Dean On Campus Blog

Ready to fly

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


18 Responses to Ready to fly

  1. Aubrey Kassirer says:

    In 1996, upon entering clerkship at Queen’s, our class neither did a white coat ceremony, nor did we recite the Hippocratic Oath. Interesting.

    • reznickr says:

      Dear Moira, I will email Jackie Duffin who leads this for Queen’s and ask her to respond. I do know the students take the oath within the first few days medical school and then again before clerkship.


    • reznickr says:


      I am not certain exactly when the tradition started at Queen’s, but again, I bet Dr. Duffin will know.


  2. Moira Browne says:

    Wow, being a Queen’s Meds ’88 grad, I slipped in under the wire a few years before this ceremony was begun, it would seem. But the enthusiasm in their faces is rather heartwarming. Thank you for sharing the photo. As for the Hippocratic Oath, I have no recollection of actually ever taking it. And you say they “re-take” it? Hmmm, I wonder if you could do some sleuthing and find out when Queen’s actually started this practice. I am curious. Thanks. 🙂


    • Dear Moira
      The Hippocratic Oath is still not a part of Queen’s graduation for a lot of reasons–to do with its content and style–many of which are controversial. I have been lucky to teach history of medicine at Queen’s since 1988–I just missed you!

      In 1996 the medical students themselves thought that it would be a good thing to incorporate into the orientation events for incoming students. As a result, they established a torchlight tour of the campus that takes place on the first day of orientation. It ends with the Oath at a suitably exotic place–most recently at the Murney Tower at the bottom of Barrie St. If we are lucky there is a moon shining on the lake.

      I select the authoritative translation of the Oath from the Loeb classical library and set it up with a little explanation of its 2500 year-old history. And the students discover it (and its differences with our world) by repeating it –or not. Of course they do not need to say anything that they do not want to say.

      Since the students organize this event, I have been amazed and pleased that they continue to ask for it every year.

      Our White Coat ceremony is very much newer and more official in that it is organized by faculty, and it follows along recent traditions established in USA and incorporated in medical schools there.

      At graduation the students respond to a Sponsio which promises allegiance to the profession and the university…just as you would have done.

      • Moira Browne says:

        Jackie! Thanks so much for your response. It is really interesting to hear about the new traditions being established at my alma mater. And I am sorry to have missed you as a lecturer but have been fortunate enough to hear you speak several times and have enjoyed it immensely.

  3. Phyllis Durnford says:

    This reminds me of the ‘capping’ ceremonies carried out in many hospital-based diploma nursing schools at the end of the ‘probationary’ period of 6 mons.after entry to the program. As a member of the class of ’67 at KGH, we were the first class to start our education, caps fixed proudly on our heads. There was some tut-tutting from the classes ahead of us, and from the grads, that the capping tradition had gone by the board. Fortunately our nursing school director, a grad from Vancouver Gen/UBC/McGill, was supported in this decision by the KGH DON, herself an English nursing import who believed in moving nursing ahead. We went completely ‘white’ half-way through second year, as the black shoes and stockings gave way to white ones. What really gave us the idea that we were ready to ‘fly’ was the black-band ceremony, at the beginning of third year! That black band was the symbol that as senior nursing students, we were ready to take on all the challenges: night shifts, charge nurse responsibility, etc.-and, intermediate, probationary nursing students, and clinical clerks, had to wait until we boarded the elevator, before they could do so. Seniority hath its privileges!

    Congratulations to the new clinical clerks! Remember, get to know the nurses on your wards. They’re there 24/7, they know their patients. There really is such a thing as ‘nursing gut instinct’. Consider this time as your first real exposure to interprofessional collegiality.

    I think there is merit to these types of ‘growth marker’ ceremonies. They represent culmination of specific periods of hard work, and the beginning of new periods of harder work, leading to the culmination, in the graduation ceremony.

    • reznickr says:

      Dear Phyllis,

      What great words and memories. I will have to try a black band next time I go into the hospital, at least while getting on the elevator! Your reminder to our medical students about the value of getting to know the nurses is important. Any experienced doctor understands the value of working hand in hand with our nursing colleagues. In my case, getting to know the “nurse on the floor” has had another great benefit…27 years of happy marriage!


