This past week, our one hundred third year medical students partook in a white coat ceremony. Our students participate in this ceremony during third year, just before their clerkship. They receive encouraging words from their deans, they smile for the cheering crowd, they re-take the Hippocratic Oath, and they celebrate the transition of entering into the largely clinical phase of their education, a time that will be devoted to direct interaction with patients.
The ceremony last week was held, for the first time, in our new medical building. It was a great event. The expressions on our students faces ranged from: relief, that they were finally finished the bulk of their classroom work; to exhilaration, at the prospect of having materially important encounters with patients as a significant contributors to the health care team; to trepidation, that their work on the wards of our hospitals could be linked to the outcomes of our patients.
The white coat ceremony is a relatively new phenomenon in medical history. It has been reported that it first started in 1989 at University of Chicago’s Pritzker School of Medicine. But its major impetus came from the Arnold P. Gold Foundation after the use of the ceremony at Columbia University College of Physicians and Surgeons in 1993.1
The purpose of the ceremony, through the symbolic donning of the white coat, is generally to remind students of their responsibility in entering a profession that puts great value on the patient doctor relationship and the associated responsibilities of dedication, altruism and professionalism. According to the Gold Foundation, “The cloaking with the white coat—the mantle of the medical profession—is a hands-on experience that underscores the bonding process”.2
The history of the white coat dates back to the 19th century. The medical profession, trying to escape criticism that many of its treatments were not grounded in science, took to the white coat as a way of more strongly linking the profession with that of scientists, who by in large wore “white coats” in their laboratories.3 Blumhagen, in his discussion of the meaning of the white coat, suggests that “the cultural significance of “whiteness” reveals a broad spectrum of meaning surrounding the healing encounter, whose most important aspects are the authority and supernatural powers of scientific physicians and the protection of patients”.4
The white coat however, has not been without its controversy. Philip suggests that “the White Coat Ceremony fosters a sense of entitlement whereby authority based on title and uniform, and authority based on trust, are poorly distinguished”.5 Others have worried that the white coat brings with it, too much formality, and has, to some extent, been discouraged for that reason in Scandinavia.6
Controversies aside, this week’s event was full of smiles. The smiles were especially broad when Tony Sanfilippo, our Associate Dean for Undergraduate Medicine, gave his remarks to the class. He told them of a story of how when his kids were growing up, they all marveled at a family birds who each year built a nest near his home. They often watched the process of the nest-building and then the extraordinary evolving of nature being manifest in the laying of eggs, emerging of young birds, and eventual pushing by the mother bird of its babies out of the nest for the first time. Tony remarked that his kids always questioned how the mother bird knew the babies would be able to fly (and not fall to the ground). He and his wife Michelle would respond to his children… because they were birds, and the mother knew her babies had feathers, a light body, strong wings…all of the equipment to fly. His message to our students, one which every faculty member shares, is that our students are now ready to “fly”, and we have every confidence that they are well equipped, extremely motivated and very well prepared to enter our hospitals and community settings as a confident junior member of our health care teams.
If you have memories of your white coat ceremony, or believe or don’t believe in “white coats” please respond to the blog…or better yet, please stop by the Macklem House, my door is always open.
4. Blumhagen DW. The doctor’s white coat: the image of the physician in modern America. Ann Intern Med. 1979;91:111-116.
5. Philip C. The white coat ceremony: turning trust into entitlement. Teaching and Learning in Medicine. 2002;14:1:56-59
6. Anvik T. Doctors in a white coat—what do patients think and what do doctors do? Scand J Prim Health Care. 1990;8:91-94