As a teaching clinician in an internal medicine residency program, it is safe to say that September is one of the more exciting and busier times of the academic year. Walking through the hallways of our department, we encounter bright-eyed fourth-year medical students scurrying about in a frenzy as they make some big decisions about what field of medicine to pursue, where to apply and whom to ask for letters of recommendation. The application process for residency can be a daunting one, but the interview process for obtaining a residency position can be even more so.
Most program directors view the interview as a “make or break” opportunity for candidates to showcase themselves. Of course, it makes sense that applicants want to look their best when they come in for the interview. But what exactly is the best? For years, interview attire across all specialties has often been what is deemed “formal business attire” a`la the business suit. What is most surprising, however, is that despite medical school officials and even residency program directors advocating for a more relaxed “business casual attire” on a day-to-day basis while in class or on the wards, the residency interview setting has not caught up to hold that similar standard. The question begs: why?
This is not an unreasonable question, and it likely stems from another hot topic of discussion: physician attire and patient perceptions. The literature goes on and on about how different specialists’ attire influences patients’ perceptions of who is caring for them: their competency, their empathy, their knowledge base, their professionalism. So it makes sense that these similar concerns would translate over into how any applicant would be perceived by a program director interviewing them to work in their institution. The applicant wants to rise to the occasion through their choice of attire, but can this “expectation” of formal dress be limiting to their ability to showcase themselves or, alternatively, even affect their perception of the program? This is the question that we pose to you now.
In an effort to elucidate this a bit further, we decided to change the unwritten expectation of “formal business attire” to that of an explicitly stated: “business casual attire is acceptable.” This was communicated via email to all applicants to our transitional year residency program at our community-based academic center over three application cycles ending in 2016, 2017 and 2018. We wanted to assess whether the applicants felt comfortable pursuing a more casual attire for their interview at our institution after being encouraged to do so in writing (we sensed that this had more weight than word of mouth). Following the interview and prior to the submission of rank order lists, an anonymous three question post-interview survey through SurveyMonkey.com was sent to applicants. Our goal was to specifically look at applicants’ acknowledgment, comfort level and execution of the casual attire recommendation, their perception of the program as a result of this recommendation, and whether or not this helped or hurt their interview experience in any way (cost, comfort with the interview itself, etc.).
The survey was sent to a total of 429 applicants during the three years of application cycles. It was completed by 44 percent (60/135) applicants the first year, 40 percent (55/138) applicants the second year and 32 percent (51/156) applicants the third year. Overall, almost all respondents (98.1 percent) acknowledged the “business casual attire is acceptable” notation in their interview invitation emails. Over half (59 percent) responded that they chose to pursue business casual attire, and free text commentary made available in the survey indicated that many applicants appreciated the change from the norm — that it created a more inviting and relaxed interview environment, that it probably allowed interviewers to remember applicants more distinctly and that it reflected positively overall on the program. On the other hand, a few applicants acknowledged the attire recommendation but felt hesitant to do so — admitting that they didn’t know how seriously to take the recommendation for fear of it having a negative impact on their performance during the interview. Finally, amongst surveyed applicants, we posed the question of what their overall opinion was regarding the relaxed dress attire. Overwhelmingly a majority (61 percent) of respondents welcomed the change and wished that more programs had advocated a “business casual attire,” that it was “a nice break away from the suit,” “a welcome vacation for my wallet and the dry cleaners,” and that it ultimately made sense since “we don’t wear suits to work every day anyway.”
Our survey demonstrated that making the recommendation of “business casual attire” did not impact the interview process in a negative way for neither the applicant nor the program. Overwhelmingly, applicants welcomed the casual attire; they felt more comfortable, they felt that the program was more inviting, and they felt that it should be instituted more commonly across programs given the day and age we live and work in. Very few of surveyed applicants who chose to dress in a more relaxed manner did acknowledge that rather than the phrase “business casual attire is acceptable” that the email should formally recommend this attire solely so that they did not feel awkward amongst those who chose to still wear suits. The topic of cost (alleviating expenses associated with purchasing and/or maintaining a formal suit and accessories, etc.) was not consistently cited as a benefit of the more casual attire.
We encourage program directors across all specialties to take these perceptions into mind as the interview season approaches. In this time of advancement and growth in medical education, we should try to put our best foot forward as a program — perhaps this process starts with the perception of acceptable attire amongst applicants and their perception of us as a program given what our own attire is on a day-to-day basis. Yes, the interview is that opportunity for an applicant and a program to shine. Looking your best will help you to do so. But does that need to happen in an often ill-fitting and bland suit? We don’t think so. Will our perception of an applicant change because they are not in a suit? Only if they choose to dress unprofessionally; in fact, we may be even more curious about them and want to learn more during their interview. Change is a good thing; change needs to be welcomed — and a change of clothes might do the residency interview process some good. The old adage holds true in this case: you wear the clothes, the clothes don’t wear you. Think about it.
Michelle Solik and Laurel Fick are internal medicine physicians.
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