White Coat Ceremony: a Medical Student’s Journey from Basic Sciences to Clinical Medicine

 

Sedigheh Ebrahimi1

 

1Medical Ethics Department, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

 

Dear Editor

 

There are some interesting rituals associated with medical education at many medical schools throughout the world. One of the most fascinating blends of meaningful tradition and innovation is the white coat ceremony (WCC). A plausible explanation for this ceremony is an assumed connection between that and encouraging professional development in medicine. It is also mainly based on the positive emotions in the participants as they feel a sense of respect, inclusion and honor [1].

The WCC is an educational activity, put on by medical schools to introduce medical students to the world of clinical medicine by offering them ”the white coat”, the symbol for becoming a doctor.

Given the cultural significance of “whiteness” that traditionally indicates purity and goodness. The pureness of medicine became reflected in the white coat of doctors. Wearing white, is a way of suggesting the need for cleanliness personified and for having a pure heart and mind to see goodness and purity in everything [2,3].

The WCC reminds the medical students of the need for their responsibility to uphold and advance personal and professional honor, integrity, and the dignity of their profession. It creates a psychological and ethical covenant for the profession from the beginning of the practice of medicine.

In Iranian medical schools the ceremony is held twice a year in the end of basic sciences and before entering into a new stage of education as clinical sciences. It has become a symbol of students’ transition from the study of preclinical sciences to practicing medicine.

In Shiraz medical school, at the beginning of the WCC programs, students participate in ethics workshops and get prepared to make a relation between the clinical education to the ethical values and professionalism. The workshops focus on the role of physicians in society, with emphasis on spirituality, professionalism, empathy, responsibility, and the respectful doctor-patient relationship. The students enjoy the program, believing that medical ethics will serve as a guide in ethical challenges that they encounter in their future practices.

The ceremony is started with a welcome speech given by the medical school dean and his administrator colleagues. It continues with the messages from the chancellor of the university, vice chancellor for education and an inspirational message from a role model to express his/her clinical experiences. Then, the chairmen of major clinical departments explain what a medical student should know and what must be employed in academic departments. Afterward, a faculty-authored professional and moral advice (Andarz) is declaimed by a prominent faculty member on behalf of all clinical teachers asking the audience that they must never forget to reflect on what the purposes of being a good doctor are. He urges them to be proud of the fact that the core objective of doctors is to do the best for the health of the patients they serve. Afterward the students pray to god for help in a style of contemporary litany and also recite their class pledge of honor written by them.

Thereafter, with a symbolic representation in the presence of friends and families, the students will be cloaked in their first white coat by one of the selected faculty members. In a ‘‘celebration atmosphere’’ students take in unison and eagerly swear the professional oath of ethical behavior with youthful energy (Table-1). This oath has been explored by the chair of the Medical ethics department of the university. When the students take an oath, they actually promise to carry out the roles and the responsibilities to the patients who trust them, in the best possible way. They commit themself to act honorably as a medical student and encounter with the people in such a way that does not distort their trust in the health care professionals.

The oath of commitment to the patient care emphasizes on the primacy of the respectful Patient-Physician relationship and the importance of kindness in medicine. It declares the students’ loyalty and honesty toward medicine and patients; along with their professional and academic power and duties as medical students .The oath also reminds them of the sense of responsibility inherent in the practice of medicine.

The WCC is an important step in professional development that associates some of the best qualities we would like to see in physicians with the incoming students themselves. It can help align medical students and medical faculty around worthy professional values and commitments that bind all doctors. The students’ strong sense of unity helps them initiate a move through an exciting time in their lives and find the importance of committing themselves to excellence, not only in the medical sciences but also in its humanitarian aspects [4,5].

Overall, WCC places the student at the beginning of the development of a particular type of identity: that of the medical profession [5]. Nevertheless, the WCC is a useful first step as an experience by which novice students become aware of the need to balance excellence in science with compassionate patient care at the beginning of their careers [4]. It encourages compassion and humility in medical students and connects them to the “idea of humanistic competence and not just scientific or technical ability” [1,4].