Believe it or not, until the late 1800s, American physicians wore black formal wear, much like a modern tuxedo. That began to change in the late nineteenth century, as germ theory and Joseph Lister’s discoveries in antiseptic surgery reshaped medical practice. Physicians started adopting white lab coats as white came to symbolize purity of purpose and scientific legitimacy. Within a few decades, the white coat had become inseparable from the image of the physician and more recently, healthcare practitioners broadly.
The White Coat Ceremony was first introduced in 1993. Dr. Arnold P. Gold, a pediatric neurologist at Columbia University and champion of humanistic care, grew troubled that medical students were not being formally taught about the values and responsibilities of the profession early in training. Often, these core tenets were not explicitly discussed until reciting the Hippocratic Oath at graduation. His solution was to move that moment of commitment to the very start of training: students cloaked in their first white coat, reciting an oath before family and faculty. The White Coat Ceremony he and the Arnold P. Gold Foundation created has since spread to 99% of AAMC-accredited U.S. medical schools and to schools in nineteen other countries. It has also been adopted by many health professions. Its intent is not pageantry, but an introduction to the psychological and ethical contract the profession has with society.
While the White Coat Ceremony is a relatively recent innovation in medicine, parallel traditions marking professional entry have long existed across healthcare, including the pinning ceremony. The roots of pinning ceremonies actually reach back to the twelfth century, when monks caring for wounded Crusaders were given a badge upon entering their order. The more immediate ancestor of today’s ceremony dates to 1883, when Queen Victoria awarded Florence Nightingale the Royal Red Cross for her nursing service during the Crimean War; Nightingale, in turn, began presenting a medal of excellence to her most accomplished students at the Nightingale School of Nursing in London. The practice crossed the Atlantic when Bellevue Hospital School of Nursing in New York became the first U.S. school to pin its graduates. These and similar ceremonies have now permeated nursing and many other health professions.
Both traditions have deep roots here at WashU Medicine. Each fall, our incoming MD students gather to receive their white coats from School of Medicine faculty and recite an oath they’ve written together as a class, pledging integrity, altruism, excellence and compassion in the practice of medicine. Our Program in Physical Therapy held its first White Coat Ceremony in August 2016; it’s now a fixture of the program’s introduction to the profession. Our audiology students take part in a White Coat Ceremony of their own, sponsored by our Student Academy of Audiology chapter, echoing a pattern seen at audiology programs nationally. And our occupational therapy students mark that same transition through a pinning ceremony rather than a coat, carrying forward the older of the two traditions.
This fall, these shared traditions continue, as our incoming interprofessional students, across MD, physical therapy, occupational therapy, and audiology, mark their own entry into their professions, whether by coat, by pin, or by oath. Each ceremony looks a little different depending on the profession it welcomes, but every one marks the same turning point: the moment a student steps toward becoming a healer and takes on the important responsibilities that come with it.
To our newest health professions students: congratulations on reaching this important milestone, and welcome to our professions, each built on a shared foundation of trust, competence, and compassionate, humanistic care that these ceremonies symbolize.