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Formal Attire Required

Every year, the Geisel School of Medicine welcomes first-year medical students to the profession in a White Coat Ceremony. In an increasingly informal age, what does it mean to wear a white medical coat?

By Susan Green

First-year medical student Emi Manuia was nervous when it came time for her to don a white medical coat for the first time. "It was a bit daunting," she says. "Wearing it comes with a huge responsibility, and I wondered how long it would take for me to feel comfortable in it." Like her fellow members of the Class of 2017, Manuia received her white coat at a ceremony in late September, one held every year at Geisel to welcome first-year students to the profession of medicine.

Susan Green is senior writer for Dartmouth Medicine.

Had Manuia been a medical student 20 years ago, she wouldn't have been confronted with the white coat's heavy symbolism so early in her education; medical students typically received one of the long white coats worn by doctors upon graduation. Giving medical students a shorter white coat is a recent convention.

On September 28, the Geisel Class of 2017 gathered at Rollins Chapel to take part in the traditional White Coat Ceremony.

In the 19th century, students wore black coats when examining cadavers out of respect for the dead (and it didn't hurt that bodily effluence wasn't as noticeable on black). Physicians likewise traditionally wore black in deference to the serious nature of the doctor-patient relationship. Visits to physicians were rare and seldom benefited the patient—quacks and mystics practiced alongside trained doctors, and even well-meaning doctors often unwittingly harmed rather than helped their patients.

But changes in the profession also led to changes in physicians' attire. The advent of aseptic surgery in the late 1880s ushered clean white coats into the operating room. When the site of medical care shifted from the home to the hospital, white coats became the garment of choice for hospital-based physicians. And by 1920, as medicine fully aligned itself with science, white coat-wearing physicians were seen as medical scientists offering healing and hope to patients. Today, the physicians' long white coat is a symbol of the responsibility physicians have for their patients.

In the early 1990s, this tradition was extended to include medical students. Citing Hippocrates, who administered an oath to students at the beginning of their medical studies, the Arnold P. Gold Foundation created the white coat ceremony to remind students of medicine's humanistic tenets. Joseph O'Donnell, a professor of medicine and an advocate for the Gold Foundation's work, wanted to start a similar ceremony at Dartmouth—one that encouraged students to begin thinking about their professional identity.

O'Donnell; David Nierenberg, a professor of pharmacology and toxicology; and Sue Ann Hennessey, then assistant dean of student affairs, worked to create such a ceremony. They all agreed that the ceremony should be celebratory and reflective, complementing two other important medical school milestones: the transition ceremony, held at the end of the second year of school, and Match Day, held near the end of the fourth year.

As physicians we have a humanistic responsibility to our patients.

"We thought if we did it, the ceremony would have to reflect Dartmouth's values," Nierenberg recalls.

Students weren't sure what to expect during the first White Coat Ceremony in 1995. But after the intensity and rush of the first six weeks of medical school, they relished the break, and, according to Nierenberg, found it meaningful to be formally welcomed into the profession of medicine while among family and friends.

Until the late 19th century, physicians and their students wore black rather than white, as shown in this painting by Thomas Eakins of a surgery led by Dr. Samuel Gross.

The ceremony has since evolved into an annual ritual. "It's not a regular day," O'Donnell says of Geisel's white coat ceremony. "It's a day students become part of a profession that has specific values and responsibilities, and it's an opportunity to pass along those values."

Medicine is a service discipline anchored in helping real people with real problems, says Richard Simons, the senior associate dean for medical education, who shared his thoughts with the Class of 2017 during this year's ceremony. "Here at Geisel we have core values by which we all live, and it's important to give students a sense of what is important to us as an organization—that as physicians we have a humanistic responsibility to our patients," he says.

A note written by alumni tucked into the pocket of each white coat, reassuring personal stories from faculty and students, and the signing of a student-drafted mission statement all come together to create a distinctive Geisel experience.

For first-year student Jennifer Fleischer, Geisel's ceremony was absolutely perfect. "It was very much a ceremony of reflection and celebration," she says. "I didn't expect it to mean as much as it did. Dartmouth has found a very respectful and wonderful way to honor the tradition of becoming a physician."

According to Nierenberg, the ceremony was never simply about the white coat but about bringing people together in a meaningful, uplifting celebration of the values of the profession. "While the white coat is a symbol, it's not the bottom line," he says. "Whether or not you wear a white coat—and there are reasons not to—you have to think about what it represents."

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