News and Commentary White Coat Ceremonies: Then and Now

All across the country, medical and other health professions schools are welcoming their first-year students. For many—if not most—schools, this welcome includes the White Coat Ceremony during which new students receive a white coat as a public acknowledgement of their entry into one of the health professions. The event’s origins date back to 1989 at the University of Chicago; at the end of orientation week, the newest class of medical students gathered in a small auditorium with faculty and family and were invested with their first white coat. I had the honor of participating in this inaugural ceremony as the faculty member delivering the keynote address. I remember sharing my earliest memories of the white coat—memories not from my years as a student or as a physician, but as a nine-year-old child when my younger sister was in a coma. For my family and me, the white coat was a symbol of hope. A symbol worn by the professionals on whose every word we clung as my sister struggled to live, and nearly died, with newly diagnosed diabetes. Many years later, when draped in my own white coat, I recognized that I gave little thought to donning the garment of hope, which had been so powerful years earlier. In this experience, I recognized that ceremonies and rituals might be as important for the faculty member as for their students and families.

As first-year students across the health professions embark on the journey of entering their respective fields, I find myself reflecting on the creation of the first White Coat Ceremony more than 30 years ago and wondering what today’s students—those in medical, nursing, and physician assistant programs—might take away from the event. Although much has changed, the ideals and commitments embedded within the ceremony remain the same.

Origins of the White Coat Ceremony

The original White Coat Ceremony at the University of Chicago was born out of a beloved faculty member’s desire to emphasize professional behaviors in his classroom where patients regularly participated by sharing their medical history with first-year medical students. This particular faculty member came to Norma Wagoner, then Dean of Students at the Pritzker School of Medicine, expressing his high expectations of his medical students when patients were present. Drawing upon her past experience, Dean Wagoner decided to create a ceremony that would stress the importance of professionalism. As she recalled during a recent conversation, “Our interest was in helping the students see that professionalism was the most important part of this transition from undergrad to medical school…We wanted to give the students a better understanding of what professionalism meant and how they might experience it.”

“Caring for People”

Today’s matriculating health professions students are entering schools and healthcare systems that look quite different from those in 1989. This year, because of the COVID-19 pandemic, few schools will have the opportunity to gather in person, with many conducting their White Coat Ceremonies virtually. However, the medium for the event should not change the spirit and purpose of the occasion: acknowledging that patient care is at the heart of being a health care professional. Dean Wagoner has been involved in medical education for more than 45 years; her experience as both an educator and administrator offers a unique perspective on the significance of the White Coat Ceremony: “The focus still seems to be on professionalism and what that white coat means. Helping students to understand what it means to be a professional, not just what the profession means, is perhaps more important than ever. The core of being a doctor is caring for people.”

The White Coat Ceremony also offers faculty the opportunity to make a public affirmation and commitment to the incoming students to serve as mentors and guides on the journey through school on the road to becoming a physician or other health care professional. At the same time, the event offers students themselves the opportunity to assume a degree of responsibility to their future patients as they make the transition to the profession.

While there is a loss in not being able to gather together with loved ones and faculty to celebrate this significant transition, the need to conduct the 2020 White Coat Ceremonies through a virtual platform is indicative of the times. Healthcare is changing, and virtual interactions have become more and more prevalent over the last many months. While this method of interaction is not ideal, it offers these future physicians, nurses, and other health professionals an introduction to the adjustments made during a global pandemic.

Not Without Controversy

White coats and the White Coat Ceremony are not without controversy. Some critiques focus on the fact that students cannot fully understand their oath—the Hippocratic Oath or a similar declaration—when they have not yet taken any medical school classes. Others note the germs that a physician can easily spread to patients via the garment itself—a concern that we can all more readily appreciate in the midst of a global pandemic. Some view the white coat as a relic of the past, or a symbol of hierarchy that differentiates students and young residents from more senior learners and faculty, as well as doctors from their patients.

While I appreciate these arguments, I also believe in the significance of this annual event. It is crucial for students entering the profession to understand the fundamental principles on which the profession rests and the values that transcend the interests of individual physicians—all based on the tenet that the needs of patients assume the highest importance.  Likewise, for students to hear faculty publicly make a promise to serve as their guides is a significant commitment. The behaviors encompassed within the notion of professionalism are complex. Even the most experienced health care professional faces challenges in their work. Students must know that their institutions do not expect them to have a command of these professional frameworks or behaviors on day one, but that they will learn and explore these ideals during their professional journey.

The Spirit of the Ceremony

As the AAMC and Arnold P. Gold Foundation recently penned in an “Insights” piece, the White Coat Ceremony is an “essential touchpoint of humanism on [medical students’] journey.” They note, too, the significance of hearing early in one’s career from institution leaders about the extraordinary importance of “human connection in health care, the importance of anti-racism in health care and our world, and the essential compassion physicians must hold and protect in their care.” These messages are, indeed, paramount for those stepping into the health professions community.

We at the Macy Foundation extend our best wishes to all those students beginning their careers in the health professions this year. They are commencing their professional education at a time of both great need and great change within the healthcare system and within society. We recognize the challenges both students and educators may be facing at this time, but we also believe that now, more than ever, is a time to hold fast to the spirit of the White Coat Ceremony. For me, that spirit represents hope—and while hope is not a strategy or a way out of this pandemic, I believe that the power of compassion and hope, dispensed evenly with scientific advances, can illuminate the path forward for patients and their health care professionals.  

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