  4. Valerie Swift says:

    My recollections as a Meds ’83 grad are similar to Aubrey’s – no ceremony and no citing of the Hippocratic Oath. Interestingly, I had the privilege this fall of attending the U of T “Stethoscope Ceremony” as a parent (daughter Brenna BSc(Hons) ’09). At U of T this replaced the ‘White Coat Ceremony” 2 years ago and occurs during the first week of medical school.

    “The stethoscope serves as a symbol of the privileges and responsibilities that all physicians are expected to bear. Patients are the focus of everything we do, whether it be clinical, research or administrative work. The stethoscope is a constant reminder of our duty to listen to the needs of those that we serve.”

    Whatever the ‘symbol’, I believe the paragraph above serves as a good reminder for all of us.

    • reznickr says:

      Thanks Valerie,

      The similarities of the program underscore the importance of the symbols as reminders to us all of the need to be patient focussed and professionally responsible.


  5. Robert Reid says:

    This is a great tradition which is sure to emphasze to new graduates the important roles they are about to assume in patient care. However the “white coat” also has potential liabilities. I recall a classmate in the 70’s who kept a pipe in the pocket of his “white jacket” and was known to accidentally flip bits of tobacco onto a patients chest when pulling out his stethoscope!! White jackets are meant to signify cleanliness yet all too often they become wrinkled and dirty from being carried in backpacks and spilled coffee (or worse). More recently there has been a move away from wearing ties and white jackets in some hospital practices because the repeated wearing of such surgical attire may transmit bacteria from one patient to another. This interesting paper examined how a switch away from standard scrubs was perceived by patients. …..Thought provoking and timely!!

    Shelton CL. Raistrick C. Warburton K. Siddiqui KH. Can changes in clinical attire reduce likelihood of cross-infection without jeopardising the doctor-patient relationship?. Journal of Hospital Infection. 74(1):22-9, 2010

    Research has shown that healthcare workers’ clothes can
    become contaminated with pathogens. This study aimed to determine
    whether hospital doctors can change their attire to reduce the possibility
    of cross-infection without jeopardising the doctor patient relationship.
    In this experimental repeated-measures study, 55 male and 45 female
    inpatients (mean age: 52.89 years) were randomly selected. Participants
    were shown photographs of medical dresscodes and asked to rate their
    appropriateness on a 5-point Likert scale. They were then read a standardised statement regarding the significance of attire to cross-infection and the exercise was repeated. Pre statement, there was no significant difference between the majority of dress options, though casual dress (male and female) and short-sleeved top (female) were considered significantly less appropriate. Post statement, surgical ‘scrubs’ and short-sleeved top/shirt were deemed most appropriate (P < 0.0001). There was no significant difference between short-sleeved shirt and scrubs for males. For females,scrubs were preferred (P ¼ 0.0005). Participants expressed no significant preference for medical attire, with the exception of a dislike of casual dress. However, once informed of the significance of attire to cross-infection, preference changes to favour dresscodes which may minimise infection risk.

    • reznickr says:

      Thanks Bob,

      You remind us of the need to constantly question our traditions, especially in light of up to date information.



  6. jim beveridge meds '71 says:

    wow what a lot of respones to your “ready to fly”
    well done and what a great analogy from the dean and birds etc!!

    No oathes hyppocratic or hypocritical or otherwise that I remember in my day.t

    But as a very nervous very young (class mate of David Walker) I will never forget our equivalent of the white coat ceremony in the buiding only known as the “Old Medical Building” on the west side of what we called the medical quadrangle, where we studied anatomy, Dr Basmagian the ambidextrous artist was truly a gift in itself to Queen’s and everyone who was a “learner” under him–Amazing an understatement!

    But the history was in the gross anatomy lab when we 70 assembled in white coats in a very smelly underventilated formaldehyde impregnated room with 20 tables each suitably draped in white ?tableclothes.

