When the UNLV School of Medicine recently welcomed its third class to the profession of medicine, it was done largely through a ritual that is now seen as a rite of passage for new medical students — the White Coat ceremony, during which each student is presented with the garment that symbolizes their entrance into the medical profession.
The ceremony includes speakers and a student-written oath (below) that is recited in front of family members, school leadership, and peers to acknowledge their central obligation of caring for patients. Each class prepares its own oath.
Earlier in the month the students had been presented stethoscopes, another ritual symbolizing their entrance into the medical profession.
The white coat ceremony tradition is relatively new in the world of academia. The first took place in 1993 at the Columbia University College of Physicians and Surgeons. It was the brainchild of Dr. Arnold Gold, a professor of clinical neurology and clinical pediatrics, who believed the practice then of having students wait until the end of their training to formally announce their adherence to expectations and responsibilities appropriate to the medical profession occurred four years too late. Gold’s idea caught on quickly.
In just a few years, the ceremony was adopted by nearly every medical school in North America. At UNLV, the UNLV School of Dental Medicine welcomed its first class in 2002 with a white coat ceremony and continues the tradition. This year's will be held Sept. 20.
What surprises many people, as Dr. Mark S. Hochberg wrote in the AMA Journal of Ethics in 2007, is that prior to the late 19th century doctors wore black. Hochberg points out that “Black attire was, and is, considered formal (e.g., today’s tuxedo). Consequently, until about 1900, physicians wore black for their patient interactions since medical encounters were thought of as...formal matters.” He said an “additional or alternative possibility for the dark garb might be that until the late 19th century, seeking medical advice was usually a last resort and frequently a precursor to death.”
From Black to White
How members of the medical profession came to wear white to symbolize cleanliness was part of a presentation by Dr. Neil Haycocks, the UNLV School of Medicine’s interim vice dean of academic affairs and education at the recent ceremony.
“The period when the white coat became a symbol of medicine is bookended by two works by renowned American artist Thomas Eakins,” Haycocks said.
“The first, produced in 1875, is an oil painting titled 'The Gross Clinic.' It depicts famed academic trauma surgeon Dr. Samuel Gross, then 70 years old, lecturing Jefferson Medical College students while his assistants surgically treat a young man for osteomyelitis of the femur. Everyone in attendance is dressed in black, which was the typical medical attire of that time…
“The second Eakins work, also in oil, is 'The Agnew Clinic.' It was commissioned by the University of Pennsylvania medical class of 1889 to honor famed surgeon and anatomist Dr. David Hayes Agnew upon his retirement. Like Gross before him, Agnew stands in a medical amphitheater lecturing medical students while his assistants undertake an operation, this time a mastectomy. The attire, however, is different, with Dr. Agnew wearing a white smock, his assistants likewise dressed in white, and the patient covered by a white sheet.
"The contrast between these two paintings indicates that in a relatively brief span the color of medicine had gone from one extreme to the other. The explanation for this dramatic change resides with a British surgeon named Joseph Lister."
In the late 1800s, Lister was a professor of surgery at the University of Glasgow and interested in Louis Pasteur's early advancements in microbiology and germ theory. Lister began applying germ theory to surgical practice, eventually adopting the use of the antiseptic phenol and documenting a dramatic decrease in the incidence of post-surgical infections.
"The implementation of antisepsis contributed to the transition of medicine to a science-based discipline," Haycocks said. "Cleanliness became a core tenet of medical practice, reflected in the pure white attire now inextricably linked with the profession."
As he concluded, Haycocks urged the new class of medical students to examine their new white coats. "This is quite literally the cleanest they will ever be. Take a mental snapshot, it will provide an interesting contrast to what they will accumulate by the end of third year: crumbs from hastily eaten snacks, stains from hastily consumed energy drinks, pen and pencil marks from hastily scribbled notes, and evidence of encounters with various bodily substances that I will not enumerate here. Remember, bleach is your friend.”
UNLV School of Medicine Class of 2023 Oath
I am honored to offer this oath upon the inception of my medical career. I fully recognize the moral responsibilities of my chosen profession, as I affirm:
Each patient is a person, to be treated with dignity, humanity, and empathy. I will respect life, honor patient autonomy, and protect privacy.
The well-being of my patients is entrusted to me. I will be an advocate for my patients and use the medical skills and knowledge necessary to do so.
All patients are equally deserving of my skill and care. I will foster an environment of inclusivity and diversity in medicine.
Honesty and integrity are foundational to my practice. I will acknowledge my inevitable limitations and failures, be open to guidance from others, and always strive to become a better physician.
Others have paved the path that is before me. I will value and respect what has been given me by my mentors. I will teach others what I've been taught, give back what I've been given.
Medicine is demanding and ever-changing. I will be a lifelong learner. I will practice self-care as a responsibility to myself and patients.
The obligations of medicine require me to hold myself and others to the highest standard of accountability. I will be an ambassador of medicine, represent the profession well, and continue to earn society's trust.
I affirm this declaration and pledge to faithfully uphold these values.