Unique curriculum for new medical students underscores meaning of white coat

Jean Sabile White Coat Ceremony

David Hungate

Jean Sabile, a member of the Class of 2020, checks the fit of his white coat after receiving the jacket as part of the Virginia Tech Carilion School of Medicine's annual White Coat Ceremony. Richard C. Vari and Dean Cynda Johnson presented him with the coat.

The white coat — certainly one of the most-recognized and revered symbols of the medical profession. For many medical students, their first time donning that crisp, white jacket with their name neatly embroidered on the front shows the world that after much hard work, they finally made it to medical school.

The white coat also has a much deeper meaning.

The traditional White Coat Ceremony, held at nearly every medical school across the country, originated at Columbia University in 1993 as a way of ensuring that students understood the expectations and responsibilities of the profession. Supported by the Arnold P. Gold Foundation, the ceremony reminds future physicians of the importance of practicing humanism in their profession.

The founding leaders of the Virginia Tech Carilion School of Medicine decided to emphasize the original intent of the ceremony to keep it from becoming solely a photo opportunity. They wanted to drive home to young future physicians that their white coat is something to be earned.

“We wanted to design a program that would properly prepare our students for the awarding of their white coats,” said Richard Vari, senior dean for academic affairs and one of the founding members of the school’s leadership team. “What can we do to ensure the intent of the ceremony really hits the mark?”

The result was a set of creative, interrelated learning experiences that makes up the school’s white coat preparation curriculum, called “Into Your White Coat.” While a survey of medical schools in the United States and Canada indicated a minority — approximately 30 percent — offer some sort of white coat preparation, few, if any, had a curriculum as involved as the one at the Virginia Tech Carilion School of Medicine.

“As with every other component of this school, we made a conscious, purposeful decision about what we were going to do and why and how we were going to do it,” said Cynda Johnson, founding dean of the school.

Instead of having a White Coat Ceremony as soon as students arrive, the Virginia Tech Carilion School of Medicine waits until October, after students have completed their first block of course work and the white coat curriculum.

In contrast, 61 percent of survey respondents held their ceremony either during orientation or early in the first semester.

“We wanted to make sure our students understood that the ceremony was more than a rite of passage,” Johnson said. “Our goal was to instill in them a deep sense of humanism and reverence for the doctor-patient relationship.”

The curriculum involves senior practitioners who deliver a series of memorable anecdotes and words of wisdom followed by moving discussions reflecting on the theme “What’s in Your White Coat?”

One such presenter is Donald Steinweg, associate professor of internal medicine at the school. Steinweg recently retired from Carilion Clinic after more than 40 years in the profession.

“When I was a medical student and putting on my first white coat, initially it was about what the patients were going to see,” Steinweg said. “But over time, I realized it’s really all about what’s in my white coat — what’s in me — that counts. In fact, the most important person I met in medical school was me.”

Steinweg tells the young future doctors that it’s what they bring to each patient encounter that makes the practice of medicine so rich and personal. He shares with them wisdom he’s learned about earning a patient’s trust, about the importance of honest communication, about listening, and about learning they are not always going to be right.

“It’s humbling and sometimes even overwhelming,” he said.

“The white coat means we, as physicians, are held to a higher standard,” said Sandy Fogel, associate professor of surgery, who is also an invited speaker for the school’s white coat curriculum. “People will expect absolute adherence to a code of conduct, partially written and partially unwritten. Once you have the white coat on, you have a contract with the patient in front of you that is every bit as binding as a written contract negotiated between lawyers and businesses.”

In addition to the special speaker series, as part of the white coat curriculum, the class, as a whole, develops its own set of Guiding Principles, which affirm the humanistic qualities that the class deems most important as they move forward in their practice of medicine. In addition, each student individually crafts an essay around the theme, “What the White Coat Means to Me.” The essays are masterpieces of wit, candor, passion, and fear.

“People ask if our students understand the importance we place on the true meaning of the white coat,” Vari said. “And the answer is ‘yes,’ because they show us through their essays that they get it.”

An excerpt from one of the essays written by a member of the Class of 2020 is a passionate example:

“How am I supposed to know what I don't know? In my white coat, I have examined no one, ordered labs on no one, diagnosed no one, counseled no one, and grieved with no one. Its cloth is free of blood, stains, and tears. It is an arranged marriage, and I have yet to meet my bride. Nevertheless, we know our responsibility, bound ceremonially to uphold our sacred oath. I can accept that my white coat does not yet have meaning. It is fresh and unsoiled, with no instructions or guide. It may be a burden or a gift. Regardless, I accept the white coat into my life and the mystery that comes with it.” --Jordan Taylor, Class of 2020.

Traditionally, excerpts from some of the essays are read at the ceremony. The Guiding Principles are read at this time and again at the Student Clinician’s Ceremony held two years later as the class is about to embark on clinical rotations. This ceremony, called, “Putting on Your White Coat,” acknowledges successful completion of the first two years of the students’ classroom training as well as the significance of their upcoming clinical years. The ceremony re-emphasizes to the students the challenges and imperatives to providing humanistic care to patients.

“As a physician, going to the White Coat Ceremony reminds me that this is why I went into the profession,” Steinweg said. “I believe our students put that white coat on, and instead of looking out and smiling at their parents for a photo, I think they reflect on the awesome responsibility of wearing the white coat.”

By Catherine Doss