    Thus was my introduction to medicine, dissection, learning in the tradition of Sir Wm Osler, but also our chance to meet a Queen’s legend and tradition,Padre Laverty, who instructed the assembled group to respect the bodies and their souls who permitted us to learn. Padre L gave a moving sermon and then white tableclothes were removed and per Grants Anatomy we got to work.

    So Richard not a white coat ceremony as you now define it, but it defined my initial experience as a student at Q’s

    Jim Beveridge, Meds ’71

    • reznickr says:

      Dear Jim,

      Thanks for your reflections. I too remember the formaldehyde smell. I didn’t however, as you have related, experience the tradition that Padre Laverty gave to Queen’s students. It’s of note that Charles Graham, Professor of Anatomy, organizes a ceremonial burial service for those who have donated their body to science each year. Many students attend and it continues the same message of respect that Padre initiated.

      All my best,


  7. Michael Beyak says:


    Thanks for your blog about the white coat ceremony, while I don’t think we had one at U of T when I “graduated” to clerkship that important transition still remains in my mind.

    Unlike many students in med school today, I was not “born” with the aspiration of being a doctor. I applied to medical school because I loved the study of physiology and pathophysiology and thought it would be interesting. Of course like most med school applicants I had no idea what being a doctor really was about. The first couple years in our at the time newly revamped “patient centered, problem based curriculum” at U of T, gave glimpses, but still was very classroom, textbook and exam based stuff.

    The first rotations in clerkship were transformative for me. Most importantly I realized how exciting medical practice really was. Being on the ward, and applying the scientific concepts I had learned in a real life setting was all that I could have hoped and more. Furthermore the interaction with patients and the amount of trust they put in me, even at the clerkship level, was incredibly satisfying as it was humbling at the same time. I vividly remember my first patient who died, as well as seeing a young patient who apparently had a devastating disease get better, leave hospital and get on with her life as a new mother, in a large part because of the good medical care she received. I remember becoming immersed in the “culture” of medicine, and the passing down of knowledge from senior and junior residents to lowly clerks like me. The first few weeks really confirmed that I had made the right career decision and many of my early role models influence how I work and teach today.

    The real practical role of the white coat itself, over and above its functions as a uniform and as a barrier from infection, deserves special and perhaps historical mention. I clerked in a period in time (long ago – late 90’s) marking the begiining of a transition between paper and electronic storage of medical information. The most junior of trainees (the PGY1s and clerks) had lab coat pockets loaded down with not only all of the medical instruments needed in day to day life, but also usually with several pocket sized reference books – known as the peripheral brain (e.g. Washington Manual, “On Call” etc) as well as the ubiquitous personal notebook used for recording pearls of information learned at the bedside from attendings and senior residents. I’m sure this resulted in a number of “occupationally acquired” back and neck problems, due to the sheer weight of the coat slung across the neck and shoulders. Gradually as one progressed through the ranks, the labcoat got lighter and even disappeared sometimes, ostensibly because one’s “central brain” had assimilated all of this information (but equally likely because there was usually a clerk or intern nearby with one of the books handy!).

    These days I hardly ever wear a white coat, for a variety of reasons, none particularly evidence based. Nonetheless I do recall that important transition in my career, and think it deserves a ceremony such as you have described to commemorate it.

    • reznickr says:

      Dear Mike,

      Thanks so much for your vivid reflections and messages for our students. We are truly privileged to be in the medical profession. Believe it or not, I still have my Washington manual, from 1977! ( although the first publication was in 1942)



  8. Ken Collins says:

    Reciting the Hippocratic Oath, more recently, has been an inconsistent part of the O-Week activities of the incoming class (the “first reading”). We were led through it in a tongue-in-cheek manner by Jacalyn Duffin in 2007, at dusk on the steep hill by the Martello Tower, our faces lit with candlelight. She was unavailable in 2008 for a repeat performance.

    Also, the symbolism of the white coat shouldn’t distract from their uncleanliness. I wouldn’t wear any shirt worn at work again without washing it, but students tend not to have several white coats to wash between wears. Get rid of these dirty smocks and the germs that go along with them.

    • reznickr says:

      Dear Ken, thanks for your views and highlighting the controversy about the wearing of white coats in hospitals with respect to infection control issues.


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