants straightening their hair for ERAS photos and interviews out of fear that natural styles would be perceived as unprofessional.

Conclusion

This study highlights the complex interplay between professional expectations, implicit bias, and personal identity in medical training, particularly regarding hairstyling choices during clinical training and the residency application process. While limitations exist, including the subjective nature of qualitative responses and the exclusion of gender identity considerations, future research should explore how gender and geographical factors shape perceptions of hairstyle prejudice. These findings underscore the urgent need for medical institutions to re-evaluate professionalism standards to foster inclusivity and eliminate race-based hair discrimination. Addressing these biases in medical education and policy is critical to ensuring a diverse, equitable healthcare workforce that enhances both provider experiences and patient outcomes.