Since the mid-1990s, undergraduate medical education has been bookended by two memorable ceremonies: the White Coat Ceremony at the start of one’s medical school career and graduation at its conclusion. In the age of COVID-19, these events, like all in-person gatherings, have been turned upside down. We realize the logistics are daunting. As tempting as it is to postpone, or to cancel, White Coat ceremonies altogether, we instead urge medical schools to forge ahead and adapt this ritual that highlights the importance of the human connection in health care.
Medical students deserve this essential touchpoint of humanism on their journey. Indeed, in the face of COVID-19 and great social unrest, the true message of the White Coat Ceremony becomes even more compelling and necessary. The White Coat Ceremony began in 1993, a brainchild of Arnold P. Gold, MD, a Columbia pediatric neurologist and co-founder of his namesake nonprofit organization. For years, Gold had observed medical students reciting the Hippocratic oath on graduation day, and he would turn to his wife (and co-founder), Sandra Gold, and shake his head: “It’s too late,” he would tell her. “They are already the physicians they will be.”
Gold believed that as clinical responsibilities have moved closer to Day 1, the oath — the traditional pledge to do no harm, to care for patients with compassion — should come at the very beginning of medical education, not the end. And so, he envisioned a ceremony that would emphasize humanism at the start. Such a ritual would reflect and reinforce the deep belief in caring for fellow human beings — the belief, in fact, that leads so many to apply to medical school.
White Coat ceremonies took off rapidly, and today, hundreds of schools around the globe hold such events. They have become an eagerly anticipated marker of the start of undergraduate medical education.
As the White Coat Ceremony has expanded over the years, the very point of this ritual risks being lost. At its core, the White Coat Ceremony is not about a piece of attire or public recognition, but rather about a physician’s fundamental, intimate responsibility to care, heal, and protect others.
As such, White Coat ceremonies are acutely relevant as we face the dual challenges of COVID-19 and racism.
The world has watched, in this unprecedented time of COVID-19, how doctors and all health care team members have risen to the moment. Without a cure, without effective therapy, health care professionals have been caring for COVID-19 patients at the primary level of human-to-human. This essential human connection can be forgotten in the ordinary day-to-day reliance on the big data of intensive care units, in times of very brief appointments, and in the midst of routine protocols. In this heightened moment of so much uncertainty and fear, doctors and nurses have stepped in to be the epicenter of care, to fulfill the definition of humanism in health care that human interests, values, and dignity prevail.
The second of the threats, racism, is a foe of equal concern. Entrenched in our institutions, our unconscious minds, and our bodies, racism threatens to tear at the human connection we are all capable of, and which physicians rely on so heavily in their care of patients.
Incoming medical students who are witnessing and participating in these transformative times need to hear leaders of their schools acknowledge and reinforce the importance of the 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.
White Coat ceremonies can be one key piece of that ongoing message from the very start. While some ceremonies are being held in person with appropriate masking and social distancing, others have had to adapt to a virtual format.
Now how does this work?
We are still learning, but the white coat is a symbol of the “beginner’s mind” that is open to all possibilities. The spirit of approaching medicine — and such logistical challenges that we face today — with an open mind is essential to remaining compassionate throughout one’s career.
As the entire academic community has begun experimenting with virtual graduations and other ceremonies, we can learn from their helpful lessons and the tools already in place. For example, with the help of a PowerPoint program framework and Zoom accounts, we have witnessed beautiful, moving celebrations of Gold Humanism Honor Society inductions.
One advantage of the virtual ceremony is that it crosses hundreds of miles in a single click. Leaders and orators have attended Gold Humanism Honor Society inductions all across the country, from Loma Linda University School of Medicine in California to East Tennessee State University James H. Quillen College of Medicine to the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York — a possibility never imagined even last year. The virtual ceremonies also mean that relatives and friends from across the globe can join.
The AAMC and the Gold Foundation are committed to helping schools adapt their White Coat ceremonies as needed to conform with the necessity of physical distancing.
We realize this is an exceptional, historically challenging time that can be disorienting to experienced mentors and new students alike. Yet the principles of the human connection in medicine are sustaining, and we are grateful to medical school leaders for ensuring the White Coat Ceremony continues this fall. To incoming medical students, congratulations on your start of this great journey and thank you, in advance, for your deeply compassionate care of your future patients.
Richard Levin, MD, is president and CEO of the Arnold P. Gold Foundation. David Skorton, MD, is president and CEO of the AAMC.