Expanding Dress Code Requirements in the Doctor of Pharmacy Program

POINT: PROFESSIONAL ATTIRE SHOULD BE REQUIRED THROUGHOUT THE PHARMD PROGRAM

Key themes related to the benefits of adopting a professional dress code in the didactic portion of professional pharmacy degree programs can be summarized as: (1) the potential benefits of a professional dress code on self-perception; (2) the potential positive perception of others; and (3) the potential benefits on academic performance.

Self-perception, self-esteem, and confidence are factors that can influence how people develop personally and professionally. The way individuals dress has the potential to affect how they perceive themselves. As one example of the effect of dress on self-perception, 222 college students from diverse majors were asked to rank their perceptions of how responsible, competent, knowledgeable, professional, honest, reliable, intelligent, trustworthy, hardworking, and efficient they felt when dressed properly vs not properly relative to the work environment.¹ The results showed a significant and positive association between proper dress and each of these 10 occupational characteristics. Another study assessed dress preference and self-perceptions among 91 graduate students in three different master’s of business administration (MBA) programs who had worn formal business, business casual, and casual attire at some point in their history of employment.² Students were asked to rate 16 different work-related perceptions while thinking about being dressed in each of these three styles. Interestingly, students perceived themselves to be more productive, competent, authoritative, and trustworthy when dressed in formal business attire in the workplace. These studies have important implications for the adoption of a professional dress code in pharmacy classrooms. They suggest that dressing in a professional manner may improve a student pharmacist’s self-perception as a professional, which is an important step in building a culture of professionalism. If students perceive themselves as more professional while wearing professional attire, then enacting a dress code throughout the curriculum and cocurriculum may be one means to support their professional development.

The clothing one wears can communicate strong and powerful messages to others, influencing the “first impression” a person makes on others. Both positive and negative judgments are made about people because of their physical appearance—sometimes within seconds. Negative first impressions may have long-lasting effects and can be difficult to change, which is why first impressions are so important. In a study to assess dress as it relates to perceptions of intelligence and academic achievement, high school students and teachers were shown photographs of girls and boys wearing four different styles defined (using student terminology) as “hood,” “artsy,” “dressy,” and casual.³ Participants were asked to estimate the intelligence level, grade point average, and terminal degree based on their appearances. Photos depicting the dressy look ranked highest for intelligence and academic achievement, whereas the hood look ranked lowest.

Although no studies have specifically examined the influence of attire on others in the context of the professional pharmacy program, the positive perception of others, such as faculty members, college administrators, and external stakeholders, is an important consideration when communicating the message that students are respectable and professional. Individuals outside the programs may appear in hallways or offices on any day, and the impressions they form of the student body may have long-lasting effects on the reputations of the programs. Requiring professional dress throughout the PharmD program will help students identify the differences between professional and unprofessional attire before they enter the experiential environment, where the impact of unprofessional dress and the perceptions of others could have a profound and negative outcome (eg, being dismissed from or failing, a practice experience) on their academic progress.

The final argument related to the benefits of implementing a professional dress code during the didactic portion of the PharmD program is that it has the potential to improve the academic performance of students. When students are dressed professionally, favorable perceptions by faculty members may influence student performance through a process referred to as the Pygmalion effect. This effect refers to a phenomenon whereby a teacher’s expectations of a student’s intelligence and ability to achieve subconsciously affects the quality of teaching in that educators teach to their expectations.⁴ Higher teacher expectations and depth at which education is delivered evoked by favorable perceptions may, in turn, positively influence a student’s actual performance.

Dress also has an impact beyond that of mere perception. In 2012, Adam and Galinsky coined the term “Enclothed Cognition” to demonstrate the effect that dress may have on a wearer’s psychological processes.⁵ The authors claim that a person’s cognition may be influenced both by the symbolic meaning of the clothes a person wears as well as the physical act of wearing a type of clothing. In this study, the authors conducted two experiments. In the first experiment, the researchers randomly assigned study subjects to either wear a lab coat or not wear a lab coat and complete a number of cognitive tasks to assess selective and sustained attention. In the second experiment, subjects all wore a lab coat, but the researchers’ assigned meaning to the lab coats by telling the subjects they were wearing an artistic painter’s coat or a doctor’s coat. Subjects wearing a lab coat performed better on cognitive tests than those not wearing a lab coat. In addition, subjects who were told the lab coat was a doctor’s coat (symbolic of a professional who exhibits a high degree of attentiveness and sustained focus) performed better on the tests than subjects who were told they were wearing an artistic painter’s coat (for whom attentiveness and focus is not as important). These results suggest that the physical act of wearing professional dress and the symbolic meaning assigned to it has the potential to positively impact performance. Although this study only examined the effect of clothing on participants’ cognitive ability during a test, the results may also transfer to other components of the program in which students must demonstrate competency.

COUNTERPOINT: PROFESSIONAL ATTIRE SHOULD NOT BE REQUIRED THROUGHOUT THE PHARMD PROGRAM

Arguments against a professional dress code in settings beyond practice laboratories and experiential sites should not be used because: (1) it would be difficult to establish relevant and measurable criteria to make professional dress codes enforceable in a consistent manner across the program; (2) there might be negative impact to stakeholders (eg, students, parents, faculty members, and administration); and (3) the focus on clothing rather than a set of desired professional behaviors would be misguided.

A considerable amount of due diligence is required of schools when developing an equitable and measurable professional dress code policy. This may become critical if existing dress code requirements are expanded to include the entire PharmD program because it may exacerbate student challenges to the policy. As student exposure to the policy increases beyond laboratories and practice sites into the classroom, student tolerance to perceived inequities may decrease. Thus, dress code policies must outline criteria with which to enforce them while remaining consistent with legal and university restrictions related to diversity. In a basic sense, one can ask whether professional attire constitute clothing alone, or a combination of clothing, appearance, and hygiene. This question was explored in a study designed to identify the effect nursing attire has on nursing professionalism.⁶ Survey participants could not agree whether to define nursing attire as dress alone or as a “total package” consisting of clothing, appearance, posture, and speech. Conceptualizing what constitutes professional attire must also take into consideration relevancy to the profession.

