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Medical student Rewan Abdelwahab presenting a research poster

September 14, 2022

By Mayo Clinic College of Medicine and Science staff

Rewan Abdelwahab, a medical student at Mayo Clinic Alix School of Medicine, saw a need for change to make clothing guidelines in the operating room more inclusive. She decided to do something about it.

Rewan Abdelwahab is eager to see medicine adapt to an increasingly diverse workforce. A third-year medical student at Mayo Clinic Alix School of Medicine, Abdelwahab wants to ensure all members of medical teams feel comfortable and welcome in their work environments.

That extends to clothing protocols in medical settings like the operating room, which can conflict with religious stipulations, creating an alienating environment.

Abdelwahab's passion for reexamining clothing guidelines for health care settings comes from personal experience. As a hijab-observing Muslim, she has devoted herself to living and dressing modestly. This includes covering her head and body when she's around people outside her family.

"My attire is the most visible manifestation of my religious commitment," says Abdelwahab, who was born in Egypt and grew up in Minneapolis. "I never go out in public without covering my head, and I never bare my arms."

Due to infection control policies, some medical settings, including the sterile operating room, have strict restrictions regarding what people can wear. And religious practices haven't always been considered in creating those guidelines.

In a commentary published in Mayo Clinic Proceedings, Abdelwahab describes the challenges people face when long-standing medical guidelines don't account for their religious needs. She's become an advocate for greater awareness about accommodating religious clothing in the operating room and has already influenced conversations across the country.

Left feeling exposed

Abdelwahab's advocacy grew from an uncomfortable experience when she was scheduled to observe a surgery and was concerned about how to keep her arms modestly covered.

Operating rooms have detailed processes to ensure the environment is as sterile as possible to protect patients and staff. Part of the process for the surgical team is to wear scrubs, which are typically short-sleeved.

Abdelwahab, who knew she would be outside the periphery of the sterile field, read up on surgical department policies and carefully chose to wear a scrub jacket over the standard short-sleeved scrubs so her arms were not exposed. However, a member of the surgical team questioned whether that was acceptable. The team also was unable to track down an alternative type of sterile head covering that would keep Abdelwahab's head modestly covered.

Rewan Abdelwahab

I felt my identity being attacked. I felt unwelcome. I concluded that maybe surgery was not meant for people like me.

Rewan Abdelwahab
medical student, Mayo Clinic Alix School of Medicine

Her experience is not unique.

Nusheen Ameenuddin, M.D., chair of Diversity and Inclusion for Mayo Clinic Health System, who also wears a hijab, had a similar experience two decades earlier as an undergraduate student shadowing a surgeon.

Dr. Ameenuddin says the confrontation left her "literally and figuratively feeling exposed." It also had a lasting effect.

I think it was largely because of my undergraduate experience that for years after that, I did not think I had the option — and certainly not the power — to speak up about any additional accommodations.

Nusheen Ameenuddin, M.D.
Pediatrician; Chair of Diversity and Inclusion for Mayo Clinic Health System

Nusheen Ameenuddin, M.D.

Changing the status quo

Abdelwahab's experience prompted her to take action. She decided to raise awareness about religious wear.

"I realized this was something I could act upon and create a resource that people could consult to develop new policies," she says.

She consulted with mentors, including J. Michael Bostwick, M.D., dean of Admissions for Mayo Clinic Alix School of Medicine. He supported Abdelwahab's interest in speaking up and encouraged her to aim to make systemic changes through various avenues.

J. Michael Bostwick, M.D.

In the past, the circumstance of needing ready alternatives for short-sleeved scrubs or different types of head coverings might have been unusual in an operating room. It's not rare anymore, We have many more applicants, and now students, who have distinct religious backgrounds — some of whom are hijabi, and all of whom are superb trainees. We need to be able to address their practices in a way that's seamless.

J. Michael Bostwick, M.D.
Dean of Admissions, Mayo Clinic Alix School of Medicine

Abdelwahab worked with Dr. Bostwick, surgical resident Alaa Sada, M.D., fellow medial student Aisha Aden, and Brenda Bearden from Surgical Services to draft an informative guide. The result was the publication of "Surgical Scrubbing and Attire in the Operating Room and ICU: A Multicultural Guide" in the Journal of the American College of Surgeons.

The article focuses on adjusting operating room protocols to accommodate hijabs, natural hair, Sikh head coverings known as dastar, and beards. The article addresses the religious and cultural backgrounds of several faiths and regions, including Muslims, Orthodox Jews, Sikhs, and groups where men maintain beards as part of cultural or religious practices.

The publication clearly addressed a need. Shortly after its publication, the journal published a letter from the Association of PeriOperative Registered Nurses that stated Abdelwahab's article had resulted in updating national guidelines for religious head coverings.

"My goal was to provide a foundation to help the medical field address diversity in the medical professions, while also continuing to ensure the safety of operating room and ICU patients," Abdelwahab says of the article.

Putting new protocols in place

Abdelwahab knew there was more work to do. She worked with Dr. Bostwick to write a personal account of her experience for Mayo Clinic Proceedings.

"I hoped to provide a more personal context to the guide we published in the Journal of American College of Surgeons to further incentivize and provide that understanding for institutions, explaining why it's necessary to have these sorts of protocols in place," she says.

She also is pleased to hear about other efforts at Mayo Clinic addressing the issue.

In collaboration with the nursing management team in the OR, Semirra Bayan, M.D., Erin O’Brien, M.D., and Hawa Ali, M.D., of Otolaryngology — Head and Neck Surgery, reached out to the facilities team to establish consistent access to disposable head coverings in surgical areas. The result is a shelf in the women's locker room of the Department of Surgery to store sterile head coverings and to keep them continually stocked.

"The goal is to ensure these resources are present when they're needed, contextualizing when alternatives to standard protocols may be relevant and ultimately educating departments about the need for protocols that may otherwise be overlooked," Abdelwahab says.

Reaching beyond the operating room

In response to Abdelwahab's advocacy, the departments of Surgery and Anesthesia have provided education for staff, including in-service training and guest speakers who describe the needs of various religious and cultural groups. Training about religious awareness and clothing in the operating room has become a part of the onboarding of new residents.

"We've always had a diverse workforce of students, staff and physicians," Bearden says. "Overall, the additional education is about being even more observant, understanding, and respectful of different cultures, so that people are cognizant on a daily basis about being respectful of each person's needs."

The efforts are reaching beyond the operating room, as well.

I am inspired by Rewan's leadership on this issue and empowered by her thoughtful, solution-centered approach. Our office is working closely with colleagues within practice areas to disseminate resources for ready access to disposable hijabs for our staff and patients.

Anjali Bhagra, M.D.
Internist; Medical director for Mayo Clinic's Office of Equity, Inclusion and Diversity

Anjali Bhagra, M.D.

Abdelwahab says she's still surprised by the groundswell of response to her advocacy.

"It's very surreal to see this story, my experience, and the guide that came out of it reaching people around me and being heard at the national level," she says.

"This is a wonderful example of how a difficult experience can be turned into a learning opportunity, followed by advocacy and education to make things easier for future generations," Dr. Ameenuddin says.

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