Are we judging GP registrars on their outfits?

Safiya Virji, Jenny Blythe and Ruth Gailer are NHS GPs, and both postgraduate and undergraduate educators for NHS England and Queen Mary University of London.

When GP registrars enter the Simulated Consultation Assessment (SCA) – the practical component of their Membership of the Royal College of General Practitioners (MRCGP) qualification – they know their communication, clinical skills, and professionalism are under scrutiny. Professionalism occupies an ambiguous space: widely acknowledged, yet rarely consistently defined or understood. Professionalism may not be a discrete domain on the SCA mark scheme, yet it inevitably shapes how registrars are assessed, creating a standard that remains open to personal interpretation. And when that interpretation is shaped by assumptions about religion, culture, gender, or identity, attire can become an easy target, and professionalism risks being used as a proxy for prejudice.

Discovering the “rules” on professional dress can be difficult. Although NHS guidance supports inclusive dress, the details are not always easy to access. Practice environments add another layer of uncertainty: what counts as “professional” varies widely, with a suit appropriate in some practices but out of place in others. When expectations are unclear, they cannot be scrutinised, standardised, or fairly applied. In this ambiguity, visible cultural or personal expressions – such as a rakhi, niqab, crucifix, or gender-nonconforming make-up – may conflict with dominant expectations, leaving registrars vulnerable to bias in clinical placements, and those perceptions can carry into high-stakes assessments.¹

Recent BMA commentary reinforces these concerns, highlighting inconsistent implementation of inclusive dress codes and describing cases where learners were inappropriately challenged about religious attire.² Patients – simulated or otherwise – also bring expectations: research shows they are more likely to associate formal dress with competence,³ increasing the risk that those who present differently are judged more harshly. In an assessment intended to be standardised, subjective influences can have a decisive impact.

These subtle expectations ripple beyond a single assessment. Learners have witnessed healthcare professionals feeling pressure to ‘tone down’ aspects of their identity – such as covering tattoos – to avoid judgement,⁴ sending a message to registrars: assimilate, or risk being penalised. Yet professionalism is not about conformity; it is about competence, communication, and care – the qualities that build trust in general practice and underpin safe clinical practice.⁵ Expecting registrars to conceal parts of who they are to meet an unspoken standard is not only discriminatory, but it also undermines the very values that medicine claims to uphold.

What’s also often overlooked is just how subjective these judgements are. A turban, hijab, or kippah – or tattoos, piercings, and rainbow lanyards – can be interpreted differently depending on who is doing the judging. However, with even well-meaning examiners bringing unconscious bias into the room,⁶ without training and explicit guidance, registrars – especially those from marginalised groups – remain vulnerable to scrutiny not based on their skills, but their identity.

With exam failure potentially delaying or derailing a career in general practice, the stakes could not be higher. Diversity may be publicly championed, but inclusive attire within assessment settings is rarely examined with the same rigour. The result? Unspoken standards may continue to influence who is perceived as “professional enough” to pass. Yes, standardised dress codes might appear to reduce ambiguity – but they also risk enforcing a narrow, dominant idea of what a GP “should” look like.

A better solution should be transparent, consistent, and above all, inclusive. Let’s make expectations clear – and work together to embed them across training and assessment environments. As GPs, trainers, and leaders, we must advocate for inclusive standards, model professional behaviour, and challenge assumptions that conflate appearance with competence. This includes supporting clear, publicly accessible guidance on dress codes, and helping ensure that patients, examiners, and educators understand these expectations. We must also promote unconscious bias training for examiners and simulated patients – not as a tick-box exercise, but as a genuine opportunity to challenge ingrained perceptions. Only by combining clarity, advocacy, and consistent application can we shift the culture so that identity is not mistaken for incompetence.

Because if we continue to assess professionalism through such a culturally dominant lens, we will keep failing GP registrars who dare to show up as themselves.

And that’s not their failure. It’s ours.

References

1. Parkinson P. Gender Identity Discrimination and Religious Freedom. Journal of Law and Religion. 2023;38(1):10-37. doi:10.1017/jlr.2022.45
2. Valsangkar A, Bansal R. Why we need to keep pressing for faith-inclusive dress codes. BMA News & Opinion. September 2025. Available from: https://www.bma.org.uk/news-and-opinion/why-we-need-to-keep-pressing-for-faith-inclusive-dress-codes. Accessed 23/09/25
3. Xun H, Chen J, Sun AH, Jenny HE, Liang F, Steinberg JP. Public Perceptions of Physician Attire and Professionalism in the US. JAMA Netw Open. 2021 Jul 1;4(7):e2117779. doi: 10.1001/jamanetworkopen.2021.17779.
4. Duric, Bea. Erasing the stigma: tattoos in the medical workforce. BMJ 2022;378:o1744. 2022.  DOI: http://dx.doi.org/10.1136/bmj.o1744 Accessed 03/10/25
5. General Medical Council (GMC) Good medical practice. 2024. Available at:  https://www.gmc-uk.org/ethical-guidance. Accessed 03/10/25
6. FitzGerald, C., Hurst, S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics 18, 19 (2017). https://doi.org/10.1186/s12910-017-0179-8 Accessed 03/10/25

Featured image by Markus Spiske on Unsplash