If the primary goal of professional dress is to enculturate students into the profession, it must do so in a manner consistent with professional pharmacy practice. The dress code must embody what the pharmacy profession considers “professional” attire and then it must be applied consistently across the entire student body and educational settings. In other words, the dress code policy must be relevant to the practice of pharmacy. Delineating a standardized dress code from the perspective of the pharmacy profession may prove difficult because of the variety of practice areas and healthcare settings. For instance, a polo shirt for males may be considered acceptable attire for pharmacists working in some retail settings whereas it may not be acceptable for a pharmacist employed in pharmaceutical sales or a hospital setting. Similarly, scrubs may be acceptable attire in certain pharmacy practice settings and not others. If dress code policies cannot be consistently applied because acceptable professional attire differs among practice sites or they do not accommodate diversity-related considerations (eg, gender identity), then they cannot be enforced.

Frequent changes to the professional dress code may be necessary because the cultural landscape of many professional programs is changing. For instance, it is not unusual for dress codes to prohibit visible tattoos. In some cultures, however, tattoos are a form of religious expression and intentionally hiding them is considered a sin.⁷ Gender identity (and the rights associated with it) is another changing area that will influence dress codes. At least seven countries now recognize a third gender and a White House petition to follow suit has been filed.⁸ Regardless of how well a professional dress code policy is constructed, there may be unintended negative consequences to stakeholders.

Requiring professional attire in the classroom could place an unjustified financial and emotional burden on students. The requirement will add to the financial obligation of students (and by extension, parents) on top of tuition, class fees, computers, books, and supplies. According to the 2014 AACP Graduating Student Survey, more than 89% of pharmacy students had to borrow money to pay for their pharmacy education with the average total amount borrowed approaching $145 000.⁹ Thus, requiring professional attire beyond practice laboratories and experiential sites has the potential to increase student debt.

Pharmacy students are already under considerable stress trying to make it through an academically challenging program. In a study on pharmacy student stress, the authors found the perceived stress scale of pharmacy students to be significantly higher than that of comparably aged people in the general US population.¹⁰ In addition to financing their clothing budget, students would need to find time to shop for and maintain a professional wardrobe as well as factor in time to dress professionally and maintain appropriate hygiene on a daily basis—all of which may add to a student’s stress level. Professional attire, depending on how it is defined, also may not be the most comfortable clothing option for students and may, therefore, stifle learning in a physical sense.

In addition to the burden a dress code may place on students and parents, faculty members and administration may also experience anxiety and tension associated with the process of enforcing a professional dress code in the classroom setting. Although faculty members would be called upon to enforce the professional dress code, not all faculty members may be comfortable with this, or even comply with these policies. Possible factors for not enforcing dress codes include different interpretations of professional attire, reluctance, refusal, limitations of the teaching environment, and gender. Difficulty enforcing dress codes may stem from differences among faculty members in interpretation of professional attire, which is influenced by age, gender, geographic origin, and educational level of the evaluator.^11-13 Moreover, some faculty members may feel that a dress code policy that differs from practice sites or research laboratories does not apply to courses they are teaching.

In some cases, faculty members may be reluctant to enforce a policy that only marginally impacts the learning process or is not grounded in evidence-based practice. Faculty members who agree with the premise behind the policy may not actually enforce it to avoid conflict or to avoid poor student evaluations. This behavior was examined in a study documenting attending physician responses to unprofessional student behavior in which clinical supervisors demonstrated their reluctance to give negative feedback to the students even though in interviews they had stated strongly that they would do so.¹⁴ Disengaged faculty members, defined as those who withdraw from collaboration and decision-making processes among colleagues are less likely to participate and enforce departmental policies.¹⁵ Finally, the teaching environment may also limit faculty enforcement of the professional dress code because faculty members may not be able to see all students in large size classes and in distance education or it may not be feasible to enforce it in these settings.

Gender differences among faculty members and students present another potential challenge to comfort in enforcement of a dress code. Faculty members may not feel comfortable addressing nonprofessional attire in a student of the opposite gender for personal reasons or because cultural norms do not allow a male to address a female about her attire or vice versa. The responsibility for and process of enforcing a dress code can lead to conflict among students, faculty members, and administration. Unhappy students, parents, and faculty members might even lead to potential lawsuits. Dress codes that do not take into account gender-based stereotypes may infringe upon a student’s First Amendment right to free speech and expression as well as their rights under the Equal Protection Clause of the Fourteenth Amendment.¹⁶ Lawsuits can be time consuming, emotionally exhausting, and expensive. Lawsuits can also damage reputations and job security.

One of the implicit purposes of adopting a professional dress code during the didactic curriculum stems from a belief that dressing professionally may translate into professional behavior. Professionalism is recognized by the Accreditation Council for Pharmacy Education (ACPE) as an important educational outcome in its 2016 Standards.¹⁷ However, professional attire is not specifically linked to ideals of professionalism in the ACPE Standards. White coats and professional attire may be perceived merely as symbols intended to reinforce the tenets of professionalism.

Professionalism refers to a desired set of behaviors and values, and learning to be professional is more than putting on a required set of clothing. Professionalization is a process that must be taught, modeled, and practiced throughout the curriculum and cocurriculum and is influenced by other factors including effective role models and the professional behavior of faculty members.^18,19 Hence, placing the emphasis on professional attire throughout the PharmD program is insufficient by itself to the professionalization process.